Week 10: The Presentation

Back again! As these ten weeks come to a close, I wanted to thank you all for following me on this experience. I've attached my final presentation, which I will be presenting in May as a way of showing all that I have learned through my internship.

https://docs.google.com/presentation/d/1bKXeLtcUFQAzZ3TSWIk0blv_HkIphCn8NMDks7c9qZA/edit#slide=id.p6

Week 9: Carbon, Carbon, and more Carbon

This week has been insanely busy, all the while quite monotonous. I flew back from Boston late Monday night, only to start back working the following morning. This week has been hectic although in a different type of way. The actual patient work and fabrication was extremely slow, that is until one of Dean’s associates brought us 10 castings from the Clinic in Mexico which needed to be laminated by next week! And so it began, we had to make and fully assemble 10 prosthetics (8 lower limb, 2 upper limb) within the next two weeks while keeping up with normal fabrication duties. These however are not your normal prosthetics, we must take every precaution and attempt to foresee any problem (then fix it) before they leave to Mexico again. There is very little room for error or adjustment as after Dean leaves the leg with them, he will no longer see them for a few months. Another difference to how things are normally run is that all of these sockets are created using carbon fiber which is usually only used for a final socket (after several plastic test versions). The Carbon fiber process itself takes a significantly longer time to make the prosthetic than the plastic preliminary prosthetic.

I previously went into some detail about the process so I will not go too deeply into what you must do to transform the carbon fiber filament into a hardened shell. I thought it may be interesting to see a step by step version of how the socket is created using carbon fiber. Below are a series of pictures depicting the steps involved.

I wanted to update everyone on the 3D scanner as well as the Foot Scanner. Firstly the good news! The foot scans have been very clear and the products created are of very high quality. Since we talked last we have had several foot orthotics come in and all of which have been a success. On a more disappointing note, the software required that allows use of the 3D scanner must be downloaded yet none of the office computers are able to run it. 

Until next week!

Week 8: An Itchy Experience

This week had a few interesting experiences that I would love to share! I had my first real experience with carbon fiber sockets and I even got to work on an i-Limb device. This week began quite slow as the fabrication shop was caught up with orders, this was until we had to fabricate the final version of a patient’s socket (using the carbon fiber rather than plastic). I was closely super-vised yet allowed to cut and remove the carbon fiber after the resin hardened the microfilaments. I was definitely in for a surprise as I cut into the carbon fiber layer. Fun fact, when you cut into carbon fiber, small fibers fly into the air getting EVERYWHERE, they are also extremely itchy making the rest of the day quite uncomfortable. We had to wear masks and eye protection continuously using an industrial strength vacuum-cleaner suctioning above the cuts. Despite the precautions I was still very itchy after sawing it off of the plaster casting. I followed this specific patient through the whole process of the initial casting, to the filling, to the modifications, all the way to the final product which was amazing to see the difference from our first meeting to him walking out of the store.

Later in the week, we finally had the parts come in to fix that prosthetic arm I talked about several weeks ago. Thursday consisted of working with David, one of the lab technicians on calibrating and putting the device back together. You would think it’s quite simple enough to make a type of hinge elbow but it is actually very complex. Here are several pictures of that process, and an instruction manual picture of the joint itself. 

After fixing all of the missing parts we had to make adjustment after adjustment to allow for both flexion of the arm as well as the locking of the elbow to keep the arm in a certain position. Then comes setup of the myo-electrical system within the hollowed out arm that extends in this particular device to the shoulder. I was shocked at how much time goes into the setup of such a device!

Week 7: The 3D Alternative

For this blog post I would like to focus on the uses and practicality of 3D printing in the world of prosthetics. The development and commercialized use of 3D printing has been adapted to this extremely specified field. As the devices became more readily available, so did the accessibility for creators to make more specialized 3D prints.

The first 3D printed prosthetic hands came in a series of parts all combined together usually needing some construction to be used by the patient. Slowly but surely more and more progress has been made to make the hands both more functional and cheaper. A new type of blueprint no longer requires the assembly and makes such a device in a single part. This type of prosthetic can be created for approximately 400$ compared to the nearly 100,000$ price tag on an iLimb device. Using the nylon 3D material the hand is both much slimmer and lighter, also requiring no power it still allows him the ability to open and close his fingers with the movement of his wrist. With the increasing public designs out on the internet there are even adaptations for such a prosthetic which can allow different movements of the fingers allowing the user to adapt to hold specific types of tools (the ability to hold a guitar, a violin, a hammer etc.).

