Of arms and men

Losing a limb in Iraq leads a Durham industrial designer on a quest
to help amputees get a better grip on things.
By Sam Boykin and Frank Maley

Capt. Jonathan Kuniholm crouches, low and quiet, as he and three dozen other Marines advance through a thick palm grove along the Euphrates River. The platoon is looking for Iraqi insurgents who a few hours earlier had fired at a boat patrolling near Haditha Dam. As they close in on the suspected hot spot, a homemade bomb hidden in an olive oil can explodes. Shrapnel rips through the squadron, knocking Kuniholm off his feet. When he regains his senses a few minutes later, he sees his right arm is nearly severed just below the elbow. His M-16 rifle is blown in half. Amid a raging firefight, Kuniholm pulls himself out of danger and is airlifted to the al-Asad air base hospital, near Baghdad. Surgeons have to amputate the lower part of his ravaged arm. It’s Jan. 1, 2005. Happy New Year.

A week later, he undergoes surgery at Duke University Hospital in Durham to prepare the injured arm for a prosthesis. A few months later at Walter Reed Army Medical Center in Washington, D.C., doctors outfit him with several artificial limbs, including one with a split-hook gripping device, which operates via a harness and cable system activated by arm movements. He’s also given a more cosmetically appealing myoelectric prosthesis, which uses electrodes to translate nerve signals produced by muscle tension in the upper arm into hand movements. Flexing his upper arm causes the hand to grip; relaxing causes it to release.

He finds both frustrating. The myoelectric limb is heavy and slow-operating. The wrist motor isn’t strong enough to turn a doorknob. The piratical split hook works better, but it’s a poor replacement for a hand, and the basic design hasn’t changed much since World War I. “This sucks,” Kuniholm thinks. “I could come up with way better ideas than this.” He has reasons to believe that. His tour in Iraq has interrupted his quest for a doctorate in biomedical engineering, and he and some guys from his master’s program had started an industrial-design consultancy in Durham — Tackle Design Inc. But he quickly discovers that lack of ideas isn’t why progress on prosthetic hands has been so slow. Patent literature is full of promising ideas that never become products.

The problem, it turned out, lay in the market. It’s too small for companies to justify spending much on research and development. About 2 million Americans — less than 1% of the population — have lost a limb to illness or trauma, and only a fraction of them need hands. “There are like 75,000 potential customers for our prosthetics in the entire United States — less than half of Durham,” Kuniholm says. “Probably half of them are right[-handed] and half of them are left, and there are all different levels and all different preferences. By the time you segment that down to a single product, you’re talking about a roomful of people.”

Tackle Design had never focused on making lots of money. It started with a client base consisting largely of what Kuniholm calls “crazy inventors,” who were long on dreams and short on cash. The partners operated more like a confederation of contractors than a buttoned-down business. Doing interesting work mattered more than raking in revenue. Marginally profitable, the company grossed less than $1 million a year.

His partners helped Kuniholm develop a strategy for making better artificial hands with meager financial resources, and the company is close to bringing products to market. The quest has brought publicity — always a struggle for a small company — but he admits it has diverted manpower and other resources. He’s enough of a realist to know that people who try to make the world a better place don’t always get rich doing it. If they’re not careful, they can go broke. “The real question that I and everybody else here is asking is, ‘Is there some way to turn this bullshit into money or not?’ And I don’t know if there is.”

As if there weren’t enough centrifugal forces tugging at Tackle Design, the departure of the de facto manager and two other partners means Kuniholm, 36, must take on more executive duties. That means more attention to building profitable, long-term client relationships and less time spent improving artificial hands. “I am doing everything I can to keep our pursuit of this and similar projects from destroying our fledgling company.”

He was working on his second bachelor’s degree when he joined the Marines in 1997. The Durham native already had a bachelor’s in English from Dartmouth and had settled in at N.C. State to pursue one in mechanical engineering. Just a year into his studies, Kuniholm felt the pull of family tradition. His paternal grandfather, who had gone to West Point, was a foreign-service officer whose wife had been career CIA. His dad had been an infantry officer in Vietnam.

