Pimp my arm 

What are good ideas worth these days? About a dime a dozen?

The four young men at Tackle Design, a small, North Carolina-based design firm (downtown Durham, that is), have a lot of good ideas. "We've thought about installing a good idea button in the shop," jokes Tackle partner Jonathan Kuniholm, who founded the company in 2003 along with Chuck Messer, Jesse Crossen and Kevin Webb. "Every time we come up with a good idea, we'd hit it, and then in real time divide our total revenue by that number to figure out what a good idea is actually worth."

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• Derek Anderson
• Tackle Design partners Chuck Messer, Kevin Webb, Jesse Crossen and Jonathan Kuniholm in their downtown Durham office.

"The point of that is to try to devalue good ideas," explains Messer. "People think that they have this great idea and somebody's going to steal it, so instead what they'll do is to lock it away in a box and never let anybody see it."

Ideas are the easy part. Making that idea a reality is the hard part. And the best way to do that, according to the Tackle philosophy, is to let go of the notion of ownership.

"We try to avoid ever taking claim for who came up with which idea at the table," Kuniholm says. "Who really cares? It doesn't matter. Because it takes you 10 minutes to come up with an idea, and it'll take you six months to turn it into a product that anybody's going to use. That's where the energy is, that's where the investment is."

"Six months of sweat and $50,000 of labor," Messer adds.

It might seem strange that people who make their living doing creative work would want to devalue ideas. But by making them free, these designers are contributing to a movement called open design.

Modeled on the concepts of the open source software movement, which makes software code available for anyone to see, modify, improve upon and distribute, open design is a nascent but growing movement in its own right. A paraplegic named Ralph Hotchkiss made his mark in 1985 by publishing a book of wheelchair designs that could be made with local materials in the developing world. In 2003, a former Peace Corps volunteer living in Wilmington named Jock Brandis created a simple, inexpensive, manually powered nut sheller that shells nuts 40 times faster than by hand and delivered it to a women's coop in Mali. Brandis' Full Belly Project continues to distribute the shellers, as well as the molds and materials to make them, throughout Africa. Tools to collaborate on open design projects are being developed, too, such as Instructibles.com, a site that offers plans and team building.

Tackle's most notable contribution to open design thus far is the Open Prosthetics Project. At openprosthetics.org, prosthetics users can join the "Pimp My Arm" or "Pimp My Leg" discussions and share ideas about how to make their devices better. Prosthetists, engineers and others are invited to contribute their time and ingenuity to realize those improvements and contribute the designs to the public domain, the common public property of knowledge and innovation that anyone may use, share, alter or sell. (Hotchkiss' organization, Whirlwind Wheelchair International, is now a partner in OPP.)

"The loop in prototyping, in just traversing that path from idea to product, has a lot of friction in it," Kuniholm says. "Our goal with the Open Prosthetics Project, and more in general with the Shared Design Alliance [the nonprofit umbrella of OPP], is to try to reduce the friction in that loop to make the free exchange of ideas about physical designs more possible."

This is a story about good ideas and a group of people trying to realize those ideas by giving them away. It's about elderly farmers in North Dakota and jaundiced babies in the developing world getting what they need -- and what the market does not provide. This story is about a little design firm in the Triangle that's plugging into a growing movement to make it easier to make stuff for everybody.

While working together on a project at N.C. State University, a group of engineering and design students hit it off. Their collaboration blossomed as they produced a surgical device. Grant money allowed them more time to work together to develop it. They found they shared a zeal for solving real-world problems.

"We were actually sitting there in a brainstorming session working on the project thinking, 'We've got such a buzz on this,' because we'd just discovered something," Messer recalls. "We thought, 'We've got to find some way that we can do this all the time.'"

They dreamed of working at places like Squid Labs, an engineering design and technology company near San Francisco; IDEO, an international firm with outposts in San Francisco, Boston and Chicago; or the lab of the TV show Myth Busters. They joked that their dream workplace would be "the bait and tackle shop with the mad scientist's lab in the back," Messer says.

Kuniholm, Messer and Crossen picked up the software-savvy Webb and founded Tackle Design. They worked out of a rented house in Raleigh while Kuniholm was still in the biomedical engineering program at Duke. They began to take on clients with the help of cheap online text-search advertising. "We started off with the low-hanging fruit of the design world," Messer explains, "which are small inventors; independents that are looking for prototypes and design work to further their inventions." The team gained experience and paid the bills.

