Julia D'Souza

Description of Project
Currently, there is a shortage of orthotic and prosthetic (O&P) devices for physical rehabilitation in the developing world as well as a vastly inadequate number of O&P technicians. In the Dominican Republic and the greater Hispaniola Island, where it is not uncommon for an amputee to wait years to be fitted for a prosthesis, this shortage was exacerbated and called to attention by the 2010 Haiti earthquake, which left high numbers of amputees in its aftermath. These amputees were in addition to a large number of diabetic amputees, victims of trauma, and children with congenital growth defects. An innovative alternative to traditional prosthetic manufacturing is necessary to meet the current and future demand for rehabilitative devices. This project aimed to simplify the production of prostheses at the ILAC Orthotics and Prosthetics Laboratory, a small start-up lab serving underserved patients in Santiago, Dominican Republic. The socket, the part of a prosthesis that interfaces with a patient's residual limb and the most customized and labor-intensive component, was targeted for simplification using digital modeling and 3D Printing. This would allow prosthetists to make more devices in a given amount of time along with lab assistants. In order to increase the impact and productivity of the lab, this project assessed the feasibility of digital manufacturing at the ILAC O&P Lab and sought to connect distant, resource-poor sites in northwest Hispaniola to the lab.

Results of Project
The production time, production price and fixed hardware costs, and quality of devices- as well as the infrastructure requirements at the ILAC O&P Laboratory- were factored into the feasibility of digital manufacturing at ILAC. It was found that scanning an amputee's residual limb and printing the socket can save roughly 4 hours of labor and limit the production to 1-2 days. This would allow patients to accomplish more steps of the fitting process in one visit. Reducing the number of office visits is especially important for ILAC patients facing a transportation barrier due to long transit times and/or their physical disability. Furthermore, automating the majority of the production would free up the prosthetist's time, allowing him to create more devices and to spend more time on one-on-one patient rehabilitation. The prosthetist at ILAC also greatly values the greater precision and reproducibility afforded by digital manufacturing. Financially, this method is on par with traditional techniques for socket manufacturing, apart from a moderate initial investment in hardware and software. A technique developed by a team at the University of Toronto estimated the plastic for each socket to cost under $10. It was assessed that the current electrical and computing capabilities of the ILAC lab can support such a system, and the lab is now pursuing implementation of a 3D-printing system under development by independent groups. The developers are testing the quality of their devices, which will assure the safety of ILAC patients. The lab hopes to leverage the skills of the lab's young, talented, and progress-minded prosthetist and explore how digital technology can further enhance the lab's capabilities alongside traditional manufacturing.