Pr oduct Number 000

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Rel eased December 12, 2003

From the Department of
LEADI NG I N THOUGHT AND ACTI ON
C
CORPORATE STRATEGY AND INTERNATIONAL BUSINESS CORPORATE STRATEGY AND INTERNATIONAL BUSINESS


ASE STUDY SERI ES E STUDY SERI ES

[= [=



















This report was written by Scott Macke, This report was written by Scott Macke,
Ruchi Misra and Ajay Sharma under the
supervision of Professor C.K.Prahalad. The
reports are intended to be catalysts for
discussion and are not intended to illustrate
effective or ineffective Strategies.

Copyright©, The University of Michigan
Business School, 2003

Jaipur Ioot:
Challenging Convention
At age J!, Sudha Chandran, an aspiring dancer, lost her right
limb in a car accident. Devastated and convinced she would never
walk, let alone dance again, she spent several months on crutches.
1hen one day in J·8!, she read about Jaipur Ioot.
1here are íive and a halí million amputees in India ;ust like
Sudha Chandran. In addition, each year, according to one estimate
an additional !¯,000 people lose their limbs due to diseases,
accidents or other ha.ards. 1he ma;ority oí these people are well
below the poverty line and cannot aííord healthcare or medical
services.
1
In a world where prosthesis is a complicated and
e×pensive industry, there is hope íor these patients. However,
nestled in the desert oí Ra;asthan is an operation oí impressive
scope that oííers hope to the some oí the most impoverished
citi.ens oí India and maybe even the world. It oííers these
handicapped citi.ens a chance to return to their livelihoods and
pursue their dreams. 1his operation is called Jaipur Ioot.
THE INNOVATION. . .
A prosthetic foot in the U.S. averages $8,000. The Jaipur Foot is
tailored to the active life styles of the poor and costs only about $30
- and it is given away free to the many handicapped poor who have
lost a limb.

Developed in J·68, Jaipur Ioot is a hand-made artiíicial íoot
and lower limb prosthesis.
2
It has revolutioni.ed liíe íor tens oí
thousands oí amputees around the world. 1his íoot was originally
designed to meet the needs oí a developing country liíestyle such
as squatting, bareíoot walking and cross-legged sitting. Primarily
íabricated and íitted by Bhagwan Mahaveer Viklang Sahayata
Samiti (BMVSS), a non-governmental, non-religious and
nonproíit organi.ation, Jaipur Ioot is íitted on appro×imately


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J6,000 patients annually, while BMVSS services appro×imately 60,000 patients by providing Jaipur íoot,
calipers and other aids and appliances. 1here are seven centers throughout India and a number oí mobile
camps held every year in various parts oí the country. Jaipur Ioot camps also have been íound in J·
countries, including Aíghanistan, Bangladesh, Dominican Republic, Honduras, Indonesia, Malawi,
Nigeria, Nepal, Nairobi, Panama, Philippines, Papua New Guinea, Rwanda, Somalia, 1rinidad,
Vietnam, Zimbabwe and Sudan.
With innovations in technology and management, as well as understanding the needs oí its
patients, BMVSS developed a unique business model. 1his model spreads the Jaipur Ioot technology
that allows rickshaw-wallah (pedicab operators) amputees to be rickshaw-wallaws, íarmer amputees to
be íarmers and in the case oí Sudha Chandran, classical Indian dancer amputees still to be classical
Indian dancers.
THE NATURE AND SCOPE OF THE PROBLEM:
Global Amputees
1here are anywhere írom J0 million to !¯ million amputees in the world, with an additional !¯0,000
added each year. 1he causes oí amputation vary greatly. In countries with a recent history oí waríare and
civil unrest, amputation is due to trauma and landmine accidents.! In places like the United States, the
causes are more related to accidents, circulatory diseases and cancer. Regardless, prosthesis in both
developing and developed nations is e×pensive and complicated, leaving a si.able number oí amputees
unable to aííord adequate prosthetic care.!
Developed World
According to a J··6 National Center íor Health Statistics study, there are more than ! million amputees in
the United States and appro×imately !00,000 new amputees every year, oí which appro×imately ¯0/ are
lower limb amputees¯ (October J···). According to the World Health Report in J··8, amputation
resulting írom diabetes will more than double globally írom J!! million cases in J··¯ to !00 million by
!0!¯.6 1he most common causes oí amputation oí lower e×tremities are disease (¯0/), trauma (!!/),
congenital or birth deíects (!/) and tumors (!/). Upper e×tremity amputation usually is due to trauma or
birth deíect. 1he cost oí prosthesis is very high in the United States, leaving many without appropriate
care. According to Mark 1aylor, írom the University oí Michigan Prosthetics Department, due to
insurance company policies and high costs, only ¯0/ oí patients in the U.S. receive the prosthetic medical
care they require.
Developing World
In the developing countries oí Asia and Aírica, land mines have leít millions oí people limbless. According
to the U.S. Centers íor Disease Control, appro×imately !00,000 children are severely disabled because oí
land mines, with an additional J¯,000 to !0,000 new victims each year.¯ Moreover, most victims are not

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soldiers, but women and children who happen to live in areas that were once war .ones. By some
estimates, there are more than J00 million land mines buried all over the planet. In many poor nations,
most amputees have to settle íor a liíetime on crutches. In Vietnam alone, land mines in;ure more than
!,000 people each year.8 It costs appro×imately 3!00 to provide a high-quality artiíicial leg in Vietnam.·

Countries with the Most Number of Landmines
COUNTRY # OF LANDMINES
Aíghanistan ·,¯00,000
Angola ·,000,000
Iraq ¯,¯00,000
Kuwait ¯,000,000
Cambodia ¯,¯00,000
Western Sahara J,¯00,000
Mo.ambique J,¯00,000
Somalia J,000,000
Bosnia-Her.egovina J,000,000
Croatia J,000,000
Source: United Nations Data

In Aíghanistan, there are appro×imately J0 million landmines and at least ¯0,000 amputees.J0 In
Cambodia, there are !¯,000 to !0,000 amputees, or one amputee per !00 inhabitants. 1here are nearly as
many land mines in Cambodia as people. Government hospitals are so severely under-resourced that
patients, including the very poor, are íorced to pay íor services or drugs, leaving many without care.JJ
In Kosovo, the World Health Organi.ation (WHO) estimated the J··· land mine in;ury rate at J0 in
J00,000, e×ceeding the rates oí both Aíghanistan and Mo.ambique. In India, there are ¯.¯ million
people suííering írom locomotor disabilities in India. Oí these, about one million have lost their limbs
and íour million suííer írom polio. Due to the increase in road accidents, diseases and other ha.ards,
!¯,000 new cases add to the population oí amputees every year.

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Treatment Costs
Developed World
PROSTHETIC COSTS IN THE UNITED STATES
BELOW THE KNEE LIMB
Legs
$4,000– $5,000
(Low End)
$7,000 –
$9,000 (Middle
End)
$10,000 –
$25,000 (High
End)
Prosthetic Sockets
$3450
(Replacement
Socket)
$650
(Replacement
Cover)
Prosthetic Feet $250 – $12,000
Prosthetic Socks $19 (Sheath) $80 (Sheath w/Gel) $25 (Wool Socks)
$9 (Single
Ply); $50
(Shrinker)
Above the Knee Legs
Legs
$8,765 (Low
End)
$12,265 (High End
without Knees and
Feet)
Prosthetic Sockets
$4300
(Replacement
Socket)
$900 (Replacement
Cover)
Prosthetic Knee $700 – $5400
Prosthetic Socks $25(Sheath) $80 (Sheath w/Gel) $25 (Wool Socks)
$10(Single
Ply), $80
(Shrinker)

Developing World
OpenRoads, a U.S.-based NGO, will be shipping J00 prosthetics every year to each site. Below is a table oí
their estimated costs oí providing limbs. It is based on the assumption that buying in bulk will reduce
overall costs. With prosthetic care as e×pensive as it is today, it leaves many patients, in both the developing
and developed world, without the care they need. A íast, dependable solution, at a cost people can aííord
(in the developing world, this cost is 30.00), is not only necessary but also imminent. Innovative business
models, such as Jaipur Ioot, already have started to accomplish this successíully.



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Year Location Number of
People Served
Cost per Site
Kosovo 50 $15,000
Rwanda 50 $15,000
Kosovo 100 $30,000
Rwanda 50 $15,000
Kosovo 100 $20,000
Rwanda 100 $20,000
Afghanistan 50 $10,000
Kosovo 100 $15,000
Rwanda 100 $15,000
Afghanistan 100 $15,000
Mozambique 50 $7,500
Kosovo 100 $15,000
Rwanda 100 $15,000
Mozambique 100 $15,000
Afghanistan 100 $15,000
Total: 1250 $237,500
4
5
OpenRoad
Cost Estimates For Providing Prosthetic Care Globally
Year and Number of People Served per Site
1
2
3

History of Prosthesis
1he history oí prosthetics begins at the very dawning oí human medical thought. Its historical twists and
turns parallel the development oí medical science, culture and civili.ation itselí.
1he prostheses oí ancient cultures began as simple crutches or wooden and leather cups depicted in
Moche pottery. An open socket peg leg had cloth rags to soíten the distal tibia and íibula and allow a
wide range oí motion. 1hese prostheses were very íunctional and incorporated many basic prosthetic
principles.
An artiíicial leg invented by Pare in J¯6J íor individuals amputated above the knee was
constructed oí iron and was the íirst artiíicial leg known to employ articulated ;oints. Ma;or advances
have been made in the íield oí prosthetic rehabilitation, stimulated in part by wars that increased the
number oí individuals who lost limbs. During the American Civil War (J86J-J86¯), interest in artiíicial
limbs and amputation surgery increased in the U.S., with the government paying íor artiíicial limbs íor
veterans. In J86!, the U.S. government enacted the íirst law providing íree prostheses to people who lost
limbs in waríare. In J8¯0, Congress passed a law that entitled war amputees to receive prostheses every
íive years.
World War II spurred íurther developments. Dissatisíaction with heavy, uncomíortable artiíicial
limbs gave impetus to prosthetic research. 1he American Orthotic and Prosthetic Association was
established in J·!· and developed educational criteria and e×aminations to certiíy prosthetists and
orthotists. In J·!¯, the National Academy oí Sciences set up a Committee on Artiíicial Limbs (CAL) to


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develop design criteria that would improve their íunctions. CAL iníluenced development oí modern
prosthetics írom J·!¯ to J·¯6. During this period, plastic replaced wood as the material oí choice, socket
designs íollowed physiological principles oí íunction, lighter-weight components were developed and
more cosmetic alternatives were íabricated.
In J·¯6, the biomechanics laboratory at University oí Caliíornia (Berkeley) introduced the solid
ankle cushion heel (SACH) íoot, which became the most popular prosthetic íoot. In the J·60s, hydraulic
knee mechanisms became more prevalent; and J·¯0 marked the inaugural year íor the international
Society íor Prosthetics and Orthotics. In J·¯J, Otto Bock introduced endoskeletal prostheses.
Modern times are characteri.ed by the emergence oí prosthetics as a science as well as an art.
Research into human movement, new materials and new technology has led to creation oí very light
and íunctional components. Gel liners provide shock-absorbing interíace between residual limb and
hard socket. Research is attempting to íind a method to bring sensation into the prosthetic limb.J!
Lower Limb Anatomy
1o understand íully the innovation behind Jaipur Ioot, it is important to know something about the
lower limb anatomy. 1he limbs must bear weight, provide a means íor locomotion and maintain
equilibrium. Bipedalism is the process by which we are able to stand upright and to move about on two
limbs. It imparts three unique íunctions on the lower limbs.
1he ankle ;oint is a hinge-type ;oint that participates in movement and is involved in lower limb
stability. Dorsiíle×ion and plantar íle×ion (Please reíer to basic íoot movements below) movements take
place at the ankle. Dorsiíle×ion is necessary in order to have the íoot contact the ground heel íirst and to
allow the íoot to clear the ground during the swing phase oí gait (please reíer to gate cycle below).
Plantar íle×ion provides the propulsive íorce necessary to liít the limb oíí the ground and start it
swinging íorward during the toe-oíí portion oí gait. 1he íoot plays an important role in supporting the
weight oí the entire body and in locomotion. 1he bones oí the íoot are arched longitudinally to help
íacilitate the support íunction. 1he transverse arch helps with movements oí the íoot. 1hese movements
help keep the sole in contact with the ground despite the unevenness oí the ground suríace. 1hey also
work in concert with the ankle ;oint to help propel the íoot oíí the ground during the toe-oíí portion oí
gait.


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Basic Foot Movements
DORSIILFXION: Ile×ion oí íoreíoot away írom ground

PLAN1ARILFXION: Ile×ion oí íoreíoot toward ground


ABDUC1ION: Movement away írom a×ial line (second toe position)

ADDUC1ION: Movement toward the a×ial line

FVFRSION: 1urning sole oí íoot outward away írom midline
INVFRSION: 1urning sole oí íoot inward toward the midline

PRONA1ION: 1riplane motion consisting oí simultaneous movements oí
eversion, abduction, dorsiíle×ion
SUPINA1ION: 1riplane motion, which combines the movements oí
inversion, adduction and plantar íle×ion




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Gait Cycle
1he rhythmic alternating movements oí the two lower e×tremities are the gait cycle, which results in
íorward movement oí the body. Simply stated, it is the manner in which we walk. Gait cycle is the activity
that occurs between heel strike oí one limb and the subsequent heel strike oí that same limb and consists oí
the íollowing phases:
Stance: It begins when heel oí the íorward limb makes contact with the ground and ends when the
toe oí the same limb leaves the ground. It consists oí:

Heel Strike: Heel oí íoot touches the ground.
Mid Stance: Ioot is ílat on the ground and the weight oí the body is directly over the limb.
1oe Oíí: Only the big toe oí the limb is in contact with the ground.
Swing: It begins when the íoot is no longer in contact with the ground. 1he limb is íree to
move.
Acceleration Swinging limb catches up to and passes the torso.
Deceleration: Iorward movement oí the limb is slowed down to position the íoot íor heel strike.
Double Support: Both limbs are in contact with the ground simultaneously.



1ypical gait cycles illustrating the phases and events during the cycle.
(Irom Human Walking, !nd Fdition, Rose and Gamble editors, Williams and Wilkins, Baltimore, J··!, p. !6.)
içïÉê=iáãÄ=mêçëíÜÉëáëW=^å=^ííÉãéí=íç=páãìä~íÉ=k~íìê~ä=iáãÄÛë=cìåÅíáçåë=

People with limb loss (acquired amputation) or limb absence (congenital deíiciency) use prosthetic
limbs to restore or imbue some oí the íunction and/or cosmetics oí an anatomical limb. Solutions diííer
in the way they mimic` the natural íoot`s íunctionality (or a part thereoí).


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DEVELOPMENT OF JAIPUR FOOT
Ram Chandra, born into a íamily oí master artisans, is commonly recogni.ed as one oí Jaipur city`s íinest
sculptors. Growing up, Chandra saw that local people who were amputated were íitted with artiíicial
limbs, either imported írom abroad or locally made, that were not íle×ible enough and did not allow íor a
normal range oí motion. 1he prosthesis did not íacilitate postures common in India such as squatting or
sitting cross-legged. Iurther, the shoes attached to the limb were made oí heavy sponge, which made the
prosthesis useless íor íarmers working in the rain or irrigated íields. 1his led to a high re;ection rate oí the
prosthesis by the local amputee population.
While watching these patients, Chandra came up with an idea oí creating an artiíicial limb that
more closely resembled a natural íoot, was lighter and was tailored íor local conditions. He took his
ideas to doctors at the city hospital and learned about human íoot anatomy. Fquipped with this
knowledge, Chandra e×perimented with locally available materials such as willow, sponges and
aluminum molds to create an artiíicial limb.
J!
One oí many deíining moments came one day when Chandra suííered a ílat tire while riding his
bicycle. According to Chandra, he went to a roadside stall whose owner was retreading a tire with
vulcani.ed rubber. Once his bicycle was íi×ed, Chandra rushed to doctors to determine ií this material
could be used íor a limb. Later he returned to the tire shop accompanied by an amputee and a íoot cast,
and asked the owner to make a rubber íoot. 1he íoot had the mobility and durability that Chandra
sought, although it had to undergo numerous reíinements. Working íurther with Dr. P.K. Sethi, an
orthopedic surgeon.and Dr. S.C.Kasliwal and Dr. Mahesh Udawat, Chandra reíined and improved the
design to eventually create what is now known as the Jaipur Ioot. 1o íacilitate the spread oí the íoot, its
creators decided not to patent the Jaipur Ioot.
Step 1: Design Considerations
1he Jaipur Ioot was designed to simulate normal íoot movements and provide a quality solution íor the
masses. Ior those poor in India who had lost their limbs, continuing to earn their livelihood was the
biggest concern. In absence oí an eííicient social security system, being able to work was essential íor their
survival. It necessitated a prosthesis, which supported their work and liíestyles. Jaipur Ioot`s design
process emphasi.ed the íollowing activities, which are commonly en;oyed by India`s working poor:

ACTIVITY MECHANICAL REQUIREMENT
14
Squatting Need íor dorsiíle×ion
Sitting Cross Legged Need íor transverse rotation oí the íoot
Walking on Uneven Ground Need íor inversion and eversion in the íoot so that varying terrain is not
transmitted to stump
Bareíoot walking Cosmetically similar to natural íoot


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Step 2: Overcoming Constraints
However, the technical demands were not the only demands íorced by the creators oí Jaipur Ioot. In
addition, they íaced the íollowing constraints.

CONSTRAINTS IMPLICATION
Poverty 1he vast ma;ority oí local amputees were poor. Lower cost oí prosthesis with the possibility oí
alignment and ad;ustments would íacilitate speciali.ed yet equally íunctional solution.
Closed Fconomy Limited import oí íoreign materials in India meant the íoot had to be íabricated írom readily
available local materials
Work Liíestyle Most amputees worked hard and long hours. 1he ability to walk on uneven ground was essential
íor their work. India was largely an agricultural economy, and days spent without limbs
threatened their livelihood and in many cases sustenance. 1his led to a need íor accessible
prosthesis that could be íitted quickly.
Limited 1rained
Manpower
Lack oí skilled labor relative to the huge demand íor prostheses necessitated a simpliíied
manuíacturing process, which could be períormed with limited training.
Step 3: Deviation from Traditional Design
1he design oí Jaipur Ioot was initially based on the SACH íoot design.
15
However, the design divorced
away írom the SACH íoot due to problems such as weight and non-suitability to local conditions. 1he
endoskeletal design was pursued, and a new, knee ;oint design evolved. Distortions were introduced in the
sockets so that adequate pressure was put only on those tissues, which could resist them. 1otal contact
sockets also were introduced.
Jaipur Ioot is made oí three blocks simulating the anatomy oí a normal íoot. 1he íoreíoot and heel
blocks are made oí sponge rubber and the ankle block consists oí light wood. 1he three components are
bound together, enclosed in a rubber shell and vulcani.ed in a mould to give it the shape and cosmetic
appearance oí a natural íoot.
Below-knee as well as above-knee prosthesis products are indigenously designed and íabricated
írom locally available and durable high-density polyethylene pipes and a Jaipur Ioot. 1hese are rapid-
íit limbs with low íabrication times. Iitting and íabrication times vary írom one hour íor below-knee
prostheses to about íive to si× hours íor above-knee prosthesis. Iunctionality oí the prosthesis mirrors
that oí a natural human limb, and it permits amputees to run, squat, sit cross-legged, climb trees and
;ump írom heights. 1he Jaipur Ioot is waterprooí and does not require maintenance aíter it is íitted.
Bareíoot walking is possible, an amputee can work in wet and muddy íields and the íoot is suitable íor
any type oí terrain. 1he patient also can wear shoes. Bio-mechanically, it is based on the standard
Patella-1endon-Bearing prosthesis and scientiíically íabricated to meet its weight distribution
requirements íor ma×imum comíort. Average weight oí the prosthesis is !.JJ kg; the weight oí a ¯¯ kg
person`s lower limb is !.!6 kg.

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Step 4: Materials Sourcing
1he Society produces the prosthesis with readily available and ine×pensive components in order to limit
the cost oí procurement as well as the cost oí the prosthesis itselí. A typical Jaipur Ioot, shank and
simulated knee ;oint is constructed with the íollowing materials:

COST ANALYSIS OF ABOVE KNEE LIMBS

WITH PLASTIC KNEE JOINT
S.
NO.