At Camp Lejeune, he served as a logistics officer, reaching the rank of first lieutenant. Managing maintenance, supply chains and transportation of men and equipment gave him skills that might have been a good fit at a place like Wal-Mart or FedEx. “But not only would I have had to move somewhere else, I would have been doing something I didn’t enjoy. It needs to be somebody’s job to figure out how many port-a-potties they need at the state fair, but I don’t want to be that guy.”

He returned to State in 2000 and finished his bachelor’s in mechanical engineering in 2002. The following year, he earned master’s degrees in that and in industrial design. In early 2003, he worked on a class project with Chuck Messer, Jesse Crossen and Jason Stevens. They decided that instead of trying to land jobs with established companies, they would start their own. Kevin Webb, a childhood friend of Crossen, joined them. Each put in $50 to get it going, and Kuniholm filed the incorporation papers. Setting up shop in the Raleigh house Messer, Webb and Crossen rented helped save money. Stevens soon dropped out, and Kuniholm began work on his doctorate at Duke. He did what he could on nights and weekends for the business, which Messer ended up running.

It provided some interesting projects. One client came up with a plastic lock for keeping shoestrings tied. Tackle Design also built prototypes, on a fee-for-service basis, of a light-emitting-diode bicycle light and a fishing lure with an LED inside. But the partners quickly learned the perils of working with “crazy inventors.” “We got stiffed on a few of those,” Kuniholm says. “And you expend so much time talking to them on the phone just trying to get a contract set up that it’s almost not worth it for a $3,000 to $5,000 job.”

The company also did work for larger clients, including conceiving and making prototypes for researchers at State who were developing tools for minimally invasive robotic surgery. But what it needed was a well-heeled client who could provide an ongoing revenue stream. “We haven’t been able to establish a relationship like that,” Kuniholm says. “The ones that we’ve had have sort of been on and off again.”

The makeup of the partnership had a lot to do with Tackle Design’s financial woes, Messer admits. “We’re kind of crazy-idea guys, and we like to brainstorm, and we get kind of fantastical about things we might do. And that kind of stuff is more fun than managing books and looking at profit-loss statements.” Those tendencies frustrated him as a manager, but he succumbed to them, too, and got sidetracked on unprofitable jobs. He spent considerable time doing pro bono work with researchers at Duke on a low-cost phototherapy light to treat Third World infants afflicted with jaundice. Saving babies inspired him in a way that thoughts of commercial success couldn’t.

But projects like that strained relationships. “Some of the things that some of the other partners went off and explored ended up making money, and some of the things that were explored did not. In the end, you can’t help but feel some tension among partners when somebody else is making money and supporting something that you’re doing or when you’re supporting somebody else.”

In 2004, Tackle Design moved to its current office, a former diner with a concrete floor and glass-and-brick facade facing the Durham County Courthouse. Its workshop is filled with tubes, wires, tools, bits of wood and metal and countless gadgets. That summer, with the Iraq war raging, Kuniholm again felt the call of duty and joined a Marine reserve unit. It was activated less than 48 hours later, and he was deployed to Anbar Province as a platoon leader in the 4th Combat Engineer Battalion. On the morning of Jan. 1, 2005, Kuniholm met with a platoon commander who had received word one of his boats had taken enemy fire on the Euphrates. He was about to send out a team to investigate. “He asked me if I wanted to go, so I grabbed my stuff.”

When word of the injury reached his partners, they started trolling the Web to learn all they could about prosthetics. “Initially it was kind of exciting,” Webb says. “We had done a lot of work in robotics, and we just assumed prosthetics had the same kind of innovation. But we found out differently.” Wounded warriors often have had to push the boundaries of prosthetics by demanding more functional and capable devices. Kuniholm figured that, as an amputee and an engineer, he was uniquely poised to do that, whether it made money or not. With a disability pension of more than $3,000 a month, a working wife and Messer running things — sort of — at Tackle Design, he could afford to pursue his passion.