In the summer of 2004, Tackle moved into their current office, a former diner with a concrete floor and glass brick facade facing the Durham courthouse. In the back is a room that seems close to the professional fantasy they described: hand tools, power saws, lab ovens, electronics, plastic-casting equipment and piles of wood and metal. There are even Lego pieces neatly stored in hardware drawers on a work bench.

Right about the time they moved into this office, Kuniholm, a Marine reservist, was shipped off to Iraq.

By now, the stories of families taking up collections to pay for Kevlar vests for their sons and daughters are becoming all too familiar. Kuniholm and his colleagues went further: They made a robot. The crew bought an off-the-shelf, remote-controlled toy truck, added an aluminum deck, a wireless video camera and a mechanism for remotely dropping an explosive charge to destroy landmines, unexploded bombs and improvised explosive devices. The parts and materials cost just over $1,000. Kuniholm took the bomb-busting robot with him to Iraq, where it served the platoon in the field until their return home.

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• Derek Anderson
• Kuniholm (left) and Messer create a rough prototype of a prosthetic device using Legos

But on New Year's Day 2005, Kuniholm encountered a situation beyond the robot's capabilities. While on patrol in palm groves along the Euphrates River, his group was attacked by insurgents. An IED detonation knocked him to the ground, broke his rifle in half and nearly severed his right arm below the elbow. One of his fellow marines later died of internal injuries. Unable to help in the firefight that ensued, Kuniholm pulled himself out of harm's way and was tended to by a medic who applied a tourniquet. By the time a boat returned him to the base, he knew what was likely to happen.

He awoke in a hospital to find his right arm amputated. "I was just psyched that I was alive," he says. "I unplugged myself from a bunch of stuff and went down and had a Whopper in the Burger King in the hospital. I was having a blast doing that."

When word of Kuniholm's injury reached the Tackle partners, they immediately hit the Web to find out everything they could about the prosthetic devices he would be able to choose from.

"We were just shockingly disappointed at everything that was out there," Messer says. "We know technology and we know what is available in other things, so it was surprising to see the complete lack of innovation in the field [of prosthetics]. At first we were very frustrated. We blamed it on the industry -- what are these slackers doing? How come there's nothing good out there?"

They soon realized why. According to a recent study conducted by Johns Hopkins University and the Amputee Coalition of America, approximately 1.9 million Americans have lost a limb. The typical amputee is over the age of 50 and has lost a leg or foot due to diabetes or some other disease. Upper-extremity amputees -- those who've lost an arm or hand -- make up a small fraction of the total.

"Even if every single one of us were to be interested in the same product -- not likely -- and all of our insurance companies would pay for that same product -- also not likely -- the total number would be less than 100,000," Kuniholm says, "which is like a prototyping run. Oh, and by the way, that would include left and right variations and different sizes. By that time, you've reduced the upper extremity to what it is: custom work."

In short, there's no money in prosthetics. "And if it's not commercially appealing," Messer says, "there's not going to be a lot of innovation."

Kuniholm is quick to add that he has been well provided for, with three prostheses made at Walter Reed Medical Center. Wars, and the government's care of its wounded, have historically brought what little advancement there has been made in prosthetic design.

It's not that Tackle Design ever intended to go into the prosthetics business (and they aren't, exactly). But they are in the business of solving problems. The thing about problems is that solving one often requires solving many others that relate to it. That doesn't faze these guys.

Take the first two fingers of your hand. Bring them together; now pull them apart. Try to pick up something with those fingers -- no cheating with the opposable digit. Try to hang onto it. Some stuff you can easily manipulate; some stuff slips from your grasp. This is roughly what it's like to use an arm prosthesis.

The typical prosthesis has two basic parts: a socket, where the residual limb connects to a molded arm or leg; and a terminal device, a foot or hand, or in many cases, a hook.

While they may look conspicuous, hooks are usually more functional than sculpted hands. The biggest issue with hooks is how to open and close them. With a body-powered prosthesis, the wearer moves his or her shoulder to open or close the hook. The tension of the grip is controlled by rubber bands -- which break, snap, dry out and deteriorate over time. Want to change the degree of tension? Add or subtract bands. Myoelectric devices do the same thing using electronic muscle sensors to send the open and close signals, but the basic design of most prosthetics hasn't changed much in 50 years.

