Moreau P1, Herfat S1,2
1Médecins Sans Frontières Foundation, Paris, France, 2University of California San Francisco, San Francisco, United States
Background: The WHO estimates 15% of the 100 million in need of prosthetic & orthotic (P&O) care have access. Over 15 years of conflict throughout the Middle East region has led to an increase of people living with disabilities, including loss of limbs, due to both conflict-related injuries and lack of access to appropriate medical care. Unilateral upper limb deficiency patients commonly seek cosmetic prostheses to help deal with the social stigma and to provide a secondary support limb for bimanual tasks. The lack of prosthetic clinicians and prohibitive cost of prostheses & materials in many countries has led to patients and providers having limited options. In the Middle East, a cosmetic upper limb prosthesis costs $1000-$3000.
Purpose: In 2017, 3D project initiated at the MSF Amman Reconstructive Surgery Hospital with the aim of evaluating the feasibility of locally designing, manufacturing and fitting customized 3D printed below elbow prostheses, while providing and develop comprehensive clinical care. The multi-disciplinary team included local staff and expats from several specialties including P&O, physiotherapy, occupational therapy and biomedical engineering.
Methods: Each patient first underwent clinical assessments to identify their specific needs. 3D surface scans of the stump and contralateral limb were acquired and used to design each socket and prosthesis. Components were 3D printed at the Irbid Fab Lab in various materials (rigid PLA, semi-flex co-polyester, flexible TPU). After fitting, clinical assessments were performed at various time points to improve the designs and refine the processes. Nine questions from the Orthotic & Prosthetic User Survey (OPUS) were used to determine patient satisfaction.
Results: By Aug-2018, 18 patients were enrolled (28% female, 44% 15 years-age, 50% trauma-related, 17% lost following enrollment) and 11 were fitted with 12 total prostheses (91% unilateral). Prostheses were worn 5h48min[Mean]±] per day with 93% patient satisfaction after 15 days (N=9 patients). Patients reported being satisfied with the weight and comfort of the prosthesis (Mean>3.8/4.0). Challenges have included long-term durability of components and paint coating. The cost of raw materials to manufacture the 3D printed prostheses ranged from $20 to $50.
Conclusion(s): We have shown the feasibility of locally designing, manufacturing and fitting 3D printed prostheses in the Jordan context. The project is continuing in Jordan with a full local team. The R&D process continues to improve the durability of the prosthesis and explore the remote design process. Future directions include expansion of the 3D project to other MSF contexts with the goal of increasing access to P&O care and further developing other 3D applications related to surgery and burns.
Implications: The MSF3D project demonstrates the utility of applying 3D technologies to global rehabilitation care for upper limb prosthetic users in humanitarian context.
Keywords: Upper limb prosthetic, humanitarian, 3D printing
Funding acknowledgements: This Project was funded by MSF Foundation donors.
Purpose: In 2017, 3D project initiated at the MSF Amman Reconstructive Surgery Hospital with the aim of evaluating the feasibility of locally designing, manufacturing and fitting customized 3D printed below elbow prostheses, while providing and develop comprehensive clinical care. The multi-disciplinary team included local staff and expats from several specialties including P&O, physiotherapy, occupational therapy and biomedical engineering.
Methods: Each patient first underwent clinical assessments to identify their specific needs. 3D surface scans of the stump and contralateral limb were acquired and used to design each socket and prosthesis. Components were 3D printed at the Irbid Fab Lab in various materials (rigid PLA, semi-flex co-polyester, flexible TPU). After fitting, clinical assessments were performed at various time points to improve the designs and refine the processes. Nine questions from the Orthotic & Prosthetic User Survey (OPUS) were used to determine patient satisfaction.
Results: By Aug-2018, 18 patients were enrolled (28% female, 44% 15 years-age, 50% trauma-related, 17% lost following enrollment) and 11 were fitted with 12 total prostheses (91% unilateral). Prostheses were worn 5h48min[Mean]±] per day with 93% patient satisfaction after 15 days (N=9 patients). Patients reported being satisfied with the weight and comfort of the prosthesis (Mean>3.8/4.0). Challenges have included long-term durability of components and paint coating. The cost of raw materials to manufacture the 3D printed prostheses ranged from $20 to $50.
Conclusion(s): We have shown the feasibility of locally designing, manufacturing and fitting 3D printed prostheses in the Jordan context. The project is continuing in Jordan with a full local team. The R&D process continues to improve the durability of the prosthesis and explore the remote design process. Future directions include expansion of the 3D project to other MSF contexts with the goal of increasing access to P&O care and further developing other 3D applications related to surgery and burns.
Implications: The MSF3D project demonstrates the utility of applying 3D technologies to global rehabilitation care for upper limb prosthetic users in humanitarian context.
Keywords: Upper limb prosthetic, humanitarian, 3D printing
Funding acknowledgements: This Project was funded by MSF Foundation donors.
Topic: Disability & rehabilitation; Disaster management; Musculoskeletal: upper limb
Ethics approval required: No
Institution: Médecins sans frontières / Doctors without borders
Ethics committee: MSF ethics committee
Reason not required: This research fulfilled the exemption criteria set by the MSF Ethics Review Board (ERB) and thus did not require MSF ERB review. agreement was given internaly for the MSF innovation pilot 3D project to start as it describes innovative ways to provide upper limb prosthetics devices in humanitarian fields.
All authors, affiliations and abstracts have been published as submitted.
