Provision of 3D Printed Orthoses and Prostheses

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The American Academy of Orthotists and Prosthetists (AAOP) recently published a position statement as regards 3D printing. It is important to differentiate between the manufacture of devices and provision of these devices to patients. The AAOP believes that it is important to establish standards to assure the efficacy and safety for patients receiving these types of orthotic and prosthetic devices. There should be education essentials and credentialing for providers.

Mark Hopkins, CPO, PT, MBA and CEO of Dankmeyer, believes that the statement provides the proper context for our efforts in 3D printing and integration into O&P practice following the highest quality standards. It is paramount that we ensure the public that we are innovative AND committed to only the highest level of practice.

If you would like to read the statement, you can click here.

3D Printing Face Shield Parts

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Some members of the Dankmeyer team have joined a local effort to make parts for medical equipment! Face shields, like masks and other protective medical equipment, are essential for medical personnel to be safe while treating COVID-19 patients. 3D printing users all over the world have jumped in to design and then make various types of equipment or parts.

Dankmeyer has responded to a Baltimore company’s call to mobilize 3D printers in our area. Open Works is a local company forced to lay off some of its team, but is using remaining staff members and its equipment to make the face shields. You can read about this effort in this article by clicking here. Will Holman, Director of Open Works: “We have now signed up 260 volunteers with access to over 500 3D printers at home, at libraries, at schools and on military bases in the state of Maryland,” Holman said Monday. “They are going to start printing these parts and sending them to us.”

The collaborative work is being called “Makers Unite”, a Collaborative Emergency Response. Dankmeyer 3D printers are chugging away to produce the parts that the plastic face shield is connected to in order to secure the shield to the wearer’s head. 3D printing isn’t fast, but we hope that our contribution, in combination with many others, will make a difference.

What is 3D printing about in O&P?

The start of 3D printing
Most people think that 3D printing is relatively new. The truth is that it was started in 1980 when Hideo Kodama first described a layer by layer approach to manufacturing. About four years later a French team filed a patent for the stereolithography process (later to be re-named as 3D printing). They later abandoned their efforts, saying they just couldn’t find a viable market for this process. At about the same time, Chuck Hull filed his own patent for a stereolithography fabrication system. Through the ’80s, with much work and experimenting, 3D printing moved from its infancy and childhood to its adolescence. Though there are certainly others, three main printing methods have emerged: SLA - which uses a photo-sensitive liquid polymer; SLS - fuses material in a powder form; and FDM - deposits heated filament on a build plate to create objects layer by layer.

3D printing and prosthetics
One of the things that make 3D printing so appealing is the possibility to design, alter and customize objects. This has led to manufacturers using it to create prototypes in a much more efficient and timely manner. In the world of prosthetics almost everything is custom built for an individual patient - making 3D printing a very useful tool. 

In the last decade, groups like e-NABLE began creating, through open-source collaborations, hands for people who were missing fingers. This has sparked the hope for customizable, lower-cost prosthetic devices.

Often when a prosthetic leg is made, the patient wants a shape that resembles a real leg. This is most often done by encasing the metal tube that connects the foot to the rest of the socket with a foam material and sanding it to a leg shape. It can then be covered with a stocking or an artificial skin. This is known as a cosmetic cover. 3D printing has given rise to a market for personalized cosmetic covers for patients who aren’t as interested in natural-looking devices or really want to have an artistic way to express themselves.  

Dankmeyer’s involvement in 3D printing
Dankmeyer began their adventure in 3D printing in 2013 with the purchase of their first printer. Several people began the process of learning to design 3D objects as well as run the printer. That year also saw a number of staff members participated in an e-NABLE sponsored event where a number of pre-printed hands were assembled. 

The first real foray into creating a 3D device was for a patient who was less than pleased with the prospect of needing to wear a “traditional” prosthetic hand. We designed and produced a superhero hand for him.

The next hand we produced was for a baby born with a defect to his right hand. He was beginning to crawl and his parents thought it was important for him to become used to wearing a prosthetic early enough that it would just be normal as he grew up.

