Freedom Is Expensive

The Karlsruhe Trade Fair Centre consists of four 12,500-square-metre aircraft hangar-like structures connected by a façade of conference rooms, atriums and events halls, all glass walls and sterile and ready for the 300 various annual fairs, conferences, concerts, tech shows, seminars and symposiums that make use of its location, pretty much in the middle of Western Europe, not far from the France–Germany border. I’m standing in the central concourse that runs along the spine of the complex, amid coffee shops and beige-food outlets not yet open, looking at the list of exhibitors. I’m here for the biennial REHAB European trade fair – strapline: Rehabilitation | Therapy | Care | Inclusion; slogan: The Trade Fair for Improved Quality of Life. The website says there are 460 exhibitors, from twenty-one countries, and I will be one of about 18,500 visitors, 35 per cent of whom will be disabled or carers, while the rest will be specialist visitors, which I suppose means they work in the med-tech industry. The map I was handed on entry is in German and shows a sea of logos in boxes. There’s a thematic layout, but none of it means much to me, so I head into Halle 1.

Below the vast curved roof and the hanging lighting gantries strung with logos and signs is the gridded mini-city of exhibitors’ stands. I make my way down the first avenue, planning to do a quick circuit and get my bearings. Each stand is divided by temporary walls headed with logos and straplines. There are various sizes: some stands, for the larger companies, are imposing, with steps and stages and display cases with LED-lit matt grey devices inside – as if they have shipped a whole high-street shop and fitters to the fair; others, tucked away in the corners of the hall, are smaller market-like stalls.

I walk, pulling my wheelie case (I’m just off the flight). The hall is almost empty, the fair has only just opened its doors and some of the stands are still setting up – there’s a woman in an orange T-shirt on a stepladder tying a bunch of orange-logoed balloons to the top of her step-and-repeat backdrop. I walk past some of the bigger stands – an area of various high-end wheelchair companies; a couple of the big prosthetic companies I know; and another company that sells portable and ceiling-mounted patient hoists, next to one with what look like huge steam ovens for sterilising rehab aids in care homes – and head into an area of smaller stands. A unifier of almost all the stands seems to be one of those pod coffee machines, with a stack of cardboard coffee cups. I’ve already been offered two as I’ve lingered to look. They seem to have a dual purpose: to entice potential customers, and to get the exhibitors through the next few days.

I’m not sure which thematic area I’m in now, but I have a feeling it’s less expensive real estate. The stands are small, less branded. And it’s not so business-like here, more jovial, and the stallholders can’t slip into English as easily as the reps up near the entrance. Here there are herbal and homeopathic remedies; cloth-sewn neck-warmers, which I think go in the microwave; decorative personalised walking sticks; and accessible barge holidays. I stop and look at the model of the barge with a little doll in a wheelchair – another coffee offered, and leaflets pressed on me. Further on there’s a stall selling a variety of children’s puppets; a wall of fuzzy colour, with rehab and additional-needs literature on posters; and another that seems to be selling rubber overshoes. I get the impression many exhibitors are independent inventors or retirees with a little more time on their hands; they’ve brought their good ideas to market to shift some stock, or perhaps to get spotted by one of the giants who takes an interest – a buyout might follow.

Disability and invention have always gone hand-in-hand. There are examples that have changed the face of the prosthetics industry: James E. Hanger lost his leg to a cannonball early in the American Civil War. He returned home with the standard-issue peg-leg, which he hated, and knew (he had a background in engineering) there must be a better way. He spent the next ten years developing a prosthetic leg with hinges at the knee and ankle, and rubber buffers to keep the thing from making too much noise. By the end of the war there were around 45,000 amputees, and Hanger had factories manufacturing his legs for them. Now Hanger, Inc. is a multinational prosthetic and orthotics company, with 4,900 employees and a 20 per cent share of the US market, which is worth approximately $4.2 billion.

Physical impairment creates very practical problems, and if you’re the one living with the problem, you tend to spend a lot of your time working out how to overcome it. We all imagine a better life – for most of us, it’s aspirational daydreams or the lottery-win what-ifs – but with a disability, solutions that will improve quality of life can be very concrete. And often there seems to be a blatant gap in the market. As ever with successful inventions, it’s a marriage of technical knowledge, determination and an idea that has a wider benefit than for solely the specific individual who has been tinkering away in the garage. There are many examples.