NAME OF MATERIAL

QUANTITY

RATE

AMOUNT
J. Jaipur Ioot J No. J!0.!¯/No. J!0.!¯
!. HDPF Pipe ·0 MM 0.60 RM1 J!6.J6/Mtr. 8¯.¯0
!. HDPF Pipe JJ0 MM 0.60 RM1 !J·.!¯/Mtr. J!J.¯¯
!. Plastic Knee Joint J Set J00/Set J00.00
¯. Plaster oí Paris ! Kg. !/Kg. J6.00
6. Stockinatte !' J¯0 Gms JJ¯/Kg. J¯.!¯
¯. Stockinatte !' !00 Gms. JJ¯/Kg. !!.00
8. A.K. Belt J No. !·/No. !·.00
·. Flastic belt J No. J0/No. J0.00
J0. Cotton Bandages ! Nos. !/No. J!.00
JJ. Dunlop Solution !0 Gms. ·0.8/Kg. J.8J
J!. Steel Screw ! Nos. 0.J!/No. 0.¯!
J!. Press Buttons ! Nos. 0.06/No. 0.!!
J!. Soap Stone Powder ¯0 Gms. !/Kg. 0.J0
J¯. Loctite J/! 1ube 0 ¯.00

1otal Material Cost

¯6!.!!
IUS3 Rs.!¯

1he estimated US3¯.68 cost oí materials outlined above includes the cost oí the components oí the
Jaipur Ioot itselí as well as the simulated ;oints íor a below-knee limb. Fach material is locally sourced
and does not require special procurement agreements. Most are virtual commodities. Iurthermore,
most oí the materials can be sourced locally ií necessary when the Jaipur Ioot is manuíactured in other
developing nations.
Step 5: Production Equipment
1he Jaipur íoot, as well as the calipers and other portions oí the prosthesis ultimately íitted on the patient,
is constructed with very basic tools. Most oí the íabrication process is completed with the tools oí an
ordinary artisan. 1he most speciali.ed piece oí equipment consists oí the íoot-shaped die used to mold the
shape oí the íoot. However, its cost is not signiíicant enough to even warrant listing on a íi×ed asset
schedule. 1he most e×pensive piece oí equipment is the vacuum-íorming machine used to get e×act replica
oí the mould and is used when heated HDPF sheet or pipe is draped over the mould oí the patient's
remaining limb (stump). 1he machine costs appro×imately !00,000 Rupees, or roughly US3!,000. Ior
heating pipe and sheets a machine is used which resembles an ordinary oven. 1he machine is commonly
íound throughout India and the rest oí the developing world. 1he Jaipur location oí the Society requires

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two vacuum íorming machines to serve an estimated 60 patients per day. Fach machine lasts írom íive to
seven years
Step 6: Labor
Iabrication oí the Jaipur Ioot, as well as the process by which a patient is íitted, is a very labor-intensive
process. 1his process capitali.es on the large supply oí skilled artisans in India and their manageable labor rates.
A Jaipur Ioot artisan is a craítsman with several years oí e×perience and is íurther trained íor several more
years to mold, sculpt and íorm the Jaipur Ioot. 1he Society typically schedules ¯0 trained technicians and
artisans each day to achieve a one-to-one patient-to-employee ratio. Artisans and technicians, who are more
e×perienced artisans, operate in a supervisory capacity and are paid by the hour plus overtime. A typical artisan
earns ¯,000 Rupees per month, or roughly US3J00 including beneíits. 1he estimated US3J,!00 annual income
oí an artisan is appro×imately twice that oí the per capita income in India.
An on-site doctor supervises the entire íabrication and íitting process. 1he Society has one doctor
on the payroll íull-time. In addition, other local doctors either volunteer their time or work on a part-
time basis to ensure that a certiíied physician approves a patient`s íinal prosthesis and íitting.
Step 7: Fab ication r
Iabrication oí Jaipur Ioot is a íast and simple process. 1he íoot incorporates locally available
materials/equipment. 1hese include a die, tread rubber compound, sponge rubber, cosmetic rubber, nylon
cords, a vulcani.er, wood and scissors. Ioot and ankle assembly is made oí a vulcani.ed rubber
compound. An aluminum die is used to cast a normal íoot shape. 1he die consists oí íour sections, which
can be bolted together. 1his allows íor ease oí setting up diííerent material components. 1he process thus
involves several stages with serial sequences oí plaster mould-die in íour sections. 1he position oí under-
suríace oí the íoot and toes is slightly rocketed with the toes slightly oíí the ground to achieve the rolling
action. 1he heel is kept slightly oíí the ground to accommodate the heel when worn in the shoe. 1his
complements the rocker` action oí the íoot. Please reíer to ^ééÉåÇáñ=a=íor details oí íabrication processK==
Sole
Fabrication
Lower Leg
Fabrication
Hind Foot
Fabrication
ForeFoot
Fabrication
Assembly
Vulcanization
Jaipur Foot Fabrication Process


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Step 8: Fitting of the Jaipur Foot
Nearly 60 patients each day obtain prostheses írom Jaipur Ioot`s main íacility in Jaipur, India.
Remarkably, unless other medical conditions intervene, each patient is custom íitted with a prosthesis in
one day - usually within three hours. 1he goal is to return the patient to their proíession and an
independent liíe aíter the patient`s íirst visit to the clinic.
However, the Society`s desire to accommodate the social requirements oí India`s poor does not
consist solely oí the speed oí service. 1he Society`s operating process also attends to the psychological
needs oí its patients. 1he Society provides on-site meals and overnight accommodations to patients at no
cost. 1hese services are shared with other patients in order to provide an immediate support group íor
the patients and to develop a sense oí community within the íacility. Additionally, íree meals and
accommodations are provided to the patient`s íamily members, again at no cost. 1his permits íamily
members to aííordably travel with patients and provide on-site support and comíort. A typical patient
e×perience to receive a Jaipur Ioot might proceed as íollows:

Monday 1:00 PM The patient catches a train from New Delhi to Jaipur, India. The patient's husband and child accompany her on the journey.
6:00 PM The family arrives at the front gate of the Society in the heart of Jaipur. A guard at the gate of the one-story facility admits the family inside.
6:30 PM The family joins other patients and family members at a communal dinner prepared by the Society's food service employee.
9:00 PM The family sleeps on mattresses in a large room within the facility's modest housing wing.
Tuesday 8:00 AM The family shares breakfast with other patients and families at the facility.
8:30 AM The patient joins the line forming in the Society's inner courtyard and awaits registration.
9:00 AM A doctor checks the patient and outlines the prosthesis that is required. The patient will keep the card until it is given to a technician.
9:10 AM prepared for a cast.
9:30 AM A trained artisan wraps a cast around the limb, forms it tightly around the limb and removes it.
9:45 AM
The patient is ushered back to the inner courtyard and waits. The artisan pours a mold into the cast, lets it dry, and then carves it to the limb's
specifications under the supervision of a technician.
10:15 AM A common polyurethane pipe is heated in a vacuum forming machine, is removed, and is stretched over the mold of the patient's remaining limb.
10:30 AM polyurethane prosthesis.
11:00 AM A prefabricated Jaipur Foot is attached to the prosthesis.
11:30 AM The patient is ushered back into the medical wing of the facility and a technician fits the prosthesis to the patient.
NOON
The on-site doctor supervises as the patient tests the new prosthesis in the inner courtyard. The patient describes some modest discomfort as
she walks around a separate inner courtyard.
12:15 PM prosthesis.
12:30 PM The patient and her family share lunch at the facility.
2:00 PM The family catches a train back to New Delhi.
7:30 PM The family returns home to resume a life similar to their lives before the loss of the patient's limb.



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Competitive Benchmarking
Jaipur Ioot supports developing country liíestyles (such as squatting, sitting cross-legged, walking on
uneven suríaces and bareíoot walking) while a conventional SACH íoot does not. Please reíer to ^ééÉåÇáñ=
_=íor a comparison oí Jaipur Ioot with the conventional prosthesis (SACH íoot).
1he table below details comparison oí Jaipur Ioot with VariIle× (Ossur) and 1rueStep (College
Park Industries), two leading prostheses in the developed world. 1he table compares the prostheses íor
range oí motion, general attributes such as cost, activities supported, and quality standards to which they
adhere.
Jaipur Ioot provides íor an e×cellent range oí dorsiíle×ion movement. As the table demonstrates,
though not e×plicitly superior to the Western prosthesis shown, the Jaipur Ioot possesses technical
characteristics that make it a comparable product. 1he clear diííerentiating íeatures are the respective
prices and the years oí introduction oí the products. 1he Jaipur Ioot presents an interesting comparison
to the Western prosthesis at a price períormance basis despite being introduced nearly two decades
beíore its Western counterparts. Iurthermore, the Jaipur Ioot compares íavorably on the activities íor
which it was designed, especially walking bareíoot, working in wet íields, walking on uneven ground
and climbing trees.

FEATURE/
FUNCTION
VARIFLEX
16
(SINCE 1990)
COLLEGE PARK FOOT
17

(SINCE 1991)
JAIPUR FOOT
18
(SINCE 1968)
o~åÖÉ=çÑ=jçíáçå=
Dorsiíle×ion Limited Dynamics !¯
0
!0
0
Plantar Ile×ion Limited Dynamics !¯
0
0
0
Inversion J!
0
(split toe version) J!
0
J0
0
Fversion J!
0
(split toe version) J!
0
J0
0
Supination Not Applicable !0
0
¯
0
Pronation Not Applicable !0
0
¯
0
^ííêáÄìíÉë=
Cost (Ioot Piece) 3J,!00 3J,0¯· 3¯ (!!0 Indian Rs.)
Average Cost (including
Prosthesis × Iitting) ·
3!,¯00 3!,¯00 3!0 (J¯00 Indian Rs.)
Iitting/Iabrication time J-! hours. J-! hours ! hours

Ioot piece Weight !!0g ¯J0 g 8¯0 g

Si.e/weight rating Up to J66 kg Up to J60 kg Not rated
Ad;ust íor heel height change Low/high heel options No No
Warranty !0 months !6 months None
Maintenance Requirements None Limited None
Average Liíe !-! years ! years !.¯ - !.0 years
^ÅíáîáíáÉë=pìééçêíÉÇ=
Work in wet íields Yes Not recommended Yes
Walk bareíoot Special sole required Yes Yes
Sit on íloor Yes Yes Yes
Squat Yes Yes Yes

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FEATURE/
FUNCTION
VARIFLEX
16
(SINCE 1990)
COLLEGE PARK FOOT
17

(SINCE 1991)
JAIPUR FOOT
18
(SINCE 1968)
Drive a car Yes Yes Yes
Ride a bike Yes. Yes Yes
Walk on uneven ground Yes (split toe version) Yes Yes
Climb trees Yes (with Limitations) Yes (with Limitations) Yes
Hike Yes Yes Yes
Swim Yes Not Recommended Yes
Run Yes Yes Yes
Quality Standards
CF Marked Yes Yes No
Additional ISO J0!!8 standard Internal Quality standards
·1his is average cost íor complete solution, which may involve multiple clinic visits. Actual costs will vary depending on options chosen.

Community Outreach: Providing Access
Bhagwan Mahaveer Viklang Sahayata Samiti (BMVSS)
1he designers oí Jaipur Ioot quickly discovered that designing a prosthesis that could withstand the
rigorous use oí India`s poor was only the beginning. 1he ne×t challenge was to construct an organi.ation
and operating system, which could make the Jaipur Ioot available to as many amputees as possible. 1he
e×pectation was that nearly all prospective amputees would íall below the poverty line. Subsequently,
Jaipur Ioot`s custodians íocused their attention on the íinancial and social needs oí India`s working poor.
1heir eííorts eventually took the íorm oí the nonproíit society named Bhagwan Mahaveer Viklang
Sahayata Samiti (BMVSS), generally reíerred to as “the Society.`
1he desiging oí the prosthesis that could withstand use by India's poor was only the beginning.
1he ne×t challange was to construct an organisation and operating system; which could make Jaipur
Ioot available to as many amputees as possible. 1he e×pectation was that nearly all oí the prospective
amputees would íall below the poverty line. 1o meet the íinancial and social needs oí the amputees and
also to promote íurther technical development, a non-proíit society named Bhagwan Mahaveer Viklang
Sahayata Samiti (BMVSS) was established in March J·¯¯ by Mr. D.R. Mehta. In the íirst ¯ year aíter the
development oí Jaipur Ioot in J·68, hardly ¯0 limbs were íitted. In the íirst year síter the íormation oí
the society ¯· limbs were íitted. Now, the number oí limbs íitted every year is around J6,000. Between
the March J·¯¯, when BMVSS was established to March !00!, BMVSS has íitted !!6,¯J¯ limbs in India
and J!,0¯0 around the world (Please reíer to table below). But íor the value system and patient centric
management practices íollowed by BMVSS, Jaipur Ioot might have remained on the shelí and in limbo.
1he BMVSS emphasi.es a holistic approach to addressing the problems oí amputees. 1he society
íocuses on not only the medical problems oí the underprivileged, but also the íinancial and social
problems as well.
1he society has laid down e×tremely simple procedures íor reception, admission, measurement
taking, manuíacturing, íitment and discharge oí patients. Unlike in all other medical centers all over the
word, patients are admitted as they arrive without regard to the time oí day. Iurther patients are
provided boarding and lodging íacilities at the centers oí BMVSS till they are provided with limbs,

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calipers or other aids. In most orthopaedic centers in the world, patients must come back several times
íor a custom íit. 1his process could take several weeks. Such a system would be unsuitable to the poor
patients who íind it e×tremely diííicult, both in physical and íinancial terms, to come back a second time
írom long distances. Jaipur Ioot is custom íitted on the same day; in íact in less than ! hours. Most
signiíicantly the prosthetics orthotics and other aids and appliances are provided totally íree oí charge to
the handicapped. But íor this policy, virtually more than ·0/ oí the patients would have remained
deprived oí artiíicial limbs, calipers and other aids and appliances. 1he setting up oí patients oriented
value and management system was an equally important innovation.
BMVSS has ten branches in India. In addition, there are appro×imately 60 workshops that íabricate
or íit the Jaipur Ioot in India. 1he Society also has aided the establishment oí several centers abroad.
Iunded by the Indian government and philanthropic groups, BMVSS and similar organi.ations oííer
medical care, room, board, and a prosthetic at no cost to the patient. It also has helped launch íree clinics
in more than a do.en countries.

INDIA: NUMBER OF ARTIFICIAL LIMBS AND OTHER AIDS DISTRIBUTED BY BMVSS
Artiíicial Limbs !J·,!¯0
Calipers J¯!,J6¯
1ricycles !6,·!J
Crutches × Other Aids !!¯,!·!
Hearing Aids 6,666
Polio Surgery !,860
Source: Jaipur Ioot (BMVSS)

World: Number of Artificial Limbs and other aids distributed
By BMVSS
Aíghanistan J,!¯¯ Panama !00
Bangladesh J,000 Philippines !,000
Dominican Republic ¯00 Papua New Guinea J¯0
Honduras !00 Rwanda ¯00
Indonesia 600 Somalia J,000
Malawi !¯0 1rinidad !00
Nigeria ¯00 Vietnam 600
Nepal !00 Zimbabwe !¯0
Nairobi ¯00 Sudan J,800
1O1AL J!,!!¯
Source: Jaipur Ioot (BMVSS)
Jaipur Foot: Filling a Social Need
1he determination was made at the outset that the Jaipur Ioot prosthesis would be provided íree by
means oí a nonproíit íramework. 1he prospect oí no additional íunds reali.ed íor additional prostheses
íitted íorced administrators to íocus on containing costs. In particular, emphasis was placed on the cost oí
the materials used to construct the Jaipur Ioot, the capital equipment required to íabricate the íoot and
the method by which the íoot was íitted to a patient in order to make the prosthesis widely available.

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Jaipur Foot Operations
1he result is an organi.ation that spends nearly ¯!/ oí its cost on the materials, labor and services
necessary to íit amputees with a prosthetic limb. 1he íollowing diagram estimates the cost components oí
providing each Jaipur Ioot:

Cost of Typical Jaipur Foot
Below Knee Limb
Materials
43%
Labor
31%
Camps
12%
Overhead
14%

Source: BMVSS Ad;usted Cost Report

Only J!/ oí the cost oí a typical Jaipur Ioot goes toward meeting overhead and administrative
costs. 1he remaining cost goes toward the materials used in the íoot, the labor employed to manuíacture
and íit the limb and the cost oí running camps, which reach the poor throughout India and beyond.
1his cost eííiciency is also reílected in the Jaipur Ioot`s annual e×penses:

Jaipur Foot 2002 Expense by Classification
(overhead costs of camps are included in Cost of Limbs and Services)
Cost of Limbs and
Services
89%
Other Assistance
7%
Operating Costs
4%

Source: BMVSS Ad;usted Cost Report


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Jaipur Ioot`s e×pense breakout íor the !00! íiscal year underscores the eííiciency oí e×pense and
underpins the Society`s eííort to serve as many patients as possible given its íinancial resources. Nearly
·0/ oí the company`s e×penses in the !00! íiscal year were directly related to the cost oí producing and
íitting prostheses íor the poor. Another ¯/ oí the company`s e×penses went toward other íorms oí
charitable assistance. Only !/ oí its e×penditures went toward administrative and overhead e×penses.
Comparison with Ossur
1he Society`s cost structure diííers signiíicantly with that oí Ossur, an Iceland-based publicly traded
company that manuíactures, markets and sells prostheses throughout Furope and North America. Ossur
is the second-largest producer oí prostheses in the world.
As the diagram demonstrates, ;ust over halí oí Ossur`s annual e×pense goes toward administrative
and operating costs while halí its e×pense goes toward the actual cost oí producing prostheses. A more
detailed e×amination oí the annual íinancial statements oí Jaipur Ioot and Ossur reveals that a
signiíicant portion oí Ossur`s e×penditures are related to sales and marketing (!J/) and research and
development (·/). Although this disparity in part underscores the diííerent competitive environments,
regulatory environments and organi.ational goals that separate the two organi.ations, it also provides a
íramework that underscores the Society`s ability to íunnel its resources directly to patients.

Ossur 2002 Expense by Classification
Cost of Limbs and
Services
48% Operating Costs
52%

Source: Ossur !00! Annual Report
Scalability
Camps
1he Society`s current method oí e×panding the reach oí the Jaipur Ioot to more remote areas oí India and
beyond is the camp system. Administrators, doctors, technicians and artisans írom the Society`s Jaipur
location travel to a predetermined site and set up a temporary íacility reíerred to as a camp. A camp is


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typically íunded by another private organi.ation or government that has invited the Society to the
location. A camp can last írom ;ust a íew days to several weeks depending on the number oí amputees
e×pected to be íitted with prostheses.
A BMVSS physician supervises camps. It takes about one day to set up and a halí day to close. 1he
sponsoring organi.ation pays the Society`s employees a travel allowance and a per diem while on site. In
general, the camp requires one artisan íor every two patients e×pected to be treated per day. 1hough
most oí the components oí a typical Jaipur Ioot and caliper can be locally sourced, the Society usually
travels with the e×pected required materials. Likewise, employees travel with the equipment necessary
to íabricate the prosthesis, including a vacuum-íorming machine, the largest and most e×pensive piece
oí equipment required íor íabrication. Any material shortages are usually covered with locally
purchased goods with little incident. 1he sponsoring organi.ation takes responsibility íor promoting the
camp and íor any transportation oí amputees.
New Locations
1he Society also íacilitates the establishment oí new permanent locations to íabricate and íit the Jaipur
Ioot. Although the Society itselí supports several locations in India, including New Delhi and Mumbai
(Bombay), the Society encourages the establishment oí other charitable organi.ations to run clinics. 1he
Society is active in assisting the new organi.ation in determining the íeasibility oí clinic location, training
oí employees and in making the Jaipur Ioot available to the clinic.
1he Society, in con;unction with a new organi.ation, studies the number oí amputees near the new
location and estimates the ongoing need íor the Jaipur Ioot prosthesis. A new location requires a
modest level oí capital e×penditure. 1he most signiíicant piece oí equipment is the vacuum-íorming
machine at an estimated cost oí US3!,000. Additional equipment and tools generally cost another
US3!,000. Artisans are trained at the Jaipur íacility íor up to si× months. Virtually all this training takes
place with patients and under the supervision oí technicians and doctors. 1he Society maintains and
updates a manual, which outlines the íabrication and íitting oí the Jaipur Ioot to assist in this process.
Aíter the new location is staííed, its employees are trained and the new clinic is ready to íit patients,
the Society sends a technician to supervise and support the clinic`s initial operations. 1he number oí
artisans and technicians at the new íacility depends on the e×pected patient load. Additionally, each
clinic retains a doctor to supervise the treatment and íitting oí patients. 1he Society makes the process to
íabricate the Jaipur Ioot available to the new clinic, or the Society simply produces the required number
oí prosthesis and supplies it to the new clinic íree oí charge.
Future of Jaipur Foot
Jaipur Foot Technical Improvements
BMVSS collaborates with hospitals, but is also involved in its own research × development to íurther
improve the limb design. R×D at BMVSS is led by Ram Chandra while Dr. M.K. Mathur, a trained
orthopedic surgeon and íormer head oí physical medicine × rehabilitation at a leading hospital, heads the
medical and technical eííort. Its staíí includes doctors, technicians and social workers.

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BMVSS/Jaipur Ioot has made several changes in the design and manuíacture oí lower-limb
prostheses to keep pace with increases in human understanding oí biomechanics and advances in
material technology. High-strength plastics are now being used instead oí aluminum. 1otal contact
sockets also have been incorporated in the design. However, the custodians oí BMVSS have targeted
other areas íor improvement. 1he Jaipur Ioot currently is being hand designed, which raises the issues
oí inconsistency, its impacts on quality and reliability.
Iurthermore, at 8¯0 grams, the current íoot piece is heavy compared to other solutions. Jaipur Ioot
has not been tested/certiíied íor any well-known international standard. It also has not yet received
regulatory approvals íor usage in certain developed countries such as United States (such an approval
has not yet been sought).
Collaboration with Space Research Organization
BMVSS has signed an agreement with the Indian Space Research Organi.ation (ISRO) to receive ISRO`s
polyurethane technology.
19
ISRO, established in J·6·, is one oí the premier space research organi.ations
in the world. Its activities include space research, design, development and launch oí satellites and other
space vehicles.
1he polyurethane technology developed by ISRO is borne out oí ISRO`s pioneering research and
development oí various polymeric materials. 1he materials are to ensure the reliability and quality oí
launch vehicles and satellites. Polyurethane is a versatile polymer that can be produced in various íorms
like adhesives, coating materials and in íle×ible or rigid íorms. ISRO has developed PU polymer and its
advanced derivatives, which are being e×tensively used in propellants, cryogenic insulation, thermal
insulation pads, structural damping, acoustic insulation and other lightweight structural materials íor
vibration control, shock absorption liners and adhesives.
1his collaboration is e×pected to reduce the cost oí manuíacturing a Jaipur Ioot. Cost oí each íoot
will be reduced by about !0/ to Rs. J!0. 1he íoot piece also will become lighter by appro×imately 60/
to !¯0 grams.
1he technology transíerred to BMVSS will help produce a more durable and comíortable artiíicial
íoot in large numbers. Average íoot íabrication time will be reduced írom three hours to around !0
minutes. PU íoot prostheses would be bio-mechanically advantageous írom a comíort level perspective.
1he slip resistance oí the PU íoot is much higher than rubber and allied materials used in conventional
artiíicial íoot prostheses. Amputees using the PU íoot prostheses could walk more saíely on any suríace
since its abrasion resistance is higher. In addition, the PU íoot lasts longer.
1he polyurethane íoam íoot molded with cosmetically attractive skin covers has been íound to be
more acceptable to amputees. 1he new polyurethane íoot has been sub;ected to accelerated íle× íatigue
tests, and several amputees have been successíully íitted with such prostheses produced under the
technology transíerred by ISRO. Iield trials have been reported to be encouraging.

