In 2016, the Rye High School Volleyball Team raised money for the Given Limb by setting up a donations table at their home games. Team member Kaitlyn Rentala was instrumental in organizing the donations table and has gone on to help the foundation in other ways, such as helping to keep this website up to date!
For the second year, Given Limb funded a paratriathlon training camp program for veterans at Brooke Army Medical Center (BAMC). The 12 camp participants were supported by a number of individuals, including those from USATri and a local group, Britton’s TriForce. The Given Limb also supported a number of participants to travel from BAMC to Chicago for an additional program focused on race training.
A team led by Dr Arjan Buis, from the Department of Biomedical Engineering, University of Strathclyde, Glasgow, Scotland, has developed the innovative system, known as Majicast, to manufacture lower limb prosthetic sockets that fit prostheses securely to patients’ residual limbs.
To cast for a new prosthesis, the residual limbs of the amputee are immersed in a tank of water one at a time, with a membrane material wrapped around them. The person’s body weight is then used to load this – similar to loading a prosthesis during gait. This pressure casting deforms the soft tissue, under a uniform load. When a limb is subject to uniform external pressure, there will be an internal equilibrium pressure at which the soft tissue has maximum load-bearing function, and where internal shear stresses are minimized.
Using this casting method, the soft tissue is ideally positioned in its stiffest form for load transfer. This means vertical movement of the limb in the socket – or pistoning – is limited, reducing deep shear stresses and so shear and friction related problems that can cause soft tissue damage and discomfort.
“The method gives uniform loading to the soft tissue,” said Dr Buis. “Normally, taking moulds is done by hand and its success depends on the skill of the person making them. There are also no current socket fit criteria other than that the resulting socket must be comfortable and functional. For an engineer that isn’t very specific, and as a result, we developed a method of both surface and volume matching.”
“The Majicast is a straightforward, fully automated, easy-to-use device that will produce high quality prosthetic sockets,” he added. “The device has been scientifically tested and clinically validated; this method has also been shown to be more repeatable and consistent than traditional methods.”
As the technique does not require a great deal of skill from technicians, it will be easy to train local people to fit prosthetics – something that is important in low income countries where demand is high and money for this is scarce.
The academics are now working with members of Dutch-based social enterprise organization ProPortion to help people in Colombia, offering high-quality artificial legs to people who have lost limbs, often through injuries from landmines.
Google has promised to pour $20 million in funding in its non-profit Google.org to support nonprofits and charities using innovative technology to improve the lives of those with disabilities.
In a blog post written by Jacquelline Fuller, the Director of Google.org on Tuesday, the tech giant announced the launch of the Google Impact Challenge: Disabilities project. Google says the scheme is designed to support those living with disabilities, and in order to propel the development of technology which assists the disabled in their daily lives — such as high-tech prosthetics — the company plans to pour $20 million in funding research.
The Google Impact Challenge will seek out nonprofits and help them find new solutions to some serious “what ifs” for the disabled community, according to the blog post. The best of submitted ideas will be supported by the tech giant and given the chance to develop and scale up using the firm’s resources.
To kick off the open call for ideas, Google has awarded funding to two companies which focus on reducing the cost of prosthetic limbs and auditory therapy, which could eventually improve access to these technologies worldwide.
One of those, the Enable community, has been awarded $600,000 to further the cause of open-source, 3D printed limbs. While traditional prosthetics can cost thousands of dollars to fit, assemble and purchase, R&D in 3D printing has the potential to revolutionize the industry. As an example, last year 3D printed limbs were used to replace limbs lost by children caught in the Sudanese war for as little as $100. Google’s funding will be used by the community — which uses 3D printers to design, assemble and fit 3D prosthetics for free — to advance the development of open-source 3D-printed upper-limb prosthetics.
Previously, our website reported on a young man, Jack Reidy, 10 years old who received a Raptor, a 3-D printed hand, through the e-NABLE organization. Jack had seen the picture of a 3D printed hand in Parade magazine, that he even considered it.
The Reidys had been working with a prosthetist named Jeff Erenstone to help develop a special hockey glove, and it turned out that Erenstone was also involved in a group of volunteers who print plastic hands.
Eventually Jack was matched with a volunteer in Michigan named Bruce Chaput, who offered to print him a hand. James remembers it all being quite foreign to him. “He sent us a picture of the printer. It looked funky; I thought it was some old age kind of thing. Obviously it’s not.”
Chaput and Jack spent a lot of time talking about what colors he wanted his hand to be. “We spent way more time talking about the colors and the hand and whatnot than actually printing it,” Chaput said, laughing. Jack picked orange and black, the colors of the high school where his dad coaches hockey.