I have a Bartlett Tendon Knee in a cupboard at home. Brian Bartlett was a member of the US Ski Team when he lost his leg in a traffic accident. Usual story: he was told he’d never ski again, so he invented a prosthetic knee that could support the user’s body weight during the high impact of extreme sports. The idea is ingenious. He used external rubber tendons that wrap over circular rollers at the knee joint, mimicking ligaments and muscles and letting an amputee ski or mountain-bike. Bartlett went on to partner with a prosthetic company and brought his idea to market.

In 1981 Dan Everard created the Yellow Peril, a little electric wheelchair (it looks like a miniature yellow forklift: big wheels in the front, castors at the back and a seat that can elevate or lower to the ground) for his daughter Ruth, who was diagnosed with muscular dystrophy. She started using the chair just before she was two. It gave her the independence to have almost all the crucial non-verbal developmental experiences that children only get through mobility – touching the radiator, for instance, and understanding it’s hot. It led to the not-for-profit Dragonmobility Ltd, which now makes elevating wheelchairs for all ages.

I know some of these inventors. A friend of mine, who was an engineer in the military and lost both legs in Afghanistan at a similar time to me, now has a PhD and works at Imperial College London, designing (among other things) a smart socket that can tell the user if their stump is too hot or under too much pressure; a leg in a box, for low- and middle-income countries; and an internal prosthetic knee that can be implanted into an amputee after injury.

And the man who fitted me for my first legs retrained as a prosthetist when he lost his foot in a motorcycle accident. All these people were taking a little control over their situation, trying to solve the problems that disability created in their daily lives.

I browse into an area of the fair where scores of mobility scooters are displayed on a huge round plinth, and beyond are all kinds of adapted and accessible vehicles: cars with clever driving aids and cantilever wheelchair lifts; vans with electronic ramps; and even a motorhome with a smaller run-around convertible car stowed inside its chassis. Next is a zone where all the stands are themed around virtual reality (VR). Two people are in a booth, sitting in chairs with headsets on and holding a games controller-type device and trying to manipulate something in whatever world they are in. One grunts in frustration, the other is smiling. They seem to be playing against each other. Ahead is a short queue; people are waiting to have a go on an exercise machine in which you VR-fly while lying on a tilting frame. I join the back – there’s a teenager on the machine at the moment, his VR goggles peering around blindly. His shorts keep falling down, and his embarrassed mother tells his laughing brother to reach in and pull them up.

Virtual reality is now used across medicine. Multisensory and three-dimensional simulated environments become a place where young doctors and healthcare professionals can train without being a burden on the healthcare system. In the past, trainee surgeons needed time-consuming hands-on experience under the supervision of senior surgeons. But in VR environments their performance can be recorded, data collected and compared, and new methods and instruments such as robotics can be trained on; and, critically, trainees learn by doing before actually doing. There are disadvantages: VR is initially expensive, it reduces real human connection and it’s consequence-free, so there is always the risk that medics might carry the cavalier approaches they have learnt virtually into the real world. But for repetitive diagnostic procedures such as colonoscopies and endoscopies, for learning anatomy and for mocking up real-world emergency situations for paramedics, and virtual sessions for GPs, it’s a powerful tool.

VR has clear benefits in rehabilitation, where recovery is often goal-orientated and requires people to be motivated and perform tedious and repetitive movements. Making people stick with their programme of exercises is difficult, especially when they leave the watchful eye of a therapist (I always lied to my physio about how much I did). VR games that encourage the patient to perform movements are becoming more immersive. Playing a VR game with the challenge of completing increasingly difficult tasks by twisting and moving a joystick or wand, or through whole-body movements in front of motion-capture programs, strengthens and increases range, improves function and keeps patients interested.

When I get to the front of the queue, I’m given some brief instructions from the marketing rep (tight, branded T-shirt tucked into chinos) and climb onto the rig. I’m sort of lying spreadeagled on it, with my legs in stirrups behind me and holding two handles in front of me – I suppose in the position you’d be in if you were holding on to the neck of a giant bird in flight. The whole thing is very unstable and pivots and rocks on a number of different sliding rollers. I find a shaky balance and lower the VR headset over my eyes. I’m high above alpine mountains in the summer, with pine forests and lakes below, flying towards a glowing green ring, with a score hovering ahead. It’s approaching quickly now and I’m not going to make it through, and I over-correct and the whole thing wobbles and clunks and I veer widely up into the sky. I find the centre again and can feel my core engaging and beginning to ache. I fly through a ring, just make it over a rocky ridge and dive onto a line of rings in the valley ahead. My score counts up. My core is really burning now. I also have a feeling that one of the reps is steadying the machine to give me a hand. After flying down a valley, trying to get through as many rings as possible, I clamber down and thank him. I’d used rudimentary VR rehab programs before – slab graphics and simple tasks, stacking coloured blocks or squeezing and twisting a joystick to make a car turn. This was different. Not only were my abs aching (and would be for the next few days), but it was fun. Escapism can be hard to find if you’re disabled. It did feel, for a moment, like I’d left Halle 1.

