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.Tweet to @thirdmesh
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