Mitt Wearables has created a below-elbow prosthetic arm that is comfortable, affordable and can be adjusted to the user’s needs. The idea started as an undergraduate project at Imperial College London and, in just under 3 years, has evolved into a much-needed innovation for people with limb differences. An alumnus of the London & Partners Business Growth programme, the company has also attended BioJapan with MedCity and recently conducted its first trial.

Mitt co-founders, Nate Macabuag and Ben Lakey, talk about the importance of listening to the users of their technology, the power of disrupting with a simple solution and the support they have received across the London life sciences ecosystem.

Early years

The concept for Mitt Wearables, aka Mitt, was first created when Nate was studying mechanical engineering at Imperial College London. Given free rein to come up with an idea, Nate’s group initially chose robotic prosthetics, with the idea of developing a state-of-the-art Iron Man style device. However Nate changed his mind, when introduced to Alex Lewis, a father, designer and also a quadruple amputee. “Alex explained the real problems in the industry to us,” Nate says. “Which is basically that today’s prosthetics haven’t changed demonstrably since the end of second world war. They are still uncomfortable, hard-to-use and expensive. So, we built this prototype of a very simple, wearable prosthetic with a socket that is soft and breathable and can be customised with a range of interchangeable hands that can hold different task-specific tools.”

“….today’s prosthetics haven’t changed demonstrably since the end of second world war. They are still uncomfortable, hard-to-use and expensive.”

Whilst Nate was creating his prototypes, Ben was also working on a prosthetic project as part of his Masters in Medical Device Design and Entrepreneurship at Imperial. The project was around high-end myoelectric prosthetic hands and he was noticing similar barriers for potential customers in accessing the technology, both in terms of affordability and ease-of-use. “I started wondering if there was a better way to make a difference. The innovative control technology our group patented was a great advancement towards intuitive prosthetic control, but the issues of affordability and accessibility remained,” he says. “These issues were very close to my heart because of a traumatic injury my sister suffered nearly 8 years ago. This injury took away her mobility and eventually led to a below-the-knee amputation. I really wanted to work on a prosthetic that could help as many people as possible. Mitt’s vision is to start with prosthetic hand designs, then move onto something that can help her one day, such as the swimming foot she’s requested.”

Having met through a mutual friend the two realised they had a very common interest. With the support of Imperial Enterprise Lab and the facilities of the Imperial College Advanced Hackspace they started working hard on perfecting not only the physical prosthetic but the means to make it accessible. “It’s a flexible sleeve that you can order pretty much like a pair of shoes,” says Nate. “So you send off your measurements and you get it in your size and you can adjust it to fit you. No need to arrange lots of appointments and no need to spend hours learning how to use it. It comes back to what everyone tells us is important: comfort, simplicity and affordability.”

“And with affordability comes accessibility,” adds Ben. “For the first time ever, we’ve designed a prosthetic that can be sent directly to the consumer.”

The extended team

The company has won a number of awards and competitions and, at one point last year, there were doing five pitches in one week. Most recently they won the Launchpad competition and an Enterprise Fellowship from the Royal Academy of Engineering.  Their first round of seed funding closed in March 2019 and they are now growing the team, recruiting a Design Engineer and a Business Development Manager.

With a future team of four, and a supporting cast of talented interns, Mitt sees itself as being nested within a much larger support system. Whilst part of the Imperial Hackspace they met their chairman Nicholas Mellor, a social entrepreneur who has worked all around the world and who both Ben and Nate see as an inspirational and valuable mentor. “His ethos is what we want to base this company around,” says Ben. “Making an impact through our designs in a sustainable way and all over the world.”

In September 2018 they were part of the London & Partners Business Development Programme where they were connected with expert advisers to help in terms of planning, marketing and the product-market fit. “They were unbelievably generous with their time and their help” says Ben. In addition to one-to-one meetings Ben and Nate attended workshops with other companies on the programme. “Just sitting next to people in our exact shoes but from a completely different industry was really helpful,” says Nate.  “We could chat through issues, cross-pollinate ideas and learn from each others’ experiences.”

International connections

In October 2018 Ben attended BioJapan with the delegation led by MedCity under sponsorship from the Department for International Development. “I went to meet other entrepreneurs and scientists in the life sciences world,” says Ben. “It was a fantastic experience and I made some great connections within the MedCity delegation who all shared the same vision about spreading innovation and technology. I also learnt more about what Japan are doing in this field and how they, as a culture, think about prosthetics.”

