118 Lifting the Burden: Integrating the technology of 3D Printing into Healthcare to Lower the Cost of Prosthetic Limbs

Faculty Mentor: Eric Robertson (Honors College, University of Utah)

As of right now, there are approximately 2.1 million people living in the United States who live with an amputated limb, whether congenital or surgical. Of these 2.1 million, an unknown number are children, who have much more complex needs when it comes to their prosthetics. In an article published by BioMed Central, the authors discuss how “[c]hildren’s prosthetic needs are complex due to their small size, constant growth, and psychosocial development” which exposes the intricacies and need for cheaper materials to lower the cost of prosthetics for families with a child amputee (Zuniga et. Al., 2015). According to Annie Murphy Paul, the author of the book The Extended Mind, “our thoughts…are powerfully shaped by the way we move our bodies” (Paul, 2021). Movement is so important in our process of thinking and using our brain, so when these kids lose the function of a limb, their brain starts shutting down, too. These prosthetics are integral to kids continuing to develop mentally. Even if the limb isn’t physically there, the thought of the movement that powers myoelectric prosthetics to work, has the same effect on the brain. The utilization of new materials and technologies, such as 3D printing, can help lower overall cost of prosthetics, make the creation process easier on the patient, and make the prosthetic more functional without adding unnecessary weight, especially for families with a child amputee.

Prosthetics are some of the most expensive medical devices in the world. Not only are the necessary for an amputee to return to a somewhat normal life, but they need to be durable enough for them to use in their everyday lives. The prospect of 3D printing in the medical field has the potential to lower overall costs in producing prosthetics, which would save families thousands of dollars in the long run. In 2015, an article published by BioMed Central explores how 3D printed prosthetics can help respond to the needs that amputee children face. These children grow at such a quick pace that they are outgrowing their prosthetics that unfortunately come with a huge price tag. This research states that “[t]he cost of a body-powered prosthetic hand ranges from $4,000 to $20,000” this price range puts extreme limits on the kind of prosthetic a family is able to purchase for their child (Zuniga et. Al., 2015). This quote benefits my research because it shows just how much of a burden prosthetics can be on a family’s financial situation. The choice for many families becomes one expensive myoelectric prosthetic or multiple prosthetics that don’t provide the same functionality. In “A Leg to Stand On,” an essay written by Vivian Sobchack, she shares her experience dealing with her amputation and the medical care that surrounds her recovery and return to a normal life. Within this essay, she states that “my full (and rather ordinary) leg probably cost no less than $10,000 to $15,000 per leg” for the most basic prosthetic that doesn’t include any myoelectric workings (Sobchack, 2004). This price almost guarantees a heavy financial burden on any person who experiences a lost limb, which can include family in the case of a child.

In the case study performed by Tong et al and published by PLOS ONE in 2019, the researchers concluded that “the integration of 3D scanning and 3D printing processes offers the ability to rapidly design and fabricate low-cost personalized and anatomical wearable systems” to share how new technologies can make necessary prosthetics more affordable (Tong et Al., 2019). This conclusion identifies and shares that 3D printing can be a solution for more affordable prosthetics which is relevant to my project because healthcare providers can share a cheaper treatment method with these children’s families, especially when their prosthetics need to be adjusted consistently. Organizations such as The Amputee Coalition will also be able to share this incredible technology to the patients that reach out to them. On their website, their goal is to “relentlessly seek opportunities to improve, always seek new answers, and offer potential solutions” for amputees (amputee- coalition.org). Part of this process of innovation is sharing the new technology of integrating 3D scanning and printing into the fabrication of prosthetics to make them so low cost. This means that the body of the prosthetic will be much cheaper for the patients and their families, so they would be able to add much higher end technology to the medical devices. Adding myoelectric workings means that the prosthetic is much more functional than a regular one; it could give the patient some autonomy back into their lives, almost if they had never lost the limb.

Another aspect of integrating 3D printing into the production of prosthetics is that the process involved in making prosthetics is long and painful, and this new technology allows the process to be easier for the patient. The current process of making prosthetics is very difficult. As stated in an article published by BioMed Central in 2015, “these devices require extensive fitting procedures to develop the terminal device and often include a complex system of cables and harnesses” (Zuniga et. Al., 2015). This quote clarifies the complexity of my problem because it discusses the invasive and painful methods needed to size a prosthetic to fit. The research presented by Zuniga et Al. shows that 3D printing may be the solution to lowering the overall cost of these essential medical devices. These prosthetics can be made with cheaper materials and made to be more comfortable for the patient, all while lowering the financial strain it puts on the family. In the article published by PLOS ONE in 2020, the affordability and versatility of “3D printing of soft materials due to the capability of 3D printing methods in delivering very sophisticated and complex geometries with no need of post- processing” is examined to inform readers about how 3D printing can change the world of prosthetics for the better and cheaper. Using a computer, accurate scans of a patient’s limb can be taken and mapped to make a more comfortable prosthetic to attach to the missing limb. The patient’s exact measurements can be considered, without a messy and painful process involved.

