Operation Namaste Making 3D Printed Molds for Prosthetic Aligners in Nepal

Last January, Certified Prosthetist-Orthotist (CPO) Jeff Erenstone, the Chief Technology Officer of Create O&P, decided to leave the company he co-founded in order to continue advancing and improving clinical and prosthetic care in the developing world.

Jeff Erenstone fitting a prosthetic liner on an amputee’s leg

In addition to treating patients in his upstate New York clinics, he has now focused all of his attention on Operation Namaste, the non-profit organization he co-founded that is working to ensure amputees around the world have easy access to comfortable prosthetic care.

According to the organization’s website, it helps “determined people achieve by providing tools and support to Orthotic and Prosthetic practitioners in Nepal and beyond.”

Operation Namaste has worked on several helpful projects, such as hosting a summit on prosthetics and orthotics, setting up Camp Namaste for Nepalese children with limb differences, helping a Paralympic hopeful play basketball, and completing the Nepal Warrior Trek, where a team of amputees and business owners traveled to the country to raise awareness and financial assistance for victims of the 2015 Nepal earthquake.

Its latest project is SILC (silicone interface liner comfort) Solutions, which is a system for fabricating silicone liners locally. In October, Operation Namaste volunteers took a trip to Kathmandu, Nepal to test out the new program, which will work to improve prosthetic care – using 3D printing – in developing countries.

“Part service trip and part trek, this trip featured a team of prosthetists, a physiotherapist, and an amputee peer counselor who toured the beautiful country of Nepal, visiting several prosthetic clinics along the way and putting on an educational summit for Nepali practitioners discussing the latest care techniques,” the website stated about the organization’s Nepal Trek 2019.

Prosthetic liners go between an amputee and their prosthesis in order to increase mobility and comfort…which is great for patients in high-income countries with either medical insurance or the money to pay for them.

SILC Solutions prosthetic liner

Erenstone said, “Without prosthetic liners, amputees would not be summiting the Himalayas, returning to active-duty military service, and competing against able-bodied athletes in Olympic sports.”

Unfortunately, these liners are not readily available, or are too expensive, for most amputees in low-income, developing countries like Nepal.

Demonstration at educational conference in Nepal

Operation Namaste’s new SILC Solutions method uses CAD-designed, 3D printed molds to create standard-sized silicone liners. Compared to typical liners, which can cost upwards of $200, the sustainable ones created by the organization will cost less than $50 to fabricate – making them far more accessible to amputees in developing countries.

Erenstone mixing silicone to make a liner in Nepal

Erenstone has firsthand experience in seeing the positive difference that a quality prosthetic liner can make in the life of an amputee, especially in places like Nepal.

“I’m really excited for this project take off in Nepal, and beyond. Our goal here was to make liners affordable, accessible, and sustainable, and I think we are achieving that,” said Erenstone.

ROMP (Range of Motion Project), a Colorado-based nonprofit organization with dovetailing goals, is partnering with Operation Namaste to help achieve the goal of improving prosthetic care all around the world.

“Gel liners are just not within reach for most people in developing countries,” said Eric Neufeld, the chair of the board at ROMP. “This has been a limiting factor in the quality of care for amputees.”

3D printed liner mold

During Operation Namaste’s recent trip to Nepal, the team of volunteers successfully tested out the new SILC Solutions program, determining that it was possible to use 3D printed molds to make lower cost prosthetics anywhere. The organization plans to finalize its SILC prosthetic liners ahead of another planned trip to Nepal in spring 2020, where volunteers will deliver necessary materials to fabricate the liners and train practitioners on the process.

Discuss this news and other 3D printing topics at 3DPrintBoard.com or share your thoughts in the Facebook comments below. 

[Images: Operation Namaste]

The post Operation Namaste Making 3D Printed Molds for Prosthetic Aligners in Nepal appeared first on 3DPrint.com | The Voice of 3D Printing / Additive Manufacturing.

Experimenting with Transmitting EMG Signals to 3D Printed Myoelectric Prosthetic Hands

Amputees have some choices when it comes to 3D printed prosthetic hands, in regards to whether the artificial limb is operated by mechanics or neurological signals. We’re also seeing examples of 3D printed myoelectric prosthetic hands, which is an externally powered artificial limb controlled by the electrical signals that are naturally generated by our muscles.

