AANEM News Express

AANEM’s Innovation Award honors forward-thinking members for designing and developing products, services, or processes to enhance or transform the quality of patient care through technology and innovation. Due to his work in PM&R and innovations in the bioengineering of adjustable lower limb prosthetics, Timothy R. Dillingham, MD, MS, has been selected for the 2022 Innovation Award.
 
Dillingham currently serves as the William J. Erdman II, professor and chair for the department of PM&R at the University of Pennsylvania. He earned his medical degree from the University of Washington, School of Medicine and completed a residency in rehabilitation medicine at the University of Washington. In addition to residency training, Dillingham pursued research in gait biomechanics and motion analysis that resulted in a master’s degree in rehabilitation medicine.
 
Following his training, Dillingham served for 4 years in the United States Army at Walter Reed Army Medical Center during the Persian Gulf War. There, he directed a large regional referral prosthetics and orthotics clinic for active duty personnel and retired military persons. Upon completing his military service, Dillingham joined the Johns Hopkins University School of Medicine where he ran a similar regional interdisciplinary clinic for persons with limb loss.
 
“Caring for persons with lower limb loss has always been a clinical interest of mine,” said Dillingham. “It became apparent to me that prosthetic socket technology was half a century out of date. It was impossible to have a hard prosthetic socket adequately fit a dynamic and changing limb, yet this is what most people received. The published science regarding patient satisfaction with conventional prostheses confirmed this impression and showed widespread dissatisfaction with the fit and comfort of conventional devices.”
 
For the last 11 years Dillingham’s, research has focused on prosthetic bioengineering of adjustable lower limb prosthetics. He’s developed an array of lower limb prosthetics that are comfortable, durable, and affordable to meet the pressing need for better prosthetics. The company he founded, iFIT Prosthetics, LLC, and his engineering partner, Advanced Design Concepts, created and are now selling a full line of adjustable prostheses for persons with transtibial and transfemoral limb loss.
 
“Adjustable sockets are ideal for the most challenging patients— persons with renal and heart diseases, limbs with skin grafts, and persons with bulbous limbs,” explained Dillingham. “These prostheses allow patients to walk immediately and the socket will comfortably accommodate the changes in the limb from reduction in swelling and inflammation that occur over time.” They have also demonstrated greater comfort and function than conventional devices in published prospective trials.
 
Another key advantage of these modular and easily-shipped prostheses is that they are fit with hand tools and can be fit anywhere—clinics, hospitals, tents, etc. - no prosthetic facilities are necessary. Further, the sockets work with most commercially
available pylons, knee units, and prosthetic feet.
 
My son and I saw first-hand how these prostheses can enhance care in low resource countries during a medical mission last summer to Botswana. There we successfully fit 17 patients in 7 days, partnering with local prosthetists,” he shared.
 
“Although prosthetists are ideal for fitting these devices, there are not enough prosthetists to meet worldwide needs,” said Dillingham. “iFIT can be fitted by trained and certified prosthetist extenders, such as allied rebilitation professionals, military medics, and prosthetic technicians when prosthetists are not available and the need is acute for these services.”
 
Developing an idea into a commercial product was one of the greatest academic challenges Dillingham said he’s ever undertaken. “Creating a new way of fabricating and fitting sockets to better meet patient needs, demonstrating their effectiveness, and creating products is a long and expensive process.”
 
His time-consuming endeavor included multiple cycles of design, prototyping, clinical testing, and then redesign. “It took 8 years to get to the geometry and materials properties that are used in the transtibial sockets. Development of the transfemoral prostheses proceeded faster, as we benefitted from our experiences with the transtibial devices.”
 
Securing and maintaining funding has also been challenging. “I am profoundly grateful for funding from the NICHD/ NCMRR and the NIA over the past 11 years supporting our work.” He now has additional NCMRR funding to develop and commercialize a line of adjustable prostheses for children to accommodate their growth. “Families spend substantial amounts of time acquiring devices for their children and often have high co-insurances and co-pays for these prostheses. In the next 6 months we want to add devices for children and teenagers to our line of prostheses, which will accommodate their unique residual limbs and provide 2 years of comfortable use.”
 
His team is also actively seeking ways to bring these devices to people in Ukraine. “The prostheses were originally designed to meet the needs of persons with lower limb loss in military conflicts and in low resource countries. In a war-torn country with few prosthetists, poor supply lines and few rehabilitation facilities, iFIT prostheses provide an ideal means of meeting the needs of this population,” he said.
 
There’s no doubt Dillingham has had an incredible impact on the future of prosthetics. “Earning patents on these concepts and devices underscored the novelty of these devices. We were the first to enter this adjustable prosthetics market and it is noteworthy that other companies followed our lead,” he said. “Indeed, the large international prosthetics companies are developing some of their own. I believe that in 5 years, most prostheses will have some adjustable socket features built into them.”
 
Dillingham appreciates the many people who were instrumental in his career, and feels fortunate to have crossed their paths. “Justus Lehmann inspired my research career; George Kraft encouraged me to join the AANEM and get involved in EDX medicine; and Ellen MacKenzie taught me how to write grant proposals. I am also very fortunate to have a wonderful and supportive wife, Liliana, who is also a research collaborator, and two great boys,
Ingram and Rhys.”
 
Dillingham reminds future innovators that perseverance is the key to success. “Research, product development, and clinical science are all fraught with challenges and difficulties” he said. “You cannot let things like manuscript rejections, not getting funded on a particular grant submission, or prototypes that just didn’t work get you down. My colleagues and engineering team helped keep the innovative spirit going through the challenges we faced—underscoring the importance of building a collaborative team for such endeavors.”