By Jacob Praga, MSBME
Devices and patient care have changed dramatically through the history of the O & P profession. At first, devices were carved of wood, based on visual inspection, then sewn with leather and bent metal; today, we cast in plaster and pull plastic. If history tells us anything, it’s that, first, newer technology will continuously become integrated into our profession and, second, we, as clinicians, should at least be open to the idea of integrating innovative technology into practice.
Currently, I am learning how to take plaster casts, modify them with a Surform® tool and sand screen, and then pull plastic that has been heated in an infrared oven over the cast. However, I have also had a glimpse into what might be the future of the profession: production of orthotic and prosthetic devices using scanning and 3D printing. Complex patients are a challenge to fit with a device, but the combination of scanning and 3D printing would allow for rapid prototyping and fitting to reach a definitive device faster than conventional methods. I look forward to integrating these innovations into my practice. Here are 2 practical–and patient-centric–reasons why:
Improved manufacturing processes. Many of the production facilities I’ve seen make in-house devices in a small lab where machines are positioned right up against each other to best utilize space—but which makes it difficult to house many models at any one time and requires that those models be discarded after a single use. Scanning a limb, however, allows the resulting digital model to be saved indefinitely—an important service for edema patients or new amputees because doing so allows clinicians to observe anatomical changes and make adjustments quickly and easily.
Lower cost. Although the devices worn by patients help them in their day-to-day life, the regrettable fact is that some cannot afford even the lowest-cost appliances available to them; or, in the case of a child amputee, whether congenital or traumatic, who cannot obtain a prosthesis because the cost of necessarily replacing it as he or she grows is too high.
3D printing allows for the creation and fabrication of these devices in a manner that offer these benefits, among others. Devices would be specific to the patient and allow for complex geometries that plaster modifications and pulling plastic don’t. The materials and the printers themselves can be inexpensive, allowing many practices to utilize them without spending a lot or needing much floor space in the lab.
Some clinicians remain skeptical that new technologies will change the O & P profession. To them, I say: We are moving in that direction. Scanning and 3D printing today might not be up to standards that some clinicians think necessary to best serve patients, but technology can change a lot in just a few years. All it will take to reach that level of service and practice is time and a mind that is open to the possibilities that these technologies offer.
Jacob Praga earned a Master’s in Biomedical Engineering from the State University of New York at Binghamton in 2018 and is an Orthotics and Prosthetics Masters Candidate at the School of Health Promotion and Human Performance, College of Health and Human Services, at Eastern Michigan State University, Ypsilanti, Michigan. He co-authored the poster, “Electroplating and 3D Printing: How to Make a Durable Low-Cost Prosthesis,” which was presented at the 2019 American Academy of Orthotists and Prosthetists Annual Meeting in Orland, Florida.
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- Loria K. The future is now—implications of 3D technology for orthoses. LER. April 2018. https://lermagazine.com/article/the-future-is-now-implications-of-3d-technology-for-orthoses. Accessed July 5, 2019.