While less sleek and functional than the iLimb device they can have huge benefits for those who are unable to afford such an expensive device. In areas of the world unable to access high-tech medical equipment these hands are another amazing option. They have so many benefits especially with children. Firstly, children are growing and are highly adaptable allowing them to pick up and use the movements much more effectively. Secondly, as they grow they are going to need different sizes of prosthetics to fit their larger limbs. The cheapness of the 3D printed hand allows just for that, even going through 10 different 3D printed hands is a fraction of the cost of the iLimb. As in all business, it will inevitably come down to demand. How many people need the device and what is the most cost-efficient way of satisfying that demand. And because the market is so small it is unlikely that the most advanced prosthetics will significantly reduce in price, pushing consumers toward the 3D alternative. 

Week 6: The Foot Scanner!

Hello again! This week was a bit different than previous weeks in that I worked less with the prosthetics and orthotics and essentially set up a new scanning system that will send the foot scans directly to an outside fabrication center that will create the foot orthotic for us. The medical equipment that we acquired needed some adjustments for it to fit the scanner and hold it for storage. This was my job for the day. I ended up spending hours taking apart the stand and modifying it so that it fit the scanner and would hold the scanner safely in transport. For the image below I essentially had to take apart everything below the monitor, pulling apart the electrical system then moving it away from the storage compartments (locking mechanism). I removed some of the shelving and the keyboard stand as neither was necessary for what we were using it for. I also had a new problem of metal support that go in the way (also no longer necessary because the storage was removed). I ended up having to take the whole section out and saw off parts, finally laying a sticky fabric so the scanner does not slide and 2 sets up straps to hold it down.

When finished with all of the setup, all of the staff came together and had an informational seminar/call with the makers of the scanner and the system to explain exactly how to work the system properly. Of course as the intern, I was chosen as the initial test subject. The scanner itself looks somewhat similar to the one below. After having my feet scanned we went through the whole process of designating the specific type of orthotics to be made.

Earlier in the week, not too much happened as one of the clinicians was down in Mexico working at a clinic. These types of clinics rely heavily on the unpaid volunteering of American clinicians to fit over 40 patients in only a few days. Without such specialized service work it would be almost impossible for patients in the poorest parts of Mexico to receive such prosthetics. 

We have been having trouble with getting the software for the 3D scanner to work on the computers in the office. Next week we are going to try re-downloading the programs to finally get that scanner working. That will be exciting because I will most likely be tasked with getting that working. 

Week 5: This Week's Experience

Hello once again!

This week was very hectic as I got my first chance to actually work on some orthotics and prosthetics. I made my first pair of sports orthotics from hardened plastic. First, I used the cast of the foot taken from the prior consultation holstering it to a post. Using the oven, you first heat the plastic so that is pliable. The plastic heated to 400 F is then draped over the molded foot, you must quickly tighten the plastic before it re-hardens to make a tight hold. You then blow air through to both cool and keep the plastic off of the mold. Finally you must cut it off of the mold with a type of saw that vibrates at a very high frequency. This cut out is then ground down until it is smoothed out and comfortable to be used as an insole. This particular insole also had a hole in the heel to provide relief so it was a little bit more complicated than the average one.

I was also allowed to work on one of the prosthetic sockets filling the socket with alginate first which provides a highly detailed copy of the original socket. Alginate is a type of gelatinous fluid that hardens in air after being in contact with water. It is often used in Hollywood masks because of the highly detailed copy that it can make. Even as the alginate has cured it is not really too hard, and is easily used to make another cast which we then manipulated. The main reason we did this was to have a copy of the previous hard plastic socket so that we could make a carbon fiber more permanent version. Because the sockets change size constantly it is easier initially to use plastic as the socket material then shift to the carbon fiber after several plastic sockets.

Overall it was a very eventful week! I learned from my mistakes and although it took me two attempts to properly lay the plastic on the molds, I was successful in making a pair of sports orthotics! Despite that I have seen some of the same patients as they have come in for new adjustments because of pain which limits their movement and then leave able to walk again with such minor adjustments.

I will see you next week! 

Week 4: Where Can Prosthetics Go??

Hello again!

For this post I hope to discuss the direction prosthetics are moving towards in the future.

Let’s begin with lower limb amputees. At McCleve, I learned of a new innovative operation not currently available within the United States but offered elsewhere known as direct skeletal fixation. This operation fuses a metal rod into the remaining bone fixing it in place as an elongation to replace the missing bone. The procedure allows for more realistic control and feeling of the leg as the prosthetic does not require a suction device to hold it in place. This type of procedure is only in research settings currently in the United States but can be done elsewhere. One such patient flew from the United States to Australia to undergo this operation. While increasing the chances of infection with such a foreign body, the benefits of a successful operation are well beyond that of conventional prosthetics. Another recent innovation in prosthetics comes with the Power Knee which allows patients to use stairs, having a more functional knee. Such a device has its limitations as it is quite bulky but can have such a huge impact allowing users to ascend and descend stairs which normal prosthetics are unable to do. 

