Tuesday, March 25, 2025
A $426,000 federal grant recently awarded to The University of North Texas Health Science Center at Fort Worth will fund a groundbreaking study on the bioethical challenges surrounding bionic
and robotic prostheses.
The grant from the National Institutes of Health (NIH) will allow Graci Finco, a UNTHSC assistant professor who holds joints appointments in the Department of Physical Therapy and the Center for Anatomical Sciences, to conduct the study to capture the perspectives of people with limb loss, clinicians and policymakers.
“Prosthetic technology is often developed without meaningful input from the people who actually use it,” Finco said. “We want to ensure that future advancements are not only innovative but also practical, accessible and aligned with the users’ needs.”
With the number of amputations expected to double by 2050, the demand for prosthetic devices is rising. While technological advancements have propelled the field forward, bioethical concerns — such as equitable access, insurance reimbursements and user involvement in development — remain largely unaddressed, Finco said.
Finco identified the R21 grant opportunity and strategically assembled an expert team to co-author a an article on bioethical issues in prosthetic development. This article, which garnered significant attention in the field, served as a foundational step to strengthen the R21 application. Building on this work, Finco’s research will involve interviews with individuals across the United States, particularly from underserved and underrepresented communities, to develop a decisional support document to guide researchers, manufacturers and funding agencies.
Cody McDonald, a collaborator from the University of Washington, emphasized the importance of the study.
“This work is crucial for shaping policies that will determine who gets access to cutting-edge prosthetic technology and how it’s integrated into clinical practice,” McDonald said. “Bioethical considerations should not be an afterthought. They need to be part of the conversation from the start.”
Finco and McDonald are among the few individuals in the country who hold a Ph.D. in their respective fields while also being certified prosthetists and orthotists. This dual expertise allows them to offer unique insights from both patient care and research perspectives.
Despite growing investment in bionic prostheses, the adoption rate has remained stagnant. Research on upper-limb prosthetic users from two decades ago identified key user needs, yet a recent update found those needs unchanged. This underscores a persistent disconnect between technological innovation and real-world usability.
“A lot of engineering goes into prosthetics, and that’s what gets attention in the media,” Finco said. “But from a clinical perspective, these are often not devices that insurance covers, and many don’t even make it to market in a way that serves the population that needs them most.”
Dr. Graci Finco, PhD, CPO, is an Assistant Professor, with dual appointments in the UNTHSC Department of Physical Therapy (College of Health Professions) and Center for Anatomical Sciences (College of Biomedical and Translational Sciences). Dr. Finco also directs the Limb Loss and Difference Lab.
Finco’s study will employ qualitative research methods, including structured interviews, to uncover widespread concerns among key stakeholders. The insights gathered will inform the creation of a decisional support document designed to guide ethical research and policy development in the field.
The project’s far-reaching collaborations include experts from Baylor College of Medicine, Northwestern University and the Amputee Coalition, among others. While data collection will be centralized at UNTHSC, Finco has assembled a multidisciplinary team of ethicists, clinicians and engineers to contribute expertise.
“The goal is to create a tool that ensures people with limb loss are part of the conversation from the outset,” Finco said. “Nothing about us without us — that’s the guiding principle.”
Finco’s R21 grant is a type of NIH research funding that supports early-stage, high-impact projects. The awards are designed for exploratory studies, pilot projects or new research ideas that may not yet have extensive preliminary data but show strong potential.
NIH R21 grants are highly competitive, with only about 14% of applications receiving funding. The findings from this study could help shape the future of prosthetic research and development, ultimately improving quality of life for those who rely on these devices.
“This research has the potential to influence how prosthetic technology is designed and implemented for decades to come,” McDonald said. “By prioritizing ethical considerations now, we can help ensure that future advancements serve those who need them most.”
The grant’s award number is R21EB036447. The content of this release is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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