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Endnotes

J
www.;aipuríoot.org
!
Please reíer to=Appendi× A íor a description oí lower limb íunctionality and prosthesis
!
http://www.mossresourcenet.org/amputa.htm
!
http://www.limbsíorliíe.org/about.htm
¯
http://www.ottobockus.com/products/op_lower_clegJ.asp
6
http://www.newbeginnings!000.org/íacts.html
¯
http://www.openroads.org/
8
http://www.poísea.org/Outreach/Outreach.html
·
http://www.poísea.org/Help.html
J0
http://www.dpa.org.sg/DPA/publication/dpipub/spring·¯/dpiJ8.htm
JJ
http://telebody.com/sihanouk/About1heHospital/about-the-Hospital.html
J!
www.nupoc.northwestern.edu/prosHistory.html
J!
Interview with Mr. Ramchandra Sharma (BMVSS)
J!
Please see Appendi× íor description oí lower limb íunctionality

Interview with Dr. MK Mathur (BMVSS)
J6
Based on inputs írom Ossur

Based on inputs írom College Park
J8
Based on inputs írom BMVSS

1he Hindu Business Line (!0 July !00! edition)

Released December 12, 2003

=

NSIMMM=é~íáÉåíë=~ååì~ääóI=ïÜáäÉ=_jspp=ëÉêîáÅÉë=~ééêçñáã~íÉäó=SMIMMM=é~íáÉåíë=Äó=éêçîáÇáåÖ=g~áéìê=ÑççíI= Å~äáéÉêë=~åÇ=çíÜÉê=~áÇë=~åÇ=~ééäá~åÅÉëK=qÜÉêÉ=~êÉ=ëÉîÉå=ÅÉåíÉêë=íÜêçìÖÜçìí=fåÇá~=~åÇ=~=åìãÄÉê=çÑ=ãçÄáäÉ= Å~ãéë=ÜÉäÇ=ÉîÉêó=óÉ~ê=áå=î~êáçìë=é~êíë=çÑ=íÜÉ=ÅçìåíêóK=g~áéìê=cççí=Å~ãéë=~äëç=Ü~îÉ=ÄÉÉå=ÑçìåÇ=áå=NV= ÅçìåíêáÉëI=áåÅäìÇáåÖ=^ÑÖÜ~åáëí~åI=_~åÖä~ÇÉëÜI=açãáåáÅ~å=oÉéìÄäáÅI=eçåÇìê~ëI=fåÇçåÉëá~I=j~ä~ïáI= káÖÉêá~I=kÉé~äI=k~áêçÄáI=m~å~ã~I=mÜáäáééáåÉëI=m~éì~=kÉï=dìáåÉ~I=oï~åÇ~I=pçã~äá~I=qêáåáÇ~ÇI= sáÉíå~ãI=wáãÄ~ÄïÉ=~åÇ=pìÇ~åK= táíÜ=áååçî~íáçåë=áå=íÉÅÜåçäçÖó=~åÇ=ã~å~ÖÉãÉåíI=~ë=ïÉää=~ë=ìåÇÉêëí~åÇáåÖ=íÜÉ=åÉÉÇë=çÑ=áíë= é~íáÉåíëI=_jspp=ÇÉîÉäçéÉÇ=~=ìåáèìÉ=ÄìëáåÉëë=ãçÇÉäK=qÜáë=ãçÇÉä=ëéêÉ~Çë=íÜÉ=g~áéìê=cççí=íÉÅÜåçäçÖó= íÜ~í=~ääçïë=êáÅâëÜ~ïJï~ää~Ü=EéÉÇáÅ~Ä=çéÉê~íçêëF=~ãéìíÉÉë=íç=ÄÉ=êáÅâëÜ~ïJï~ää~ïëI=Ñ~êãÉê=~ãéìíÉÉë=íç= ÄÉ=Ñ~êãÉêë=~åÇ=áå=íÜÉ=Å~ëÉ=çÑ=pìÇÜ~=`Ü~åÇê~åI=Åä~ëëáÅ~ä=fåÇá~å=Ç~åÅÉê=~ãéìíÉÉë=ëíáää=íç=ÄÉ=Åä~ëëáÅ~ä= fåÇá~å=Ç~åÅÉêëK==
THE NATURE AND SCOPE OF THE PROBLEM: Global Amputees

qÜÉêÉ=~êÉ=~åóïÜÉêÉ=Ñêçã=NM=ãáääáçå=íç=OR=ãáääáçå=~ãéìíÉÉë=áå=íÜÉ=ïçêäÇI=ïáíÜ=~å=~ÇÇáíáçå~ä=ORMIMMM= ~ÇÇÉÇ=É~ÅÜ=óÉ~êK=qÜÉ=Å~ìëÉë=çÑ=~ãéìí~íáçå=î~êó=ÖêÉ~íäóK=få=ÅçìåíêáÉë=ïáíÜ=~=êÉÅÉåí=Üáëíçêó=çÑ=ï~êÑ~êÉ=~åÇ= Åáîáä=ìåêÉëíI=~ãéìí~íáçå=áë=ÇìÉ=íç=íê~ìã~=~åÇ=ä~åÇãáåÉ=~ÅÅáÇÉåíëKP=få=éä~ÅÉë=äáâÉ=íÜÉ=råáíÉÇ=pí~íÉëI=íÜÉ= Å~ìëÉë=~êÉ=ãçêÉ=êÉä~íÉÇ=íç=~ÅÅáÇÉåíëI=ÅáêÅìä~íçêó=ÇáëÉ~ëÉë=~åÇ=Å~åÅÉêK=oÉÖ~êÇäÉëëI=éêçëíÜÉëáë=áå=ÄçíÜ= ÇÉîÉäçéáåÖ=~åÇ=ÇÉîÉäçéÉÇ=å~íáçåë=áë=ÉñéÉåëáîÉ=~åÇ=ÅçãéäáÅ~íÉÇI=äÉ~îáåÖ=~=ëáò~ÄäÉ=åìãÄÉê=çÑ=~ãéìíÉÉë= ìå~ÄäÉ=íç=~ÑÑçêÇ=~ÇÉèì~íÉ=éêçëíÜÉíáÅ=Å~êÉKQ==
Developed World

^ÅÅçêÇáåÖ=íç=~=NVVS=k~íáçå~ä=`ÉåíÉê=Ñçê=eÉ~äíÜ=pí~íáëíáÅë=ëíìÇóI=íÜÉêÉ=~êÉ=ãçêÉ=íÜ~å=Q=ãáääáçå=~ãéìíÉÉë=áå= íÜÉ=råáíÉÇ=pí~íÉë=~åÇ=~ééêçñáã~íÉäó=OMMIMMM=åÉï=~ãéìíÉÉë=ÉîÉêó=óÉ~êI=çÑ=ïÜáÅÜ=~ééêçñáã~íÉäó=TMB=~êÉ= äçïÉê=äáãÄ=~ãéìíÉÉëR=ElÅíçÄÉê=NVVVFK=^ÅÅçêÇáåÖ=íç=íÜÉ=tçêäÇ=eÉ~äíÜ=oÉéçêí=áå=NVVUI=~ãéìí~íáçå= êÉëìäíáåÖ=Ñêçã=Çá~ÄÉíÉë=ïáää=ãçêÉ=íÜ~å=ÇçìÄäÉ=ÖäçÄ~ääó=Ñêçã=NQP=ãáääáçå=Å~ëÉë=áå=NVVT=íç=PMM=ãáääáçå=Äó= OMORKS=qÜÉ=ãçëí=Åçããçå=Å~ìëÉë=çÑ=~ãéìí~íáçå=çÑ=äçïÉê=ÉñíêÉãáíáÉë=~êÉ=ÇáëÉ~ëÉ=ETMBFI=íê~ìã~=EOOBFI= ÅçåÖÉåáí~ä=çê=ÄáêíÜ=ÇÉÑÉÅíë=EQBF=~åÇ=íìãçêë=EQBFK=rééÉê=ÉñíêÉãáíó=~ãéìí~íáçå=ìëì~ääó=áë=ÇìÉ=íç=íê~ìã~=çê= ÄáêíÜ=ÇÉÑÉÅíK=qÜÉ=Åçëí=çÑ=éêçëíÜÉëáë=áë=îÉêó=ÜáÖÜ=áå=íÜÉ=råáíÉÇ=pí~íÉëI=äÉ~îáåÖ=ã~åó=ïáíÜçìí=~ééêçéêá~íÉ= Å~êÉK=^ÅÅçêÇáåÖ=íç=j~êâ=q~óäçêI=Ñêçã=íÜÉ=råáîÉêëáíó=çÑ=jáÅÜáÖ~å=mêçëíÜÉíáÅë=aÉé~êíãÉåíI=ÇìÉ=íç= áåëìê~åÅÉ=Åçãé~åó=éçäáÅáÉë=~åÇ=ÜáÖÜ=ÅçëíëI=çåäó=RMB=çÑ=é~íáÉåíë=áå=íÜÉ=rKpK=êÉÅÉáîÉ=íÜÉ=éêçëíÜÉíáÅ=ãÉÇáÅ~ä= Å~êÉ=íÜÉó=êÉèìáêÉK==
Developing World

få=íÜÉ=ÇÉîÉäçéáåÖ=ÅçìåíêáÉë=çÑ=^ëá~=~åÇ=^ÑêáÅ~I=ä~åÇ=ãáåÉë=Ü~îÉ=äÉÑí=ãáääáçåë=çÑ=éÉçéäÉ=äáãÄäÉëëK=^ÅÅçêÇáåÖ= íç=íÜÉ=rKpK=`ÉåíÉêë=Ñçê=aáëÉ~ëÉ=`çåíêçäI=~ééêçñáã~íÉäó=PMMIMMM=ÅÜáäÇêÉå=~êÉ=ëÉîÉêÉäó=Çáë~ÄäÉÇ=ÄÉÅ~ìëÉ=çÑ= ä~åÇ=ãáåÉëI=ïáíÜ=~å=~ÇÇáíáçå~ä=NRIMMM=íç=OMIMMM=åÉï=îáÅíáãë=É~ÅÜ=óÉ~êKT=jçêÉçîÉêI=ãçëí=îáÅíáãë=~êÉ=åçí=
© 2003 University of Michigan Regents 2 of 21

Released December 12. 2003 = ëçäÇáÉêëI=Äìí=ïçãÉå=~åÇ=ÅÜáäÇêÉå=ïÜç=Ü~ééÉå=íç=äáîÉ=áå=~êÉ~ë=íÜ~í=ïÉêÉ=çåÅÉ=ï~ê=òçåÉëK=_ó=ëçãÉ= Éëíáã~íÉëI=íÜÉêÉ=~êÉ=ãçêÉ=íÜ~å=NMM=ãáääáçå=ä~åÇ=ãáåÉë=ÄìêáÉÇ=~ää=çîÉê=íÜÉ=éä~åÉíK=få=ã~åó=éççê=å~íáçåëI= ãçëí=~ãéìíÉÉë=Ü~îÉ=íç=ëÉííäÉ=Ñçê=~=äáÑÉíáãÉ=çå=ÅêìíÅÜÉëK=få=sáÉíå~ã=~äçåÉI=ä~åÇ=ãáåÉë=áåàìêÉ=ãçêÉ=íÜ~å= OIMMM=éÉçéäÉ=É~ÅÜ=óÉ~êKU=fí=Åçëíë=~ééêçñáã~íÉäó=APMM=íç=éêçîáÇÉ=~=ÜáÖÜJèì~äáíó=~êíáÑáÅá~ä=äÉÖ=áå=sáÉíå~ãKV= = Countries with the Most Number of Landmines # OF LANDMINES VIRMMIMMM= VIMMMIMMM= TIRMMIMMM= RIMMMIMMM= RIRMMIMMM= NIRMMIMMM= NIRMMIMMM= NIMMMIMMM= NIMMMIMMM= NIMMMIMMM= COUNTRY ^ÑÖÜ~åáëí~å= ^åÖçä~= fê~è= hìï~áí= `~ãÄçÇá~= tÉëíÉêå=p~Ü~ê~= jçò~ãÄáèìÉ= pçã~äá~= _çëåá~JeÉêòÉÖçîáå~= `êç~íá~= pçìêÅÉW=råáíÉÇ=k~íáçåë=a~í~= = få=^ÑÖÜ~åáëí~åI=íÜÉêÉ=~êÉ=~ééêçñáã~íÉäó=NM=ãáääáçå=ä~åÇãáåÉë=~åÇ=~í=äÉ~ëí=RMIMMM=~ãéìíÉÉëKNM=få= `~ãÄçÇá~I=íÜÉêÉ=~êÉ=ORIMMM=íç=QMIMMM=~ãéìíÉÉëI=çê=çåÉ=~ãéìíÉÉ=éÉê=PMM=áåÜ~Äáí~åíëK=qÜÉêÉ=~êÉ=åÉ~êäó=~ë= ã~åó=ä~åÇ=ãáåÉë=áå=`~ãÄçÇá~=~ë=éÉçéäÉK=dçîÉêåãÉåí=Üçëéáí~äë=~êÉ=ëç=ëÉîÉêÉäó=ìåÇÉêJêÉëçìêÅÉÇ=íÜ~í= é~íáÉåíëI=áåÅäìÇáåÖ=íÜÉ=îÉêó=éççêI=~êÉ=ÑçêÅÉÇ=íç=é~ó=Ñçê=ëÉêîáÅÉë=çê=ÇêìÖëI=äÉ~îáåÖ=ã~åó=ïáíÜçìí=Å~êÉKNN= få=hçëçîçI=íÜÉ=tçêäÇ=eÉ~äíÜ=lêÖ~åáò~íáçå=EtelF=Éëíáã~íÉÇ=íÜÉ=NVVV=ä~åÇ=ãáåÉ=áåàìêó=ê~íÉ=~í=NM=áå= NMMIMMMI=ÉñÅÉÉÇáåÖ=íÜÉ=ê~íÉë=çÑ=ÄçíÜ=^ÑÖÜ~åáëí~å=~åÇ=jçò~ãÄáèìÉK=få=fåÇá~I=íÜÉêÉ=~êÉ=RKR=ãáääáçå= éÉçéäÉ=ëìÑÑÉêáåÖ=Ñêçã=äçÅçãçíçê=Çáë~ÄáäáíáÉë=áå=fåÇá~K=lÑ=íÜÉëÉI=~Äçìí=çåÉ=ãáääáçå=Ü~îÉ=äçëí=íÜÉáê=äáãÄë= ~åÇ=Ñçìê=ãáääáçå=ëìÑÑÉê=Ñêçã=éçäáçK=aìÉ=íç=íÜÉ=áåÅêÉ~ëÉ=áå=êç~Ç=~ÅÅáÇÉåíëI=ÇáëÉ~ëÉë=~åÇ=çíÜÉê=Ü~ò~êÇëI= ORIMMM=åÉï=Å~ëÉë=~ÇÇ=íç=íÜÉ=éçéìä~íáçå=çÑ=~ãéìíÉÉë=ÉîÉêó=óÉ~êK== © 2003 University of Michigan Regents 3 of 21 .

$50 (Shrinker) Prosthetic Socks $19 (Sheath) $80 (Sheath w/Gel) $25 (Wool Socks) Legs Above the Knee Legs $12.000 – $4.Released December 12.000 $9 (Single Ply).000 (High End) Legs Prosthetic Sockets Prosthetic Feet $250 – $12.000– $5.265 (High End $8. $80 (Shrinker) Prosthetic Sockets Prosthetic Knee Prosthetic Socks $25(Sheath) $80 (Sheath w/Gel) $25 (Wool Socks) = Developing World léÉåoç~ÇëI=~=rKpKJÄ~ëÉÇ=kdlI=ïáää=ÄÉ=ëÜáééáåÖ=NMM=éêçëíÜÉíáÅë=ÉîÉêó=óÉ~ê=íç=É~ÅÜ=ëáíÉK=_Éäçï=áë=~=í~ÄäÉ=çÑ= íÜÉáê=Éëíáã~íÉÇ=Åçëíë=çÑ=éêçîáÇáåÖ=äáãÄëK=fí=áë=Ä~ëÉÇ=çå=íÜÉ=~ëëìãéíáçå=íÜ~í=ÄìóáåÖ=áå=Äìäâ=ïáää=êÉÇìÅÉ= çîÉê~ää=ÅçëíëK=táíÜ=éêçëíÜÉíáÅ=Å~êÉ=~ë=ÉñéÉåëáîÉ=~ë=áí=áë=íçÇ~óI=áí=äÉ~îÉë=ã~åó=é~íáÉåíëI=áå=ÄçíÜ=íÜÉ=ÇÉîÉäçéáåÖ= ~åÇ=ÇÉîÉäçéÉÇ=ïçêäÇI=ïáíÜçìí=íÜÉ=Å~êÉ=íÜÉó=åÉÉÇK=^=Ñ~ëíI=ÇÉéÉåÇ~ÄäÉ=ëçäìíáçåI=~í=~=Åçëí=éÉçéäÉ=Å~å=~ÑÑçêÇ= Eáå=íÜÉ=ÇÉîÉäçéáåÖ=ïçêäÇI=íÜáë=Åçëí=áë=AMKMMFI=áë=åçí=çåäó=åÉÅÉëë~êó=Äìí=~äëç=áããáåÉåíK=fååçî~íáîÉ=ÄìëáåÉëë= ãçÇÉäëI=ëìÅÜ=~ë=g~áéìê=cççíI=~äêÉ~Çó=Ü~îÉ=ëí~êíÉÇ=íç=~ÅÅçãéäáëÜ=íÜáë=ëìÅÅÉëëÑìääóK== = © 2003 University of Michigan Regents 4 of 21 .000 (Middle (Low End) End) $3450 (Replacement Socket) $650 (Replacement Cover) $10.000 $9.765 (Low without Knees and End) Feet) $4300 (Replacement $900 (Replacement Socket) Cover) $700 – $5400 $10(Single Ply).000 – $25. 2003 = Treatment Costs Developed World PROSTHETIC COSTS IN THE UNITED STATES BELOW THE KNEE LIMB $7.

000 $15.000 $20.000 $15.500 1 2 3 4 5 = History of Prosthesis qÜÉ=Üáëíçêó=çÑ=éêçëíÜÉíáÅë=ÄÉÖáåë=~í=íÜÉ=îÉêó=Ç~ïåáåÖ=çÑ=Üìã~å=ãÉÇáÅ~ä=íÜçìÖÜíK=fíë=ÜáëíçêáÅ~ä=íïáëíë=~åÇ= íìêåë=é~ê~ääÉä=íÜÉ=ÇÉîÉäçéãÉåí=çÑ=ãÉÇáÅ~ä=ëÅáÉåÅÉI=ÅìäíìêÉ=~åÇ=Åáîáäáò~íáçå=áíëÉäÑK== qÜÉ=éêçëíÜÉëÉë=çÑ=~åÅáÉåí=ÅìäíìêÉë=ÄÉÖ~å=~ë=ëáãéäÉ=ÅêìíÅÜÉë=çê=ïççÇÉå=~åÇ=äÉ~íÜÉê=Åìéë=ÇÉéáÅíÉÇ=áå= jçÅÜÉ=éçííÉêóK=^å=çéÉå=ëçÅâÉí=éÉÖ=äÉÖ=Ü~Ç=ÅäçíÜ=ê~Öë=íç=ëçÑíÉå=íÜÉ=Çáëí~ä=íáÄá~=~åÇ=ÑáÄìä~=~åÇ=~ääçï=~= ïáÇÉ=ê~åÖÉ=çÑ=ãçíáçåK=qÜÉëÉ=éêçëíÜÉëÉë=ïÉêÉ=îÉêó=ÑìåÅíáçå~ä=~åÇ=áåÅçêéçê~íÉÇ=ã~åó=Ä~ëáÅ=éêçëíÜÉíáÅ= éêáåÅáéäÉëK= ^å=~êíáÑáÅá~ä=äÉÖ=áåîÉåíÉÇ=Äó=m~êÉ=áå=NRSN=Ñçê=áåÇáîáÇì~äë=~ãéìí~íÉÇ=~ÄçîÉ=íÜÉ=âåÉÉ=ï~ë= ÅçåëíêìÅíÉÇ=çÑ=áêçå=~åÇ=ï~ë=íÜÉ=Ñáêëí=~êíáÑáÅá~ä=äÉÖ=âåçïå=íç=Éãéäçó=~êíáÅìä~íÉÇ=àçáåíëK=j~àçê=~Çî~åÅÉë= Ü~îÉ=ÄÉÉå=ã~ÇÉ=áå=íÜÉ=ÑáÉäÇ=çÑ=éêçëíÜÉíáÅ=êÉÜ~Äáäáí~íáçåI=ëíáãìä~íÉÇ=áå=é~êí=Äó=ï~êë=íÜ~í=áåÅêÉ~ëÉÇ=íÜÉ= åìãÄÉê=çÑ=áåÇáîáÇì~äë=ïÜç=äçëí=äáãÄëK=aìêáåÖ=íÜÉ=^ãÉêáÅ~å=`áîáä=t~ê=ENUSNJNUSRFI=áåíÉêÉëí=áå=~êíáÑáÅá~ä= äáãÄë=~åÇ=~ãéìí~íáçå=ëìêÖÉêó=áåÅêÉ~ëÉÇ=áå=íÜÉ=rKpKI=ïáíÜ=íÜÉ=ÖçîÉêåãÉåí=é~óáåÖ=Ñçê=~êíáÑáÅá~ä=äáãÄë=Ñçê= îÉíÉê~åëK=få=NUSOI=íÜÉ=rKpK=ÖçîÉêåãÉåí=Éå~ÅíÉÇ=íÜÉ=Ñáêëí=ä~ï=éêçîáÇáåÖ=ÑêÉÉ=éêçëíÜÉëÉë=íç=éÉçéäÉ=ïÜç=äçëí= äáãÄë=áå=ï~êÑ~êÉK=få=NUTMI=`çåÖêÉëë=é~ëëÉÇ=~=ä~ï=íÜ~í=ÉåíáíäÉÇ=ï~ê=~ãéìíÉÉë=íç=êÉÅÉáîÉ=éêçëíÜÉëÉë=ÉîÉêó= ÑáîÉ=óÉ~êëK== tçêäÇ=t~ê=ff=ëéìêêÉÇ=ÑìêíÜÉê=ÇÉîÉäçéãÉåíëK=aáëë~íáëÑ~Åíáçå=ïáíÜ=ÜÉ~îóI=ìåÅçãÑçêí~ÄäÉ=~êíáÑáÅá~ä= äáãÄë=Ö~îÉ=áãéÉíìë=íç=éêçëíÜÉíáÅ=êÉëÉ~êÅÜK=qÜÉ=^ãÉêáÅ~å=lêíÜçíáÅ=~åÇ=mêçëíÜÉíáÅ=^ëëçÅá~íáçå=ï~ë= Éëí~ÄäáëÜÉÇ=áå=NVQV=~åÇ=ÇÉîÉäçéÉÇ=ÉÇìÅ~íáçå~ä=ÅêáíÉêá~=~åÇ=Éñ~ãáå~íáçåë=íç=ÅÉêíáÑó=éêçëíÜÉíáëíë=~åÇ= çêíÜçíáëíëK=få=NVQRI=íÜÉ=k~íáçå~ä=^Å~ÇÉãó=çÑ=pÅáÉåÅÉë=ëÉí=ìé=~=`çããáííÉÉ=çå=^êíáÑáÅá~ä=iáãÄë=E`^iF=íç= 5 of 21 © 2003 University of Michigan Regents .000 $30.000 $15.000 $15.000 $15.000 $237.Released December 12.000 $15.000 $10.500 $15. 2003 = Year OpenRoad Cost Estimates For Providing Prosthetic Care Globally Year and Number of People Served per Site Location Number of Cost per Site People Served Kosovo Rwanda Kosovo Rwanda Kosovo Rwanda Afghanistan Kosovo Rwanda Afghanistan Mozambique Kosovo Rwanda Mozambique Afghanistan Total: 50 50 100 50 100 100 50 100 100 100 50 100 100 100 100 1250 $15.000 $15.000 $7.000 $15.000 $20.