Like a lot of wearers, Kuniholm would love to have a device that regulated grip tension some better way. Surely somebody out there had improved on this particular mousetrap, he thought. Research turned up a device called a vector prehensor, invented by professors Larry Carlson at the University of Colorado at Boulder and Dan Frey at the Massachusetts Institute of Technology. It uses an adjustable dial to control the tension of an internal spring. It's not available for purchase, unfortunately, because it was never manufactured. But Carlson and Frey weren't the first ones to employ the concept. A prior art search turned up a 1954 German patent for a similar device, but that one never saw the light of day, either.

"A patent was issued, no product was ever made and it was basically forgotten about," Kuniholm says. "I'm convinced that there are lots of good ideas that remain hidden in the patent literature that deserve to be publicized and made more accessible."

Carlson and Frey have decided to contribute the design they developed to OPP, which will make the plans available under the public domain. If somebody else manages to make some money off their work, they don't mind, Kuniholm says.

"Somebody asked us early on, 'Aren't you concerned that somebody will steal your ideas?' And we said, 'That's the idea!' Nothing would make us happier than if a company that's already engaged in developing prosthetics devices -- that has marketing, distribution, sales support, engineering -- were to take our designs and modify them a little bit, make it appropriate to the portion of the market they were looking at, and then sell it. We would have had an idea that made it to the marketplace, and that would mean more options for prosthetic users, which is the point."

The market is good at producing better cell phones and MP3 players -- things millions of affluent people are willing to pay for. Innovation in those areas is rapid. But the market isn't very good at innovating when the products won't sell by the millions, or when customers don't have the money to pay.

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• Derek Anderson

Bob Malkin is a professor of engineering at Duke and director of the Duke chapter of Engineering World Health. He oversees a nonprofit business plan competition called CUREs (Competition for Underserved and Resource-poor Economies), now in its second year. Biomedical engineering students design inexpensive devices to serve a need in the developing world while business and management students devise a nonprofit business plan to deploy this new technology. Tackle's Messer is a judge for the contest, and through it has enlisted Tackle to further develop last year's winning entry, a light therapy device to cure babies born with jaundice. The blue-spectrum light breaks down a substance called biliruben so that the body can process it. It's a simple process, but the cost of devices used in Western hospitals is well out of reach of most hospitals in the developing world. This one is cheap and easy to repair. Messer and his colleagues took on the task of improving the design, and they plan to assemble a set of prototypes this winter that will be tested at Duke Hospital and eventually in the field.

There's another important component to the CUREs competition designed to help the developing world: All designs go into the public domain.

"There is an intellectual basis and a historical basis for this," Malkin says of the project's intellectual property stance. "When we were the developing world, around 1870 or so, we regularly violated intellectual property rights." Today, the West rigorously enforces intellectual property laws, forcing developing nations to pay licensing fees or buy devices they can't afford. "By enforcing those sorts of rules, we're kicking away the ladder, removing a rung of the ladder that we're not allowing the developing world to use. The essential rung for development is intellectual property, and denying them that is denying them the very tools that we used when we were developing."

The patent system, like the copyright system, was designed to protect, reward and thereby foster innovation. Patents grant inventors the exclusive right to produce and sell their inventions -- but only for a limited time, and only if the inventors share with the public a written description of their invention, in sufficient detail that another skilled person could recreate it.

In theory, the patent system encourages people "to stand on each other's shoulders in some sense to further innovation," Webb says. "Innovation is really a communal process, and you have to have something that gets people talking to each other, understanding what they're doing in a way that allows them to build on their ideas and advance things societally."

While that concept isn't popular among most pharmaceutical, aerospace and technology companies, Webb believes using patents in that way can give a boost to industries, like prosthetics, where innovation is lagging behind.

A related Tackle endeavor is the All Patents Initiative, which is in the process of digitizing a vast archive of patents -- nearly 4 million in all -- filed with the U.S. Patent Office between 1790 and 1976. While the U.S. Patent Office has kept digital records of patents after 1976, those before that date have languished, virtually inaccessible, scanned in and made into TIFF image files, the text unsearchable. Thanks to a partnership with the Internet Archive, HP Labs and Duke University, those documents are being made searchable through optical character recognition and will eventually include metadata (general information about the documents) that will help inventors and scholars learn about the history of innovation by allowing them to peruse the vault of American ideas. A beta version of the search, encompassing all patents between 1836 and 1925, is up at search.allpatents.org. (Plug in "artificial limb," and you'll find that not much has changed since 1919.)