I exit into the open air, cross an asphalt courtyard where a couple of people are testing out three-wheeled electric trikes and enter Halle 2. More of the same – every imaginable disability aid. I pass a stall of attachments that motorise wheelchairs: a large off-road tyre and handlebars, which you bolt on the front of the chair, is the flagship product. Behind this is a queue of people waiting to try out a futuristic wheelchair. I watch one pink-haired woman waiting in her battered, boxy electric wheelchair, covered in rock-concert stickers with square battery and exposed wires all slung underneath. Her friend helps her transfer across. The old chair was an extension of her goth style and she looks out of place in this shiny machine – it’s two-wheeled and gyroscopically stabilised. There’s something magic in the way it stays upright (a bit like a Segway but stranger, because the centre of gravity is so high), and it wouldn’t be out of place gliding into a scene of Star Trek. The marketing rep (branded hoodie this time) shows the woman the controls and she grasps the control stick and moves the chair out into the crowds. The machine leans her forward and accelerates with all the smoothness and whirring of new electric vehicles, and the rep jogs after her, one hand out, ready to grab the top of the seat if she gets it wrong.

There are bar stools around a pod with questionnaires, and I take a seat to watch. As the woman returns, her pink fringe flutters on her forehead. She is genuinely beaming. The rep shows her another feature, and a pair of caterpillar tracks lower from the chair’s undercarriage and it climbs backwards up a short flight of demonstration steps – it seems stable enough, but the woman is nervous; it does look precarious, but the rep gives the machine a push to demonstrate how solid it is, which makes her shriek. When she descends, the rep shows her another function and the chair deploys two pilot wheels behind, which – in tandem with the caterpillar tracks – create a lifting triangle, and she rises until she is at the same height as her friend and they are both laughing.

In my ten-year experience of disability there have been a handful of things that have been truly life-changing: my microprocessor knee; learning to drive again; my kayak; and my electric Swifty scooter. These are all items that have given me back my freedom. Not only that, but they were all paid for by the NHS, or applied for through charities. I can’t really ride a bike any more (the Bartlett Tendon Knee was okay for a bit, but, with two legs missing, it just wasn’t practical), but Swifty means I have personal electric mobility, can keep up with my daughter on her bike and can commute without relying on a car. It is wind-in-the-hair freedom. Personal electric mobility seems to be here to stay (for everyone, not just the disabled), with scooter rental companies already changing the environment of big cities, and more commuters opting for them.

The woman is back in her own chair now. It suits her better; there’s something about the sleek grey and LED lights of the new wheelchair that is slightly over the top. She is talking to the rep. I imagine they are discussing cost and timelines. (I look them up later: around €30,000 – which, given the price of my prosthetic legs, seems good value – and a year-long waiting list.) Then her friend is writing on a clipboard, presumably the woman’s email address. I wonder what sacrifices she’ll have to make to afford it. And I suppose she’ll choose black and turn the lights off, and cover it in stickers, and it will suit her too.

The next day I return to the fair. It’s noisier. If Friday was for the marketing-rep catch-ups and inter-industry conversations, today (Saturday) is for the people. All the food and drink outlets are open, and the place is packed. I pass a game of wheelchair rugby in the foyer and join the sea of atypical bodies propelled by every kind of mobility device, prosthetics and orthotics, and parents pushing their children with multiple severe disabilities, flowing between stands, all searching for the latest gadget that will make their lives a little easier. I notice people are carrying red branded buckets, using them as receptacles for marketing material handed out at stands and by students clad in the branded liveries – pens and pencil cases, leaflets and brochures. And keyrings are popular; there’s also a mug and a small soft toy that seem particularly prized by two young girls comparing their hauls.

A few World Health Organization facts: worldwide about fifteen people in every 100 have a disability, and between two and four people in every 100 are severely disabled; there are 500,000 spinal injuries each year, and sixty-five million wheelchair users (and between ten and twenty million people need a wheelchair but cannot afford one); in the next thirty years the number of people over the age of eighty is set to almost quadruple, to 395 million; and in Europe there are currently forty million people who cannot walk without some sort of mobility aid. It’s a large market.

