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.
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...
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.”
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 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.
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...
Prosthetics have been in use for thousands of years. Although early devices cannot be compared with contemporary ones, we know that ancient Egyptians, Chinese and Romans were able to replace missing body parts as long as 3,000 years ago.
The first milestone in the subsequent evolution of prosthetics was the introduction of the wooden peg leg, explained to MedicalExpo e-magazine Dr. Horst-Heinrich Aschoff, chief physician and head of the Endo-Exo Center at the Sana Klinik in Lübeck, Germany. The peg leg was used for centuries and can still be found in many countries today.
The first movable-hand prosthesis dates to the end of the Middle Ages. After losing an arm in battle, German knight Götz von Berlichingen had an iron hand made. He could use his intact hand to open and close the artificial one and position the fingers, thanks to built-in wheels and springs. At about the same time, French surgeon Ambroise Paré introduced the first leg prosthesis that could be properly attached to the remaining part of the leg.
War Triggered Progress
However, since members of society’s modest classes could not afford such elaborate aids, the peg leg and arm remained the solution of choice until the middle of the 19th century. It was the American Civil War and its hundreds of thousands of wounded soldiers that launched the industrial production of prosthetics. Government financing helped create a whole new manufacturing industry.
The American Civil War launched the industrial production of prosthetics.
In Europe, a similar evolution resulted from World War I. The industrial revolution allowed for large-scale production of prostheses. In 1917, German surgeon Ferdinand Sauerbruch revolutionized arm prosthetics by creating the first device that could be controlled by the muscles of the stump.
Prosthetics continued to evolve after the Second World War, after the demand rose enormously, and “because the introduction of synthetics marked another milestone after the introduction of the peg leg,” explained Dr. Aschoff. Today, Dr. Aschoff notes that medical progress has made it possible for people to move their prostheses via a direct link to the nervous system. “We need to take our hats off to what is possible today.”
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:
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.