When Ken Heide, a prosthetist in Fargo, N.D., heard about the Open Prosthetics Project, he saw his chance to get the Trautman hook back on the market. The Trautman hook is a terminal invented in the early 20th century, manufactured in Minneapolis by the Paul Trautman company. It was especially popular with Midwestern farmers, Heide says, because the hook can bear the weight involved in farm labor. "As crude a device as it is, it has an advantage of an interlocking finger pad. The fingers have little serrated teeth. That's a mechanical advantage for people who want to grab ahold of something and hang on." For some reason, it stopped being manufactured sometime in the 1980s.

Heide is an old-school practitioner of orthotics and prosthetics. He learned from his father, a below-the-knee amputee, how to carve wooden legs, feet and sockets and how to mold leather-laced prostheses. "The old art has not been lost," he says. That's why the old-timers come to him. People tend to prefer the prosthetic devices they're used to, and he's had more than one patient with an $8,000 state-of-the-art leg and gel liner come in and ask him to replace it with the old-fashioned model, which run $5,000 at the most. "In this profession, the trade secrets are not what you know, it's how did you do it?" Heide says.

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• Derek Anderson
• Kuniholm watches as Messer moves from Legos to computer-assisted design to develop the device.

He's observed a fierce devotion to the Trautman hook among his patients over the years. When bringing one in for repair, they'd wait four or five hours rather than leave it at the shop. "There's like a black market out there for these terminal devices," Heide says. Having obtained Paul Trautman's blessing, Heide estimates he's spent approximately $10,000 of his own money over the past three and a half years trying to bring it back.

He started by contacting tooling shops and engineering firms. They wanted money up front to pay for the development and prototyping. He tried that, with poor results. Tackle didn't ask for a consulting fee; they wanted him to contribute the design to OPP. "He was willing to do whatever he could to further the process of getting these hooks made," Kuniholm says. "And because he agreed to open source it and let us publish the design, we agreed to do the reverse engineering for free."

Heide gave the designers a couple of the best hooks he could borrow. They reverse-engineered them, creating a Computer Assisted Design model they could then improve upon. Finally, the CAD design was presented to a metal manufacturing company, which produced a prototype. Now Heide can take orders for the device; he needs at least 10 orders to have a batch made, and he expects to sell them for about $700 each. Heide guesses he'll sell between 100 and 200 a year. "Those guys over there did a fantastic job," he says. The CAD design is available for free at the OPP site. It's the closest OPP has come to producing a prosthetic device that's been put to use.

Luckily, the manufacturing hurdles that have made the Trautman hook -- and prosthetics in general -- so costly and impractical to produce are slowly going away. Many miles (and about a century) from the wood carving tools of Heide's workshop is FineLine Prototyping near Brier Creek in Raleigh. FineLine, and its offshoot company Printapart.com, do rapid prototyping, a new trend in manufacturing that allows inexpensive, high-resolution parts to be made in very small quantities. The technique is called additive fabrication -- instead of carving a big chunk of material into something smaller, this process adds material bit by bit to form something into the desired shape according to a computer design.

Rob Connelly, president of FineLine, is a mechanical engineering graduate of NCSU. He says the 7,000-square-foot building looks mostly like an office. "We do have something of a machine room where we have all the machines that make these parts. But it's air-conditioned and quiet and not messy. They look like a bunch of refrigerators sitting in a room. They make the parts quietly with nobody standing around them. And they work 24/7."

The company makes automotive dashboards and medical devices, among other things, but they also take orders from hobbyists and jewelry makers. For now, they can only work in plastics. But within two years, Connelly predicts, the technology will be good enough and cheap enough to do the same kind of manufacturing with metals.

For small design firms like Tackle, services like that are the equivalent of a photocopying machine introduced into an office full of carbon-paper-stained wretches.

"It's going to have a major impact on open design," Webb says. "If you have to manufacture in groups of 10,000, it's not feasible to do open design, but if anybody can click and order the thing they just downloaded, it suddenly becomes dramatically feasible. It's a major difference."

"And if they can modify it a little bit and then do it," Kuniholm adds, "then you've basically completely democratized hardware."

At some point, the Tackle team predicts, open design will make its breakthrough. "I can tell you that it's not going to be Open Prosthetics," Kuniholm says, "but there will be some product that ends up capturing public imagination and energy and ends up proving that this works."

This story originally appeared in the Independent Weekly, Durham, N.C.