2003 = ÇÉîÉäçé=ÇÉëáÖå=ÅêáíÉêá~=íÜ~í=ïçìäÇ=áãéêçîÉ=íÜÉáê=ÑìåÅíáçåëK=`^i=áåÑäìÉåÅÉÇ=ÇÉîÉäçéãÉåí=çÑ=ãçÇÉêå= éêçëíÜÉíáÅë=Ñêçã=NVQT=íç=NVTSK=aìêáåÖ=íÜáë=éÉêáçÇI=éä~ëíáÅ=êÉéä~ÅÉÇ=ïççÇ=~ë=íÜÉ=ã~íÉêá~ä=çÑ=ÅÜçáÅÉI=ëçÅâÉí= ÇÉëáÖåë=ÑçääçïÉÇ=éÜóëáçäçÖáÅ~ä=éêáåÅáéäÉë=çÑ=ÑìåÅíáçåI=äáÖÜíÉêJïÉáÖÜí=ÅçãéçåÉåíë=ïÉêÉ=ÇÉîÉäçéÉÇ=~åÇ= ãçêÉ=ÅçëãÉíáÅ=~äíÉêå~íáîÉë=ïÉêÉ=Ñ~ÄêáÅ~íÉÇK== få=NVRSI=íÜÉ=ÄáçãÉÅÜ~åáÅë=ä~Äçê~íçêó=~í=råáîÉêëáíó=çÑ=`~äáÑçêåá~=E_ÉêâÉäÉóF=áåíêçÇìÅÉÇ=íÜÉ=ëçäáÇ= ~åâäÉ=ÅìëÜáçå=ÜÉÉä=Ep^`eF=ÑççíI=ïÜáÅÜ=ÄÉÅ~ãÉ=íÜÉ=ãçëí=éçéìä~ê=éêçëíÜÉíáÅ=ÑççíK=få=íÜÉ=NVSMëI=ÜóÇê~ìäáÅ= âåÉÉ=ãÉÅÜ~åáëãë=ÄÉÅ~ãÉ=ãçêÉ=éêÉî~äÉåíX=~åÇ=NVTM=ã~êâÉÇ=íÜÉ=áå~ìÖìê~ä=óÉ~ê=Ñçê=íÜÉ=áåíÉêå~íáçå~ä= pçÅáÉíó=Ñçê=mêçëíÜÉíáÅë=~åÇ=lêíÜçíáÅëK=få=NVTNI=lííç=_çÅâ=áåíêçÇìÅÉÇ=ÉåÇçëâÉäÉí~ä=éêçëíÜÉëÉëK== jçÇÉêå=íáãÉë=~êÉ=ÅÜ~ê~ÅíÉêáòÉÇ=Äó=íÜÉ=ÉãÉêÖÉåÅÉ=çÑ=éêçëíÜÉíáÅë=~ë=~=ëÅáÉåÅÉ=~ë=ïÉää=~ë=~å=~êíK= oÉëÉ~êÅÜ=áåíç=Üìã~å=ãçîÉãÉåíI=åÉï=ã~íÉêá~äë=~åÇ=åÉï=íÉÅÜåçäçÖó=Ü~ë=äÉÇ=íç=ÅêÉ~íáçå=çÑ=îÉêó=äáÖÜí= ~åÇ=ÑìåÅíáçå~ä=ÅçãéçåÉåíëK=dÉä=äáåÉêë=éêçîáÇÉ=ëÜçÅâJ~ÄëçêÄáåÖ=áåíÉêÑ~ÅÉ=ÄÉíïÉÉå=êÉëáÇì~ä=äáãÄ=~åÇ= Ü~êÇ=ëçÅâÉíK=oÉëÉ~êÅÜ=áë=~ííÉãéíáåÖ=íç=ÑáåÇ=~=ãÉíÜçÇ=íç=ÄêáåÖ=ëÉåë~íáçå=áåíç=íÜÉ=éêçëíÜÉíáÅ=äáãÄKNO= Lower Limb Anatomy qç=ìåÇÉêëí~åÇ=Ñìääó=íÜÉ=áååçî~íáçå=ÄÉÜáåÇ=g~áéìê=cççíI=áí=áë=áãéçêí~åí=íç=âåçï=ëçãÉíÜáåÖ=~Äçìí=íÜÉ= äçïÉê=äáãÄ=~å~íçãóK=qÜÉ=äáãÄë=ãìëí=ÄÉ~ê=ïÉáÖÜíI=éêçîáÇÉ=~=ãÉ~åë=Ñçê=äçÅçãçíáçå=~åÇ=ã~áåí~áå= ÉèìáäáÄêáìãK=_áéÉÇ~äáëã=áë=íÜÉ=éêçÅÉëë=Äó=ïÜáÅÜ=ïÉ=~êÉ=~ÄäÉ=íç=ëí~åÇ=ìéêáÖÜí=~åÇ=íç=ãçîÉ=~Äçìí=çå=íïç= äáãÄëK=fí=áãé~êíë=íÜêÉÉ=ìåáèìÉ=ÑìåÅíáçåë=çå=íÜÉ=äçïÉê=äáãÄëK== qÜÉ=~åâäÉ=àçáåí=áë=~=ÜáåÖÉJíóéÉ=àçáåí=íÜ~í=é~êíáÅáé~íÉë=áå=ãçîÉãÉåí=~åÇ=áë=áåîçäîÉÇ=áå=äçïÉê=äáãÄ= ëí~ÄáäáíóK=açêëáÑäÉñáçå=~åÇ=éä~åí~ê=ÑäÉñáçå=EmäÉ~ëÉ=êÉÑÉê=íç=Ä~ëáÅ=Ñççí=ãçîÉãÉåíë=ÄÉäçïF=ãçîÉãÉåíë=í~âÉ= éä~ÅÉ=~í=íÜÉ=~åâäÉK=açêëáÑäÉñáçå=áë=åÉÅÉëë~êó=áå=çêÇÉê=íç=Ü~îÉ=íÜÉ=Ñççí=Åçåí~Åí=íÜÉ=ÖêçìåÇ=ÜÉÉä=Ñáêëí=~åÇ=íç= ~ääçï=íÜÉ=Ñççí=íç=ÅäÉ~ê=íÜÉ=ÖêçìåÇ=ÇìêáåÖ=íÜÉ=ëïáåÖ=éÜ~ëÉ=çÑ=Ö~áí=EéäÉ~ëÉ=êÉÑÉê=íç=Ö~íÉ=ÅóÅäÉ=ÄÉäçïFK= mä~åí~ê=ÑäÉñáçå=éêçîáÇÉë=íÜÉ=éêçéìäëáîÉ=ÑçêÅÉ=åÉÅÉëë~êó=íç=äáÑí=íÜÉ=äáãÄ=çÑÑ=íÜÉ=ÖêçìåÇ=~åÇ=ëí~êí=áí= ëïáåÖáåÖ=Ñçêï~êÇ=ÇìêáåÖ=íÜÉ=íçÉJçÑÑ=éçêíáçå=çÑ=Ö~áíK=qÜÉ=Ñççí=éä~óë=~å=áãéçêí~åí=êçäÉ=áå=ëìééçêíáåÖ=íÜÉ= ïÉáÖÜí=çÑ=íÜÉ=ÉåíáêÉ=ÄçÇó=~åÇ=áå=äçÅçãçíáçåK=qÜÉ=ÄçåÉë=çÑ=íÜÉ=Ñççí=~êÉ=~êÅÜÉÇ=äçåÖáíìÇáå~ääó=íç=ÜÉäé= Ñ~Åáäáí~íÉ=íÜÉ=ëìééçêí=ÑìåÅíáçåK=qÜÉ=íê~åëîÉêëÉ=~êÅÜ=ÜÉäéë=ïáíÜ=ãçîÉãÉåíë=çÑ=íÜÉ=ÑççíK=qÜÉëÉ=ãçîÉãÉåíë= ÜÉäé=âÉÉé=íÜÉ=ëçäÉ=áå=Åçåí~Åí=ïáíÜ=íÜÉ=ÖêçìåÇ=ÇÉëéáíÉ=íÜÉ=ìåÉîÉååÉëë=çÑ=íÜÉ=ÖêçìåÇ=ëìêÑ~ÅÉK=qÜÉó=~äëç= ïçêâ=áå=ÅçåÅÉêí=ïáíÜ=íÜÉ=~åâäÉ=àçáåí=íç=ÜÉäé=éêçéÉä=íÜÉ=Ñççí=çÑÑ=íÜÉ=ÖêçìåÇ=ÇìêáåÖ=íÜÉ=íçÉJçÑÑ=éçêíáçå=çÑ= Ö~áíK== = © 2003 University of Michigan Regents 6 of 21 .Released December 12.

Released December 12. 2003 = Basic Foot Movements alopfcibuflkW=cäÉñáçå=çÑ=ÑçêÉÑççí=~ï~ó=Ñêçã=ÖêçìåÇ= = mi^kq^ocibuflkW=cäÉñáçå=çÑ=ÑçêÉÑççí=íçï~êÇ=ÖêçìåÇ = ^_ar`qflkW=jçîÉãÉåí=~ï~ó=Ñêçã=~ñá~ä=äáåÉ=EëÉÅçåÇ=íçÉ=éçëáíáçåF= = ^aar`qflkW=jçîÉãÉåí=íçï~êÇ=íÜÉ=~ñá~ä=äáåÉ = bsbopflkW=qìêåáåÖ=ëçäÉ=çÑ=Ñççí=çìíï~êÇ=~ï~ó=Ñêçã=ãáÇäáåÉ== fksbopflkW=qìêåáåÖ=ëçäÉ=çÑ=Ñççí=áåï~êÇ=íçï~êÇ=íÜÉ=ãáÇäáåÉ = molk^qflkW=qêáéä~åÉ=ãçíáçå=ÅçåëáëíáåÖ=çÑ=ëáãìäí~åÉçìë=ãçîÉãÉåíë=çÑ= ÉîÉêëáçåI=~ÄÇìÅíáçåI=ÇçêëáÑäÉñáçå= prmfk^qflkW=qêáéä~åÉ=ãçíáçåI=ïÜáÅÜ=ÅçãÄáåÉë=íÜÉ=ãçîÉãÉåíë=çÑ= áåîÉêëáçåI=~ÇÇìÅíáçå=~åÇ=éä~åí~ê=ÑäÉñáçå= = = © 2003 University of Michigan Regents 7 of 21 .

Released December 12. 2003 = Gait Cycle qÜÉ=êÜóíÜãáÅ=~äíÉêå~íáåÖ=ãçîÉãÉåíë=çÑ=íÜÉ=íïç=äçïÉê=ÉñíêÉãáíáÉë=~êÉ=íÜÉ=Ö~áí=ÅóÅäÉI=ïÜáÅÜ=êÉëìäíë=áå= Ñçêï~êÇ=ãçîÉãÉåí=çÑ=íÜÉ=ÄçÇóK=páãéäó=ëí~íÉÇI=áí=áë=íÜÉ=ã~ååÉê=áå=ïÜáÅÜ=ïÉ=ï~äâK=d~áí=ÅóÅäÉ=áë=íÜÉ=~Åíáîáíó= íÜ~í=çÅÅìêë=ÄÉíïÉÉå=ÜÉÉä=ëíêáâÉ=çÑ=çåÉ=äáãÄ=~åÇ=íÜÉ=ëìÄëÉèìÉåí=ÜÉÉä=ëíêáâÉ=çÑ=íÜ~í=ë~ãÉ=äáãÄ=~åÇ=Åçåëáëíë=çÑ= íÜÉ=ÑçääçïáåÖ=éÜ~ëÉëW== pí~åÅÉW=fí=ÄÉÖáåë=ïÜÉå=ÜÉÉä=çÑ=íÜÉ=Ñçêï~êÇ=äáãÄ=ã~âÉë=Åçåí~Åí=ïáíÜ=íÜÉ=ÖêçìåÇ=~åÇ=ÉåÇë=ïÜÉå=íÜÉ= íçÉ=çÑ=íÜÉ=ë~ãÉ=äáãÄ=äÉ~îÉë=íÜÉ=ÖêçìåÇK=fí=Åçåëáëíë=çÑW= = eÉÉä=píêáâÉW== jáÇ=pí~åÅÉW== qçÉ=lÑÑW== pïáåÖW= ^ÅÅÉäÉê~íáçå= aÉÅÉäÉê~íáçåW= açìÄäÉ=pìééçêíW= eÉÉä=çÑ=Ñççí=íçìÅÜÉë=íÜÉ=ÖêçìåÇK= cççí=áë=Ñä~í=çå=íÜÉ=ÖêçìåÇ=~åÇ=íÜÉ=ïÉáÖÜí=çÑ=íÜÉ=ÄçÇó=áë=ÇáêÉÅíäó=çîÉê=íÜÉ=äáãÄK= låäó=íÜÉ=ÄáÖ=íçÉ=çÑ=íÜÉ=äáãÄ=áë=áå=Åçåí~Åí=ïáíÜ=íÜÉ=ÖêçìåÇK= fí=ÄÉÖáåë=ïÜÉå=íÜÉ=Ñççí=áë=åç=äçåÖÉê=áå=Åçåí~Åí=ïáíÜ=íÜÉ=ÖêçìåÇK=qÜÉ=äáãÄ=áë=ÑêÉÉ=íç= ãçîÉK== pïáåÖáåÖ=äáãÄ=Å~íÅÜÉë=ìé=íç=~åÇ=é~ëëÉë=íÜÉ=íçêëçK= cçêï~êÇ=ãçîÉãÉåí=çÑ=íÜÉ=äáãÄ=áë=ëäçïÉÇ=Ççïå=íç=éçëáíáçå=íÜÉ=Ñççí=Ñçê=ÜÉÉä=ëíêáâÉK= _çíÜ=äáãÄë=~êÉ=áå=Åçåí~Åí=ïáíÜ=íÜÉ=ÖêçìåÇ=ëáãìäí~åÉçìëäóK= = = = qóéáÅ~ä=Ö~áí=ÅóÅäÉë=áääìëíê~íáåÖ=íÜÉ=éÜ~ëÉë=~åÇ=ÉîÉåíë=ÇìêáåÖ=íÜÉ=ÅóÅäÉK= =Ecêçã=eìã~å=t~äâáåÖI=OåÇ=bÇáíáçåI=oçëÉ=~åÇ=d~ãÄäÉ=ÉÇáíçêëI=táääá~ãë=~åÇ=táäâáåëI=_~äíáãçêÉI=NVVQI=éK=OSKF= içïÉê=iáãÄ=mêçëíÜÉëáëW=^å=^ííÉãéí=íç=páãìä~íÉ=k~íìê~ä=iáãÄÛë=cìåÅíáçåë= = mÉçéäÉ=ïáíÜ=äáãÄ=äçëë=E~ÅèìáêÉÇ=~ãéìí~íáçåF=çê=äáãÄ=~ÄëÉåÅÉ=EÅçåÖÉåáí~ä=ÇÉÑáÅáÉåÅóF=ìëÉ=éêçëíÜÉíáÅ= äáãÄë=íç=êÉëíçêÉ=çê=áãÄìÉ=ëçãÉ=çÑ=íÜÉ=ÑìåÅíáçå=~åÇLçê=ÅçëãÉíáÅë=çÑ=~å=~å~íçãáÅ~ä=äáãÄK=pçäìíáçåë=ÇáÑÑÉê= áå=íÜÉ=ï~ó=íÜÉó=ÚãáãáÅÛ=íÜÉ=å~íìê~ä=ÑççíÛë=ÑìåÅíáçå~äáíó=Eçê=~=é~êí=íÜÉêÉçÑFK== © 2003 University of Michigan Regents 8 of 21 .

Released December 12. 2003 = DEVELOPMENT OF JAIPUR FOOT o~ã=`Ü~åÇê~I=Äçêå=áåíç=~=Ñ~ãáäó=çÑ=ã~ëíÉê=~êíáë~åëI=áë=Åçããçåäó=êÉÅçÖåáòÉÇ=~ë=çåÉ=çÑ=g~áéìê=ÅáíóÛë=ÑáåÉëí= ëÅìäéíçêëK=dêçïáåÖ=ìéI=`Ü~åÇê~=ë~ï=íÜ~í=äçÅ~ä=éÉçéäÉ=ïÜç=ïÉêÉ=~ãéìí~íÉÇ=ïÉêÉ=ÑáííÉÇ=ïáíÜ=~êíáÑáÅá~ä= äáãÄëI=ÉáíÜÉê=áãéçêíÉÇ=Ñêçã=~Äêç~Ç=çê=äçÅ~ääó=ã~ÇÉI=íÜ~í=ïÉêÉ=åçí=ÑäÉñáÄäÉ=ÉåçìÖÜ=~åÇ=ÇáÇ=åçí=~ääçï=Ñçê=~= åçêã~ä=ê~åÖÉ=çÑ=ãçíáçåK=qÜÉ=éêçëíÜÉëáë=ÇáÇ=åçí=Ñ~Åáäáí~íÉ=éçëíìêÉë=Åçããçå=áå=fåÇá~=ëìÅÜ=~ë=ëèì~ííáåÖ=çê= ëáííáåÖ=ÅêçëëJäÉÖÖÉÇK=cìêíÜÉêI=íÜÉ=ëÜçÉë=~íí~ÅÜÉÇ=íç=íÜÉ=äáãÄ=ïÉêÉ=ã~ÇÉ=çÑ=ÜÉ~îó=ëéçåÖÉI=ïÜáÅÜ=ã~ÇÉ=íÜÉ= éêçëíÜÉëáë=ìëÉäÉëë=Ñçê=Ñ~êãÉêë=ïçêâáåÖ=áå=íÜÉ=ê~áå=çê=áêêáÖ~íÉÇ=ÑáÉäÇëK=qÜáë=äÉÇ=íç=~=ÜáÖÜ=êÉàÉÅíáçå=ê~íÉ=çÑ=íÜÉ= éêçëíÜÉëáë=Äó=íÜÉ=äçÅ~ä=~ãéìíÉÉ=éçéìä~íáçåK= tÜáäÉ=ï~íÅÜáåÖ=íÜÉëÉ=é~íáÉåíëI=`Ü~åÇê~=Å~ãÉ=ìé=ïáíÜ=~å=áÇÉ~=çÑ=ÅêÉ~íáåÖ=~å=~êíáÑáÅá~ä=äáãÄ=íÜ~í= ãçêÉ=ÅäçëÉäó=êÉëÉãÄäÉÇ=~=å~íìê~ä=ÑççíI=ï~ë=äáÖÜíÉê=~åÇ=ï~ë=í~áäçêÉÇ=Ñçê=äçÅ~ä=ÅçåÇáíáçåëK=eÉ=íççâ=Üáë= áÇÉ~ë=íç=ÇçÅíçêë=~í=íÜÉ=Åáíó=Üçëéáí~ä=~åÇ=äÉ~êåÉÇ=~Äçìí=Üìã~å=Ñççí=~å~íçãóK=bèìáééÉÇ=ïáíÜ=íÜáë= âåçïäÉÇÖÉI=`Ü~åÇê~=ÉñéÉêáãÉåíÉÇ=ïáíÜ=äçÅ~ääó=~î~áä~ÄäÉ=ã~íÉêá~äë=ëìÅÜ=~ë=ïáääçïI=ëéçåÖÉë=~åÇ= NP ~äìãáåìã=ãçäÇë=íç=ÅêÉ~íÉ=~å=~êíáÑáÅá~ä=äáãÄK låÉ=çÑ=ã~åó=ÇÉÑáåáåÖ=ãçãÉåíë=Å~ãÉ=çåÉ=Ç~ó=ïÜÉå=`Ü~åÇê~=ëìÑÑÉêÉÇ=~=Ñä~í=íáêÉ=ïÜáäÉ=êáÇáåÖ=Üáë= ÄáÅóÅäÉK=^ÅÅçêÇáåÖ=íç=`Ü~åÇê~I=ÜÉ=ïÉåí=íç=~=êç~ÇëáÇÉ=ëí~ää=ïÜçëÉ=çïåÉê=ï~ë=êÉíêÉ~ÇáåÖ=~=íáêÉ=ïáíÜ= îìäÅ~åáòÉÇ=êìÄÄÉêK=låÅÉ=Üáë=ÄáÅóÅäÉ=ï~ë=ÑáñÉÇI=`Ü~åÇê~=êìëÜÉÇ=íç=ÇçÅíçêë=íç=ÇÉíÉêãáåÉ=áÑ=íÜáë=ã~íÉêá~ä= ÅçìäÇ=ÄÉ=ìëÉÇ=Ñçê=~=äáãÄK=i~íÉê=ÜÉ=êÉíìêåÉÇ=íç=íÜÉ=íáêÉ=ëÜçé=~ÅÅçãé~åáÉÇ=Äó=~å=~ãéìíÉÉ=~åÇ=~=Ñççí=Å~ëíI= ~åÇ=~ëâÉÇ=íÜÉ=çïåÉê=íç=ã~âÉ=~=êìÄÄÉê=ÑççíK=qÜÉ=Ñççí=Ü~Ç=íÜÉ=ãçÄáäáíó=~åÇ=Çìê~Äáäáíó=íÜ~í=`Ü~åÇê~= ëçìÖÜíI=~äíÜçìÖÜ=áí=Ü~Ç=íç=ìåÇÉêÖç=åìãÉêçìë=êÉÑáåÉãÉåíëK=tçêâáåÖ=ÑìêíÜÉê=ïáíÜ=aêK=mKhK=pÉíÜáI=~å= çêíÜçéÉÇáÅ=ëìêÖÉçåK~åÇ=aêK=pK`Kh~ëäáï~ä=~åÇ=aêK=j~ÜÉëÜ=rÇ~ï~íI=`Ü~åÇê~=êÉÑáåÉÇ=~åÇ=áãéêçîÉÇ=íÜÉ= ÇÉëáÖå=íç=ÉîÉåíì~ääó=ÅêÉ~íÉ=ïÜ~í=áë=åçï=âåçïå=~ë=íÜÉ=g~áéìê=cççíK=qç=Ñ~Åáäáí~íÉ=íÜÉ=ëéêÉ~Ç=çÑ=íÜÉ=ÑççíI=áíë= ÅêÉ~íçêë=ÇÉÅáÇÉÇ=åçí=íç=é~íÉåí=íÜÉ=g~áéìê=cççíK== Step 1: Design Considerations qÜÉ=g~áéìê=cççí=ï~ë=ÇÉëáÖåÉÇ=íç=ëáãìä~íÉ=åçêã~ä=Ñççí=ãçîÉãÉåíë=~åÇ=éêçîáÇÉ=~=èì~äáíó=ëçäìíáçå=Ñçê=íÜÉ= ã~ëëÉëK=cçê=íÜçëÉ=éççê=áå=fåÇá~=ïÜç=Ü~Ç=äçëí=íÜÉáê=äáãÄëI=ÅçåíáåìáåÖ=íç=É~êå=íÜÉáê=äáîÉäáÜççÇ=ï~ë=íÜÉ= ÄáÖÖÉëí=ÅçåÅÉêåK=få=~ÄëÉåÅÉ=çÑ=~å=ÉÑÑáÅáÉåí=ëçÅá~ä=ëÉÅìêáíó=ëóëíÉãI=ÄÉáåÖ=~ÄäÉ=íç=ïçêâ=ï~ë=ÉëëÉåíá~ä=Ñçê=íÜÉáê= ëìêîáî~äK=fí=åÉÅÉëëáí~íÉÇ=~=éêçëíÜÉëáëI=ïÜáÅÜ=ëìééçêíÉÇ=íÜÉáê=ïçêâ=~åÇ=äáÑÉëíóäÉëK=g~áéìê=cççíÛë=ÇÉëáÖå= éêçÅÉëë=ÉãéÜ~ëáòÉÇ=íÜÉ=ÑçääçïáåÖ=~ÅíáîáíáÉëI=ïÜáÅÜ=~êÉ=Åçããçåäó=ÉåàçóÉÇ=Äó=fåÇá~Ûë=ïçêâáåÖ=éççêW= = ACTIVITY pèì~ííáåÖ= páííáåÖ=`êçëë=iÉÖÖÉÇ= t~äâáåÖ=çå=råÉîÉå=dêçìåÇ= _~êÉÑççí=ï~äâáåÖ= MECHANICAL REQUIREMENT 14 kÉÉÇ=Ñçê=ÇçêëáÑäÉñáçå= kÉÉÇ=Ñçê=íê~åëîÉêëÉ=êçí~íáçå=çÑ=íÜÉ=Ñççí== kÉÉÇ=Ñçê=áåîÉêëáçå=~åÇ=ÉîÉêëáçå=áå=íÜÉ=Ñççí=ëç=íÜ~í=î~êóáåÖ=íÉêê~áå=áë=åçí= íê~åëãáííÉÇ=íç=ëíìãé== `çëãÉíáÅ~ääó=ëáãáä~ê=íç=å~íìê~ä=Ñççí= © 2003 University of Michigan Regents 9 of 21 .