If you are interested in seeing a video we made as an introduction to 3D printing, just click on the video link below.

Lindale Middle School Hosts E-Nable Event

On April 22, 2017,  Kristen Beltran, Board Eligible Prosthetist Orthotist, and Art Ross, Fabrication Technician, attended the Anne Arundel County Schools E-Nable event at Lindale Middle School. For the Science, Technology, Engineering, and Mathematics (STEM) elementary and middle school students, this was a culminating event to showcase their efforts on a series of projects they worked on throughout the school year. These projects include biomimicry, film segments on various medical conditions, and writing children’s books about amputation.

At the end of March, STEM teachers came to the Dankmeyer office in Linthicum to see a prosthetic and orthotic practice in action, and to film our technicians at work. Chuck Poole, Fabrication Director, provided the teachers with some tools and various prosthetic parts to take back to their students.  This would allow the students to get up close and personal with the components. One of the teachers, Dan Fitzgerald, said that the students felt trusted and thought that it was a good experience for them to get exposure to the technology used to make prostheses. 

Left to Right - Brad Sweet (STEM program), Art Ross, Timm Green (STEM program), and Kristen Beltran holding student books.

At the E-Nable event on April 22, Kristen and Art spoke to the students about different types of prostheses and orthoses, shared their passion for their jobs, and showed how various upper and lower limb prostheses and orthoses work. Feedback from the students showed how excited they were about the hands-on work with the various types of tools and equipment.

The middle school students will provide Dankmeyer with the children’s stories they wrote on amputations. They want their stories to be shared with the community.  We hope to post some of these creative works soon.  

You can read about last year's event by checking on our Older News below.  If you are interested in knowing more about this program, or 3D printing please let us know!  Send an email to info@dankmeyer.com.

 

Tiny Hand from the 3D Printer

We have been working with various 3D print designs since we first acquired our first 3D printer in 2013.  In the beginning, we printed simple shapes and one piece tools in order to learn the software and work with the materials.  The 3D printer is slow, and it is a meticulous process to print any design.  Now, we are able to use this printer to produce several usable prosthetic devices, the most recent of which is a prosthetic hand for a very young patient.  

The original design for this particular prosthetic hand was acquired and then modified over a period of time by our technicians.  The initial model (shown in the bright green) is a standard E-Nable hand - the hand is wrist activated with usable fingers.  Dankmeyer staff members attended an E-Nable conference in September 2014 where they learned how to assemble these prostheses. (That story is further down in this 3D Printing news.)

This design was adjusted using software to create a plan for the first printing effort - with some estimations, since this is all a very new, custom design.  We were seeking to find just the right size for the patient, which takes some creativity as well as trial and error.

The first printing created a device with a palm size reduced from the original E-Nable model, and a modified cuff.  After a fitting with the patient, changes where made for a second printing - the palm was slightly enlarged, and the cuff was redesigned.  This is the version fit at the patient’s next appointment, shown below.

You can see from the ruler that this 3D printed hand is about 6 inches in length, and when shown in comparison to Art Ross’ (Lead 3D Technician) hand you can see that the hand and fingers of the prosthesis are very small.  

We are continuing to test the limits of the current printer as we explore the ever expanding technology of 3D printing, with an eye toward acquiring an even better printer in the future. Especially if we can create smiles like this one!

If you are interested in seeing a video we made as an introduction to 3D printing, and one that features our own Art Ross and some of our projects, just click on the video link below.

E-Nable Project at Anne Arundel Schools Wraps Up

Kristen Beltran and event organizer Kris Hanks.

Art Ross, Kristen Beltran and Brad Sweet from the Lindale Middle School E-Nable program.

One hundred students in grades 4-12 representing four Anne Arundel schools, and their community partners gathered together to complete their project on 3D printing of prosthetic hands.