The above images show both the X-ray view and the view post operation of the direct skeletal fixation procedure.

I had the opportunity to meet with an Ossur representative, one of the leading companies in prosthetic parts from silicon sleeves to power knees, learning about this new device. In addition I was also shown a new type of prosthetic foot which has a split toe to provide more range of motion and increased balance. Such a small change can have a huge impact on the functionality of the limb. In general, the industry is slowly improving, year after year increasing strength and movement of the device while decreasing the overall weight. 

One very new research project has been able to create a prosthetic leg that is controlled by neural impulses communicating with the leg’s computer. Rather than the myoelectric signals that are currently used in the iLimb device (in upper extremities) this type of leg relies solely on the nerve signals. Another kind of similar cutting-edge form of prosthetic comes in the form of targeted muscle reinnervation (TMR) surgery. By redirecting the amputated nerves elsewhere in the body with functional nerves one can allow the user to control the prosthetic with the activity readings of the redirected nerve. Because the nerve is intact the use of the nerve will cause the movement. Although only research stages such operations and devices could revolutionize the capabilities of prosthetic devices.

Above is an image of prosthetic leg controlled by neural impulses and what nerves it focuses on.

Until next week! 

Sebastien Gilmour 

Images retrieved from: 

http://www.amputeeimplantdevices.com/wp-content/uploads/2014/12/Standing-xray1-e1418430132653.jpg

https://blesma.org/media/231277/IMG_5343.jpg

http://www.proklinik.com.tr/en/prosthetics/lower-extremity/microprocessor-knees/power-knee/

http://www.wired.com/2013/10/is-this-brain-controlled-bionic-leg-the-future-of-prosthetics/

Week 3: The Business Side & Upcoming Weeks

After my first few weeks on site, I have learned much about the insurance side as well as the business side of the prosthetic/orthotic industry. I will be outlining both sides in this blog post.

Firstly the insurance side of both orthotics and prosthetics. The biggest problems for McCleve occur from the insurance side of this industry. As a small privately owned business, a large portion on the payment comes from the insurance like any medical facility. Every prosthetic and orthotic device provided to patients must go through a process to be confirmed by the insurance company. Often times the corporation does not want to pay out and will attempt to find loopholes and/or push for a very clearly written reasoning of why the device is necessary. Lacking a limb is not considered enough of a reason for an insurance company to pay for a prosthetic leg. One must show dedication and drive to walk again and clearly state why they need their lost limb. Because some patients are more active and require a different type of prosthetic device to allow for such high activity levels, insurance companies must be convinced that the individual will continue at such a level and will try to prevent paying the higher cost of the better prosthetic.

The biggest proportion of business comes not from walk-in appointments but from doctor referrals. To show doctors the newest devices and update them on different prosthetic and orthotic technology, companies will often have in-service presentations. Providing lunch and an informative presentation both improves ties with the people who will be sending them business and educates them of different devices that can be prescribed. While having a fully booked day, the clinicians must also be prepared to fit in patients who come in needing bracing.

I am also excited to announce that in the upcoming weeks I will be working with the clinicians to implement a new type of 3D imaging device that will be able to capture 3D images of the stumps of patients to provide a more precise cast (3D printed) to make the socket off of. Like any other industry, technology is currently advancing and changing the way things are done in the field. Implementation of such technology successfully will cut down the time it takes to create a cast as well as increasing the precision of the cast. I hope to show an example of this software and how it works in the near future.

Thank you for reading this week’s edition! I will see you next week! 

Week 2: My First Interaction with iLimb!

Hello once again!

After my second week on site, I have been lucky enough to see two rare iLimb devices. The prosthetic industry is dominated by lower extremity prosthetics because of the prevalence of diabetic amputations to lower limbs. Amputations are most commonly a last case scenario after diabetic sores develop then become infected with gangrene and the only option at that point is to remove the infected portion of the limb. Many patients even start with a below the knee amputation and must have further amputation (above the knee) because of more infection. Upper extremity devices make up a very small percentage of the prosthetic field.

On Tuesday of this week I was fortunate in that a Touch Bionics Sales Representative stopped by the office to show off the latest and greatest new devices. The newest prosthetic is called the iLimb Quantum. The difference between this form and the previous model is the newly added gyroscope feature which allows for more options for movement. The device works with the myoelectric signals that come from the muscles. For an above the elbow amputation specifically, the user is able to flex the bicep to perform the movement and flex the tricep muscle to release the movement. With a held flex, the digit will make a small twitch which tells the user that they are able to switch between the four hand functions which are picked up by the gyroscope. For movement in up, down, left, and right directions, a different hand function can be set using the phone application. It is astounding the quick response and movement that the new prosthetic hand offers. Even the hold strength has been quadrupled allowing the hand to bear a weight of approximately 200 pounds. 