Released December 12. 2003 = Step 2: Overcoming Constraints eçïÉîÉêI=íÜÉ=íÉÅÜåáÅ~ä=ÇÉã~åÇë=ïÉêÉ=åçí=íÜÉ=çåäó=ÇÉã~åÇë=ÑçêÅÉÇ=Äó=íÜÉ=ÅêÉ~íçêë=çÑ=g~áéìê=cççíK=få= ~ÇÇáíáçåI=íÜÉó=Ñ~ÅÉÇ=íÜÉ=ÑçääçïáåÖ=Åçåëíê~áåíëK== = CONSTRAINTS mçîÉêíó= `äçëÉÇ=bÅçåçãó= tçêâ=iáÑÉëíóäÉ= IMPLICATION qÜÉ=î~ëí=ã~àçêáíó=çÑ=äçÅ~ä=~ãéìíÉÉë=ïÉêÉ=éççêK=içïÉê=Åçëí=çÑ=éêçëíÜÉëáë=ïáíÜ=íÜÉ=éçëëáÄáäáíó=çÑ= ~äáÖåãÉåí=~åÇ=~ÇàìëíãÉåíë=ïçìäÇ=Ñ~Åáäáí~íÉ=ëéÉÅá~äáòÉÇ=óÉí=Éèì~ääó=ÑìåÅíáçå~ä=ëçäìíáçåK= iáãáíÉÇ=áãéçêí=çÑ=ÑçêÉáÖå=ã~íÉêá~äë=áå=fåÇá~=ãÉ~åí=íÜÉ=Ñççí=Ü~Ç=íç=ÄÉ=Ñ~ÄêáÅ~íÉÇ=Ñêçã=êÉ~Çáäó= ~î~áä~ÄäÉ=äçÅ~ä=ã~íÉêá~äë= jçëí=~ãéìíÉÉë=ïçêâÉÇ=Ü~êÇ=~åÇ=äçåÖ=ÜçìêëK=qÜÉ=~Äáäáíó=íç=ï~äâ=çå=ìåÉîÉå=ÖêçìåÇ=ï~ë=ÉëëÉåíá~ä= Ñçê=íÜÉáê=ïçêâK=fåÇá~=ï~ë=ä~êÖÉäó=~å=~ÖêáÅìäíìê~ä=ÉÅçåçãóI=~åÇ=Ç~óë=ëéÉåí=ïáíÜçìí=äáãÄë= íÜêÉ~íÉåÉÇ=íÜÉáê=äáîÉäáÜççÇ=~åÇ=áå=ã~åó=Å~ëÉë=ëìëíÉå~åÅÉK=qÜáë=äÉÇ=íç=~=åÉÉÇ=Ñçê=~ÅÅÉëëáÄäÉ= éêçëíÜÉëáë=íÜ~í=ÅçìäÇ=ÄÉ=ÑáííÉÇ=èìáÅâäóK= i~Åâ=çÑ=ëâáääÉÇ=ä~Äçê=êÉä~íáîÉ=íç=íÜÉ=ÜìÖÉ=ÇÉã~åÇ=Ñçê=éêçëíÜÉëÉë=åÉÅÉëëáí~íÉÇ=~=ëáãéäáÑáÉÇ= ã~åìÑ~ÅíìêáåÖ=éêçÅÉëëI=ïÜáÅÜ=ÅçìäÇ=ÄÉ=éÉêÑçêãÉÇ=ïáíÜ=äáãáíÉÇ=íê~áåáåÖK== iáãáíÉÇ=qê~áåÉÇ= j~åéçïÉê= Step 3: Deviation from Traditional Design qÜÉ=ÇÉëáÖå=çÑ=g~áéìê=cççí=ï~ë=áåáíá~ääó=Ä~ëÉÇ=çå=íÜÉ=p^`e=Ñççí=ÇÉëáÖåK15=eçïÉîÉêI=íÜÉ=ÇÉëáÖå=ÇáîçêÅÉÇ= ~ï~ó=Ñêçã=íÜÉ=p^`e=Ñççí=ÇìÉ=íç=éêçÄäÉãë=ëìÅÜ=~ë=ïÉáÖÜí=~åÇ=åçåJëìáí~Äáäáíó=íç=äçÅ~ä=ÅçåÇáíáçåëK=qÜÉ= ÉåÇçëâÉäÉí~ä=ÇÉëáÖå=ï~ë=éìêëìÉÇI=~åÇ=~=åÉïI=âåÉÉ=àçáåí=ÇÉëáÖå=ÉîçäîÉÇK=aáëíçêíáçåë=ïÉêÉ=áåíêçÇìÅÉÇ=áå=íÜÉ= ëçÅâÉíë=ëç=íÜ~í=~ÇÉèì~íÉ=éêÉëëìêÉ=ï~ë=éìí=çåäó=çå=íÜçëÉ=íáëëìÉëI=ïÜáÅÜ=ÅçìäÇ=êÉëáëí=íÜÉãK=qçí~ä=Åçåí~Åí= ëçÅâÉíë=~äëç=ïÉêÉ=áåíêçÇìÅÉÇK= g~áéìê=cççí=áë=ã~ÇÉ=çÑ=íÜêÉÉ=ÄäçÅâë=ëáãìä~íáåÖ=íÜÉ=~å~íçãó=çÑ=~=åçêã~ä=ÑççíK=qÜÉ=ÑçêÉÑççí=~åÇ=ÜÉÉä= ÄäçÅâë=~êÉ=ã~ÇÉ=çÑ=ëéçåÖÉ=êìÄÄÉê=~åÇ=íÜÉ=~åâäÉ=ÄäçÅâ=Åçåëáëíë=çÑ=äáÖÜí=ïççÇK=qÜÉ=íÜêÉÉ=ÅçãéçåÉåíë=~êÉ= ÄçìåÇ=íçÖÉíÜÉêI=ÉåÅäçëÉÇ=áå=~=êìÄÄÉê=ëÜÉää=~åÇ=îìäÅ~åáòÉÇ=áå=~=ãçìäÇ=íç=ÖáîÉ=áí=íÜÉ=ëÜ~éÉ=~åÇ=ÅçëãÉíáÅ= ~ééÉ~ê~åÅÉ=çÑ=~=å~íìê~ä=ÑççíK== _ÉäçïJâåÉÉ=~ë=ïÉää=~ë=~ÄçîÉJâåÉÉ=éêçëíÜÉëáë=éêçÇìÅíë=~êÉ=áåÇáÖÉåçìëäó=ÇÉëáÖåÉÇ=~åÇ=Ñ~ÄêáÅ~íÉÇ= Ñêçã=äçÅ~ääó=~î~áä~ÄäÉ=~åÇ=Çìê~ÄäÉ=ÜáÖÜJÇÉåëáíó=éçäóÉíÜóäÉåÉ=éáéÉë=~åÇ=~=g~áéìê=cççíK=qÜÉëÉ=~êÉ=ê~éáÇJ Ñáí=äáãÄë=ïáíÜ=äçï=Ñ~ÄêáÅ~íáçå=íáãÉëK=cáííáåÖ=~åÇ=Ñ~ÄêáÅ~íáçå=íáãÉë=î~êó=Ñêçã=çåÉ=Üçìê=Ñçê=ÄÉäçïJâåÉÉ= éêçëíÜÉëÉë=íç=~Äçìí=ÑáîÉ=íç=ëáñ=Üçìêë=Ñçê=~ÄçîÉJâåÉÉ=éêçëíÜÉëáëK=cìåÅíáçå~äáíó=çÑ=íÜÉ=éêçëíÜÉëáë=ãáêêçêë= íÜ~í=çÑ=~=å~íìê~ä=Üìã~å=äáãÄI=~åÇ=áí=éÉêãáíë=~ãéìíÉÉë=íç=êìåI=ëèì~íI=ëáí=ÅêçëëJäÉÖÖÉÇI=ÅäáãÄ=íêÉÉë=~åÇ= àìãé=Ñêçã=ÜÉáÖÜíëK=qÜÉ=g~áéìê=cççí=áë=ï~íÉêéêççÑ=~åÇ=ÇçÉë=åçí=êÉèìáêÉ=ã~áåíÉå~åÅÉ=~ÑíÉê=áí=áë=ÑáííÉÇK= _~êÉÑççí=ï~äâáåÖ=áë=éçëëáÄäÉI=~å=~ãéìíÉÉ=Å~å=ïçêâ=áå=ïÉí=~åÇ=ãìÇÇó=ÑáÉäÇë=~åÇ=íÜÉ=Ñççí=áë=ëìáí~ÄäÉ=Ñçê= ~åó=íóéÉ=çÑ=íÉêê~áåK=qÜÉ=é~íáÉåí=~äëç=Å~å=ïÉ~ê=ëÜçÉëK=_áçJãÉÅÜ~åáÅ~ääóI=áí=áë=Ä~ëÉÇ=çå=íÜÉ=ëí~åÇ~êÇ= m~íÉää~JqÉåÇçåJ_É~êáåÖ=éêçëíÜÉëáë=~åÇ=ëÅáÉåíáÑáÅ~ääó=Ñ~ÄêáÅ~íÉÇ=íç=ãÉÉí=áíë=ïÉáÖÜí=ÇáëíêáÄìíáçå= êÉèìáêÉãÉåíë=Ñçê=ã~ñáãìã=ÅçãÑçêíK=^îÉê~ÖÉ=ïÉáÖÜí=çÑ=íÜÉ=éêçëíÜÉëáë=áë=PKNN=âÖX=íÜÉ=ïÉáÖÜí=çÑ=~=RR=âÖ= éÉêëçåÛë=äçïÉê=äáãÄ=áë=PKPS=âÖK== © 2003 University of Michigan Regents 10 of 21 .

2003 = Step 4: Materials Sourcing qÜÉ=pçÅáÉíó=éêçÇìÅÉë=íÜÉ=éêçëíÜÉëáë=ïáíÜ=êÉ~Çáäó=~î~áä~ÄäÉ=~åÇ=áåÉñéÉåëáîÉ=ÅçãéçåÉåíë=áå=çêÇÉê=íç=äáãáí= íÜÉ=Åçëí=çÑ=éêçÅìêÉãÉåí=~ë=ïÉää=~ë=íÜÉ=Åçëí=çÑ=íÜÉ=éêçëíÜÉëáë=áíëÉäÑK=^=íóéáÅ~ä=g~áéìê=cççíI=ëÜ~åâ=~åÇ= ëáãìä~íÉÇ=âåÉÉ=àçáåí=áë=ÅçåëíêìÅíÉÇ=ïáíÜ=íÜÉ=ÑçääçïáåÖ=ã~íÉêá~äëW= = COST ANALYSIS OF ABOVE KNEE LIMBS WITH PLASTIC KNEE JOINT S. NK= OK= PK= QK= RK= SK= TK= UK= VK= NMK= NNK= NOK= NPK= NQK= NRK= NAME OF MATERIAL g~áéìê=cççí== eamb=máéÉ=VM=jj= eamb=máéÉ=NNM=jj= mä~ëíáÅ=håÉÉ=gçáåí= mä~ëíÉê=çÑ=m~êáë= píçÅâáå~ííÉ=O?= píçÅâáå~ííÉ=Q?= ^KhK=_Éäí= bä~ëíáÅ=ÄÉäí= `çííçå=_~åÇ~ÖÉë= aìåäçé=pçäìíáçå= píÉÉä=pÅêÉï= mêÉëë=_ìííçåë= pç~é=píçåÉ=mçïÇÉê= içÅíáíÉ= qçí~ä=j~íÉêá~ä=`çëí= QUANTITY N=kçK= MKSM=ojq= MKSM=ojq= N=pÉí= Q=hÖK= NRM=dãë= OMM=dãëK= N=kçK= N=kçK= P=kçëK= OM=dãëK= Q=kçëK= Q=kçëK= RM=dãëK= NLQ=qìÄÉ= RATE NOMKORLkçK= NQSKNSLjíêK= ONVKORLjíêK= NMMLpÉí= QLhÖK= NNRLhÖK= NNRLhÖK= PVLkçK= NMLkçK= QLkçK= VMKULhÖK= MKNPLkçK= MKMSLkçK= OLhÖK= M= AMOUNT NOMKOR= UTKTM= NPNKRR= NMMKMM= NSKMM= NTKOR= OPKMM= PVKMM= NMKMM= NOKMM= NKUN= MKRO= MKOQ= MKNM= RKMM= RSQKQO= frpA=ZoëKQR= = qÜÉ=Éëíáã~íÉÇ=rpATKSU=Åçëí=çÑ=ã~íÉêá~äë=çìíäáåÉÇ=~ÄçîÉ=áåÅäìÇÉë=íÜÉ=Åçëí=çÑ=íÜÉ=ÅçãéçåÉåíë=çÑ=íÜÉ= g~áéìê=cççí=áíëÉäÑ=~ë=ïÉää=~ë=íÜÉ=ëáãìä~íÉÇ=àçáåíë=Ñçê=~=ÄÉäçïJâåÉÉ=äáãÄK=b~ÅÜ=ã~íÉêá~ä=áë=äçÅ~ääó=ëçìêÅÉÇ= ~åÇ=ÇçÉë=åçí=êÉèìáêÉ=ëéÉÅá~ä=éêçÅìêÉãÉåí=~ÖêÉÉãÉåíëK=jçëí=~êÉ=îáêíì~ä=ÅçããçÇáíáÉëK=cìêíÜÉêãçêÉI= ãçëí=çÑ=íÜÉ=ã~íÉêá~äë=Å~å=ÄÉ=ëçìêÅÉÇ=äçÅ~ääó=áÑ=åÉÅÉëë~êó=ïÜÉå=íÜÉ=g~áéìê=cççí=áë=ã~åìÑ~ÅíìêÉÇ=áå=çíÜÉê= ÇÉîÉäçéáåÖ=å~íáçåëK= Step 5: Production Equipment qÜÉ=g~áéìê=ÑççíI=~ë=ïÉää=~ë=íÜÉ=Å~äáéÉêë=~åÇ=çíÜÉê=éçêíáçåë=çÑ=íÜÉ=éêçëíÜÉëáë=ìäíáã~íÉäó=ÑáííÉÇ=çå=íÜÉ=é~íáÉåíI= áë=ÅçåëíêìÅíÉÇ=ïáíÜ=îÉêó=Ä~ëáÅ=íççäëK=jçëí=çÑ=íÜÉ=Ñ~ÄêáÅ~íáçå=éêçÅÉëë=áë=ÅçãéäÉíÉÇ=ïáíÜ=íÜÉ=íççäë=çÑ=~å= çêÇáå~êó=~êíáë~åK=qÜÉ=ãçëí=ëéÉÅá~äáòÉÇ=éáÉÅÉ=çÑ=ÉèìáéãÉåí=Åçåëáëíë=çÑ=íÜÉ=ÑççíJëÜ~éÉÇ=ÇáÉ=ìëÉÇ=íç=ãçäÇ=íÜÉ= ëÜ~éÉ=çÑ=íÜÉ=ÑççíK=eçïÉîÉêI=áíë=Åçëí=áë=åçí=ëáÖåáÑáÅ~åí=ÉåçìÖÜ=íç=ÉîÉå=ï~êê~åí=äáëíáåÖ=çå=~=ÑáñÉÇ=~ëëÉí= ëÅÜÉÇìäÉK=qÜÉ=ãçëí=ÉñéÉåëáîÉ=éáÉÅÉ=çÑ=ÉèìáéãÉåí=áë=íÜÉ=î~ÅììãJÑçêãáåÖ=ã~ÅÜáåÉ=ìëÉÇ=íç=ÖÉí=Éñ~Åí=êÉéäáÅ~= çÑ=íÜÉ=ãçìäÇ=~åÇ=áë=ìëÉÇ=ïÜÉå=ÜÉ~íÉÇ=eamb=ëÜÉÉí=çê=éáéÉ=áë=Çê~éÉÇ=çîÉê=íÜÉ=ãçìäÇ=çÑ=íÜÉ=é~íáÉåíDë= êÉã~áåáåÖ=äáãÄ=EëíìãéFK=qÜÉ=ã~ÅÜáåÉ=Åçëíë=~ééêçñáã~íÉäó=OMMIMMM=oìéÉÉëI=çê=êçìÖÜäó=rpAQIMMMK=cçê= ÜÉ~íáåÖ=éáéÉ=~åÇ=ëÜÉÉíë=~=ã~ÅÜáåÉ=áë=ìëÉÇ=ïÜáÅÜ=êÉëÉãÄäÉë=~å=çêÇáå~êó=çîÉåK=qÜÉ=ã~ÅÜáåÉ=áë=Åçããçåäó= ÑçìåÇ=íÜêçìÖÜçìí=fåÇá~=~åÇ=íÜÉ=êÉëí=çÑ=íÜÉ=ÇÉîÉäçéáåÖ=ïçêäÇK=qÜÉ=g~áéìê=äçÅ~íáçå=çÑ=íÜÉ=pçÅáÉíó=êÉèìáêÉë= © 2003 University of Michigan Regents 11 of 21 .Released December 12. NO.

