This proposal combines academic expertise in digital manufacturing and heterogeneous foams (University of Strathclyde, Department of Design, Manufacture and Engineering Management) with prosthetics practitioners (University of Strathclyde, National Centre for Prosthetics and Orthotics) and non-academic partners, manufacturers (Blatchford Ltd.) and service users (PACE Rehabilitation, an SME), to investigate the feasibility of revolutionising the functionality and appearance of prosthetic cosmoses. Currently, flexible polyurethane foam cosmoses are a widely used component of prostheses for limbs. In a very labour intensive process, cosmoses may be machined from slab stock to a semi finished form and then shaped further to match patient requirements. An ordinary covering stocking is often added to enhance the cosmetic appearance of the prosthesis. Amputees cover their metal orthopaedic limb (i.e. artificial leg, arm, etc) with a two-fold function cosmesis: it protects the expensive equipment and, in theory, it provides a better aesthetic appearance to the patient's orthopaedic prosthesis. The reality is that cosmetic covers underperform the artificial limb, attract dirt, are non-water proof or fire resistant, impede the normal functioning of joint(s) and have a poor visual finishing which hinders the patient's psychological recovery and acceptance of their new condition and appearance.Although widely used, the foam cosmesis neither deforms like human limbs nor withstands repeated flexure, and its appearance is far from resembling human skin. These problems have their root in the standardized nature of the foam used; with a homogeneous and uniform pore size throughout the material, the stiffness will also be constant and consequently it will bend in an 'unnatural' way. Ultimately the highly stressed areas will fail, and the foam will tear at the joints (especially on the knee). The mechanical properties of foams are determined by their cellular structure; so small cells with thicker walls create stronger, stiffer materials than large open pours. Traditional manufacturing methods have fabricated cosmoses from blocks of homogeneous foam resulting in objects that have uniform mechanical properties. However it is also well known that variation in cellular structure can produce impressive combinations of strength and flexibility. To date, no manufacturing process for mass production has existed capable of dynamically varying the cellular structure of foamed material. Consequently, a controlled variation of features in the cosmesis to suit patient's movements and needs is not available. This proposal seeks to enable the mass customization of functionally graded foams, so they can be fitted to orthopaedic limbs and replicate the movement of the existing (healthy) limb. Using recently reported advanced manufacturing techniques never used before in this field, (e.g. computational modelling and simulation of foamed materials' behaviour, rapid prototyping technologies, ultrasonic irradiation, etc), as well as cutting-edge technology in scanning and measurement of materials properties, we aim to provide end-users (both practitioner prosthetists and patients) with a method of influencing shape, appearance, function and behaviour of foam cosmoses for orthopaedic applications.This proposal envisages a 2 year work program during which the commercial partners will help with patient satisfaction interviews, will input directly into the specification of requirements, and assist with the assessment of results. Our intention with the outcomes of this project is to pave the way for our partners to apply the results and implement them in the production process, allowing them to take the work forward and exploit the benefits that the project's output will provide to the relevant industry, rehabilitation services, carers (i.e. orthotists), the National Health Service and, most importantly, the patient.

The World Health Organisation says that there are about 100 million people globally who need prosthetic or orthotic (P&O) services and as populations age, more than two billion people are expected to require health-related assistive devices by 2030. In the UK the Disabled Living Foundation estimates that 6.5 million people live with mobility disablement, with many reliant on P&O services, including an estimated two million orthotic users. In parts of the developing world the aftermath of conflict, such as land mines, and greater rates of traumatic injuries from accidents, means there is a growing need for prosthetics and orthotics for younger people living in poor social and economic circumstances. Often they need P&O devices to stay at work and sustain their families. Poor devices, services and access to these contravene their basic human rights. In the context of this need, we want to establish the EPSRC Centre for Doctoral Training in P&O. This will address the national, and global, shortage of suitably skilled engineers and scientists to become future innovators in P&O technologies. Current academia, industry and care centres have limited researchers, and research activity has lagged behind rapid technology advancements. The Centre will support a minimum of 58 doctoral students whose studies will enable them to become leaders of the future. The Centre will bring together the only two P&O undergraduate education facilities in the UK (Salford and Strathclyde) with P&O research centres of excellence at Imperial College and the University of Southampton. Our vision is for the Centre to become the national and global leader in P&O research training, and the translation of research into innovation that impacts on the lives of people each day, in developed and developing countries. The Centre will work to support training for students from low and middle-income countries (LMIC). Our students will be immersed in industry and real-world experiences which will equip them to lead the P&O sector across technology, social or economic contexts. Our aims are to: 1. Develop a new model of P&O research training and translation of research into innovation. In addition to the doctoral training, this will result in Master's programmes operating across Institutions. 2. Produce ambitious PhD research projects that will be grounded in real-world challenges, but at the cutting-edge of new biomedical science and technologies. 3. Produce a significant impact on the UK P&O industry sector by leading innovation. 4. Have an international impact by attracting an increasing number of CDT students from overseas. 5. Establish a P&O student society which will have matured into a lasting doctoral community with international reach. 6. To have a significant impact on the training of doctoral candidates from LMIC. 7. Attract additional external funding for P&O research. Creating a new generation of P&O research leaders will, over time, have a significant economic, societal and health impact. For users, it will mean access to improved generations of assistive devices which will match the users' needs resulting in a better quality of life. Clinical services will benefit from improved service data, superior products and improved user outcomes. For industry, it will open up new market opportunities, nationally and globally. For the students themselves, they will have access to careers that have a real purpose, enabling them and their future teams to make a difference in the lives of people with disabilities.