Digital healthcare technologies: Modern tools to transform prosthetic care

User perspectives of digital manufacturing for lower-limb prosthetic sockets

BACKGROUND

There is growing interest to use digital technology (DT) for manufacturing lower-limb prosthetic sockets to improve efficiency and clinical outcomes. However, little is known about how lower-limb prosthesis users perceive DTs, such as 3D scanning and 3D printing.

OBJECTIVES

This study aimed to provide an understanding of perceptions and experiences with DT for prosthetic socket manufacturing from the perspective of prosthesis users.

STUDY DESIGN

A qualitative descriptive research study.

METHODS

Nine lower-limb prosthesis users (mean age 56; 5 female; 4 male) participated in one-on-one semistructured telephone interviews. Inductive thematic analysis was performed to identify a codebook and emerging themes from the interview transcripts.

RESULTS

Two major themes were identified: (1) expectations and prioritization of 3D printed socket usability and (2) facilitators and barriers to uptake of DT among patients.

CONCLUSION

DT methods were found to be acceptable and feasible from a patient perspective, although technological advancements are still required, and real-time communication about the process may be vital for ensuring patient engagement. Consideration of these findings may improve patient satisfaction to emerging prosthesis treatment plans and ultimately support widespread adoption of DT as an additional tool for fabricating prosthetic sockets.

Business practices efficiency: Impact of integrating digital technology on clinical P&O practices

Additive manufacturing (AM) is on the path to transforming the approach to Prosthetics and Orthotics (P&O) manufacturing. Although digitalization of limbs and other body parts is not new to the field, it has not been widely accepted by the industry for various reasons. However, the reliability and precision that AM can attain, and the availability of various materials is improving rapidly. This professional opinion article discusses the ways that AM has changed P&O services, with a specific focus on prosthetic socket manufacturing. Digitalizing P&O services will eventually change the business model used in clinics, which is further explored here.

Comparison of multiple 3D scanners to capture foot, ankle, and lower leg morphology

BACKGROUND

3D scanning of the foot and ankle is gaining popularity as an alternative method to traditional plaster casting to fabricate ankle-foot orthoses (AFOs). However, comparisons between different types of 3D scanners are limited.

OBJECTIVES

The aim of this study was to evaluate the accuracy and speed of seven 3D scanners to capture foot, ankle, and lower leg morphology to fabricate AFOs.

STUDY DESIGN

Repeated-measures design.

METHODS

The lower leg region of 10 healthy participants (mean age 27.8 years, standard deviation [SD] 9.3) was assessed with 7 different 3D scanners: Artec Eva (Eva), Structure Sensor (SS I), Structure Sensor Mark II (SS II), Sense 3D Scanner (Sense), Vorum Spectra (Spectra), Trnio 3D Scanner App on iPhone 11 (Trnio 11), and Trnio 3D Scanner App on iPhone 12 (Trnio 12). The reliability of the measurement protocol was confirmed initially. The accuracy was calculated by comparing the digital scan with clinical measures. A percentage difference of #5% was considered acceptable. Bland and Altman plots were used to show the mean bias and limit of agreement (LoA) for each 3D scanner. Speed was the time needed for 1 complete scan.

RESULTS

The mean accuracy ranged from 6.4% (SD 10.0) to 230.8% (SD 8.4), with the SS I (21.1%, SD 6.8), SS II (21.7%, SD 7.5), and Eva (2.5%, SD 4.5) within an acceptable range. Similarly, Bland and Altman plots for Eva, SS I, and SS II showed the smallest mean bias and LoA 21.7 mm (LoA 25.8 to 9.3), 21.0 mm (LoA 210.3 to 8.3), and 0.7 mm (LoA 213 to 11.5), respectively. The mean speed of the 3D scanners ranged from 20.8 seconds (SD 8.1, SS I) to 329.6 seconds (SD 200.2, Spectra).

CONCLUSIONS

Eva, SS I, and SS II appear to be the most accurate and fastest 3D scanners for capturing foot, ankle, and lower leg morphology, which could be used for AFO fabrication.

Prosthetic Sockets: Tensile Behavior of Vacuum Infiltrated Fused Deposition Modeling Sandwich Structure Composites

The development of novel materials will enable a new generation of prosthetic devices to be built with additive manufacturing (AM). Vacuum infiltrated sandwich structure composites are a promising approach for building prosthetic sockets via AM. In this paper, we test the tensile properties of 18 different composite material configurations using ASTM D638. These composites were manufactured using a custom vacuum infiltration method and had varying filament materials, infiltrated matrix materials, and print directions. Several material-matrix-print composites showed higher ultimate tensile strengths and reduced anisotropy compared to full-infill control samples. However, the mechanical properties of these composites were limited by a large degree of porosity due to the manufacturing method. Still, the results were sufficiently promising to create a proof of concept prosthetic socket via the vacuum infiltration method. Future research should focus on reducing porosity defects and investigating additional material-matrix-print combinations.