A group of researchers from the Gujarat Institute of Technology and Government Engineering College, which are both in India, recently published a paper, titled “Wireless Transmission of Electromyography (EMG) Signals to operate 3D Printed Myo-Electric Hand,” that explains their new methodology of wirelessly transmitting Electromyography (EMG) signals to a 3D printed myoelectric prosthetic hand.

The abstract reads, “Sometimes in case of particular amputees, fetching EMG signals by sensors is not possible from that destructed muscles but, EMG generated from healthy muscles besides that amputees can be used in the transmission of signals. The objective of this research is to generate the new technique for transmitting EMG signals without wire from any adequate healthy muscles. In this methodology, we used the EMG sensor to detect EMG signals, which perform a pre-processing task and featured extraction on EMG signals by using a microcontroller. That extracted output then applied to universal remote control transmitting circuit as input which sends the signals to the receiver circuit, output signals from that receiver circuit directly applied to servo motor of a myoelectric prosthetic hand. The objective of this research to fetch and carry EMG signals from the healthy muscle and train the victim suffering from amputee in which acquiring adequate EMG signal from very adjacent tissue of damaged area is not possible due to burning and inflammatory issues.”

The researchers wrote that myoelectric hands are more reliably and accurate, and that amputees can configure the motion of the hands in a much more natural way, with more freedom. EMG-based myoelectric hands are popular on the market, because they are more efficient. You can see how the team’s 3D printed myoelectric prosthetic hand, which is controlled through wireless EMG transmissions, works in the diagram below.

Block Diagram of Wireless EMG Control for Prosthetic Hand

The team conducted their experiments on the right hands of six people, ages 21-24, that were not differently-abled, and two with below the elbow amputations. Because the subjects all had major differences in body muscle fat, the results of electrical signal powering the prosthetic were altered a little more than normal.

EMG signals are associated with the muscle’s contraction and relaxation movements, but the body’s signals are of low potential, so amplifier circuits and filters are needed to help get rid of unnecessary noises. Traditional EMG analysis instruments often use painful needle electrodes, but wireless EMG ideology can help in situations where it’s not possible to get adequate signals across the muscles for various reasons, such as muscle fatigue and allergic reactions. In this experiment, a microcontroller with an embedded 8 bit ADC (Analog to Digital Converter) was used to sample the signal, while a motor driver circuit controlled the amount of voltage and current supplied to drive the motor.

“There are many modules and terminology that are available in market like Bluetooth and Wi-Fi connectivity. But the most significant concern undertaken by our study that all modules requires basic power consumption and first time pairing and in such case that doesn’t proved to be most useful due to some connectivity issue. Therefore, developing RF Based Wireless unit opted by our team,” the researchers wrote. “Since we had utilize almost 5 servo motors, we need to develop multichannel wireless TX that can control up to 5 different appliance or motor. Wireless TX concept is based on transmitting our low frequency signal from one end to another by modulating with predecided carrier frequency which has high frequency which can transmit signal at a large range, even prosthetics don’t require such a high range. We had used 27MHz of frequency to modulate our low energy signal which is encoded to certain signal by IC TX-2B.”

Wireless vs wired prosthetic hand

The team noted that by 3D printing the hands, there are more opportunities to design accurate parts for good results. They used a Makerbot 3D printer to make the hands out of ABS and PLA, with 90 to 100% infill and normal print speed. Supports were used, and the hands were polished for a better overall aesthetic. Each hand had metacarpal fingers and an enclosure, wrist, and ring of the wrist, along with a standard below elbow piece to enclose and link the structure so the fingers could be moved.

In order to learn more about the participants’ muscles and find out which ones generated the signal most dominantly, an EMG spectrum analysis was performed on each person before muscle sensors were deployed on their arms. This would allow them to avoid inconsistent signals.

One of the amputees could not generate an EMG signal from his lower elbow, possibly due to muscle destruction or a lack of physiotherapy exercise.

Motor Moving Mechanism of the Prosthetic finger

“Wireless EMG Based Prosthetic Hand can be consider meaningful for both condition either person suffering with wrist disarticulation or standard above elbow,” the researchers concluded.

