Skip to content

Disability: The Role Of Conventional Prosthetic Devices In The World Today And The Impact Of 3D Printing.

Inclusion of people with Disability in the World today.According to the World Report on Disability, there are more than 1 billion people with disability worldwide, about 15% of the global population. Of this number, between 110 million and 190 million adults experience significant difficulties in functioning. It is estimated that some 93 children-or more than one in 20 of those under 15 years of age-live with a moderate or severe disability. The majority would benefit from prosthetics and orthotics services, if available within a country.

Upper limb prosthetic rehabilitation is more challenging, in regions where disability or disfigurement of the body is severely stigmatized, there is social and familial exclusion. Such shunning and exclusion can be very debilitating for young adults, especially children.

Prosthesis work with patients is just a part of the continuum of rehabilitation of the patient. Prosthesis work helps patient to overcome the emotional after-effects of limb-loss, to develop confidence and also the identify their capabilities and perform activities which help them to return to active life in their society.

Prosthetics is a specialty within the field of healthcare technology concerned with the design, manufacture and application of prostheses. Prosthesis (prosthetic device/product): externally applied device used to replace wholly, or in part, an absent or deficient limb segment (plural: prostheses). Common examples are artificial legs or hands.

Orthosis (orthotic device/product): an externally applied device used to modify the structural and
functional characteristics of the neuromuscular and skeletal systems (plural: orthoses). Common examples are braces, splints and supports,

Provision of prosthetics and orthotics devices are usually part of the secondary/tertiary care, habilitation and rehabilitation programs. A prosthesis/orthosis enables a person with a disability or functional impairment to remain active, productive and independent, participate in society and lead a healthy and dignified life. 

A good quality orthosis/prosthesis when appropriate to the user and the user’s environment has a significant impact on the level of independence of the user and reduces the need for formal support services.

The problem of accessing prosthesis devices is acuter in low- and middle-income countries. In this field, charities with non-trained professionals often provide prosthetics and orthotics services meaning that service quality is compromised which results in poor quality and fit. This kind of intervention can also cause secondary complications. Without access to prosthetics and orthotics services, people are often confined to their homes – excluded from participating in society and locked into poverty and isolation.

The current gap in access to such devices will be magnified in the future by the immense projected population growth, especially as the number of older people worldwide increases from 841 million in 2013 (11.7% of the world’s population) to more than 2 billion (21.1%) by 2050.

PICO issues: Effectiveness of prosthetics and orthotics services.

Population: People with physical impairments or limb loss or functional limitations or deformities in limb or spine

Intervention: Provision of prosthetics/orthotics services

Comparator: Non-provision of prosthetics/orthotics services or provision of alternative assistive products (such as crutches, walkers, sitting board with castors, wheelchairs, and tricycles)

Outcomes: Primary: Coverage or access to services; prevention of fall/injuries; prevention of deformities or secondary health conditions; avoidance of premature deaths; disability-adjusted life years (DALY)/ quality-adjusted life years (QALY); better health outcomes (functioning and quality of life); mobility and safety; user’s satisfaction; cosmetic/image; building human capacity; time and physical burden for care services or givers.

Outcomes: Secondary: Human rights; empowerment; economical gain for individual and family; independence; self-confidence and self-esteem; educational and job opportunities; social acceptance; participation and inclusion.

The key important tool for optimum utilization of any prosthesis devices is that it should address the following issues:

Comfortable to the user

  • Reduce the pain
  • Access to services
  • Enable Independence
  • Improved Participation
  • Increase the Quality of Life
  • Cost-effective short-term and long-term

The growth of additive manufacturing technologies has a significant impact on prosthetics applications. This is currently seen in trans-radial prosthetic hands, which enables the needs of child amputees. The 3D printed devices have improved the functionality with fully movable fingers, and some of the devices have integrated artificial intelligence tools, which can resemble the functions of an anatomical hand.

However, there are significant Challenges like:

  • Accessibility-Easily Available Durable, comfortable, and easy for patients to use and maintain
  • Affordability-Cost effective, modern and consistent with international standards with Easy for technicians to learn, use, and repair
  • Availability- Standardized but compatible with the climate in different world regions

The real benefit of 3D printing is when the customer-centric approach is taken to devise innovations, starting from the pain points of construction of patients and the assets of healthcare professionals.

Source:

WHO. World report on disability. Geneva, World Health Organization, 2011

United Nations, Department of Economic and Social Affairs, Population Division. 2013. World Population Ageing 2013

 

Cost Estimate of Various Prosthetic Devices Using 3D printing Technology

 

One of the biggest barriers to the use of prosthetic limb of any kind are the associated costs. The average useful life of most of the prosthetic devices is between 3 to 5 years. The added lifetime cost of the prosthetic utilization is upwards to several folds in the range of $100,000 upwards, depending on the needs of the patient. In case of children, costs could escalate further, as the need changes every year with their growth. In addition, these costs are significantly prohibitive in resource-poor communities worldwide. 3D printing stands to eliminate or greatly reduce costs is in the cost of care from a medical professional. With the use of additive manufacturing technologies, the cost savings in device applications like prosthetics is significant. The real disruption comes from the reduction in the traditional manufacturing of patient care chain.

This is generally being observed in compassionate use instances associated with transradial prosthetic hands which have popularized thanks primarily to organizations such as e-Nable and meeting the needs of child amputees. In prosthetics, 3D printing has already shown a potential for the development of many projects for manufacturing upper limb prosthetic devices. The 3D printed/manufactured device has improved functionality with fully movable fingers and with the advancement of technologies in additive manufacturing, the durability and the long-term function of these prosthetic devices can be improved

3D printing stands to eliminate or greatly reduce costs of care from a medical professional. This has resulted in the significant interest in the exploration of 3D printing technology in prosthetic devices. An additive manufactured prosthetic can be fabricated quite effectively reducing the costs. The overall cost reduction benefit can be passed on to the patients, by using a digital controlled manufacturing process bypassing the traditional supply chain, the lowered costs are primarily due to a decrease in the manual labour and the cost of the material.

Although, there is a need for a technician who is familiar with the 3D printing process to assemble and engage the prosthetic device. But the expertise levels could be reduced considerably as compared to manual fabrication of the prosthetic devices.

The other area in which additive manufacturing stands to gain is by greatly reducing the costs of care from a health care provider. The lower hospital or longer time stay and the relative ease of using a 3D printed prosthetic device help the patient to be mobilized quite early.

In case of the upper limb prosthetic devices, the longevity, aesthetic quality, and reliability of a printed device may not meet the same performance of a regular customized prosthetic device manufactured traditionally, when comparing the lifetime costs the value proposition of printed devices remains quite strong. The compassionate use instances associated with trans radial prosthetic hands has also lowered the long-time cost of the upper limb devices’. Also, in case of the lower extremity prosthetics, 3D printing is applied differently mostly because of the load-bearing requirement of such products.

For the present, the use of 3D printing technology and its impact is either niche based as in the custom prosthetic manufacturing of upper limb prosthetic devices, or largely disruptive but, there are still significant barriers before it can have widespread applications.

 

Source:

National Institute of Standards and technology

Smartech Market publishing:3D-PRINTED MEDICAL PROSTHETICS MARKETS