On Christmas Day, the hand arrived at Erenstone’s office. But it wasn’t exactly a Christmas miracle. When Erenstone opened the box, he immediately noticed a long crack in the hand. And when he picked it up things got worse. “It literally crumbled in my hand,” he said.
Recently there’s been a lot of hype surrounding the promise of 3D printed limbs. Everywhere from The New York Times to Popular Science to the Today Show has run stories on people all over the world printing hands. The narrative goes like this: Prosthetic hands are really expensive—a recent Uproxx documentary about 3D printed hands claimed that the average prosthetic on the market costs $60,000—while the 3D printed version cost far less, and can be fixed and replaced with a simple push of a button on a printer. Welcome to the future, the world in which the everyman can print his own arm, breaking free from the chains of debt-by-prosthetic.
But that’s not exactly a true story.
Last month, the American Orthotics and Prosthetics Association (AOPA) released a statement clarifying a few key points. The average upper extremity prosthesis does not cost anywhere near $40,000 to $80,000, as many of these accounts claim. It actually costs something like $1,500 to $8,000. The AOPA statement also pointed out that in many cases, the people printing hands are operating illegally. There are 15 states in which providing a prosthetic or orthotic device is illegal without a license. Prosthetists are trained medical professionals, with licenses that take years of education and apprenticeships. The people printing these arms have none of that, which can, in theory, become dangerous. These arms and hands they’re printing aren’t FDA tested, break easily, and should never be used to replace a prosthetic arm.
Of course, the reality of 3D printed prosthetics is somewhere in between the media hype and the concerns of prosthetists with an industry to protect. Prosthetics made by 3D printers can certainly help some people, especially children who are embarrassed of their missing limb. But it’s also important to remember that these are, for the most part, hands made out of thin layers of plastic, printed by volunteer hobbyists with no training.
Some organizations understand that. The group that Erenstone hooked the Reidys up with is one of them, called e-NABLE. e-NABLE is a community-based group that connects amputees with hobbyists who have 3D printers, and is a good example of an organization that understand the limits of their technology.
“We don’t even call these things prosthetics,” Jon Schull, the co-founder of e-NABLE, told me. Schull said they have turned away amputees asking for hands for tasks that they’re not capable of standing up to. “We had someone who used to ride a motorcycle, who wanted hands so he could ride his motorcycle again. He had big hopes for what this could do that we weren’t comfortable with. He was going to use it to operate heavy machinery that could injure himself and others.”
Despite that, Schull said that the group’s relationship with prosthetists is shaky. “Some of them are concerned that we’re undercutting their industry. Some of them understand that we’re opening up a new market.”
The AOPA statement came out of frustration from prosthetists that some 3D printing groups were promoting their work using inaccurate numbers. But Tom Fise, the executive director of AOPA, said that he’s not trying to discourage groups like e-NABLE from doing the work they do. “I think that everybody has to be moved by these stories, and by the light that advances in technology have brought into the lives of families and kids and all of that. I don’t want to ever diminish that.” But he also said that it’s important to keep kids safe too. “Overall, it’s a public safety kind of issue.”
Take Jack’s hand, for example. It was broken out of the box, and Erenstone spent Christmas Eve rushing to fix it the best he could. “I super-glued the thing back together as best I could. But I knew how easily it broke and I knew it wasn’t going to last.” When Jack came in the next day to get the hand fitted, it broke again. Erenstone was able to get it working, but it broke when Jack got home as well.
Chaput, the volunteer who made the hand, said it was the first he ever printed for someone (to become an e-NABLE printer, volunteers have to print and assemble a test hand, but this was his first that a human would use). Chaput is a chemical engineer by day, and like the rest of the e-NABLE printers, he does all this work for free. He thinks two things probably went wrong in the printing, and both are endemic to the way that 3D printing works.
You can think of 3D printing like a very precise hot glue gun that lays down thin layers of hot plastic. This means that the pieces that get printed are very strong in some ways, but weak in others. So if you pull up on the piece, pulling perpendicular the direction the layers were laid down, it can break. This is how the biggest crack in Jack’s hand formed. The other, smaller cracks were likely due to another common 3D printing challenge: temperature.
“You’re always battling the temperature,” Chaput said. “When you extrude, you want it to come out soft obviously, it has to leave the nozzle and bond, but then you want it to harden quickly. It’s the soft but hard concept that you’re always battling.” Chaput said that he thinks that Jack’s hand was made a little bit too cold, which caused cracks to form.
For Chaput, this whole thing was a learning experience. “Every time you make one it comes out better. And that’s the thing, that whole hand was only eight bucks worth of plastic, so making more of them is no big deal.”
When I asked him if he was worried about sending something that might be broken to a kid to use, something that a kid could get hurt using, he said he was. “That’s why I like having Jeff [Erenstone] there. Sending it out to a totally random person that you don’t know what they’re going to do with it, particularly when they have a really young kid—that is an unsettling thought.”
