United We Stand: Allied Efforts Drive O&P to New Heights

There are certain prosthetic limbs that remain functional in water; there are others that can match the likeness of a child’s favorite superhero; and prostheses controlled by thought are currently being developed.

The O&P industry is transforming abstract ideas into clinical reality, but they are not doing it alone. Collaborative efforts among artists, makers, therapists and thinkers have spawned some of the most imaginative devices the field has ever seen. According to industry leaders, the journey is only beginning.

Finding an inner superpower

In health care, collaboration makes a difference, Kate Ganim, co-director of KIDmob – a nonprofit design education firm in San Francisco, Calif. – told O&P Business News.

When her sister was born without a hand, Ganim knew she would be a part of that difference.

“I realized there were amputees across the country without the means to obtain a standard prosthesis, but also engineers capable of building low-cost prostheses,” she said. “I had a personal interest in connecting the dots. I wanted to bring the groups together.”

With the help of Brown University, POA Prosthetics and the Helping Hands Foundation, she began doing that. Inspired by RoboHand, an open-sourced 3-D printable prosthetic hand, they launched the Superhero Cyborgs camp – a week-long workshop teaching children to design their own body modifications, ranging from exoskeletons to prostheses.

“We came up with the idea when we learned about RoboHand,” Ganim said. “We printed out a few copies…and asked ourselves: ‘if kids are accepting this hand attachment, why don’t we run with it?’”

The team assigned a designer, an engineer and a prosthetist to each student, and “ran with any idea that came to mind,” Ganim said. It was the allied effort that took the workshop to new heights.

“By having the kids work with a diverse group of facilitators, they got input from different fields,” she said. “With a variety of expertise coming together, it allowed for a bunch of perspectives – each offering something that maybe the other field wasn’t thinking.”

“When you work together, you end up with a better solution,” Robert Gailey, PhD, PT, professor of physical therapy at the University of Miami, Miller School of Medicine, told O&P Business News. “It is not just the prosthesis that offers increased mobility – it is the training, the therapy, the skin care – we feed off each other’s creative energy to get results for the patient.”

Superhero Cyborgs achieved creative results, Ganim said. At the end of the workshop, each child had a better understanding of how prostheses work, and the confidence to design one that worked for them.

“One child came away with a device that has interchangeable parts for his Wii controller and Super Soaker,” Ganim said.

The camp taught children that they are not limited to prostheses on the market, and it reframed the way they think about limb difference, she added.

“It was empowering to show the kids that [a prosthesis] is not a disability…it is device that can enable this inner superpower. Introducing them to new tools, a new way of thinking and bringing their ideas to reality – that is the reason why we did this.”

At home and abroad

Bringing ideas to reality is something the University of Hartford knows well. For the fourth year, students and faculty are headed to Lima, Peru, to provide clinical care to impoverished amputees.

“The mission trips started as a grassroots effort,” Paul Armstrong, MS, CP, prosthetics & orthotics instructor at the University of Hartford, told O&P Business News. “Now it is an ongoing project, a trip we do on an annual cycle.”

Members of the prosthetics, orthotics, physical therapy and engineering programs have started fashioning devices and raising funds for the upcoming trip.

“Collaboration early on is best,” Kevin Carroll, MS, CP, FAAOP, vice president of prosthetics at Hanger Clinic, told O&P Business News. “If an idea is communicated from the very first prototype, it can be conceptualized to the final product.”

“By opening perspectives [among specialties] we can solve problems one group may not have seen before,” Matthew Parente, MS, PT, CPO, clinical director of the Prosthetics and Orthotics program at the University of Hartford, told O&P Business News. “We are taking separate groups and giving them a common language.”

When communication is consistent, it creates trust between parties that typically do not work together, Parente said. That trust was important in launching the mission trips, Armstrong added.

“What was unique about starting the trips…was our relationship with the physicians and physical therapists [in Peru]. We were able to get information on patients upfront, and begin building devices in advance.”

Last year, they built more than 50 devices for local amputees, and are now working with Peruvian clinicians to provide follow-up care to those patients.

The team is pushing further, Mary Arico, PhD, assistant professor of biomedical engineering at the University of Hartford, said.

They are working with LIMBS International, a nonprofit humanitarian organization, to provide prostheses to additional developing nations.

“We want to develop a durable, energy-efficient [lower limb prosthesis] that can be made inexpensively overseas,” Arico said.

A senior design team at the university is currently exploring new materials to build a prototype, and plan to begin gait and mechanical testing for ISO standards later this year.

“One of the greatest benefits of these programs is that we are serving populations in need,” Armstrong said. “When you provide someone with their first prosthesis, they understand the value and what it can bring to their life. Our goal is to educate them so they…can educate others, and spread that value across the globe.”

Hurdles ahead

Accomplishing that will not be easy, Gailey said. While collaboration holds many benefits, some do not see the importance, he said.

“The main reason why people do not collaborate is because they feel they do not have time. I call it short-term reward, long-term fee.

