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
The Future of Prosthetics
Saturday, April 23, 2016
Saturday, April 16, 2016
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.
Friday, April 8, 2016
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!
Saturday, April 2, 2016
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.
Friday, March 25, 2016
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.
Friday, March 11, 2016
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!
Friday, March 4, 2016
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.
Sebastien Gilmour
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.
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/
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