In recent years, 3D printing has facilitated important breakthroughs in the field of prosthetics. This has been particularly welcome in the developing world, where the need is greatest and resources are most limited. Nonprofit organizations and design schools are using technology for making customized, affordable prosthetic devices.
Canada-based nonprofit organization Nia Technologies is taking a different approach. While most organizations work directly with patients, Nia focuses on empowering the clinicians who make these devices. Matt Ratto, Nia’s chief science officer, spoke about his work at Autodesk’s annual conference, Autodesk University, in Las Vegas last November.
“Our work is driven by a set of social values,” said Ratto. “We start not just from technology, but from the values we use to change the way we design and the choices we make, in order to create real impact.” These values include innovation, environment-appropriate solutions, partnerships, and sustainability.
Building on the idea of impact design, which combines multiple design disciplines to create positive change and lasting impact, Nia provides local prosthetists and clinicians with new digital tools to simplify and speed up their work. By deploying these tools out in the world instead of resorting to making the devices at Nia facilities, the company hopes to create long-term, sustainable impact.
“Not just anyone can produce good devices,” Ratto explained. “We want to build on the expertise of clinicians by maximizing the time they can spend on clinically relevant activities.” This includes making decisions that directly involve the patient, including device design, fit, and ongoing patient care. 3D modeling activities should not be part of that.
Creating Tools and Changing Lives
Nia began in 2013 when Ratto, who is also associate professor at the University of Toronto’s Faculty of Information, was approached by a Ugandan nonprofit clinic interested in 3D printing. In the beginning, Ratto said, it was assumed they would send the technology—3D scanners and printers—to Uganda, where local technicians would scan patients and send the data to technologists in Canada, who would then send 3D models back to Uganda to be printed. But the Nia team rejected this approach.
“We want to add capacity to existing clinical settings, even if it’s technically more difficult with a slower progression towards treating more patients,” said Ratto. “We need to introduce this in a way that creates sustainable impact.”
In the developing world, over 30 million people are in need of prosthetics. About a third of these people need a lower-limb prosthesis and many of them are children. Sadly, less than 15 percent will receive the help they need. Loss of mobility is particularly devastating for children. When they can’t walk or run, they can become socially isolated and may be unable to attend school. Their parents or caretakers often have to work less in order to take care of them, which impacts the family as a whole as well as the greater community. Their future prospects are limited too.
On top of financial barriers, availability prevents many low-income children from getting the healthcare they need—there are simply not enough prosthetic clinics to serve them. The slow, difficult process of manually designing, making, and fitting quality devices exacerbates the problem. Conventional methods involving plaster casts and molding take about a week to complete, requiring long hospital stays and resulting in loss of income for caretakers.
This is where Nia Technologies is changing the game. With support from Grand Challenges Canada, Autodesk Foundation, the Google foundation, and others, Nia uses existing 3D scanning, modeling, and printing technology to create new digital tools that help clinicians work faster and reduce costs. Nia used Autodesk’s Fusion 360 to create initial models of the prosthetics and developed Orthogen, a custom 3D modeling software that uses Meshmixer for use in the clinics. Together with iPads fitted with 3D scanning technology for capturing the external shape of the limb, clinicians can use the software to design quality devices quickly and easily and manufacture them on the spot using 3D printers.
With these digital tools, the whole process takes about 10 hours—an 85 percent time reduction compared to conventional methods. This amounts to about a 300 percvent increase in practitioner productivity. Shorter hospital stays significantly reduce costs for patients and their parents or caretakers, making the process more accessible and allowing the possibility of thousands more that can be fitted with prosthetics.
By preserving some aspects of the manual process, Nia facilitates the transfer of knowledge and augments the growing expertise of skilled local practitioners. Clinics are able to maintain distribution of labor, with clinicians doing the scanning, technologists modeling, and technicians printing. And by automating processes that are not clinically relevant, Nia allows practitioners to focus on patient care.
In the modeling process, for example, the customized prosthetic socket must be integrated into a standard prosthetic connector. This alignment is crucial to how well the device works for the patient and how well they can walk. Nia’s custom software allows the prosthetist to move the connector around and find the correct placement and then click a button to automate the integration without altering the internal structure of the socket—a complex CAD/CAM modeling activity that clinicians need not learn.
Ratto believes the key to creating lasting impact is “understanding the fit between society and technology, not just instrumentally trying to produce a technology that solves some simple problem.” For the developing world especially, this “technological solutionism” has largely failed to produce long-term results or solve complex issues. According to Ratto, “A more value-driven approach is really necessary to create the kind of solutions, outcomes, and capacity-building processes that are necessary to solve these kinds of problems.”
For more information, you can watch Ratto’s Autodesk University 2016 class online or visit the Autodesk Foundation website.