The European medical technology industry (devices, diagnostics and digital products, or solutions used to save and improve people’s lives) represents a €120 billion market. It files around 14,000 new patents a year, the second highest of all sectors behind digital communications. It employs 730,000 people – Germany has the most, at 227,000 (twenty-eight per 100,000), making Karlsruhe a good home for this trade show (although Ireland has the most per capita, at eighty-three per 100,000). It’s an industry that has an important economic and societal impact and it is, of course, a competitive market.

The REHAB fair isn’t as garish as some marketing environments, not so aggressive, but it still plays on our aspirations. There are posters of beautiful people with their mobility aids in beautiful settings under slogans: It’s time for boundless freedom; LIFE WITHOUT LIMITATIONS; It’s not just walking – it’s More Than Walking. The market forces of capitalism are in play, and they are after us: the limping, wheeling, blind, deaf customers who have come to find out which of the latest products will make our lives easier. As you’d expect, some of this tech is mind-blowingly expensive – someone has to pay for all those clever scientists and all this branding.

And there’s inequality here too, of course. Some of the people moving around the maze of stalls will have had insurance payments of millions of euros – the motorcyclist knocked off a bike; the worker caught in an industrial accident; or the child starved of oxygen by a negligent hospital. Many will have fought through the courts, waiting years for payouts. But even millions of euros only go so far, when spread over a lifetime. Very few of the people at this fair won’t have to weigh up carefully whether the benefit of a new assistive technology is worth the outlay; whether to wait for the next generation of device or make do with what they’ve already got. Then there are the unknowns, hidden behind the slogans. What if it doesn’t quite do what it promises or needs replacing soon; how long is the warranty; and what if my very specific disability isn’t quite catered for? But what price do you put on being able to walk, or get upstairs in your home, or read the paper, or drive a car? Imagine that you had never been able to go to the beach, or for a walk through the woods, but a new wheelchair might offer you the chance.

I’m sure there will be some people who haven’t even shown up, even though they have dreamt of it. They are the ones who slip through the gaps and have little support, left to struggle on because their disability was congenital, or misunderstood, or no one was to blame for their accident. Add other structural inequalities – poverty, age, race, being a woman, being unemployed, doing badly at school – which all mean you’re more likely to be disabled. And there are those too proud, or unable, to ask for help from charities and support groups; they are the people who will never be able to afford some of this kit.

This huge fair is a shop front. It also represents the fact that there’s a hidden tax on being disabled. Being a hybrid human means expensive kit – you have to pay for the privilege of leading a normal life.

Ahead is the Ottobock stand. It’s one of the big ones and has the feel of a luxury sports shop. It’s the company that makes my bionic prosthetic knee, among many other medtech devices and services, and is valued at $3.5 billion – the Apple or Microsoft of prosthetics companies. There it is, uplit on a plinth, one of their flagship products, with the poster behind: Reclaim all you want to be. The strapline trying to sell a dream – and I know, even though it is the best prosthetic knee out there, reclaiming all I want to be is an un-keepable promise, tinged with a little of the hollowness of so much branding. But Reclaim all you want to be within the current constraints of technology, and at a practical price point wouldn’t have flown in the marketing meeting.

And yet, for all the inequality and spin, I have the feeling there’s goodwill and altruism behind the transactions going on here. So many of the companies represented are not-for-profits, and even in the big stalls like this one, where the marketing is slick and flashy, there’s more than simply hard-nosed business. So many of the scientists I’ve met described the personal motivation for what they were doing – a disabled relative or childhood friend – and it’s the same among the reps and company management. Fundamentally, it’s about making people’s lives better. Maybe it is about as noble an industry as you can get.

Across the stage, two models are chatting. They have seen me looking at my knee on display and wave and give a thumbs-up. They are tall and good-looking. Her prosthetic leg is remarkably eye-catching, between the high-heeled ankle boots and black leather miniskirt. He is a muscled hipster with a trimmed beard, shaved head and wearing shorts, and there is a certain sexiness to the prosthetic alongside his tattooed leg. I smile and wave back.