The cultural aspect of prosthetics is an important consideration for Mitt who are intending to reach all the corners of their world with their product. They have also visited China and India to understand potential users and learn what they want from a prosthetic. “It’s important to understand the cultural nuances,” says Nate. “In each country we may need to redefine the problem and it’s not something you can do over emails or internet searches.”

Trialling the wearable prosthetic

Mitt have recently conducted a ten-person trial of their prosthetic. Participants provided their limb circumference and length online and received their prosthetic in the post. Having previously tested the functionality of the product, this trial was more about piloting whether it was possible to provide a prosthetic to a person without meeting them. “The feedback is fantastic,” says Nate. “The participants range from a two-year-old girl who is using her prosthetic for painting to a 46 year old man who is building a birdhouse. And all the changes people are suggesting are really minor.”

Alongside the qualitative feedback the trial is gathering data from standard clinical questionnaires. These are a necessity for the NHS and prosthetists to consider the product and, although the questionnaires are providing positive results, it’s clear from the participant feedback that they don’t really assess the relevant qualities in a prosthetic. “It’s tricky because, similar to the prosthetics themselves, these questionnaires were developed decades ago,” comments Nate. “People on the trial are telling us that what they evaluate isn’t important to their lives.”

“How do you measure the impact of helping a person to do something they’ve wanted to do for years rather than assessing a standard. A little boy wants to hold a star-wars laser in his hand but there is no clinical assessment that will capture what that means to that boy.”

Mitt are working with University of Edinburgh Lecturer and Surgeon Aidan Roche, a world-renowned prosthetics researcher, and Sam Bennett, an Oxford-based doctor,  to plan their user trials and evaluate the results. The group is developing new assessment questionnaires that ask a different style of questions than existing scorecards. “When we started this venture, as academics our first port of call was to look at scientific literature,” says Nate. “And looking back on it now, I think that might be why people are still designing prosthetics that don’t work for the user because they are relying on these assessments that are collecting limited data.”

“It’s tough,” adds Ben. “How do you measure the impact of helping a person to do something they’ve wanted to do for years rather than assessing a standard. A little boy wants to hold a star-wars laser in his hand but there is no clinical assessment that will capture what that means to that boy.”

London ecosystem and the future

At the start the team were using space and resources at the Imperial Hackspace in White City, and in March 2019, they moved down the road to the Ugli Campus. They clearly believe that London will continue to provide opportunities for them to develop, learn and grow. “I truly believe London is the best place in the world to be an entrepreneur,” says Ben who is originally from Canada. “The quality of investors, advisors, mentors and partners we have met in the last year, would have taken me 20 years to meet back home. The amount of high-end organisations, people, funding and offers to help, all in such close proximity – I can’t see it being matched anywhere else in the world right now.”

“Honing in even more, I love it here in White City,” says Nate. “There is a real buzz about the area with so many new buildings and companies and so much investment going on.”

So far Mitt have not actively marketed their product and have worked with several charities to connect them to the limb different community, including the Douglas Bader Foundation, Blesma, Reach, Steel Bones and the Limbless Association.

“…I love it here in White City. There is a real buzz about the area with so many new buildings and companies and so much investment going on.”

The team are now collating the data from the trial and acting on the suggested changes. They’ve filed the patents for the device so that, once the adjustments have been made, they can start to scale-up manufacturing and set up a launch.

“No one has done direct to consumer prosthetics before so it’s important to keep the feedback channels open,” says Ben. “We’re planning on doing a number of sales batch trials in the autumn and to grow sustainably over the years. For me this is a lifetime commitment – I often echo my late grandfather’s words that ‘If you love what you do, it will never feel like work.’ I want to build a company that never feels like work for Nate, myself or any of our employees.”

Ben and Nate are both aware that they need to pace themselves although they are very keen to start manufacturing at scale and reach their customers. Even in the short time the company has been up and running, so much has happened that the two co-founders find it difficult to pick one defining moment in its development. Amongst the awards and the accolades, it seems that the feedback on their prosthetic still has the most lasting impression on them. “It’s amazing what people are sending to us from the trial and saying they can do with the prosthetic,” says Nate. “The messages, the paintings, the letters, the pictures and the videos – receiving those are such rewarding moments and everything else is working towards that.”