Educating the next generation to solve complex health problems through design thinking
IMG_0094.jpg

Blog

Design for Disability: 3D Imaging, Hands for Haiti, and the Enable hand build @ Comcast Collaboration Studio

As common as 3D printing has become in popular culture, it still elicits a sense of wonderment and curiosity in most people who are exposed to it. After the initial “WOW SO COOL” moment, the next reaction is generally a dichotomy. Either they can’t wait to learn how to use it or feel like there is no way they can figure out such a seemingly complex technology. Once these individuals learn about 3D printing and experience it, next comes a wonderful example of human behavior...the person who couldn’t wait to dive in realizes that there is far more detail and complexity to using the technology successfully than is readily apparent as you joyfully watch the extrusion of a perfectly formed object. The person who was apprehensive realizes that much of the “work” is done by algorithms hid beneath a well designed user interface and that this complicated machine is not more than a very precisely controlled miniaturized glue gun. This differing response and experience is what makes teaching (and learning for that matter) so fun and rewarding!

The next question that arises is when encountering these different types of learners...how do you get them through their respective moments of frustration? The answer is simple, give them purpose that is real and meaningful. While the answer is simple, the route to achieving purpose is not, that is, unless you are teaching students how to 3D print for healthcare! Teaching someone to use a 3D printer means that they end up with a real physical object they can hold in their hands. It’s very gratifying and it also feels good to know you have the capability to use such an incredible device. Even for myself, as many prints as I have run, I still feel like each successful print I pull off bed is like I’ve passed another test at 3D Print University! As for making the experience meaningful, that has nothing to do with the 3D printer and everything to do with what you use it for. And that brings me to the 2nd and 3rd classes of our Design for Disability course…our Enable hand build.

 Students checking out a sample Phoenix V2 Enable hand build

Students checking out a sample Phoenix V2 Enable hand build

We decided to use Enable upper limb devices as our first 3D print project as it would allow our students to explore a functional use for the technology via a design/process that has been perfected in the thousands of iterations and prints by the Enable community. Few use cases exist for desktop 3D printers in healthcare and we wanted to be sure that the first printing experience for our students had the right mix of being real/functional and meaningful. Our partners at Enable Community Foundation helped us to connect with a young boy in the country of Jordan who was in need of a prosthetic device. Using photos shared with us by his domestic relatives, we decided to create a few different scales that he could try with hopes of getting close to an optimal fit. For class, we instructed our students to download, scale, and prepare the files for printing. They also had to consider the colors of the various parts of the hand and make sure the files were separated accordingly. No easy task when each hand is made up of over 30 3D printed components!

 Dante Varotsis describes his experience implementing a 3D printed prosthetics program in Haiti

Dante Varotsis describes his experience implementing a 3D printed prosthetics program in Haiti

Once the the files were prepared and the prints started, we transitioned from beginning to create one of these incredible devices to learning about an example where they are being used on the front lines of care. Dante Varotsis, came to class to talk about his brainchild, Hands for Haiti. A partnership between Enable Community Foundation and Ultimaker, this is one of the best examples of 3D printers being used to replace a supply chain in a hard to access environment, outside of the international space station. The goal of this project was to outfit local prosthetists and therapists in Haiti with 3D printers and teach them the skills so that they can create custom prosthetics in a place where the infrastructure for traditional prosthetics does not exist. Dante enumerated on the many challenges with the program. From the technical side, how to deal with regular power interruptions (3D printers don’t like losing power mid print), to the human side where they had to redesign the prostheses to look more human because the original designs looked unnatural and were seen to be culturally unacceptable. These insights and real world lessons brought the class back to earth and made everyone think about the many ways in which 3D printers can help on the technical side while also considering the human factors which must never be ignored.