Soon after he got back, he and his partners started the nonprofit Shared Design Alliance and its Open Prosthetics Project, an online forum for inventors, amputees and others interested in swapping ideas for improving artificial limbs. Crossen did much of the initial work, and Kuniholm has kept it going. It invites visitors to join “Pimp My Arm” or “Pimp My Leg” discussions. The goal is to lower entry barriers for products by providing a platform for low-cost experimentation and collaboration. None of the ideas that come from OPP are covered by patents, which can be costly to acquire and defend, but because they’re published online, they can’t be patented by others, Kuniholm says.

Some OPP projects show promise and might produce revenue for Tackle Design, though probably not much. The company is working with an electrical engineer who is designing a circuit board that could make it possible to use myoelectric controls in toys and other devices. “Then maybe we could achieve some of the economies of scale that come with a larger market by adding additional audiences,” Kuniholm says.

At the urging of a prosthetist in Fargo, N.D., who discovered him through OPP, Kuniholm is trying to bring back the Trautman hook. Introduced in the 1920s, the device is a voluntary-opening prosthetic, meaning its pincers are held closed with elastic bands. It has a back lock, which generates more pinching power after a user latches onto an object and pulls, and its serrated teeth interlock, giving it a strong grip. Such rugged and practical features developed a passionate following among farmers and ranchers in the Midwest. But the manufacturer went out of business in the 1990s. The prosthetist offered to pay for a prototype, and Tackle Design agreed to do the design work for free — as long as the results stayed in the public domain.

While other companies make similar backlocking hooks, Kuniholm says they’re bulkier and heavier than the Trautman hook. Tackle Design reverse-engineered the device and created a computer-assisted design model it could then improve upon. Kuniholm enlisted Boulder, Colo.-based Rapid Tool, which makes production molds for machine parts, to build four prototypes. He gave them to amputees for a tryout, and based on their feedback, industrial-engineering students at State are smoothing the rough edges. Kuniholm expects to make a production run of about 16 by the end of May and charge $150 per hook.

He also is working to refine the elastic bands used with most voluntary-opening prosthetic hooks, including the Trautman. He experimented with different types of tubing until he came across one made of silicone with the right strength, durability and elasticity. He needed a machine to efficiently cut the tubing to appropriate lengths, so he enlisted the aid of biomedical-engineering students at Duke.

Once the machine is ready, probably this spring, the bands will be produced by OE Enterprises, a Hillsborough nonprofit that employs disabled people for subcontracting services such as assembly and packaging. Details about how to carve up any proceeds haven’t been worked out, but OE plans to sell the bands through its Web site. “OE Enterprises specializes in the companies that fall through the cracks,” Sales Manager Alan Pitstick says. “We get in on the ground floor and grow with a company in a partnership and help make the project profitable.”

Kuniholm isn’t holding his breath. Tackle Design’s main effort to bring in more money involves trying to win more consulting business from inventors of medical devices, especially doctors. “We’re trying to get a push going right now to advertise in the hospitals, because doctors have more money than your typical crazy inventor and probably also have a better idea of what they really need.”

What the company needs most now might be a real businessman to keep an eye on the bottom line. Messer left the company last fall to co-host the Discovery Channel show Smash Lab. Crossen and Webb are busy with projects taken in-house by clients. All are still partners but spend little, if any, time on Tackle Design. Only Sean Hilliard, a graduate of State’s industrial-design program who came on board last year, works there full time.

Messer doubts that he’ll return, but he’s proud of the work done there such as the phototherapy light and OPP. And though it ended up creating tension, he sees value in the company’s relaxed attitude toward money. “If you’re solely interested in turning a profit, you often don’t take the risks that you need to in order to find yourself as a company — or as people. By exploring lots of different things and being willing to take risks, we were able to do some things that were innovative.”

If that lands you on TV, it probably seems like a pretty good gambit. If not, maybe it makes sense, at some point, to make some changes and indulge your passion less often. Kuniholm says he’s ready to do that. For Tackle Design to survive, he might have to fill the leadership vacuum. But he’s not crazy about the idea. “If you know somebody who feels like investing a bunch of money in this and being a taskmaster and doing the stuff that nobody wants to do, let me know. We’d love to have that guy.”