The current standard of making prosthetics includes plastering and molding the limb, which takes a long time and is very uncomfortable. Vivian Sobchack also comments on this process in her essay, “A Leg to Stand On.” She discusses the process she undergoes anytime she needs a new prosthetic, “I have had four successive sockets that were molded of fiberglass and ‘thermo-flex’ plastic to conform, over time, to the changing shape of my stump” (Sobchack, 2004). If a patient’s measurements can be stored in the computer, then the patient saves money on the cost of materials to mold their limb every time they need a new prosthetic made. Currently, carbon-fiber, fiberglass, and many other materials are combined to form a prosthetic, which usually involves layers of molding to the site of amputation, peeling off the mold, and then waiting for the prosthetic to be formed. Since these child amputees have gone through enough losing limbs, the process for shaping these devices should be as easy as possible for them. Computer programs will be able to take away the pain or discomfort of making these medical devices, allowing these kids to enjoy their lives away from the doctor’s office.

In 2020, Mohammadi et Al. published an article that explored using different materials within the process of 3D printing a prosthetic. This group created a “hand [that] was 3D printed from soft material, into which all the actuation and control systems are embedded” to prove that myoelectric prosthetics don’t need to be unnecessarily rigid or heavy with extra parts (Mohammadi et Al., 2020). This notion refers to 3D printing as a method to make prosthetic devices not only more affordable, but better functioning for the user, which is relevant to my research in making prosthetics more affordable in a time where they are becoming more technologically advanced. In 2019, Tong et al published an article that explores a case study of using 3D printing to help create more affordable prosthetics for families and make the design process easier by using 3D scanning techniques. The group’s research investigated many different technologies, but their conclusion found that 3D printing techniques are “relatively low cost, [portable], [flexible] in range and resolution, and [user-friendly]” (Tong et Al., 2019). This research gathers information into the tools that are used in conjunction with 3D printing to make creating prosthetics easier, more affordable for families, and lighter for the patient to wear. Due to the way 3D printing works, taking a solid form of a material, and melting it to be printed into layers, brand new materials can be used when making prosthetics. These materials can be much lighter than the traditional combination of carbon, plexiglass, and fiberglass. These materials can also give the prosthetic a flexibility that they haven’t had before while still being durable and able to protect an expensive myoelectric system.

The current model of prosthetics includes a heavy price tag, and a long and sometimes painful creation process, which leaves the prosthetic being much heavier than a normal limb. 3D printing is opening a new door for families, healthcare workers, and everyone involved in the life of a child amputee. In 2020, Brian Hare and Vanessa Woods wrote Survival of the Friendliest, a book examining our origins and understanding our common humanity. Within their research, they found that “most of us would respond to a child in distress…we have tremendous potential for compassion, and we evolved uniquely to show friendliness to intragroup strangers” (Hare & Woods, 2020). Wanting to help these children and families who are burdened by expensive medical care is intrinsic to who we are as people. Everyone should be excited by the prospect of 3D printing being integrated into the creation of prosthetics, as it will alleviate much of the burden of having a prosthetic and needing to keep it in great condition. 3D printing could help these kids be kids and lose the emotional toll that constant appointments to fix or resize the prosthetic can take on a child because the medical device that makes them whole again doesn’t need to be taken away again and again.

Bibliography

Amputee Coalition. (2023). Mission and Vision: We Actively Innovate. Mission & Vision – Amputee Coalition (amputee-coalition.org)

Hare, B, Woods, V. (2020). Survival of the Friendliest: Understanding our Origins and Rediscovering our Common Humanity. Random House.

Mohammadi, A., Lavranos, J., Zhou, H., Mutlu, R., Alici, G., Tan, Y., Choong, P., & Oetomo, D. (2020). A practical 3D-printed soft robotic prosthetic hand with multi-articulating capabilities. PLoS ONE, 15(5), 1–23. https://doi.org/10.1371/journal.pone.0232766

Paul, A. (2021). The Extended Mind: The Power of Thinking Outside the Brain. HarperCollins.

Sobchack, V. (2004). A Leg to Stand On: Prosthetics, Metaphor, and Materiality. In Carnal Thoughts: Embodiment and Moving Image Culture (1st ed., pp. 205–225). University of California Press. http://www.jstor.org/stable/10.1525/j.ctt1pnx76.13

Tong, Y., Kucukdeger, E., Halper, J., Cesewski, E., Karakozoff, E., Haring, A. P., McIlvain, D., Singh, M., Khandelwal, N., Meholic, A., Laheri, S., Sharma, A., & Johnson, B. N. (2019). Low-cost sensor-integrated 3D-printed personalized prosthetic hands for children with amniotic band syndrome: A case study in sensing pressure distribution on an anatomical human-machine interface (AHMI) using 3D-printed conformal electrode arrays. PLoS ONE, 14(3), 1–23. https://doi.org/10.1371/journal.pone.0214120

Zuniga, J., Katsavelis, D., Peck, J., Stollberg, J., Petrykowski, M., Carson, A., & Fernandez, C. (2015). Cyborg beast: a low-cost 3d-printed prosthetic hand for children with upper-limb differences. BMC Research Notes, 8(1), 155–171. https://doi.org/10.1186/s13104-015-0971-9