Everyone left that day as the printers whirred with the first layers of PLA extruding on the plates forming the outlines of what would soon become prosthetic hands for a boy in Jordan. Each hand would require around 24 hours to print at the quality we wanted so the students left imagining what they would look like when they got back. I wish I could say that they all printed perfectly the first time, but there were some bed adhesion problems we had to work through and clogged machines to deal with in between class. As far as desktop 3D printing technology has come, it is still very much an “enthusiast's tool" in that they take more TLC than most casual consumers are used to giving their other home technologies. However, with the supportive 3D printing community we quickly worked through the problems we were having, and when the students came back, we had 3 complete hands printed and ready to be assembled.

 Bridget Downey demonstrating 3D imaging technology to the class

Bridget Downey demonstrating 3D imaging technology to the class

To begin our third class, we were lucky to have with us a colleague, Bridget Downey, who specializes in 3D Imaging and will be exploring 3D printing medical images with JeffDESIGN. She gave the class an awesome show-and-tell as she demonstrated the power of 3D Cat Scan (CT) images to add more clarity to a case by presenting a clinician with a more real word view of a patient’s anatomy. This was pointedly demonstrated when she showed us a CT of a pumpkin (and a few other interesting objects)! In the traditional 2D “slice” view, the image looked like a hollow ring with some spots in the middle. In 3D view, what had looked like hollow space, revealed a pattern showing nature's beautiful complexity in detail with flesh and seeds arranged in functional segments. And this was just a pumpkin! She continued to show us how she could instantly peel away layers of the scan of a human body from skin, to muscles, to organs, and then to bone. With this technology, any particular layer or section can be isolated and prepared for 3D printing. This has tremendous implications for surgical planning, where a surgeon can practice on a 3D printed model of an actual patient, mastering the procedure before they even make a single cut. [Scroll through the gallery below to check out the images]

As difficult as it was to move on from the enlightening 3D imaging demo...we had hands to build, so build them we did! Before that however, I focused the students’ attention on the “Failed Prints, aka Lessons” table where I had saved the various prints that had been started and went wrong. I likened it to “Reading the Tea Leaves” and went through each print and pointed out the abnormalities and what caused them. Poor bed adhesion, clogged nozzle, or drafts causing uneven temperature, each of these failures provided an example and learning opportunity for the class. Our 3 hand assembly teams, Hot Rods, Superman, and SilverFox, then set out to build, claimed their parts, and began to smooth out the rough edges and remove unnecessary support material. They split up the work of assembling the fingers, putting it all together, and stringing up the “tendons” made of high test fishing line. One group from each team got to thermoform the gauntlet. One of the cool things about thermoplastics (the stuff we use for 3D printing) is that you can print them flat and then heat them up so they can be molded to fit a person perfectly. So we submerged the flat gauntlet in hot water and carefully molded it to whomever on the team had the smallest wrist to best match our young patient. When class was over, we had three functional (and mostly complete) prosthetic hands.

 Phoenix V2 Enable hands

Phoenix V2 Enable hands

Keeping in mind the ethos of a designer, having the child present to participate in the process would have been optimal. However, with the limitation of distance, we had to settle for building and sending and waiting for feedback to iterate. The students however now have one successful print behind them, which is a great confidence builder. For the second half of the course, we will be pivoting. Now the focus of the class will be designing for a patient, and the 3D printers will be there as tools to support that process. We will be being joined by a person with a significant disability for the next class. We will work with them to understand their needs, and then co-create solutions for and with them with the goal of addressing some of those needs. By the end of the next 3 classes, we hope to have a selection of unique devices that our students will present out.  I am excited to have this experience with my students and can’t wait to see what they do.

 Left to right: The instructors of Design for Disability, Todd Corlett and Mikael Avery from Philadelphia University , and Rob Pugliese and Bon Ku from Thomas Jefferson University, JeffDESIGN

Left to right: The instructors of Design for Disability, Todd Corlett and Mikael Avery from Philadelphia University , and Rob Pugliese and Bon Ku from Thomas Jefferson University, JeffDESIGN

Robert PuglieseComment