2003 = íïç=î~Åììã=ÑçêãáåÖ=ã~ÅÜáåÉë=íç=ëÉêîÉ=~å=Éëíáã~íÉÇ=SM=é~íáÉåíë=éÉê=Ç~óK=b~ÅÜ=ã~ÅÜáåÉ=ä~ëíë=Ñêçã=ÑáîÉ=íç= ëÉîÉå=óÉ~êë= Step 6: Labor c~ÄêáÅ~íáçå=çÑ=íÜÉ=g~áéìê=cççíI=~ë=ïÉää=~ë=íÜÉ=éêçÅÉëë=Äó=ïÜáÅÜ=~=é~íáÉåí=áë=ÑáííÉÇI=áë=~=îÉêó=ä~ÄçêJáåíÉåëáîÉ= éêçÅÉëëK=qÜáë=éêçÅÉëë=Å~éáí~äáòÉë=çå=íÜÉ=ä~êÖÉ=ëìééäó=çÑ=ëâáääÉÇ=~êíáë~åë=áå=fåÇá~=~åÇ=íÜÉáê=ã~å~ÖÉ~ÄäÉ=ä~Äçê=ê~íÉëK= ^=g~áéìê=cççí=~êíáë~å=áë=~=Åê~Ñíëã~å=ïáíÜ=ëÉîÉê~ä=óÉ~êë=çÑ=ÉñéÉêáÉåÅÉ=~åÇ=áë=ÑìêíÜÉê=íê~áåÉÇ=Ñçê=ëÉîÉê~ä=ãçêÉ= óÉ~êë=íç=ãçäÇI=ëÅìäéí=~åÇ=Ñçêã=íÜÉ=g~áéìê=cççíK=qÜÉ=pçÅáÉíó=íóéáÅ~ääó=ëÅÜÉÇìäÉë=TM=íê~áåÉÇ=íÉÅÜåáÅá~åë=~åÇ= ~êíáë~åë=É~ÅÜ=Ç~ó=íç=~ÅÜáÉîÉ=~=çåÉJíçJçåÉ=é~íáÉåíJíçJÉãéäçóÉÉ=ê~íáçK=^êíáë~åë=~åÇ=íÉÅÜåáÅá~åëI=ïÜç=~êÉ=ãçêÉ= ÉñéÉêáÉåÅÉÇ=~êíáë~åëI=çéÉê~íÉ=áå=~=ëìéÉêîáëçêó=Å~é~Åáíó=~åÇ=~êÉ=é~áÇ=Äó=íÜÉ=Üçìê=éäìë=çîÉêíáãÉK=^=íóéáÅ~ä=~êíáë~å= É~êåë=RIMMM=oìéÉÉë=éÉê=ãçåíÜI=çê=êçìÖÜäó=rpANMM=áåÅäìÇáåÖ=ÄÉåÉÑáíëK=qÜÉ=Éëíáã~íÉÇ=rpANIOMM=~ååì~ä=áåÅçãÉ= çÑ=~å=~êíáë~å=áë=~ééêçñáã~íÉäó=íïáÅÉ=íÜ~í=çÑ=íÜÉ=éÉê=Å~éáí~=áåÅçãÉ=áå=fåÇá~K= ^å=çåJëáíÉ=ÇçÅíçê=ëìéÉêîáëÉë=íÜÉ=ÉåíáêÉ=Ñ~ÄêáÅ~íáçå=~åÇ=ÑáííáåÖ=éêçÅÉëëK=qÜÉ=pçÅáÉíó=Ü~ë=çåÉ=ÇçÅíçê= çå=íÜÉ=é~óêçää=ÑìääJíáãÉK=få=~ÇÇáíáçåI=çíÜÉê=äçÅ~ä=ÇçÅíçêë=ÉáíÜÉê=îçäìåíÉÉê=íÜÉáê=íáãÉ=çê=ïçêâ=çå=~=é~êíJ íáãÉ=Ä~ëáë=íç=ÉåëìêÉ=íÜ~í=~=ÅÉêíáÑáÉÇ=éÜóëáÅá~å=~ééêçîÉë=~=é~íáÉåíÛë=Ñáå~ä=éêçëíÜÉëáë=~åÇ=ÑáííáåÖK== Step 7: Fabrication c~ÄêáÅ~íáçå=çÑ=g~áéìê=cççí=áë=~=Ñ~ëí=~åÇ=ëáãéäÉ=éêçÅÉëëK=qÜÉ=Ñççí=áåÅçêéçê~íÉë=äçÅ~ääó=~î~áä~ÄäÉ= ã~íÉêá~äëLÉèìáéãÉåíK=qÜÉëÉ=áåÅäìÇÉ=~=ÇáÉI=íêÉ~Ç=êìÄÄÉê=ÅçãéçìåÇI=ëéçåÖÉ=êìÄÄÉêI=ÅçëãÉíáÅ=êìÄÄÉêI=åóäçå= ÅçêÇëI=~=îìäÅ~åáòÉêI=ïççÇ=~åÇ=ëÅáëëçêëK=cççí=~åÇ=~åâäÉ=~ëëÉãÄäó=áë=ã~ÇÉ=çÑ=~=îìäÅ~åáòÉÇ=êìÄÄÉê= ÅçãéçìåÇK=^å=~äìãáåìã=ÇáÉ=áë=ìëÉÇ=íç=Å~ëí=~=åçêã~ä=Ñççí=ëÜ~éÉK=qÜÉ=ÇáÉ=Åçåëáëíë=çÑ=Ñçìê=ëÉÅíáçåëI=ïÜáÅÜ= Å~å=ÄÉ=ÄçäíÉÇ=íçÖÉíÜÉêK=qÜáë=~ääçïë=Ñçê=É~ëÉ=çÑ=ëÉííáåÖ=ìé=ÇáÑÑÉêÉåí=ã~íÉêá~ä=ÅçãéçåÉåíëK=qÜÉ=éêçÅÉëë=íÜìë= áåîçäîÉë=ëÉîÉê~ä=ëí~ÖÉë=ïáíÜ=ëÉêá~ä=ëÉèìÉåÅÉë=çÑ=éä~ëíÉê=ãçìäÇJÇáÉ=áå=Ñçìê=ëÉÅíáçåëK=qÜÉ=éçëáíáçå=çÑ=ìåÇÉêJ ëìêÑ~ÅÉ=çÑ=íÜÉ=Ñççí=~åÇ=íçÉë=áë=ëäáÖÜíäó=êçÅâÉíÉÇ=ïáíÜ=íÜÉ=íçÉë=ëäáÖÜíäó=çÑÑ=íÜÉ=ÖêçìåÇ=íç=~ÅÜáÉîÉ=íÜÉ=êçääáåÖ= ~ÅíáçåK=qÜÉ=ÜÉÉä=áë=âÉéí=ëäáÖÜíäó=çÑÑ=íÜÉ=ÖêçìåÇ=íç=~ÅÅçããçÇ~íÉ=íÜÉ=ÜÉÉä=ïÜÉå=ïçêå=áå=íÜÉ=ëÜçÉK=qÜáë= ÅçãéäÉãÉåíë=íÜÉ=ÚêçÅâÉêÛ=~Åíáçå=çÑ=íÜÉ=ÑççíK=mäÉ~ëÉ=êÉÑÉê=íç=^ééÉåÇáñ=a=Ñçê=ÇÉí~áäë=çÑ=Ñ~ÄêáÅ~íáçå=éêçÅÉëëK== Lower Leg Fabrication Hind Foot Fabrication Sole Fabrication ForeFoot Fabrication Vulcanization Assembly Jaipur Foot Fabrication Process 12 of 21 © 2003 University of Michigan Regents .Released December 12.

The patient will keep the card until it is given to a technician. lets it dry. The patient describes some modest discomfort as she walks around a separate inner courtyard. A trained artisan wraps a cast around the limb. The on-site doctor supervises as the patient tests the new prosthesis in the inner courtyard. The patient is ushered back to the inner courtyard and waits.Released December 12. The family catches a train back to New Delhi. A guard at the gate of the one-story facility admits the family inside. 2003 = Step 8: Fitting of the Jaipur Foot kÉ~êäó=SM=é~íáÉåíë=É~ÅÜ=Ç~ó=çÄí~áå=éêçëíÜÉëÉë=Ñêçã=g~áéìê=cççíÛë=ã~áå=Ñ~Åáäáíó=áå=g~áéìêI=fåÇá~K= oÉã~êâ~ÄäóI=ìåäÉëë=çíÜÉê=ãÉÇáÅ~ä=ÅçåÇáíáçåë=áåíÉêîÉåÉI=É~ÅÜ=é~íáÉåí=áë=Åìëíçã=ÑáííÉÇ=ïáíÜ=~=éêçëíÜÉëáë=áå= çåÉ=Ç~ó=Ó=ìëì~ääó=ïáíÜáå=íÜêÉÉ=ÜçìêëK=qÜÉ=Öç~ä=áë=íç=êÉíìêå=íÜÉ=é~íáÉåí=íç=íÜÉáê=éêçÑÉëëáçå=~åÇ=~å= áåÇÉéÉåÇÉåí=äáÑÉ=~ÑíÉê=íÜÉ=é~íáÉåíÛë=Ñáêëí=îáëáí=íç=íÜÉ=ÅäáåáÅK= eçïÉîÉêI=íÜÉ=pçÅáÉíóÛë=ÇÉëáêÉ=íç=~ÅÅçããçÇ~íÉ=íÜÉ=ëçÅá~ä=êÉèìáêÉãÉåíë=çÑ=fåÇá~Ûë=éççê=ÇçÉë=åçí= Åçåëáëí=ëçäÉäó=çÑ=íÜÉ=ëéÉÉÇ=çÑ=ëÉêîáÅÉK=qÜÉ=pçÅáÉíóÛë=çéÉê~íáåÖ=éêçÅÉëë=~äëç=~ííÉåÇë=íç=íÜÉ=éëóÅÜçäçÖáÅ~ä= åÉÉÇë=çÑ=áíë=é~íáÉåíëK=qÜÉ=pçÅáÉíó=éêçîáÇÉë=çåJëáíÉ=ãÉ~äë=~åÇ=çîÉêåáÖÜí=~ÅÅçããçÇ~íáçåë=íç=é~íáÉåíë=~í=åç= ÅçëíK=qÜÉëÉ=ëÉêîáÅÉë=~êÉ=ëÜ~êÉÇ=ïáíÜ=çíÜÉê=é~íáÉåíë=áå=çêÇÉê=íç=éêçîáÇÉ=~å=áããÉÇá~íÉ=ëìééçêí=Öêçìé=Ñçê= íÜÉ=é~íáÉåíë=~åÇ=íç=ÇÉîÉäçé=~=ëÉåëÉ=çÑ=Åçããìåáíó=ïáíÜáå=íÜÉ=Ñ~ÅáäáíóK=^ÇÇáíáçå~ääóI=ÑêÉÉ=ãÉ~äë=~åÇ= ~ÅÅçããçÇ~íáçåë=~êÉ=éêçîáÇÉÇ=íç=íÜÉ=é~íáÉåíÛë=Ñ~ãáäó=ãÉãÄÉêëI=~Ö~áå=~í=åç=ÅçëíK=qÜáë=éÉêãáíë=Ñ~ãáäó= ãÉãÄÉêë=íç=~ÑÑçêÇ~Ääó=íê~îÉä=ïáíÜ=é~íáÉåíë=~åÇ=éêçîáÇÉ=çåJëáíÉ=ëìééçêí=~åÇ=ÅçãÑçêíK=^=íóéáÅ~ä=é~íáÉåí= ÉñéÉêáÉåÅÉ=íç=êÉÅÉáîÉ=~=g~áéìê=cççí=ãáÖÜí=éêçÅÉÉÇ=~ë=ÑçääçïëW== = Monday 1:00 PM 6:00 PM 6:30 PM 9:00 PM Tuesday 8:00 AM 8:30 AM 9:00 AM 9:10 AM 9:30 AM 9:45 AM 10:15 AM 10:30 AM 11:00 AM 11:30 AM NOON 12:15 PM 12:30 PM 2:00 PM 7:30 PM The patient catches a train from New Delhi to Jaipur. = © 2003 University of Michigan Regents 13 of 21 . India. The family returns home to resume a life similar to their lives before the loss of the patient's limb. The artisan pours a mold into the cast. The family joins other patients and family members at a communal dinner prepared by the Society's food service employee. prepared for a cast. The patient and her family share lunch at the facility. The patient's husband and child accompany her on the journey. A prefabricated Jaipur Foot is attached to the prosthesis. polyurethane prosthesis. forms it tightly around the limb and removes it. and is stretched over the mold of the patient's remaining limb. The patient joins the line forming in the Society's inner courtyard and awaits registration. prosthesis. A common polyurethane pipe is heated in a vacuum forming machine. is removed. The family arrives at the front gate of the Society in the heart of Jaipur. and then carves it to the limb's specifications under the supervision of a technician. The patient is ushered back into the medical wing of the facility and a technician fits the prosthesis to the patient. A doctor checks the patient and outlines the prosthesis that is required. The family shares breakfast with other patients and families at the facility. The family sleeps on mattresses in a large room within the facility's modest housing wing.

Released December 12. 2003 = Competitive Benchmarking g~áéìê=cççí=ëìééçêíë=ÇÉîÉäçéáåÖ=Åçìåíêó=äáÑÉëíóäÉë=EëìÅÜ=~ë=ëèì~ííáåÖI=ëáííáåÖ=ÅêçëëJäÉÖÖÉÇI=ï~äâáåÖ=çå= ìåÉîÉå=ëìêÑ~ÅÉë=~åÇ=Ä~êÉÑççí=ï~äâáåÖF=ïÜáäÉ=~=ÅçåîÉåíáçå~ä=p^`e=Ñççí=ÇçÉë=åçíK=mäÉ~ëÉ=êÉÑÉê=íç=^ééÉåÇáñ= _=Ñçê=~=Åçãé~êáëçå=çÑ=g~áéìê=cççí=ïáíÜ=íÜÉ=ÅçåîÉåíáçå~ä=éêçëíÜÉëáë=Ep^`e=ÑççíFK== qÜÉ=í~ÄäÉ=ÄÉäçï=ÇÉí~áäë=Åçãé~êáëçå=çÑ=g~áéìê=cççí=ïáíÜ=s~êácäÉñ=ElëëìêF=~åÇ=qêìÉpíÉé=E`çääÉÖÉ= m~êâ=fåÇìëíêáÉëFI=íïç=äÉ~ÇáåÖ=éêçëíÜÉëÉë=áå=íÜÉ=ÇÉîÉäçéÉÇ=ïçêäÇK=qÜÉ=í~ÄäÉ=Åçãé~êÉë=íÜÉ=éêçëíÜÉëÉë=Ñçê= ê~åÖÉ=çÑ=ãçíáçåI=ÖÉåÉê~ä=~ííêáÄìíÉë=ëìÅÜ=~ë=ÅçëíI=~ÅíáîáíáÉë=ëìééçêíÉÇI=~åÇ=èì~äáíó=ëí~åÇ~êÇë=íç=ïÜáÅÜ=íÜÉó= ~ÇÜÉêÉK== g~áéìê=cççí=éêçîáÇÉë=Ñçê=~å=ÉñÅÉääÉåí=ê~åÖÉ=çÑ=ÇçêëáÑäÉñáçå=ãçîÉãÉåíK=^ë=íÜÉ=í~ÄäÉ=ÇÉãçåëíê~íÉëI= íÜçìÖÜ=åçí=ÉñéäáÅáíäó=ëìéÉêáçê=íç=íÜÉ=tÉëíÉêå=éêçëíÜÉëáë=ëÜçïåI=íÜÉ=g~áéìê=cççí=éçëëÉëëÉë=íÉÅÜåáÅ~ä= ÅÜ~ê~ÅíÉêáëíáÅë=íÜ~í=ã~âÉ=áí=~=Åçãé~ê~ÄäÉ=éêçÇìÅíK=qÜÉ=ÅäÉ~ê=ÇáÑÑÉêÉåíá~íáåÖ=ÑÉ~íìêÉë=~êÉ=íÜÉ=êÉëéÉÅíáîÉ= éêáÅÉë=~åÇ=íÜÉ=óÉ~êë=çÑ=áåíêçÇìÅíáçå=çÑ=íÜÉ=éêçÇìÅíëK=qÜÉ=g~áéìê=cççí=éêÉëÉåíë=~å=áåíÉêÉëíáåÖ=Åçãé~êáëçå= íç=íÜÉ=tÉëíÉêå=éêçëíÜÉëáë=~í=~=éêáÅÉ=éÉêÑçêã~åÅÉ=Ä~ëáë=ÇÉëéáíÉ=ÄÉáåÖ=áåíêçÇìÅÉÇ=åÉ~êäó=íïç=ÇÉÅ~ÇÉë= ÄÉÑçêÉ=áíë=tÉëíÉêå=ÅçìåíÉêé~êíëK=cìêíÜÉêãçêÉI=íÜÉ=g~áéìê=cççí=Åçãé~êÉë=Ñ~îçê~Ääó=çå=íÜÉ=~ÅíáîáíáÉë=Ñçê= ïÜáÅÜ=áí=ï~ë=ÇÉëáÖåÉÇI=ÉëéÉÅá~ääó=ï~äâáåÖ=Ä~êÉÑççíI=ïçêâáåÖ=áå=ïÉí=ÑáÉäÇëI=ï~äâáåÖ=çå=ìåÉîÉå=ÖêçìåÇ= ~åÇ=ÅäáãÄáåÖ=íêÉÉëK= = FEATURE/ FUNCTION o~åÖÉ=çÑ=jçíáçå= açêëáÑäÉñáçå= mä~åí~ê=cäÉñáçå= fåîÉêëáçå== bîÉêëáçå= pìéáå~íáçå== mêçå~íáçå= ^ííêáÄìíÉë= `çëí=Ecççí=máÉÅÉF= ^îÉê~ÖÉ=`çëí=EáåÅäìÇáåÖ= mêçëíÜÉëáë=C=cáííáåÖF=G= cáííáåÖLc~ÄêáÅ~íáçå=íáãÉ= cççí=éáÉÅÉ=tÉáÖÜí== páòÉLïÉáÖÜí=ê~íáåÖ= ^Çàìëí=Ñçê=ÜÉÉä=ÜÉáÖÜí=ÅÜ~åÖÉ= t~êê~åíó== j~áåíÉå~åÅÉ=oÉèìáêÉãÉåíë= ^îÉê~ÖÉ=iáÑÉ= ^ÅíáîáíáÉë=pìééçêíÉÇ= tçêâ=áå=ïÉí=ÑáÉäÇë= t~äâ=Ä~êÉÑççí= páí=çå=Ñäççê= pèì~í= VARIFLEX 16 (SINCE 1990) iáãáíÉÇ=aóå~ãáÅë= iáãáíÉÇ=aóå~ãáÅë= NOM=Eëéäáí=íçÉ=îÉêëáçåF= NOM=Eëéäáí=íçÉ=îÉêëáçåF= kçí=^ééäáÅ~ÄäÉ= kçí=^ééäáÅ~ÄäÉ= ANIQMM= APITMM= NJO=ÜçìêëK= OQMÖ= ré=íç=NSS=âÖ= içïLÜáÖÜ=ÜÉÉä=çéíáçåë= PM=ãçåíÜë= kçåÉ= OJP=óÉ~êë= vÉë= péÉÅá~ä=ëçäÉ=êÉèìáêÉÇ== vÉë= vÉë= COLLEGE PARK FOOT 17 (SINCE 1991) ORM ORM NOM NOM OMM OMM ANIMRV= AOITMM= NJO=Üçìêë= RNM=Ö== ré=íç=NSM=âÖ= kç= PS=ãçåíÜë= iáãáíÉÇ== P=óÉ~êë= kçí=êÉÅçããÉåÇÉÇ= vÉë= vÉë= vÉë= JAIPUR FOOT 18 (SINCE 1968) QMM MM NMM NMM TM RM AR=EOQM=fåÇá~å=oëKF= APM=ENRMM=fåÇá~å=oëKF= O=Üçìêë= = URM=Ö= == kçí=ê~íÉÇ= kç= kçåÉ== kçåÉ= OKR=Ó=PKM=óÉ~êë= vÉë= vÉë= vÉë= vÉë= © 2003 University of Michigan Regents 14 of 21 .