I’m not suggesting that everyone is going to want to head to their next national disability and assistive-tech fair – it’s no Geneva Motor Show – but there is some amazing kit on display, and it’s kit we’re all far more likely to use in our lifetimes than a supercar (by some estimates, we’re all likely to spend around 20 per cent of our lifetimes with a disability). It’s not much of a leap to think that the exoskeleton I’m now standing in front of, at the next stand, will be the mobility scooter of the next 100 years. And perhaps if more of us knew about the technology on offer we might be better at adopting it when our bodies start to deteriorate and need assistance.

The main reason to I travelled to Karlsruhe is taking place in a football pitch-sized area in the corner of Halle 2. As I approach I can see through the balloons and stand logos a huge suspended LCD screen playing a slick montage, and I start to notice looping, propulsive Hans Zimmer-esque music over the noise of the crowds. The Cybathlon is a sort of mash-up of Formula One, the Paralympics and a series of elaborate party games. It was set up by Robert Riener, a Swiss professor of sensory-motor systems, to break down barriers between the disabled, the public and the assistive-technology developers, with the goal of better integrating disabled people into society. It’s essentially a sports day – a hybrid Olympics – where med-tech companies and university bioengineering departments can gather to test their latest ideas and devices against each other. The competition is fun and creates a spectacle, but it’s mostly about collaboration, exposure, research and, critically, ensuring that people with disability are in proper dialogue with those who develop the assistive devices they use.

The first Cybathlon took place in 2016 in Switzerland in an adapted athletics arena. The packed-out audience watched sixty-six teams from twenty-five countries take part in the six different disciplines: exoskeleton race, arm-prosthesis race, leg-prosthesis race, brain–computer interface race, powered wheelchair race and functional electrical-stimulation bike race. Here in Karlsruhe we’re between full Cybathlons (like the Olympics, it’s a four-yearly event), so only the arm-prosthesis and leg-prosthesis races are being showcased. It’s a sort of travelling qualifying series, set up to promote the event and drive scientific exchange between teams – this time making use of the REHAB trade show as a venue.

Right now the leg-prosthesis race is about to start, and the two pilots (the term used for the disabled competitors) are being interviewed at the start of the track. A presenter holds a microphone up to them and asks questions, and it’s beamed onto the huge LCD screen above us. There are a few people watching, having drifted over from the stands to see what’s happening, sipping beers in plastic cups and eating huge pretzels. Then the presenter and cameraman are out of the way, and a graphic fizzes across the screen, counting the pilots down with a percussive heartbeat sound effect: 3-2-1 GO. They race down two parallel tracks with a series of obstacles in the way. It’s not exactly high-octane. Before they can get up a head of steam, they have to sit and stand, holding a plate and cutlery; then they step over a series of hurdles balancing two apples on plates – the nearest pilot drops one and it rolls away and he’s back to retry the obstacle; then it’s carrying a crate and ball over some steps; after that it’s across a cambered slope, carrying more apples. Green flags are lifted, with that extremely snappy action they use in all sports, every time they complete an obstacle. A red flag goes up if the pilots make an infringement or rely on their good legs when they should be using their prosthetic ones. One of the pilots has the same leg as me, while the other has an Össur Power Knee. It’s the Real Madrid v. Barcelona of prosthetic races.

I lean on the blue-logoed hoardings – CYBATHLON | MOVING PEOPLE AND TECHNOLOGY – that run the length of the 50-metre or so course and watch them pass. At first glance (and I imagine to most of the able-bodied spectators) it looks like a glorified egg-and-spoon race and lacks the athletic speed, grace and gritty competitiveness of the kind we’re used to in good sports entertainment. But as someone who uses a prosthetic leg, I can see how difficult the tasks would be: stepping a prosthetic through the hurdles while at the same time balancing apples on a plate; walking along a cambered slope; standing from a chair without pushing up with your hands – all very hard to do quickly and without dropping what you’re carrying. I can see the determination and human skill.

But if you don’t know this, or don’t look hard enough for it, it all seems a bit laboured, and you’d be sipping your beer and eating your pretzel wondering when something exciting was going to happen. No one cheers at the sublime, imperceptible movement the pilot has just made in their thigh to engage the algorithm that makes their prosthetic step over a hurdle, all while balancing on the other leg and holding a plate with two plastic apples – it goes unnoticed. But I can see it, and I know that I’d have fallen over and the apples would be on the floor; I know it is a skill-move comparable to an overhead kick, or a backhand topspin lob, or a fourth-down no-look pass.

