MedicalExpo e-Magazine - #20 – Revolutionary Limb ProsthesesMedicalExpo e-Magazine

The Smart Magazine About Medical Technology Innovations

Revolutionary Limb Prostheses: The Feel Again




Today’s new myoelectric and brain-controlled limb prostheses are so ingenious that they can let users “feel” again, combining robotics and design at the same time. Thanks to 3-D-printing, revolutionary new prosthetics have become much more affordable.

In this edition, we also will introduce you to the new Siemens Multitom Rax scanner. It’s the first machine that allows 3-D-imaging of patients in their natural standing position and a small revolution in this sector.

Hot Topic
This is the major challenge facing developers of prosthetic limbs today : How to empower the user with a real sense of touch
Bebionic small hand opening purse (Courtesy of Steeper)

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Thanks to a new generation of prosthetic arms, patients can take a sensory step forward and “feel” again.   With approximately 10 to 15 million amputees in the world, those without arms or legs make up a significant percentage of our society. But these numbers don’t make everyday existence any less of a...


Hot Topic
Our devices are in the hundreds of dollars. We only need a few measurements and about a week to make a hand
6-year-old Julian and his 3-D-printed mechanical hand (Courtesy of BGP)

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According to a current WHO estimate, more than 100 million people worldwide need a prosthesis or orthosis, and 9 in 10 of them have no access to these relatively expensive devices. Several organizations are currently trying to fill this dramatic medical supply gap with the help of 3-D technology.

 

Born without fingers on his right hand, 6-year-old Julian used to hide this part of his body on family photographs. That is, until he met Perry Weinthal, Chad Coarsey and Manny Papir from The Bionic Glove Project (BGP) in 2015, who gave the little boy from Florida a 3-D-printed mechanical hand. Julian quickly outgrew the first device and is now on his second bionic hand, which BGP made in his favorite colors including parts that glow in the dark. BGP told us:

He is proud to show his hand off now.

However, just as he will periodically need bigger shoes, Julian will periodically have to get another hand. Maybe as many as 20 before he’s fully grown. Luckily, BGP can manufacture 3-D-printed hands at a relatively low price:

“Our devices are in the hundreds of dollars. We only need a few measurements and about a week to make a hand. Without 3-D printing this would not be possible. It is an additive technology as opposed to reductive technologies, which are extremely wasteful, and it allows us to use low-cost materials.”

Training Wheels

By contrast, classically custom-made prosthetic devices can take weeks or even months to produce and easily cost several tens of thousands of dollars, with most health insurance companies only covering one per patient if at all. According to BGP, this is especially an issue for young children as they can out-grow a hand every four months. For adults the issue centers around the fact that their muscle anatomy can change by using a new prosthetic. BGP has seen adult forearms grow as much as 12% from regular use of their hands.

We look at this as training wheels. Our devices are tools to teach children and young adults how to use prosthetics

“Prosthetists create wonderful works of art, but children are not viable clients at that point. We are talking a cost nearly equivalent of a car every quarter or semester and not many families can afford that. Also, Julian’s parents used to ask, ‘What if he breaks it?’ But thanks to rapid prototyping, we now have an inventory of parts, and we can replace anything on a given hand right away. We don’t discourage breaking of hands, because it means that they are out there using it, and that’s a good sign.”

At the same time, BGP says they are not trying to compete with the prosthetics industry: “We look at this as training wheels. Our devices are tools to teach children and young adults how to use prosthetics, as well as keep their bone and muscle growth bilaterally equal. So when they reach adulthood they have the capability of running a high-end prosthetic, if they want to.”

It Works Like a Pulley

The design for the 3-D-printed bionic hands BGP has made for Julian and about 15 other patients is based upon open source files from the e-NABLE Community. Users control the flexion and extension of the fingers by moving their wrists:

“It is totally mechanically powered and works just like a pulley, when you have a rope around a ring and pulling a bucket. Imagine that bucket being the fingers and the rope is tied around each of them. As you pull the rope by bending the wrist, you are pulling the fingers to tighten and can grasp things.”

The-Gang (1)

The BGP team (Courtesy of BGP)

The vast majority of the parts in a BGP-made mechanical hand are 3-D-printed: “We use some external hardware, such as the padding, the straps, or the cables, and some screws. But everything else is 3-D-printed, using polylactic acid (PLA).”

Other 3-D prosthetic developments from the e-NABLE community, such as the Cyborg Beast hand, are made from acrylonitrile butadiene styrene (ABS), which is also the material used to create Lego construction toys. The costs for a Cyborg Beast hand can be as low as $50 USD.

Adding Robotics Into the Mix

While the BGP and Cyborg Beast hands are examples of 3-D-printed mechanical prostheses, there are also organizations that add robotics into the mix, such as Exiii’s HACKberry, which costs around $200 USD, or Dextrus, by the Open Hand Project. Open Hand Project founder Joel Gibbard explained in the Dextrus crowdfunding video:

The aim of the Open Hand Project is to make robotic prosthetic hands more accessible to the people that need them.

“At the moment these devices do exist, but they can cost up to $100,000 USD. The Dextrus can offer comparable functionality to leading prosthetic hands, at one-hundredth of the cost,” he added.


Innovation Focus
We can do full 3-D tomography in weight-bearing position, meaning that the patient is standing and does not need to move
The new Multitom Rax (Courtesy of Siemens AG, Munich/Berlin)

The new Multitom Rax X-ray scanner from Siemens Healthineers enables, for the very first time, full radiographic 3-D-imaging of patients in their natural standing position, thanks to two robotic arms that move around the person. Dr. Lars Hofmann is a physician and is the head of global marketing & product management of...