2003 = FEATURE/ FUNCTION aêáîÉ=~=Å~ê== oáÇÉ=~=ÄáâÉ= t~äâ=çå=ìåÉîÉå=ÖêçìåÇ= `äáãÄ=íêÉÉë= eáâÉ= pïáã= oìå= nì~äáíó=pí~åÇ~êÇë= `b=j~êâÉÇ= ^ÇÇáíáçå~ä= VARIFLEX 16 (SINCE 1990) vÉë== vÉëK== vÉë=Eëéäáí=íçÉ=îÉêëáçåF== vÉë=EïáíÜ=iáãáí~íáçåëF== vÉë== vÉë== vÉë== vÉë= fpl=NMPOU=ëí~åÇ~êÇ== COLLEGE PARK FOOT 17 (SINCE 1991) vÉë= vÉë= vÉë= vÉë=EïáíÜ=iáãáí~íáçåëF= vÉë= kçí=oÉÅçããÉåÇÉÇ= vÉë= vÉë= JAIPUR FOOT 18 (SINCE 1968) vÉë= vÉë= vÉë= vÉë= vÉë= vÉë= vÉë= kç= fåíÉêå~ä=nì~äáíó=ëí~åÇ~êÇë== GqÜáë=áë=~îÉê~ÖÉ=Åçëí=Ñçê=ÅçãéäÉíÉ=ëçäìíáçåI=ïÜáÅÜ=ã~ó=áåîçäîÉ=ãìäíáéäÉ=ÅäáåáÅ=îáëáíëK=^Åíì~ä=Åçëíë=ïáää=î~êó=ÇÉéÉåÇáåÖ=çå=çéíáçåë=ÅÜçëÉåK= = Community Outreach: Providing Access Bhagwan Mahaveer Viklang Sahayata Samiti (BMVSS) qÜÉ=ÇÉëáÖåÉêë=çÑ=g~áéìê=cççí=èìáÅâäó=ÇáëÅçîÉêÉÇ=íÜ~í=ÇÉëáÖåáåÖ=~=éêçëíÜÉëáë=íÜ~í=ÅçìäÇ=ïáíÜëí~åÇ=íÜÉ= êáÖçêçìë=ìëÉ=çÑ=fåÇá~Ûë=éççê=ï~ë=çåäó=íÜÉ=ÄÉÖáååáåÖK=qÜÉ=åÉñí=ÅÜ~ääÉåÖÉ=ï~ë=íç=ÅçåëíêìÅí=~å=çêÖ~åáò~íáçå= ~åÇ=çéÉê~íáåÖ=ëóëíÉãI=ïÜáÅÜ=ÅçìäÇ=ã~âÉ=íÜÉ=g~áéìê=cççí=~î~áä~ÄäÉ=íç=~ë=ã~åó=~ãéìíÉÉë=~ë=éçëëáÄäÉK=qÜÉ= ÉñéÉÅí~íáçå=ï~ë=íÜ~í=åÉ~êäó=~ää=éêçëéÉÅíáîÉ=~ãéìíÉÉë=ïçìäÇ=Ñ~ää=ÄÉäçï=íÜÉ=éçîÉêíó=äáåÉK=pìÄëÉèìÉåíäóI= g~áéìê=cççíÛë=ÅìëíçÇá~åë=ÑçÅìëÉÇ=íÜÉáê=~ííÉåíáçå=çå=íÜÉ=Ñáå~åÅá~ä=~åÇ=ëçÅá~ä=åÉÉÇë=çÑ=fåÇá~Ûë=ïçêâáåÖ=éççêK= qÜÉáê=ÉÑÑçêíë=ÉîÉåíì~ääó=íççâ=íÜÉ=Ñçêã=çÑ=íÜÉ=åçåéêçÑáí=ëçÅáÉíó=å~ãÉÇ=_Ü~Öï~å=j~Ü~îÉÉê=sáâä~åÖ= p~Ü~ó~í~=p~ãáíá=E_jsppFI=ÖÉåÉê~ääó=êÉÑÉêêÉÇ=íç=~ë=“íÜÉ=pçÅáÉíóKÒ= qÜÉ=ÇÉëáÖáåÖ=çÑ=íÜÉ=éêçëíÜÉëáë=íÜ~í=ÅçìäÇ=ïáíÜëí~åÇ=ìëÉ=Äó=fåÇá~Dë=éççê=ï~ë=çåäó=íÜÉ=ÄÉÖáååáåÖK= qÜÉ=åÉñí=ÅÜ~ää~åÖÉ=ï~ë=íç=ÅçåëíêìÅí=~å=çêÖ~åáë~íáçå=~åÇ=çéÉê~íáåÖ=ëóëíÉãX=ïÜáÅÜ=ÅçìäÇ=ã~âÉ=g~áéìê= cççí=~î~áä~ÄäÉ=íç=~ë=ã~åó=~ãéìíÉÉë=~ë=éçëëáÄäÉK=qÜÉ=ÉñéÉÅí~íáçå=ï~ë=íÜ~í=åÉ~êäó=~ää=çÑ=íÜÉ=éêçëéÉÅíáîÉ= ~ãéìíÉÉë=ïçìäÇ=Ñ~ää=ÄÉäçï=íÜÉ=éçîÉêíó=äáåÉK=qç=ãÉÉí=íÜÉ=Ñáå~åÅá~ä=~åÇ=ëçÅá~ä=åÉÉÇë=çÑ=íÜÉ=~ãéìíÉÉë=~åÇ= ~äëç=íç=éêçãçíÉ=ÑìêíÜÉê=íÉÅÜåáÅ~ä=ÇÉîÉäçéãÉåíI=~=åçåJéêçÑáí=ëçÅáÉíó=å~ãÉÇ=_Ü~Öï~å=j~Ü~îÉÉê=sáâä~åÖ= p~Ü~ó~í~=p~ãáíá=E_jsppF=ï~ë=Éëí~ÄäáëÜÉÇ=áå=j~êÅÜ=NVTR=Äó=jêK=aKoK=jÉÜí~K=få=íÜÉ=Ñáêëí=T=óÉ~ê=~ÑíÉê=íÜÉ= ÇÉîÉäçéãÉåí=çÑ=g~áéìê=cççí=áå=NVSUI=Ü~êÇäó=RM=äáãÄë=ïÉêÉ=ÑáííÉÇK=få=íÜÉ=Ñáêëí=óÉ~ê=ëÑíÉê=íÜÉ=Ñçêã~íáçå=çÑ= íÜÉ=ëçÅáÉíó=RV=äáãÄë=ïÉêÉ=ÑáííÉÇK=kçïI=íÜÉ=åìãÄÉê=çÑ=äáãÄë=ÑáííÉÇ=ÉîÉêó=óÉ~ê=áë=~êçìåÇ=NSIMMMK=_ÉíïÉÉå= íÜÉ=j~êÅÜ=NVTRI=ïÜÉå=_jspp=ï~ë=Éëí~ÄäáëÜÉÇ=íç=j~êÅÜ=OMMPI=_jspp=Ü~ë=ÑáííÉÇ=OPSITNT=äáãÄë=áå=fåÇá~= ~åÇ=NQIMTM=~êçìåÇ=íÜÉ=ïçêäÇ=EmäÉ~ëÉ=êÉÑÉê=íç=í~ÄäÉ=ÄÉäçïFK==_ìí=Ñçê=íÜÉ=î~äìÉ=ëóëíÉã=~åÇ=é~íáÉåí=ÅÉåíêáÅ= ã~å~ÖÉãÉåí=éê~ÅíáÅÉë=ÑçääçïÉÇ=Äó=_jsppI=g~áéìê=cççí=ãáÖÜí=Ü~îÉ=êÉã~áåÉÇ=çå=íÜÉ=ëÜÉäÑ=~åÇ=áå=äáãÄçK= qÜÉ=_jspp=ÉãéÜ~ëáòÉë=~=ÜçäáëíáÅ=~ééêç~ÅÜ=íç=~ÇÇêÉëëáåÖ=íÜÉ=éêçÄäÉãë=çÑ=~ãéìíÉÉëK=qÜÉ=ëçÅáÉíó= ÑçÅìëÉë=çå=åçí=çåäó=íÜÉ=ãÉÇáÅ~ä=éêçÄäÉãë=çÑ=íÜÉ=ìåÇÉêéêáîáäÉÖÉÇI=Äìí=~äëç=íÜÉ=Ñáå~åÅá~ä=~åÇ=ëçÅá~ä= éêçÄäÉãë=~ë=ïÉääK== qÜÉ=ëçÅáÉíó=Ü~ë=ä~áÇ=Ççïå=ÉñíêÉãÉäó=ëáãéäÉ=éêçÅÉÇìêÉë=Ñçê=êÉÅÉéíáçåI=~ÇãáëëáçåI=ãÉ~ëìêÉãÉåí= í~âáåÖI=ã~åìÑ~ÅíìêáåÖI=ÑáíãÉåí=~åÇ=ÇáëÅÜ~êÖÉ=çÑ=é~íáÉåíëK=råäáâÉ=áå=~ää=çíÜÉê=ãÉÇáÅ~ä=ÅÉåíÉêë=~ää=çîÉê=íÜÉ= ïçêÇI=é~íáÉåíë=~êÉ=~ÇãáííÉÇ=~ë=íÜÉó=~êêáîÉ=ïáíÜçìí=êÉÖ~êÇ=íç=íÜÉ=íáãÉ=çÑ=Ç~óK==cìêíÜÉê=é~íáÉåíë=~êÉ= éêçîáÇÉÇ=Äç~êÇáåÖ=~åÇ=äçÇÖáåÖ=Ñ~ÅáäáíáÉë=~í=íÜÉ=ÅÉåíÉêë=çÑ=_jspp=íáää=íÜÉó=~êÉ=éêçîáÇÉÇ=ïáíÜ=äáãÄëI= © 2003 University of Michigan Regents 15 of 21 .Released December 12.

Released December 12. 2003 = Å~äáéÉêë=çê=çíÜÉê=~áÇëK==få=ãçëí=çêíÜçé~ÉÇáÅ=ÅÉåíÉêë=áå=íÜÉ=ïçêäÇI=é~íáÉåíë=ãìëí=ÅçãÉ=Ä~Åâ=ëÉîÉê~ä=íáãÉë= Ñçê=~=Åìëíçã=ÑáíK==qÜáë=éêçÅÉëë=ÅçìäÇ=í~âÉ=ëÉîÉê~ä=ïÉÉâëK==pìÅÜ=~=ëóëíÉã=ïçìäÇ=ÄÉ=ìåëìáí~ÄäÉ=íç=íÜÉ=éççê= é~íáÉåíë=ïÜç=ÑáåÇ=áí=ÉñíêÉãÉäó=ÇáÑÑáÅìäíI=ÄçíÜ=áå=éÜóëáÅ~ä=~åÇ=Ñáå~åÅá~ä=íÉêãëI=íç=ÅçãÉ=Ä~Åâ=~=ëÉÅçåÇ=íáãÉ= Ñêçã=äçåÖ=Çáëí~åÅÉëK=g~áéìê=cççí=áë=Åìëíçã=ÑáííÉÇ=çå=íÜÉ=ë~ãÉ=Ç~óX=áå=Ñ~Åí=áå=äÉëë=íÜ~å=Q=ÜçìêëK==jçëí= ëáÖåáÑáÅ~åíäó=íÜÉ=éêçëíÜÉíáÅë=çêíÜçíáÅë=~åÇ=çíÜÉê=~áÇë=~åÇ=~ééäá~åÅÉë=~êÉ=éêçîáÇÉÇ=íçí~ääó=ÑêÉÉ=çÑ=ÅÜ~êÖÉ=íç= íÜÉ=Ü~åÇáÅ~ééÉÇK=_ìí=Ñçê=íÜáë=éçäáÅóI=îáêíì~ääó=ãçêÉ=íÜ~å=VMB=çÑ=íÜÉ=é~íáÉåíë=ïçìäÇ=Ü~îÉ=êÉã~áåÉÇ= ÇÉéêáîÉÇ=çÑ=~êíáÑáÅá~ä=äáãÄëI=Å~äáéÉêë=~åÇ=çíÜÉê=~áÇë=~åÇ=~ééäá~åÅÉëK=qÜÉ=ëÉííáåÖ=ìé=çÑ=é~íáÉåíë=çêáÉåíÉÇ= î~äìÉ=~åÇ=ã~å~ÖÉãÉåí=ëóëíÉã=ï~ë=~å=Éèì~ääó=áãéçêí~åí=áååçî~íáçåK= _jspp=Ü~ë=íÉå=Äê~åÅÜÉë=áå=fåÇá~K=få=~ÇÇáíáçåI=íÜÉêÉ=~êÉ=~ééêçñáã~íÉäó=SM=ïçêâëÜçéë=íÜ~í=Ñ~ÄêáÅ~íÉ= çê=Ñáí=íÜÉ=g~áéìê=cççí=áå=fåÇá~K=qÜÉ=pçÅáÉíó=~äëç=Ü~ë=~áÇÉÇ=íÜÉ=Éëí~ÄäáëÜãÉåí=çÑ=ëÉîÉê~ä=ÅÉåíÉêë=~Äêç~ÇK= cìåÇÉÇ=Äó=íÜÉ=fåÇá~å=ÖçîÉêåãÉåí=~åÇ=éÜáä~åíÜêçéáÅ=ÖêçìéëI=_jspp=~åÇ=ëáãáä~ê=çêÖ~åáò~íáçåë=çÑÑÉê= ãÉÇáÅ~ä=Å~êÉI=êççãI=Äç~êÇI=~åÇ=~=éêçëíÜÉíáÅ=~í=åç=Åçëí=íç=íÜÉ=é~íáÉåíK=fí=~äëç=Ü~ë=ÜÉäéÉÇ=ä~ìåÅÜ=ÑêÉÉ=ÅäáåáÅë= áå=ãçêÉ=íÜ~å=~=ÇçòÉå=ÅçìåíêáÉëK= = INDIA: NUMBER OF ARTIFICIAL LIMBS AND OTHER AIDS DISTRIBUTED BY BMVSS ^êíáÑáÅá~ä=iáãÄë= ONVIQRM= `~äáéÉêë= NROINSR= qêáÅóÅäÉë= PSIVQN= `êìíÅÜÉë=C=líÜÉê=^áÇë= OORIQVO= eÉ~êáåÖ=^áÇë= SISSS= mçäáç=pìêÖÉêó= PIUSM= pçìêÅÉW=g~áéìê=cççí=E_jsppF= = World: Number of Artificial Limbs and other aids distributed By BMVSS ^ÑÖÜ~åáëí~å= _~åÖä~ÇÉëÜ= açãáåáÅ~å=oÉéìÄäáÅ= eçåÇìê~ë= fåÇçåÉëá~= j~ä~ïá= káÖÉêá~= kÉé~ä= k~áêçÄá= pçìêÅÉW=g~áéìê=cççí=E_jsppF= NIPRR= NIMMM= RMM= QMM= SMM= ORM= RMM= OMM= RMM= m~å~ã~= mÜáäáééáåÉë= m~éì~=kÉï=dìáåÉ~= oï~åÇ~= pçã~äá~= qêáåáÇ~Ç= sáÉíå~ã= wáãÄ~ÄïÉ= pìÇ~å= qlq^i= QMM= PIMMM= NTM= RMM= NIMMM= OMM= SMM= ORM= NIUMM= NPIOOR= Jaipur Foot: Filling a Social Need qÜÉ=ÇÉíÉêãáå~íáçå=ï~ë=ã~ÇÉ=~í=íÜÉ=çìíëÉí=íÜ~í=íÜÉ=g~áéìê=cççí=éêçëíÜÉëáë=ïçìäÇ=ÄÉ=éêçîáÇÉÇ=ÑêÉÉ=Äó= ãÉ~åë=çÑ=~=åçåéêçÑáí=Ñê~ãÉïçêâK=qÜÉ=éêçëéÉÅí=çÑ=åç=~ÇÇáíáçå~ä=ÑìåÇë=êÉ~äáòÉÇ=Ñçê=~ÇÇáíáçå~ä=éêçëíÜÉëÉë= ÑáííÉÇ=ÑçêÅÉÇ=~Çãáåáëíê~íçêë=íç=ÑçÅìë=çå=Åçåí~áåáåÖ=ÅçëíëK=få=é~êíáÅìä~êI=ÉãéÜ~ëáë=ï~ë=éä~ÅÉÇ=çå=íÜÉ=Åçëí=çÑ= íÜÉ=ã~íÉêá~äë=ìëÉÇ=íç=ÅçåëíêìÅí=íÜÉ=g~áéìê=cççíI=íÜÉ=Å~éáí~ä=ÉèìáéãÉåí=êÉèìáêÉÇ=íç=Ñ~ÄêáÅ~íÉ=íÜÉ=Ñççí=~åÇ= íÜÉ=ãÉíÜçÇ=Äó=ïÜáÅÜ=íÜÉ=Ñççí=ï~ë=ÑáííÉÇ=íç=~=é~íáÉåí=áå=çêÇÉê=íç=ã~âÉ=íÜÉ=éêçëíÜÉëáë=ïáÇÉäó=~î~áä~ÄäÉK== © 2003 University of Michigan Regents 16 of 21 .

2003 = Jaipur Foot Operations qÜÉ=êÉëìäí=áë=~å=çêÖ~åáò~íáçå=íÜ~í=ëéÉåÇë=åÉ~êäó=TQB=çÑ=áíë=Åçëí=çå=íÜÉ=ã~íÉêá~äëI=ä~Äçê=~åÇ=ëÉêîáÅÉë= åÉÅÉëë~êó=íç=Ñáí=~ãéìíÉÉë=ïáíÜ=~=éêçëíÜÉíáÅ=äáãÄK=qÜÉ=ÑçääçïáåÖ=Çá~Öê~ã=Éëíáã~íÉë=íÜÉ=Åçëí=ÅçãéçåÉåíë=çÑ= éêçîáÇáåÖ=É~ÅÜ=g~áéìê=cççíW= = Cost of Typical Jaipur Foot Below Knee Lim b Overhead 14% Camps 12% Materials 43% Labor 31% pçìêÅÉW=_jspp=^ÇàìëíÉÇ=`çëí=oÉéçêí= = = låäó=NQB=çÑ=íÜÉ=Åçëí=çÑ=~=íóéáÅ~ä=g~áéìê=cççí=ÖçÉë=íçï~êÇ=ãÉÉíáåÖ=çîÉêÜÉ~Ç=~åÇ=~Çãáåáëíê~íáîÉ= ÅçëíëK=qÜÉ=êÉã~áåáåÖ=Åçëí=ÖçÉë=íçï~êÇ=íÜÉ=ã~íÉêá~äë=ìëÉÇ=áå=íÜÉ=ÑççíI=íÜÉ=ä~Äçê=ÉãéäçóÉÇ=íç=ã~åìÑ~ÅíìêÉ= ~åÇ=Ñáí=íÜÉ=äáãÄ=~åÇ=íÜÉ=Åçëí=çÑ=êìååáåÖ=Å~ãéëI=ïÜáÅÜ=êÉ~ÅÜ=íÜÉ=éççê=íÜêçìÖÜçìí=fåÇá~=~åÇ=ÄÉóçåÇK= qÜáë=Åçëí=ÉÑÑáÅáÉåÅó=áë=~äëç=êÉÑäÉÅíÉÇ=áå=íÜÉ=g~áéìê=cççíÛë=~ååì~ä=ÉñéÉåëÉëW= = Jaipur Foot 2002 Expense by Classification (overhead costs of camps are included in Cost of Limb s and Services) Other Assistance 7% Operating Costs 4% Cost of Limbs and Services 89% pçìêÅÉW=_jspp=^ÇàìëíÉÇ=`çëí=oÉéçêí= = © 2003 University of Michigan Regents 17 of 21 .Released December 12.

2003 = g~áéìê=cççíÛë=ÉñéÉåëÉ=ÄêÉ~âçìí=Ñçê=íÜÉ=OMMO=ÑáëÅ~ä=óÉ~ê=ìåÇÉêëÅçêÉë=íÜÉ=ÉÑÑáÅáÉåÅó=çÑ=ÉñéÉåëÉ=~åÇ= ìåÇÉêéáåë=íÜÉ=pçÅáÉíóÛë=ÉÑÑçêí=íç=ëÉêîÉ=~ë=ã~åó=é~íáÉåíë=~ë=éçëëáÄäÉ=ÖáîÉå=áíë=Ñáå~åÅá~ä=êÉëçìêÅÉëK=kÉ~êäó= VMB=çÑ=íÜÉ=Åçãé~åóÛë=ÉñéÉåëÉë=áå=íÜÉ=OMMO=ÑáëÅ~ä=óÉ~ê=ïÉêÉ=ÇáêÉÅíäó=êÉä~íÉÇ=íç=íÜÉ=Åçëí=çÑ=éêçÇìÅáåÖ=~åÇ= ÑáííáåÖ=éêçëíÜÉëÉë=Ñçê=íÜÉ=éççêK=^åçíÜÉê=TB=çÑ=íÜÉ=Åçãé~åóÛë=ÉñéÉåëÉë=ïÉåí=íçï~êÇ=çíÜÉê=Ñçêãë=çÑ= ÅÜ~êáí~ÄäÉ=~ëëáëí~åÅÉK=låäó=QB=çÑ=áíë=ÉñéÉåÇáíìêÉë=ïÉåí=íçï~êÇ=~Çãáåáëíê~íáîÉ=~åÇ=çîÉêÜÉ~Ç=ÉñéÉåëÉëK= Comparison with Ossur qÜÉ=pçÅáÉíóÛë=Åçëí=ëíêìÅíìêÉ=ÇáÑÑÉêë=ëáÖåáÑáÅ~åíäó=ïáíÜ=íÜ~í=çÑ=lëëìêI=~å=fÅÉä~åÇJÄ~ëÉÇ=éìÄäáÅäó=íê~ÇÉÇ= Åçãé~åó=íÜ~í=ã~åìÑ~ÅíìêÉëI=ã~êâÉíë=~åÇ=ëÉääë=éêçëíÜÉëÉë=íÜêçìÖÜçìí=bìêçéÉ=~åÇ=kçêíÜ=^ãÉêáÅ~K=lëëìê= áë=íÜÉ=ëÉÅçåÇJä~êÖÉëí=éêçÇìÅÉê=çÑ=éêçëíÜÉëÉë=áå=íÜÉ=ïçêäÇK= ^ë=íÜÉ=Çá~Öê~ã=ÇÉãçåëíê~íÉëI=àìëí=çîÉê=Ü~äÑ=çÑ=lëëìêÛë=~ååì~ä=ÉñéÉåëÉ=ÖçÉë=íçï~êÇ=~Çãáåáëíê~íáîÉ= ~åÇ=çéÉê~íáåÖ=Åçëíë=ïÜáäÉ=Ü~äÑ=áíë=ÉñéÉåëÉ=ÖçÉë=íçï~êÇ=íÜÉ=~Åíì~ä=Åçëí=çÑ=éêçÇìÅáåÖ=éêçëíÜÉëÉëK=^=ãçêÉ= ÇÉí~áäÉÇ=Éñ~ãáå~íáçå=çÑ=íÜÉ=~ååì~ä=Ñáå~åÅá~ä=ëí~íÉãÉåíë=çÑ=g~áéìê=cççí=~åÇ=lëëìê=êÉîÉ~äë=íÜ~í=~= ëáÖåáÑáÅ~åí=éçêíáçå=çÑ=lëëìêÛë=ÉñéÉåÇáíìêÉë=~êÉ=êÉä~íÉÇ=íç=ë~äÉë=~åÇ=ã~êâÉíáåÖ=EONBF=~åÇ=êÉëÉ~êÅÜ=~åÇ= ÇÉîÉäçéãÉåí=EVBFK=^äíÜçìÖÜ=íÜáë=Çáëé~êáíó=áå=é~êí=ìåÇÉêëÅçêÉë=íÜÉ=ÇáÑÑÉêÉåí=ÅçãéÉíáíáîÉ=ÉåîáêçåãÉåíëI= êÉÖìä~íçêó=ÉåîáêçåãÉåíë=~åÇ=çêÖ~åáò~íáçå~ä=Öç~äë=íÜ~í=ëÉé~ê~íÉ=íÜÉ=íïç=çêÖ~åáò~íáçåëI=áí=~äëç=éêçîáÇÉë=~= Ñê~ãÉïçêâ=íÜ~í=ìåÇÉêëÅçêÉë=íÜÉ=pçÅáÉíóÛë=~Äáäáíó=íç=ÑìååÉä=áíë=êÉëçìêÅÉë=ÇáêÉÅíäó=íç=é~íáÉåíëK= = Ossur 2002 Expense by Classification Operating Costs 52% Cost of Limbs and Services 48% pçìêÅÉW=lëëìê=OMMO=^ååì~ä=oÉéçêí= = Scalability Camps qÜÉ=pçÅáÉíóÛë=ÅìêêÉåí=ãÉíÜçÇ=çÑ=Éñé~åÇáåÖ=íÜÉ=êÉ~ÅÜ=çÑ=íÜÉ=g~áéìê=cççí=íç=ãçêÉ=êÉãçíÉ=~êÉ~ë=çÑ=fåÇá~=~åÇ= ÄÉóçåÇ=áë=íÜÉ=Å~ãé=ëóëíÉãK=^Çãáåáëíê~íçêëI=ÇçÅíçêëI=íÉÅÜåáÅá~åë=~åÇ=~êíáë~åë=Ñêçã=íÜÉ=pçÅáÉíóÛë=g~áéìê= äçÅ~íáçå=íê~îÉä=íç=~=éêÉÇÉíÉêãáåÉÇ=ëáíÉ=~åÇ=ëÉí=ìé=~=íÉãéçê~êó=Ñ~Åáäáíó=êÉÑÉêêÉÇ=íç=~ë=~=Å~ãéK=^=Å~ãé=áë= © 2003 University of Michigan Regents 18 of 21 .Released December 12.

