By L.W. Barnes
Shane Coltrain, CPO, knows computer-aided design and computer-aided manufacturing (CAD-CAM) as well as anyone in his field. That’s because he’s been using it for about eight years, gaining experience with the tool every day while so many of his industry colleagues remain resistant to make the technological leap.
If asked, Coltrain, the president of Orthotics & Prosthetics East in Greenville, NC, will wax poetic about CAD-CAM’s efficiencies (using the computer has cut his fabrication and adjustment time by more than a third) and its accuracy. The question, for those considering the move to CAD-CAM, is what specific features make the technology so powerful for the practitioners who have committed their time and dollars to use it.
For Coltrain, that boils down to one word: mobility. While CAD-CAM devices are inherently portable, some are more mobile than others. The unit he uses requires less setup, and fewer components are necessary to capture a scan.
Still, Coltrain said, “I can scan anything from a foot to a cranial helmet.”
Michael J. Nunnery, CPO, is the chairman of the American Academy of Orthotists & Prosthetists (AAOP) CAD-CAM Society, which gathers to discuss the development of CAD-CAM and to move related issues forward within the O&P profession.
Nunnery, the owner of Nunnery Orthotic & Prosthetic Technologies in North Kingstown, RI, has been in the O&P field for 22 years, and has used CAD-CAM for six. He praises CAD for its “consistent shape capture.”
But what really impresses him about CAD-CAM is its ability to track a patient’s physical changes over time. It’s all about record keeping, he says, allowing a practitioner to page back through an electronic library of patients. Every image is date-stamped. And the changes are clear as day.
“If you look at conventional modeling with plaster, at some point we have to throw those models away—that’s it,” Nunnery said. “With CAD, we have the ability to keep records and compare very quickly a shape capture done three years ago with one done today.”
He does this routinely in order to determine whether any changes to the limbs have occurred, such as differences in volume.
Nunnery points to several causes of limb change. Atrophy of soft tissue (disuse atrophy) is especially common in new amputees throughout the first year or more. Weight gain or loss, edema, or fluctuating edema often may be associated with other medical conditions not related specifically to amputation. Increased muscle mass (hypertrophy) is less common, but does happen. Minor surgical limb revisions may also change limb shape.
When it comes to the tools of the trade, Nunnery favors a handheld scanner over the flat-bed scanner, pen, or ring. The scanner he uses works off a set of reflective dots that are applied to the area being examined to create a 3-D image.
Nunnery says the manufacturers are “doing a nice job, trying to gear the CAD-CAM software toward the clinical practitioners so that it makes sense.” Still, he says, many clinicians are having trouble adopting the technology.
“They have to relearn things they were taught in school, and unfortunately there’s a [negative] mindset among some clinical practitioners,” Nunnery said.
Anyone who has made the leap to CAD-CAM will attest that there is a price tag for would-be efficiencies. Perhaps time, industry experts agree, is the biggest foe, creating a loss in productivity while the shift from plaster to a computer mouse is underway.
If Coltrain could change anything about the technology, it would be to create a more gradual learning curve in order to get more practitioners on board. Learning how to use the computer-aided tools to manipulate a trim line, for example, is particularly onerous for newbies, he said.
“A lot of them are scared,” Coltrain lamented. “That’s the biggest change I’d make—to make CAD more user-friendly for some of the practitioners who are hesitant about switching over.”