I’d heard Robert Riener speak. He said he set up the Cybathlon for lots of very marketable reasons, but he had other less obvious ambitions: showing what our taxes and research-and-development grants pay for; trying to help med-tech companies bring their product to market; and, one of the most important reasons for him, showing people the reality: that we’re a long way from the dreams of science fiction. People’s expectations are distorted by popular culture. When you see Iron Man or the Terminator or Luke Sky-walker in the movies, you start to think prosthetic devices can outperform our human biology. I’m often stopped by people in the street and asked how high I can jump, or if I can run faster now I have prosthetics – and I have to tell them I can’t jump or run at all in these legs, and they look confused and disappointed, and I feel I’ve let them down. And watching the two pilots painstakingly make their way down the course is underwhelming to the untrained eye – these are two of the best microprocessor knees around, but they still have a very long way to go before they equal the performance of the average human limb, let alone the fantasies of science fiction. But look closer, understand a few of the developments that have been required to get even this far, and you see that the technology that is letting the pilots do this is astonishing; it’s come a long way already.

The race is over, and up on the big screen the winner is being interviewed and I walk towards one of the food outlets. I grab a beer and sit near the start. On the course they are changing over the tasks, ready for the upper-limb race, and there’s a lull. A man starts limbering up next to me, like a 100-metre runner, rolling his shoulder and doing little vertical jumps from his ankles. He seems nervous.

‘Good luck,’ I say.

He’s called Bert and is one of the pilots up next. He has a Touch Bionics i-limb. Bert is Dutch and tells me he’s been practising in his garage.

‘I’d never unscrew a light bulb with my prosthetic – I’d just use my real hand – so I’ve been practising, you know.’

I ask him what it’s like being an ambassador. He tells me how great it was being at the first Cybathlon in 2016 – life-changing; the travel can be good too, and he likes trying out the latest kit and software upgrades: it makes him feel useful, and part of it.

‘You should try it,’ he says.

We talk some more, then he is called over to the start and is enlarged, up on the big screen, being interviewed.

Much like the leg race, the arm race is a series of tasks – and for the prosthetic hands the tasks are far more intricate. First is a table with different objects. The pilots have to cut a loaf of bread (foam), unwrap a chocolate, open a bottle, jam-jar and tin can, then take a match out of a box and light a candle; then it’s on to a washing line, where they have to put on and zip up a hoodie, then do up two buttons on a shirt. Bert is struggling with the buttons, and I notice the other pilot is using her teeth to help, which surely isn’t allowed. Bert said there was a risk for companies putting their products on display like this, testing them against the competition in front of the public. It shows their limitations. I hadn’t thought about it like that – I suppose, if I was in the market for a new prosthetic, I might come and watch how they performed against each other.

Bert is catching up on the laces task: he has to tie two shoes together and then hang them over the washing line. It is amazing watching the bionic fingers pinch the lace. Then he has to put a variety of objects into holes: a USB stick, a key. He’s now concentrating very hard, crouched down, making the fingers close onto a credit card, which he has slid to the edge of a desk. There’s something slightly painful about watching someone struggling to pick up a credit card when you know they could simply use their biological hand in a single motion and push it into the slot. Bert’s getting flustered now, obviously trying to tense the muscles in his stump next to sensors that activate the prosthetic fingers to close slowly around the card, and the seconds are counting up. It’s a reminder of why, because of the training and cognitive effort of operating them, around 50 per cent of people abandon these bionic hands.

He’s on the hammer-and-nail task now, then manages to screw in the light bulb before cutting a sheet of paper with movements of the limb that seem almost magically human – he’s into his stride again. Then there are six boxes. He has to reach in and identify by ‘feeling’ with his prosthetic (and no visual cues) what is inside, before placing six corresponding objects on top of the boxes: a ball, a block, a piece of foam, and so on. I notice the other pilot is banging the object against the inside of the box to get an audible clue – again surely not in the spirit. There are a few cheers at the green flags each time the pilots get one right. And then there is one of those ring-and-buzz wire games.

I’m not sure if Bert won or not; there were green and red flags going up on both sides of the course. It doesn’t seem to matter. When he is interviewed afterwards, I’m surprised to see him crying. He can hardly answer the questions, he is so choked up. The camera zooms in so that Halle 2 has a close-up of the emotion on the big screen. It obviously meant a lot to him.

Later, at the prize-giving, Bert punches both biological and bionic hands into the air in triumph, as he jumps onto the third step of the podium. He kisses his medal; it’s as if he has won the Olympics, and there are a few whoops from those still watching.