But many of the e-NABLE volunteers do just that—they mail the printed hand to the person who asked for it. In the vast majority of cases, that’s fine. Since most kids aren’t using them for sports or intense activity they’re not likely to hurt themselves. And e-NABLE is careful to explain to recipients what the hands are capable of. But not everyone is like e-NABLE. There are other groups and companies advertising 3D printing as a full replacement for a hand. And that’s where Erenstone and Fries start to get worried. “3D printing does not break physics,” said Erenstone. Plastic can only take so much.
Jack’s story has an interesting coda, one that points to the future of 3D printed prosthetic devices. After his first Raptor hand came out of the box broken, Erenstone decided he would make something else for him. Something better. So he teamed up with Steve Wood, an engineer based in the UK who had become involved in the e-NABLE community and whose designs Erenstone described to me as “brilliant” more than once. In 2013, Wood came across a material called Filaflex—a more flexible material than the usual hard plastic. He started playing around with it. “I created a hinge between two rigid parts, and that grew into a finger because a finger is full of three hinges, and the finger then developed into a hand because I needed something to connect the finger too.” Eventually he had something he called a “Flexy-Hand.”
That was what Erenstone wanted to give Jack—so he sent scans of Jack’s hand to Wood and asked if he could make him one. Not only did Wood make a Flexy-Hand for him, he also printed out a copy of Jack’s hand to test the device out on. He sent both to Erenstone, and in January the Reidy family gathered in Erenstone’s office, with Wood on video chat, to test out the hand.
Within a few minutes, Jack was picking up bottles, grasping cans, and even writing his name with his left hand—something he had never done before. “Think of the dexterity it takes to write your name. He’d never done that with his left hand before, because it wasn’t a possibility,” Erenstone said. Wood had never watched someone put on one of his devices for the first time. “He took to it like a fish to water,” Wood said.
But the Flexy-Hand isn’t quite the same as what the average e-NABLE volunteer is able to make. Wood is an engineer by training with years of experience in building and designing mechanical devices using special design software called CAD. “I’m sure I have a massive advantage in understanding CAD and having 28 years or so of engineering experience behind me. It must count for something.” And Filaflex isn’t easy to print, nor is it as cheap as the standard plastic. Not all 3D printers can handle the material, and it can be finicky.
Erenstone said that all told, including his time helping Jack fit the device, the Flexy-Hand probably costs $2,000. Compared to the standard 3D printed hand that’s a lot. But compared to a carbon fiber hand that might run something like $8,000, it’s not. And Erenstone said this was the first 3D printed prosthetic that he would be willing to put on a patient as a real prosthetic device.
But this is where the promising future of 3D printed hands probably lies. Not in the $30, volunteer-printed version, but in this middle ground where engineers and prosthetists work together to make something slightly cheaper than the average professionally made device.
Wood said he couldn’t make the hand without Erenstone’s help. “I can make custom designs made to measure all day long, but I’m not medically trained and I don’t have the qualifications for the fitting of prosthetics. This is I think where it becomes a good partnership between myself and Jeff.”
Jack has had his Flexy-Hand at home for about two months now. James said he was hesitant to use it at first since he didn’t want to break it like the earlier Raptor hand, but in the past few days Jack has started wearing it more. But even the fancy new hand doesn’t work for a lot of situations. On Thursday he tried the hand at hockey practice for the first time. It didn’t fit quite right in the glove, so he couldn’t use it. He also tried to shoot hoops with the hand, and he took it off pretty quickly. “With Jack it might have been different if he lost his hand after birth,” James said. “I think that he is so used to being without, especially with sports.”
Despite all the back and forth, James is hesitant to criticize the e-NABLE process. “I wouldn’t call them issues, since they’re just getting started,” he said. “It’s a great thing, but it’s not 100 percent functional for everything you do in life. I don’t want to knock it, it’s been great.”
Here’s how Schull thinks about 3D printed hands: “What I say these days is that these devices are compared favorably, especially by kids, to commercial prosthetics costing thousands or tens of thousands of dollars. They’re compared favorably. But, a 9-year-old will compare peanut butter very favorably to caviar. And indeed peanut butter is probably a better fit for that kid, but they’re just not the same.”
Rehabilitation experts at the University of Pittsburgh School of Medicine hope to one day give people with an arm amputation a prosthetic limb that not only moves like a natural one, but “feels” like it, too. They expect such sensation will improve dexterous control of the device and give users greater intuition about what they are doing with their prosthetic.