“Sure, you saved yourself an hour because you did not get together with the therapist or engineer, but you increased time spent with each patient because you did not get the full picture,” he said.

He added that clinics that do not collaborate early on, could miss key opportunities to address an issue.

“Often times a therapist needs to get a hold of a prosthetist – or a prosthetist needs to get a hold of a therapist – for an alignment change or socket issue. It takes 2 [days] or 3 days to hear back and then it is too late.

“The patient moves forward without proper treatment, they lose visits because of their health care plan and it is a missed opportunity to work together.”

Another issue is education, Gailey said. Many professionals do not have the time or opportunity to gain knowledge in other fields, which could lead to barriers in communication.

“That was big a challenge [in our project],” Arico said. “Our engineers had to figure out how to share information with a group of non-engineers.”

“The problem is we do not get to spend enough time with the engineers,” Carroll said. “The only time prosthetists and clinicians get with those guys is at the national Academy or AOPA meetings. So it becomes a bit of a language barrier.”

O&P professionals have insight in other fields, but they are not in those fields and their knowledge does not reach the extent of those who are, Carroll said.

That lack of knowledge could cause some to become myopic, John Miguelez, CP, FAAOP, president and senior clinical director at Advanced Arm Dynamics, told O&P Business News.

He said it is important both sides collaborate so patients can reach their goals. Occupational therapy is critical for successful outcomes, particularly in upper limb rehabilitation, he added.

But when an expert is deep into a specific field, it could be difficult to get a broader perspective, Gailey said. That inflexibility could put a strain on their relationships.

“We need to be open minded. The idea of having separate agendas – that is ancient thinking,” he said. “The facilities that are thriving are the ones working together. The facilities on an island are the ones staying behind.”

The bigger picture

The University of Hartford is moving ahead, Michael Wininger, PhD, assistant professor of prosthetics & orthotics at the university, told O&P Business News. By teaching students collaboration now, they are ensuring it for the future, he said.

“The students here are of a brave stripe. They do not have much fear of going into a new environment or a new department…[and] are willing to explore beyond their first instincts,” he said. “For the generation that will take over this field, collaboration will be a natural thought process.”

A key asset in collaboration is having access to one another, Arico said.

“Having everyone together allowed us to talk to groups we are not used to talking to. The communication was a challenge, but it was the type of challenge we need to embrace,” she said.

“It is important for us to understand that the way we see things is not always the best way. We have to think about how other fields see it, and we have to think about how the users see it.”

The users should get involved, Ganim added.

“Patients are going to be the experts on what their own needs are. If they participate and develop ideas…they will have a better understanding of where some devices fall short,” she said. “There are designers and engineers willing to support them…so getting patients involved is an important step.”

The University of Delaware is getting patients involved, and using Google Glass to make prostheses less expensive. Steven Stanhope, PhD, professor of physical therapy at the University of Delaware, and Jingyi Yu, associate professor of computer and information sciences, have found a way to capture a basic image of a lower limb and instantly convert it into a 3-D model.

“It is very simple…anyone can wear the glasses and capture an image,” Yu said. “We then stitch the images together and transform them into a 3-D printable template.”

A standard 3-D imaging machine could cost up to $200,000, Yu said. Using Google Glass could ease the burden on prosthetists and eliminate clinic trips for the patient, he said.

“It is very accessible…patients could use their phones if they wanted to. Smartphones would allow them to capture an image, upload it to our server and see real-time 3-D images superimposed over the screen.”

The team is working to commercialize a smartphone application, integrate it with Google Glass and bring high-tech activities within reach of more people, Yu said.

“We are in an era of emerging technologies. Many typically challenging tasks can now be done with a simple device,” he said. “Each field can benefit from the next. We have to come together…[and] collaborate to see that bigger picture.”

A look forward

The University of Delaware sees that picture. They are currently applying for National Institutes of Health funding and Small Business Innovation Research grants for the project.

KIDmob is also continuing efforts with their project. They are seeking new partnerships in order to make the Superhero Cyborgs camp happen again.

“There are a number of families reaching out, asking when we are going to do it again,” Ganim said. “We need folks…who are not going to stand back and tell us a million reason why an idea will not work. We need those willing to jump in and figure out how to make it work.”

The University of Hartford is working to finalize the mission trips. They recently selected a team for Peru and are preparing initial devices. The trip will deploy in March.

“We have some fundraisers going on and we are getting the logistics in order,” Armstrong said. “All the pieces are falling in…and we are excited to put them together.”

Gailey is traveling the United States to educate others about the importance of teamwork, and Advanced Arm Dynamics is working with clinics and universities to explore new surgical procedures for amputees.

“Cross-field collaboration is vital for success,” Carroll said. “If industries band together, it could change the entire dimension of O&P.” Experts need to reach across the table to developers, designers and to people on the fringes of pioneering new concepts, he said.

“What might seem like a silly idea could be the breakthrough we have been waiting on. We need to continue working together in order to find out.” – by Shawn M. Carter