Prosthetic Foot for High Heels (Courtesy of JHU Senior Design Team)

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A team of Johns Hopkins University students, working with a physician and prosthetic experts, has developed Prominence, the first prosthetic foot that can wear...



A special stethoscope to detect knee injuries (Courtesy of Georgia Tech)

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Beware of crackling knees! Research engineers at the Georgia Institute of Technology are working on a special stethoscope to detect knee injuries. The device...



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  • Analytica 2016 (Courtesy of Messe München)

    In the context of the Analytica 2016 Conference in April in Munich, Germany, MedicalExpo e-magazine came back on one of the biggest trends in the laboratory sector: the increasing use of rapid diagnostic tests at the point of care. Norman Moore, director of scientific affairs, infectious diseases at Alere answered our questions.

    MedicalExpo e-mag: What is the purpose of the rapid tests?

    Norman Moore: The purpose of these tests is to provide reliable and actionable information to healthcare professionals. Some of our tests are administered in doctors’ offices, thereby eliminating the need for the patient to go to the hospital. Other tests are used in hospitals to direct therapy or in emergency departments. Some tests are used to screen and others are used for confirmations.

    ME e-mag: Do you use biomarkers for that? Could you explain how it works?

    Norman Moore: Our tests rely on a variety of markers. In the case of cardiac disease, we look for biomarkers that get released into the bloodstream. In the case of many of our infectious disease tests, we can look for either the genetic information or antigens.

    In some examples like HIV, we can bring the test out into the community to better link patients to proper care.

    In the case of genetic information, we use Alere i to amplify the DNA and detect it in a matter of minutes. In the case of antigens, we can see them with antibodies in a variety of ways like lateral flow tests and enzyme assays. In some diseases like HIV, it becomes important to find the person’s own antibodies as a confirmation so we can use recombinant antigens to identify what antibodies are circulating in a person’s system.

    ME e-mag: Can you do combinations of different tests?

    Norman Moore: Yes. For example, we have a dual test for HIV and syphilis.

    Moreover, we now know that most people that die of influenza actually die of complications—usually pneumonia. Alere has both pneumonia and influenza tests (they are separate tests). When it comes to enteric disease, there is a plethora of causes and Alere has quite a few tests to help direct therapy. In the case of Shiga toxin and enteric disease, it can become more important to test since some antibiotics can make the situation worse.

    ME e-mag: Who is using these tests mainly?

    Alere has a dual test for HIV and syphilis.

    Norman Moore: Our tests are used by healthcare professionals and patients all over the world—both in developed and developing countries. First users depend on the test and where the patient need is greatest. In the hospitals, the majority of testing can be done by laboratory staff. However, since many are CLIA-waived, nurses can do testing as well. These tests can be done in urgent care settings as well as doctors’ offices. In some examples like HIV, we can bring the test out into the community to better link patients to proper care.

    ME e-mag: Are you working on new tests and applications for the future?

    Norman Moore: Yes. Rapid diagnostics at the point of care is a highly dynamic and fast-paced industry. As healthcare becomes increasingly decentralized, there is great opportunity for growth. We are continuously working on the development of new tests and applications.

    Alere makes rapid tests for a large number of tests for:

    • Infectious Diseases – HIV, tropical diseases (malaria, dengue), liver (hepatitis), respiratory (influenza, pneumonia, strep, RSV), healthcare associated infections (C. difficile), sexual health (chlamydia, gonorrhea)
    • Cardiometabolic Diseases – HbA1c, lipids, anti-coagulation management, cardiac markers, blood gas analytes
    • Toxicology – Alere toxicology tests for a number of different drugs in a variety of settings including workplace, government, pain management, hospitals and reference labs.


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    Diagnosing osteoporosis at the point-of-care (Courtesy of Bone Index)

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    Imagine diagnosing osteoporosis at the point-of-care—without radiation. That’s what Finnish company Bone Index is proposing with its Bindex ultrasound device. It evaluates the cortical bone thickness of the tibia and immediately calculates the density index, which has historically been obtained using large dual-energy X-ray absorptiometry (DXA) machines in hospitals. Plugged directly into a laptop loaded with special software, Bindex can perform exams at the point-of-care.

    The device received U.S. Food and Drug Administration (FDA) clearance in May. The manufacturer claims that research and practical trials have demonstrated results comparable to DXA readings. According to Bone Index, it gives reliable results in just 30 seconds, allowing physicians to perform more screenings, and to order treatment or medication immediately. Bindex is also very easy to use in any environment thanks to the “plug and examine” system.

    Worldwide, an estimated 200 million people are afflicted with osteoporosis. Bone Index suggests its device could help the 75% who have not been diagnosed.


    CONTRIBUTORS



    J. Suen 

    J. Suen is a Hong Kong-based freelance journalist writing about health and medical news.

     


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    Daniel Allen

    Daniel Allen is a writer and a photographer. His work has been featured in numerous publications, including CNN, BBC, The Sunday Times, The Guardian, National Geographic Traveller, Discovery Channel.


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    Celia Sampol

    Celia Sampol has been a journalist for 15 years. She worked in Brussels and Washington for national medias (Agence France Presse, Liberation). She’s now the editor-in-chief of MedicalExpo e-magazine.


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    Kristina Müller

    Kristina Müller is a freelance journalist writing mainly about nautical and medical issues.


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    Christina Kuhrcke

    Christina Kuhrcke is a Berlin-based freelance journalist, doctor and digital storyteller.


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