“Wireless method completely isolates the sensor and actuator portion because they get communicate by radio frequency network only which drives by low power.

“Overall, we had taken observation that it is novel technology to transfer EMG signal from healthy muscles rather than amputate hand to the sensor to operate prosthetic hand.”

Co-authors of the paper are Sunny M. Patel, Dinesh R. Damodar, Chintan A. Patel, and Raj B. Patel.

Create O&P Co-Founder Jeff Erenstone Resigning to Bring More 3D Printed Prosthetics to Developing Countries

3D printing orthotic and prosthetic manufacturer Create O&P, based in New York, is responsible for creating the first medical-grade 3D printed arm for a survivor of the Haiti earthquake. Soon after this feat, it introduced the Create 3400: the first and only fully integrated medical-grade 3D printer for orthotic and prosthetic devices. The company’s mission is to manufacture cost-effective 3D printed prosthetics that are easily accessible around the world, and not just in the US. It’s safe to say that Create O&P has used 3D printing to do a lot of good in the world.

Jeff Erenstone, the co-founder and Chief Technology Officer of Create O&P, is a certified prosthetist-orthotist. He already had his own clinical practice, Mountain Orthotic and Prosthetic Services, when he launched the company in late 2014 after seeing the potential of using 3D printing to increase productivity in the orthotic and prosthetic care industry. Now, he’s decided to move on in order to continue advancing and improving clinical and prosthetic care in the developing world, and this week announced his resignation as the company’s CTO.

“I am very proud to have co-founded this business and work with hundreds of clinic owners to improve care for their patients and enhance efficiency at the same time. I am excited to take the lessons we learned here and improve care in the developing world where this technology will allow for clinical care in areas where it otherwise is currently unavailable,” Erenstone said.

Erenstone will be continuing his work in the orthotics and prosthetics field by expanding the use of applied 3D printing solutions in clinical work in developing regions of the world through his non-profit organization, Operation Namaste, which he also co-founded. This is a pretty inspiring move, in my opinion.

“I am very proud of the products we developed at Create O&P, which today includes 3D printers, software, education and other tools with which O&P clinicians can produce a whole range of products. With Create O&P’s capabilities, clinicians in the United States and throughout the world have seen drastic improvements in the efficiency of their practices,” said Erenstone. “I am glad to be leaving this company in competent and energetic hands.”

The heartwarming Operation Namaste organization wants to ensure that amputees all around the world can have easy access to 3D printed prosthetic care. Its mission is “to provide a continuum of prosthetic care and related rehabilitative services to the people of Nepal” and other developing countries as well, such as Haiti.

Some of the projects that Operation Namaste has worked on include a summit on prosthetics and orthotics, Camp Namaste for Nepalese children with limb differences, and the Nepal Warrior Trek, where a team of amputees (including an Ohio police officer) and business owners journeyed to the country for a long trek with the purpose of raising awareness and financial assistance for victims of the 2015 Nepal earthquake.

“We will very much miss Jeff at Create O&P and wish him the best of luck as he brings 3D technology to places where patients too often don’t receive care. Jeff’s contributions to this company are immeasurable,” stated Create O&P’s CEO Cecilia “Cissi” Schaffer. “As a clinician, practitioner and visionary, Jeff saw the challenges domestic clinics face, particularly as they relate to net margins. He knew that 3D printing was the only solution that would both improve efficiency and improve clinical care.”

Erenstone was the company’s first CEO, and oversaw the development of two generations of its 3D printers, which includes its current series that makes it possible to manufacture diagnostic sockets, hands-free, in less than three hours. In addition, he also created Create O&P’s Rapid Plaster software, digitally replicates the processes that clinicians use in order to design sockets, as well as other devices, for their patients.

[Image: Create O&P]

“It was an honor to co-found this company with Jeff. We are implementing Jeff’s vision, which he himself tirelessly pursued for over four years,” said Create O&P Co-Founder and Chief Financial Officer Dan Kelleher. “I am grateful to Jeff for the opportunity to help him pursue this digital future since 2014.”

Discuss this news and other 3D printing topics at 3DPrintBoard.com or share your thoughts in the Facebook comments below. 