With funding from the Defense Advanced Research Projects Agency (DARPA)’s Hand Proprioception and Touch Interfaces (HAPTIX) program, Robert Gaunt, Ph.D., assistant professor, Department of Physical Medicine and Rehabilitation (PM&R), Pitt School of Medicine and a multidisciplinary research team from Pitt, West Virginia University and Ripple LLC will begin developing the technology with the aim of being able to test it in patients’ homes within four years.
“Advanced prosthetic limbs that behave like the hand and arm they are replacing have been an unrealized promise for many years largely because until recently, the technologies to really accomplish this goal simply haven’t been available,” Dr. Gaunt said. “To make the most of these new capabilities, we have to integrate the prosthetic into the remaining neural circuitry so the patient can use it like a regular hand that, for example, can pick up a pen, gently hold an egg or turn a stuck doorknob.”
In the 18-month, first phase of the project, the team will recruit five volunteers to try to demonstrate that stimulation of the sensory portion of the spinal cord nerves, which would normally innervate the hand and forearm, can cause the amputee to feel distinct sensations of touch and joint movement in the “phantom” hand and wrist.
They also plan to insert fine-wire electrodes into the forearm muscles of able-bodied volunteers to collect and interpret muscle signals to guide movement of a virtual prosthetic hand to control hand opening and closing, as well as thumb movement. Eventually, the team aims to devise a fully implantable system for home use.
OP Solutions Inc. has teamed up with the Amputee Coalition to launch Prosthetist Finder, an online directory that allows amputees to find their ideal prosthetist.
The new tool is currently featured on the Amputee Coalition’s website (see Given Limb’s Resources page for link) and gives users control to find prosthetists with specific qualities and characteristics. Selection data are based on location, hours of operation, credentials, and experience.
The NGO, Christian Blind Mission Canada, has received $90,000 through the Grand Challenges Canada fund, to support the creation of 3D prosthetics for children in the developing world.
“There are more than ten million people in the world with amputations, most of whom live in developing countries,” says Mitch Wilkie, director of international programs at Christian Blind Mission. “Around 300,000 of them are landmine survivors and this number is growing by about 26,000 people annually.”
Conventional prosthetic sockets for the remaining part of patients’ injured limbs are made using plaster-of-Paris molds, but these take up to a week to dry in the sun. Children also require at least two fittings a year — equivalent to around 25 prostheses over a lifetime — to adjust for body growth, making the process expensive for their families.
“We are confident that we can expedite this whole process with 3-D scanning and printing,” says Wilkie. The team hopes to produce prostheses in developing countries for around $250. At present, they cost up to $5,000 in developed countries. The 3D printing efforts will be first launched in Uganda.
Poverty is the dominant cause of amputation in Africa. It is also the factor that denies amputees the opportunity to get back on their feet. In Gambia, a country heavily affected by diabetes, a basic prosthetic leg costs around $530. When you consider that the average yearly wage is $380, it’s easy to understand how quickly lives can be robbed of mobility and movement. To make matters worse, in many African countries amputees suffer social stigma and exclusion for their predicament, as amputation is widely seen as divine judgment.
In the UK, over 5,000 prosthetic limbs are discarded every year, many of them in perfect condition. Once a prosthetic limb has been used or even tried on, it is considered by law a biohazard and cannot be redistributed in the EU. In many cases, organizations such as hospitals and nursing homes are forced pay to have prosthetic limbs disposed of.
Legs4Africa has stepped in to end this wasteful cycle and get the limbs to where they need to be. This year, Pall-Ex, the leading UK and European palletized freight network, is transporting 1000 prosthetic limbs to Gatwick Airport, where they will then be flown to hospital mobility departments in Gambia and Senegal.
Kevin Buchanan, group managing director of Pall-Ex, said: “It has been quite an ambitious project for the charity, particularly with the threat of Ebola affecting that area – but that’s more incentive to help in whatever way we can.”
Other companies involved in the project include builder Adrian Dale to provide pallets, DS Smith to provide packaging, and Ground Qube to supply the manpower.
For more information: http://legs4africa.org
Powered prostheses could improve ankle power, step-to-step transition and reduce metabolic demands over passive devices, according to a study recently published in Prosthetics and Orthotics International.
Researchers at the Brooke Army Medical Center used repeated measures to explore mechanical work during step-to-step transitions from a trailing prosthetic to the leading intact limb, steady state metabolic rate and ankle joint kinetics and kinematics.
Six patients using passive and powered ankle-foot prostheses and six able-bodied controls took part in the study. They walked at a standardized speed across level ground and up a 5-degree incline.
Findings showed that the powered prosthesis generated 63% greater trailing limb step-to-step transition work than the passive device during level walking. It also increased ankle power compared to the passive device. Metabolic rate was lower with the powered prosthesis during level walking, but not inclined walking, the study found.
These results could benefit further development and use of actively powered prosthetic devices in high-functioning individuals, according to the study.