Above is a representation of what the iLimb device looks like and the variability of the hand based upon your other hand's size. 

Although just a demo hand, I was able to see the functionality of the iLimb device and see the effectiveness of such a device. My second encounter came in the form of an arm which had been completely taken apart to add a design on the exterior of the socket. Unfortunately in doing so the user accidentally lost parts and needed the limb fixed. As a company that creates custom made prosthetics, one option for patients is to add a graphic. From sports teams to TV shows, people have a huge variability in what they want upon their prosthetic. A press is used to copy the printed image onto a t-shirt and from the t-shirt it is able to be used to make the image upon the device itself. 

That’s all for now, I’ll see you next week! 

My First Week!

Hello again!

On my first day of the internship, I was welcomed by the employees of McCleve Orthotics and Prosthetics and was immediately whisked off to the first patient consult this week. My first real experience with prosthetics came in the form of an above the knee amputation. I quickly learned the complexity that goes into each prosthetic device as they are custom made on site in the fabrication room (also known as the fab). This leg in particular had made use of the LimbLogic device, which allows for elevated vacuum of the stump, providing a more secure and comfortable prosthetic. The prosthetic itself is made up several parts: the foot, the pylon, the knee, and the socket. Such devices must be frequently adjusted as the size of the stump constantly shifts with the amount of swelling in the leg. To combat this, wearers are provided with variable socks to fill in the extra room while still maintaining the suction.

When working with prosthetics and orthotics, each patient is different and the specific needs of the patient must be met. As a company that creates both, the clientele is extremely varied. From sports injuries to amputations, the clinicians find ways to improve patient’s mobility.

I was astounded upon entrance of the fab to find the immense time and effort that goes into every device created. A simple shoe insert to provide more support can take over an hour of work! In prosthetics, the devices take a huge amount of time to create as they are a multi-step process. First the initial mold must be created from plaster much like that used on a cast. Then from here they fill this casting with a hard plaster to make a replica of the stump. The replica is then covered with a heated plastic (taken straight from the ovens) to provide a molding of the socket. This isn’t even the actual socket! The final socket is fabricated from carbon fiber filaments coated in resin upon the hard plastic covering!

One difference that makes McCleve special is the way that they cater to their patient’s needs. Often times, prosthetic patients find it difficult to reach the office, whether it be because transportation from home or admittance into hospital. Today was my first time leaving the office and visiting a patient in the hospital. It was an interesting change, suiting up in gown and gloves (to prevent infection), and meeting with a patient so soon after surgery.

My first week on site has been an amazing experience! In the next upcoming week, I will further my research and provide a more detailed discussion of the prosthetic devices themselves.

See you next week!

Sebastien 

Image Retrieved from McCleveop.com

Introduction

Hi and welcome to my blog!

My name is Sebastien Gilmour, and I am currently a senior at BASIS Scottsdale Charter School. I have been attending BASIS all the way from fifth grade and I am very excited to announce that I will be finishing up my final year’s third trimester with an independent senior research project. Over the course of ten weeks, I will be working at an internship for a minimum of 15 hours per week conducting research about an innovative prosthetic device called iLimb. After the ten week period of interning and researching for my topic, I will be presenting my thesis in a final presentation to the Senior Research Project Board.

I have been interested in neuroscience since tenth grade and I wanted to intern in something related to my intended major. I first learned of neuroprosthetic devices from the Nicolelis Lab’s pioneering research at Duke University. From my initial reading, I was intrigued at the research and the ability of these devices to be controlled by electric signals. This field fascinated me because of the potential of using this technology to make prosthetic devices controllable by the mind in a way mimicking organic materials.

With my internship at McCleve Orthotics and Prosthetics, I will have the opportunity to work at a company dedicated to helping amputees and other individuals improving their mobility and quality of life.  Beginning this research, I have no real experience in prosthetics themselves although I have worked in a hospital setting before (Clinical Studies Department at Mayo Clinic). 

Through this project, I hope to analyze the potential for transhuman movements (the idea that technology and drugs will alter the limits of human performance) to take to the mainstream in addition to the potential future of similar such technology. While talking about this subject in a social context, I will also be talking about the technology itself, explaining how the processes work.

Every week of this research project I will recount my research finding, and all of the experiences at my internship. By analyzing available data, and the use of first-hand experience, in regards to the accessibility, effectiveness, and design, I hope to answer “How effective the i-Limb device is to fully restoring one’s limb function.”

Here is a website link to my Internship Location Site: http://www.mccleveop.com/