Released December 12. 2003 = íóéáÅ~ääó=ÑìåÇÉÇ=Äó=~åçíÜÉê=éêáî~íÉ=çêÖ~åáò~íáçå=çê=ÖçîÉêåãÉåí=íÜ~í=Ü~ë=áåîáíÉÇ=íÜÉ=pçÅáÉíó=íç=íÜÉ= äçÅ~íáçåK=^=Å~ãé=Å~å=ä~ëí=Ñêçã=àìëí=~=ÑÉï=Ç~óë=íç=ëÉîÉê~ä=ïÉÉâë=ÇÉéÉåÇáåÖ=çå=íÜÉ=åìãÄÉê=çÑ=~ãéìíÉÉë= ÉñéÉÅíÉÇ=íç=ÄÉ=ÑáííÉÇ=ïáíÜ=éêçëíÜÉëÉëK= ^=_jspp=éÜóëáÅá~å=ëìéÉêîáëÉë=Å~ãéëK=fí=í~âÉë=~Äçìí=çåÉ=Ç~ó=íç=ëÉí=ìé=~åÇ=~=Ü~äÑ=Ç~ó=íç=ÅäçëÉK=qÜÉ= ëéçåëçêáåÖ=çêÖ~åáò~íáçå=é~óë=íÜÉ=pçÅáÉíóÛë=ÉãéäçóÉÉë=~=íê~îÉä=~ääçï~åÅÉ=~åÇ=~=éÉê=ÇáÉã=ïÜáäÉ=çå=ëáíÉK=få= ÖÉåÉê~äI=íÜÉ=Å~ãé=êÉèìáêÉë=çåÉ=~êíáë~å=Ñçê=ÉîÉêó=íïç=é~íáÉåíë=ÉñéÉÅíÉÇ=íç=ÄÉ=íêÉ~íÉÇ=éÉê=Ç~óK=qÜçìÖÜ= ãçëí=çÑ=íÜÉ=ÅçãéçåÉåíë=çÑ=~=íóéáÅ~ä=g~áéìê=cççí=~åÇ=Å~äáéÉê=Å~å=ÄÉ=äçÅ~ääó=ëçìêÅÉÇI=íÜÉ=pçÅáÉíó=ìëì~ääó= íê~îÉäë=ïáíÜ=íÜÉ=ÉñéÉÅíÉÇ=êÉèìáêÉÇ=ã~íÉêá~äëK=iáâÉïáëÉI=ÉãéäçóÉÉë=íê~îÉä=ïáíÜ=íÜÉ=ÉèìáéãÉåí=åÉÅÉëë~êó= íç=Ñ~ÄêáÅ~íÉ=íÜÉ=éêçëíÜÉëáëI=áåÅäìÇáåÖ=~=î~ÅììãJÑçêãáåÖ=ã~ÅÜáåÉI=íÜÉ=ä~êÖÉëí=~åÇ=ãçëí=ÉñéÉåëáîÉ=éáÉÅÉ= çÑ=ÉèìáéãÉåí=êÉèìáêÉÇ=Ñçê=Ñ~ÄêáÅ~íáçåK=^åó=ã~íÉêá~ä=ëÜçêí~ÖÉë=~êÉ=ìëì~ääó=ÅçîÉêÉÇ=ïáíÜ=äçÅ~ääó= éìêÅÜ~ëÉÇ=ÖççÇë=ïáíÜ=äáííäÉ=áåÅáÇÉåíK=qÜÉ=ëéçåëçêáåÖ=çêÖ~åáò~íáçå=í~âÉë=êÉëéçåëáÄáäáíó=Ñçê=éêçãçíáåÖ=íÜÉ= Å~ãé=~åÇ=Ñçê=~åó=íê~åëéçêí~íáçå=çÑ=~ãéìíÉÉëK== New Locations qÜÉ=pçÅáÉíó=~äëç=Ñ~Åáäáí~íÉë=íÜÉ=Éëí~ÄäáëÜãÉåí=çÑ=åÉï=éÉêã~åÉåí=äçÅ~íáçåë=íç=Ñ~ÄêáÅ~íÉ=~åÇ=Ñáí=íÜÉ=g~áéìê= cççíK=^äíÜçìÖÜ=íÜÉ=pçÅáÉíó=áíëÉäÑ=ëìééçêíë=ëÉîÉê~ä=äçÅ~íáçåë=áå=fåÇá~I=áåÅäìÇáåÖ=kÉï=aÉäÜá=~åÇ=jìãÄ~á= E_çãÄ~óFI=íÜÉ=pçÅáÉíó=ÉåÅçìê~ÖÉë=íÜÉ=Éëí~ÄäáëÜãÉåí=çÑ=çíÜÉê=ÅÜ~êáí~ÄäÉ=çêÖ~åáò~íáçåë=íç=êìå=ÅäáåáÅëK=qÜÉ= pçÅáÉíó=áë=~ÅíáîÉ=áå=~ëëáëíáåÖ=íÜÉ=åÉï=çêÖ~åáò~íáçå=áå=ÇÉíÉêãáåáåÖ=íÜÉ=ÑÉ~ëáÄáäáíó=çÑ=ÅäáåáÅ=äçÅ~íáçåI=íê~áåáåÖ= çÑ=ÉãéäçóÉÉë=~åÇ=áå=ã~âáåÖ=íÜÉ=g~áéìê=cççí=~î~áä~ÄäÉ=íç=íÜÉ=ÅäáåáÅK= qÜÉ=pçÅáÉíóI=áå=ÅçåàìåÅíáçå=ïáíÜ=~=åÉï=çêÖ~åáò~íáçåI=ëíìÇáÉë=íÜÉ=åìãÄÉê=çÑ=~ãéìíÉÉë=åÉ~ê=íÜÉ=åÉï= äçÅ~íáçå=~åÇ=Éëíáã~íÉë=íÜÉ=çåÖçáåÖ=åÉÉÇ=Ñçê=íÜÉ=g~áéìê=cççí=éêçëíÜÉëáëK=^=åÉï=äçÅ~íáçå=êÉèìáêÉë=~= ãçÇÉëí=äÉîÉä=çÑ=Å~éáí~ä=ÉñéÉåÇáíìêÉK=qÜÉ=ãçëí=ëáÖåáÑáÅ~åí=éáÉÅÉ=çÑ=ÉèìáéãÉåí=áë=íÜÉ=î~ÅììãJÑçêãáåÖ= ã~ÅÜáåÉ=~í=~å=Éëíáã~íÉÇ=Åçëí=çÑ=rpAOIMMMK=^ÇÇáíáçå~ä=ÉèìáéãÉåí=~åÇ=íççäë=ÖÉåÉê~ääó=Åçëí=~åçíÜÉê= rpAOIMMMK=^êíáë~åë=~êÉ=íê~áåÉÇ=~í=íÜÉ=g~áéìê=Ñ~Åáäáíó=Ñçê=ìé=íç=ëáñ=ãçåíÜëK=sáêíì~ääó=~ää=íÜáë=íê~áåáåÖ=í~âÉë= éä~ÅÉ=ïáíÜ=é~íáÉåíë=~åÇ=ìåÇÉê=íÜÉ=ëìéÉêîáëáçå=çÑ=íÉÅÜåáÅá~åë=~åÇ=ÇçÅíçêëK=qÜÉ=pçÅáÉíó=ã~áåí~áåë=~åÇ= ìéÇ~íÉë=~=ã~åì~äI=ïÜáÅÜ=çìíäáåÉë=íÜÉ=Ñ~ÄêáÅ~íáçå=~åÇ=ÑáííáåÖ=çÑ=íÜÉ=g~áéìê=cççí=íç=~ëëáëí=áå=íÜáë=éêçÅÉëëK= ^ÑíÉê=íÜÉ=åÉï=äçÅ~íáçå=áë=ëí~ÑÑÉÇI=áíë=ÉãéäçóÉÉë=~êÉ=íê~áåÉÇ=~åÇ=íÜÉ=åÉï=ÅäáåáÅ=áë=êÉ~Çó=íç=Ñáí=é~íáÉåíëI= íÜÉ=pçÅáÉíó=ëÉåÇë=~=íÉÅÜåáÅá~å=íç=ëìéÉêîáëÉ=~åÇ=ëìééçêí=íÜÉ=ÅäáåáÅÛë=áåáíá~ä=çéÉê~íáçåëK=qÜÉ=åìãÄÉê=çÑ= ~êíáë~åë=~åÇ=íÉÅÜåáÅá~åë=~í=íÜÉ=åÉï=Ñ~Åáäáíó=ÇÉéÉåÇë=çå=íÜÉ=ÉñéÉÅíÉÇ=é~íáÉåí=äç~ÇK=^ÇÇáíáçå~ääóI=É~ÅÜ= ÅäáåáÅ=êÉí~áåë=~=ÇçÅíçê=íç=ëìéÉêîáëÉ=íÜÉ=íêÉ~íãÉåí=~åÇ=ÑáííáåÖ=çÑ=é~íáÉåíëK=qÜÉ=pçÅáÉíó=ã~âÉë=íÜÉ=éêçÅÉëë=íç= Ñ~ÄêáÅ~íÉ=íÜÉ=g~áéìê=cççí=~î~áä~ÄäÉ=íç=íÜÉ=åÉï=ÅäáåáÅI=çê=íÜÉ=pçÅáÉíó=ëáãéäó=éêçÇìÅÉë=íÜÉ=êÉèìáêÉÇ=åìãÄÉê= çÑ=éêçëíÜÉëáë=~åÇ=ëìééäáÉë=áí=íç=íÜÉ=åÉï=ÅäáåáÅ=ÑêÉÉ=çÑ=ÅÜ~êÖÉK= Future of Jaipur Foot Jaipur Foot Technical Improvements _jspp=Åçää~Äçê~íÉë=ïáíÜ=Üçëéáí~äëI=Äìí=áë=~äëç=áåîçäîÉÇ=áå=áíë=çïå=êÉëÉ~êÅÜ=C=ÇÉîÉäçéãÉåí=íç=ÑìêíÜÉê= áãéêçîÉ=íÜÉ=äáãÄ=ÇÉëáÖåK=oCa=~í=_jspp=áë=äÉÇ=Äó=o~ã=`Ü~åÇê~=ïÜáäÉ=aêK=jKhK=j~íÜìêI=~=íê~áåÉÇ= çêíÜçéÉÇáÅ=ëìêÖÉçå=~åÇ=ÑçêãÉê=ÜÉ~Ç=çÑ=éÜóëáÅ~ä=ãÉÇáÅáåÉ=C=êÉÜ~Äáäáí~íáçå=~í=~=äÉ~ÇáåÖ=Üçëéáí~äI=ÜÉ~Çë=íÜÉ= ãÉÇáÅ~ä=~åÇ=íÉÅÜåáÅ~ä=ÉÑÑçêíK=fíë=ëí~ÑÑ=áåÅäìÇÉë=ÇçÅíçêëI=íÉÅÜåáÅá~åë=~åÇ=ëçÅá~ä=ïçêâÉêëK== © 2003 University of Michigan Regents 19 of 21 .

2003 = _jsppLg~áéìê=cççí=Ü~ë=ã~ÇÉ=ëÉîÉê~ä=ÅÜ~åÖÉë=áå=íÜÉ=ÇÉëáÖå=~åÇ=ã~åìÑ~ÅíìêÉ=çÑ=äçïÉêJäáãÄ= éêçëíÜÉëÉë=íç=âÉÉé=é~ÅÉ=ïáíÜ=áåÅêÉ~ëÉë=áå=Üìã~å=ìåÇÉêëí~åÇáåÖ=çÑ=ÄáçãÉÅÜ~åáÅë=~åÇ=~Çî~åÅÉë=áå= ã~íÉêá~ä=íÉÅÜåçäçÖóK=eáÖÜJëíêÉåÖíÜ=éä~ëíáÅë=~êÉ=åçï=ÄÉáåÖ=ìëÉÇ=áåëíÉ~Ç=çÑ=~äìãáåìãK=qçí~ä=Åçåí~Åí= ëçÅâÉíë=~äëç=Ü~îÉ=ÄÉÉå=áåÅçêéçê~íÉÇ=áå=íÜÉ=ÇÉëáÖåK=eçïÉîÉêI=íÜÉ=ÅìëíçÇá~åë=çÑ=_jspp=Ü~îÉ=í~êÖÉíÉÇ= çíÜÉê=~êÉ~ë=Ñçê=áãéêçîÉãÉåíK=qÜÉ=g~áéìê=cççí=ÅìêêÉåíäó=áë=ÄÉáåÖ=Ü~åÇ=ÇÉëáÖåÉÇI=ïÜáÅÜ=ê~áëÉë=íÜÉ=áëëìÉë= çÑ=áåÅçåëáëíÉåÅóI=áíë=áãé~Åíë=çå=èì~äáíó=~åÇ=êÉäá~ÄáäáíóK== cìêíÜÉêãçêÉI=~í=URM=Öê~ãëI=íÜÉ=ÅìêêÉåí=Ñççí=éáÉÅÉ=áë=ÜÉ~îó=Åçãé~êÉÇ=íç=çíÜÉê=ëçäìíáçåëK=g~áéìê=cççí= Ü~ë=åçí=ÄÉÉå=íÉëíÉÇLÅÉêíáÑáÉÇ=Ñçê=~åó=ïÉääJâåçïå=áåíÉêå~íáçå~ä=ëí~åÇ~êÇK=fí=~äëç=Ü~ë=åçí=óÉí=êÉÅÉáîÉÇ= êÉÖìä~íçêó=~ééêçî~äë=Ñçê=ìë~ÖÉ=áå=ÅÉêí~áå=ÇÉîÉäçéÉÇ=ÅçìåíêáÉë=ëìÅÜ=~ë=råáíÉÇ=pí~íÉë=EëìÅÜ=~å=~ééêçî~ä= Ü~ë=åçí=óÉí=ÄÉÉå=ëçìÖÜíFK== Collaboration with Space Research Organization _jspp=Ü~ë=ëáÖåÉÇ=~å=~ÖêÉÉãÉåí=ïáíÜ=íÜÉ=fåÇá~å=pé~ÅÉ=oÉëÉ~êÅÜ=lêÖ~åáò~íáçå=EfpolF=íç=êÉÅÉáîÉ=fpolÛë= éçäóìêÉíÜ~åÉ=íÉÅÜåçäçÖóK19=fpolI=Éëí~ÄäáëÜÉÇ=áå=NVSVI=áë=çåÉ=çÑ=íÜÉ=éêÉãáÉê=ëé~ÅÉ=êÉëÉ~êÅÜ=çêÖ~åáò~íáçåë= áå=íÜÉ=ïçêäÇK=fíë=~ÅíáîáíáÉë=áåÅäìÇÉ=ëé~ÅÉ=êÉëÉ~êÅÜI=ÇÉëáÖåI=ÇÉîÉäçéãÉåí=~åÇ=ä~ìåÅÜ=çÑ=ë~íÉääáíÉë=~åÇ=çíÜÉê= ëé~ÅÉ=îÉÜáÅäÉëK== qÜÉ=éçäóìêÉíÜ~åÉ=íÉÅÜåçäçÖó=ÇÉîÉäçéÉÇ=Äó=fpol=áë=ÄçêåÉ=çìí=çÑ=fpolÛë=éáçåÉÉêáåÖ=êÉëÉ~êÅÜ=~åÇ= ÇÉîÉäçéãÉåí=çÑ=î~êáçìë=éçäóãÉêáÅ=ã~íÉêá~äëK=qÜÉ=ã~íÉêá~äë=~êÉ=íç=ÉåëìêÉ=íÜÉ=êÉäá~Äáäáíó=~åÇ=èì~äáíó=çÑ= ä~ìåÅÜ=îÉÜáÅäÉë=~åÇ=ë~íÉääáíÉëK=mçäóìêÉíÜ~åÉ=áë=~=îÉêë~íáäÉ=éçäóãÉê=íÜ~í=Å~å=ÄÉ=éêçÇìÅÉÇ=áå=î~êáçìë=Ñçêãë= äáâÉ=~ÇÜÉëáîÉëI=Åç~íáåÖ=ã~íÉêá~äë=~åÇ=áå=ÑäÉñáÄäÉ=çê=êáÖáÇ=ÑçêãëK=fpol=Ü~ë=ÇÉîÉäçéÉÇ=mr=éçäóãÉê=~åÇ=áíë= ~Çî~åÅÉÇ=ÇÉêáî~íáîÉëI=ïÜáÅÜ=~êÉ=ÄÉáåÖ=ÉñíÉåëáîÉäó=ìëÉÇ=áå=éêçéÉää~åíëI=ÅêóçÖÉåáÅ=áåëìä~íáçåI=íÜÉêã~ä= áåëìä~íáçå=é~ÇëI=ëíêìÅíìê~ä=Ç~ãéáåÖI=~ÅçìëíáÅ=áåëìä~íáçå=~åÇ=çíÜÉê=äáÖÜíïÉáÖÜí=ëíêìÅíìê~ä=ã~íÉêá~äë=Ñçê= îáÄê~íáçå=ÅçåíêçäI=ëÜçÅâ=~Äëçêéíáçå=äáåÉêë=~åÇ=~ÇÜÉëáîÉëK== qÜáë=Åçää~Äçê~íáçå=áë=ÉñéÉÅíÉÇ=íç=êÉÇìÅÉ=íÜÉ=Åçëí=çÑ=ã~åìÑ~ÅíìêáåÖ=~=g~áéìê=cççíK==`çëí=çÑ=É~ÅÜ=Ñççí= ïáää=ÄÉ=êÉÇìÅÉÇ=Äó=~Äçìí=QMB=íç=oëK=NQMK=qÜÉ=Ñççí=éáÉÅÉ=~äëç=ïáää=ÄÉÅçãÉ=äáÖÜíÉê=Äó=~ééêçñáã~íÉäó=SMB= íç=PRM=Öê~ãëK== qÜÉ=íÉÅÜåçäçÖó=íê~åëÑÉêêÉÇ=íç=_jspp=ïáää=ÜÉäé=éêçÇìÅÉ=~=ãçêÉ=Çìê~ÄäÉ=~åÇ=ÅçãÑçêí~ÄäÉ=~êíáÑáÅá~ä= Ñççí=áå=ä~êÖÉ=åìãÄÉêëK=^îÉê~ÖÉ=Ñççí=Ñ~ÄêáÅ~íáçå=íáãÉ=ïáää=ÄÉ=êÉÇìÅÉÇ=Ñêçã=íÜêÉÉ=Üçìêë=íç=~êçìåÇ=QM= ãáåìíÉëK=mr=Ñççí=éêçëíÜÉëÉë=ïçìäÇ=ÄÉ=ÄáçJãÉÅÜ~åáÅ~ääó=~Çî~åí~ÖÉçìë=Ñêçã=~=ÅçãÑçêí=äÉîÉä=éÉêëéÉÅíáîÉK= qÜÉ=ëäáé=êÉëáëí~åÅÉ=çÑ=íÜÉ=mr=Ñççí=áë=ãìÅÜ=ÜáÖÜÉê=íÜ~å=êìÄÄÉê=~åÇ=~ääáÉÇ=ã~íÉêá~äë=ìëÉÇ=áå=ÅçåîÉåíáçå~ä= ~êíáÑáÅá~ä=Ñççí=éêçëíÜÉëÉëK=^ãéìíÉÉë=ìëáåÖ=íÜÉ=mr=Ñççí=éêçëíÜÉëÉë=ÅçìäÇ=ï~äâ=ãçêÉ=ë~ÑÉäó=çå=~åó=ëìêÑ~ÅÉ= ëáåÅÉ=áíë=~Äê~ëáçå=êÉëáëí~åÅÉ=áë=ÜáÖÜÉêK=få=~ÇÇáíáçåI=íÜÉ=mr=Ñççí=ä~ëíë=äçåÖÉêK= qÜÉ=éçäóìêÉíÜ~åÉ=Ñç~ã=Ñççí=ãçäÇÉÇ=ïáíÜ=ÅçëãÉíáÅ~ääó=~ííê~ÅíáîÉ=ëâáå=ÅçîÉêë=Ü~ë=ÄÉÉå=ÑçìåÇ=íç=ÄÉ= ãçêÉ=~ÅÅÉéí~ÄäÉ=íç=~ãéìíÉÉëK=qÜÉ=åÉï=éçäóìêÉíÜ~åÉ=Ñççí=Ü~ë=ÄÉÉå=ëìÄàÉÅíÉÇ=íç=~ÅÅÉäÉê~íÉÇ=ÑäÉñ=Ñ~íáÖìÉ= íÉëíëI=~åÇ=ëÉîÉê~ä=~ãéìíÉÉë=Ü~îÉ=ÄÉÉå=ëìÅÅÉëëÑìääó=ÑáííÉÇ=ïáíÜ=ëìÅÜ=éêçëíÜÉëÉë=éêçÇìÅÉÇ=ìåÇÉê=íÜÉ= íÉÅÜåçäçÖó=íê~åëÑÉêêÉÇ=Äó=fpolK=cáÉäÇ=íêá~äë=Ü~îÉ=ÄÉÉå=êÉéçêíÉÇ=íç=ÄÉ=ÉåÅçìê~ÖáåÖK== © 2003 University of Michigan Regents 20 of 21 .Released December 12.

2003 = Endnotes ======================================================== N O =ïïïKà~áéìêÑççíKçêÖ= = =mäÉ~ëÉ=êÉÑÉê=íç=^ééÉåÇáñ=^=Ñçê=~=ÇÉëÅêáéíáçå=çÑ=äçïÉê=äáãÄ=ÑìåÅíáçå~äáíó=~åÇ=éêçëíÜÉëáë= P =ÜííéWLLïïïKãçëëêÉëçìêÅÉåÉíKçêÖL~ãéìí~KÜíã= Q =ÜííéWLLïïïKäáãÄëÑçêäáÑÉKçêÖL~ÄçìíKÜíã== R =ÜííéWLLïïïKçííçÄçÅâìëKÅçãLéêçÇìÅíëLçé|äçïÉê|ÅäÉÖNK~ëé= S =ÜííéWLLïïïKåÉïÄÉÖáååáåÖëOMMMKçêÖLÑ~ÅíëKÜíãä= T =ÜííéWLLïïïKçéÉåêç~ÇëKçêÖL= U =ÜííéWLLïïïKéçÑëÉ~KçêÖLlìíêÉ~ÅÜLlìíêÉ~ÅÜKÜíãä= V =ÜííéWLLïïïKéçÑëÉ~KçêÖLeÉäéKÜíãä= NM =ÜííéWLLïïïKÇé~KçêÖKëÖLam^LéìÄäáÅ~íáçåLÇéáéìÄLëéêáåÖVTLÇéáNUKÜíã= NN =ÜííéWLLíÉäÉÄçÇóKÅçãLëáÜ~åçìâL^ÄçìíqÜÉeçëéáí~äL~ÄçìíJíÜÉJeçëéáí~äKÜíãä= NO =ïïïKåìéçÅKåçêíÜïÉëíÉêåKÉÇìLéêçëeáëíçêóKÜíãä= NP =fåíÉêîáÉï=ïáíÜ=jêK=o~ãÅÜ~åÇê~=pÜ~êã~=E_jsppF= NQ =mäÉ~ëÉ=ëÉÉ=^ééÉåÇáñ=Ñçê=ÇÉëÅêáéíáçå=çÑ=äçïÉê=äáãÄ=ÑìåÅíáçå~äáíó= NR =fåíÉêîáÉï=ïáíÜ=aêK=jh=j~íÜìê=E_jsppF= NS =_~ëÉÇ=çå=áåéìíë=Ñêçã=lëëìê= NT =_~ëÉÇ=çå=áåéìíë=Ñêçã=`çääÉÖÉ=m~êâ= NU =_~ëÉÇ=çå=áåéìíë=Ñêçã=_jspp= NV =qÜÉ=eáåÇì=_ìëáåÉëë=iáåÉ=EPM=gìäó=OMMO=ÉÇáíáçåF= © 2003 University of Michigan Regents 21 of 21 .Released December 12.

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