This Problem Based Learning project, focused on prostheses, wrapped up Saturday April 23, 2016 when students from the Anne Arundel schools gathered at North County High School in Glen Burnie, MD.  The E-Nable Helping Hands Event allowed the Science, Technology, Engineering, and Mathematics (STEM) students to connect after their months long work on the project. The Helping Hands event was designed to provide one hundred STEM students with an opportunity to work with new 3D printing technology, encourage “out of the box” thinking, and interact with community partners. During the school year, these students from grades 4-12 have focused on upper limb prostheses, particularly prosthetic hands. Class activities have included design and drawing of prosthetic hands for multiple active functions, writing a children’s book about prosthetic devices, and the 3D printing of prosthetic hands.
 
Dankmeyer, Inc provided support at various levels, starting with hosting visiting students in the Linthicum office earlier in the spring.  There students attended a presentation given by Kristen Beltran, Resident Prosthetist Orthotist, and toured the facility, with the opportunity to see a lamination and plastic drape molding in the lab.  Kristen also went to schools with demonstrations of upper and lower limb devices.  Saturday’s event included rotations to different areas showcasing the works of the various participant schools.  One rotation included professionals at work - so Art Ross, Prosthetic & Orthotic Lab Technician, and Kristen joined the students at the event with a Dankmeyer display and presentation on prosthetic and orthotic clinical practice. They provided additional information on prostheses and orthoses, with demos of terminal devices that serve a variety of recreational and daily use purposes, such as golf, kayaking, basketball, eating, cooking, and using tools.   The students were excited and curious to see how prosthetic devices operate. 

- Contributed by Kristen Beltran and Art Ross

Prosthetists meet printers - E-NABLE Conference, 9/28/2014 at Johns Hopkins Hospital

Dankmeyer, Inc. was proud to be a Gold Level sponsor of this groundbreaking conference held at Johns Hopkins Hospital in Baltimore, MD on 9/28/2014.  A number of Dankmeyer staff participated in the daylong event.  E-NABLE is a growing group of over 1500 members who have come together from all over the world to help create and design 3D Printed assistive hand devices for those in need. Some of those devices were printed and assembled at this conference, and are modeled by Dankmeyer participants in the picture here.

Mark Hopkins, Theresa Funk, Sheryl Nathanson, Angie Swindell and Shawn Ross participated in the conference.

Mark Hopkins, Theresa Funk, Sheryl Nathanson, Angie Swindell and Shawn Ross participated in the conference.

What exactly was this conference all about? The e-NABLE website states: 

“e-NABLE’s collaborative approach to design and democratization of 3D-printed prostheses could significantly improve millions of lives worldwide. Now is the time to bring these technologies and practices into mainstream medicine.” – Dr. Albert Chi – Trauma surgeon at Johns Hopkins Medical, Lieutenant Commander in the US Naval Reserve and world-renowned researcher on state-of-the-art prosthetics.

• We have a conference to introduce prosthetists to the 3D printing world.

• We SHOW them our designs and introduce them to the global e-NABLE community.

• We walk them through how to assemble a device – step, by step.

• We invite children who are missing fingers and hands and their families to attend  and teach them how to create their own devices as well as introduce them to prosthetists and the medical community – so they can see just how much these $50 hands can do.

• We introduce prosthetists to the collaborative innovation practices of e-NABLE, and we learn from them about ways we can increase options for them and their patients.

Angie Swindell, our Clinical Director models a device.

Angie Swindell, our Clinical Director models a device.

Theresa Funk, Dankmeyer's Resident in Prosthetics and Orthotics, prepared a summary of the conference in a short document.

Another attendee, Cristina Romagnoli, PhD., posted a very informative blog about the event, with a number of pictures and video.  She also provided a Twitter feed #EnabletheFuture.  Cristina is a Physical Therapist at Johns Hopkins Hospital.  

The Baltimore Sun was there and featured an article about the event which you can read here.

There is also a video about 3D devices in a story about a father looking for prosthetic solutions for his son.  Watch that YouTube video here.

Dankmeyer team members are very busy exploring the latest 3D printing and scanning technologies to bring to Dankmeyer.  We will post developments soon!