[Images: Operation Namaste unless otherwise noted]

MSF Hospital in Jordan Continues to Help Wounded Victims of War with 3D Printed Prosthetics

Ahmad is the first patient to receive an above-elbow 3D printed prosthetic from MSF. Technicians added an extra piece to substitute the humerus in the prosthetic, and Ahmad will be able to both bend and stretch the arm.

For over ten years now, Médecins Sans Frontières (MSF), known in English as Doctors Without Borders, has been operating a reconstructive surgery hospital in Amman, Jordan. Patients from many Middle Eastern countries who are victims of bomb blasts, shrapnel, bullets, and other war-related wounds are healed there.

But the MSF-run hospital also offers upper limb amputees something in addition to emergency medical care – 3D printed prosthetics.

Moreau scans the amputated hand of Ibrahim, a patient from Iraq. The scanned image appears in real-time on his computer and will provide accurate measurements for his tailor-made prosthetics.

Pierre Moreau, the clinical coordinator for MSF’s 3D printed prosthetic project in Jordan, said, “The MSF Foundation launched the 3D project in Amman in February last year, and we started to see the first patients two months later.

“So far, we have delivered 16 printed prosthetics. But our role doesn’t stop here. We support patients through a string of occupational therapy sessions to show what they can do with them.”

The project began as a study and is still technically in its experimental phase. Patients come to the hospital from places where it’s hard to get proper treatment, and too expensive for subsequent therapy, like Gaza, Iraq, Syria, and Yemen, and MSF uses 3D scanning and printing to help them regain partial functionality. In turn, patient feedback helps the organization improve the quality of the 3D printed prosthetics.

34-year-old Ibrahim suffered injuries to his head, hand, and leg from a car explosion, and has had a total of six surgeries. While his hand was only initially broken, improper treatment caused it to rot, and doctors soon amputated it; Ibrahim has been dealing with the resulting pain for over two years.

Ibrahim’s 3D scans

At MSF’s Jordanian hospital, Ibrahim’s hands were scanned, and a mirrored picture will “be matched with the scan of the injured part” to make a more accurate prosthetic. Before his injury, Ibrahim was a driver, and his 3D printed prosthetic will allow him to return to work.

MSF is also 3D printing transparent masks for patients with facial burns, which are used to apply pressure on the affected surface to keep skin soft and flat after graft surgeries to help the face heal with less scarring. 7-year-old Nour Saleh suffered head injuries in 2014 when a small device exploded near the family home, and eventually underwent a skin graft procedure in Baghdad.

The family didn’t have enough money to cover all of her medical costs, and MSF accepted the case two years ago. Thanks to four surgeries at the Jordanian hospital, Nour was able to grow her hair back, which really helped with her self esteem.


Traditionally manufactured below-elbow prosthetics can cost anywhere from $200 to $2,000. But for a 3D printed prosthesis, factoring in the material, production time, case estimation, and assessment of the patient’s needs, the overall costs are much lower.

“The idea is to be able to produce 3D-printed prosthetics in the future in places difficult to access and lacking a sound healthcare system, like in conflict areas,” explained Moreau. “But the way to do it is still under discussion, as it is not always easy to find technicians available in these areas, and printers are still expensive.”

Samar Ismail

Prices are expected to keep going down as people in the industry work to develop cheaper 3D printers and innovative materials. Speaking of materials, MSF 3D Project Supervisor Samar Ismail takes care of the post-processing work for the 3D printed prosthetics, which includes painting them a color that matches the patients’ complexions and adding a varnish safety layer so food can be safely handled.

44-year-old Abu Mohammad was working in a field when a bomb was dropped, which affected both his hands and legs.

“It was impossible to escape the accident,” he explained. “Warplanes arrive suddenly and when you notice their presence, it is because you are on the ground groaning in pain.”

He uses a walker to move, and, as he has a nerve injury and multiple amputated fingers, received an active-system prosthetic, which will allow him to open and close his hand and activate the prosthetic thumb by moving his shoulder. This will help Mohammad complete tasks like combing his hair or holding a phone.

23-year-old Abdulkareem was also injured by a bomb dropped from an airplane. At the local hospital where he sought treatment, he received an uncomfortable prosthesis made with traditional methods that he rarely used. 17-year-old war victim Ahmad Meqdad was injured outside when a plane dropped a barrel bomb near his home seven years ago, and was taken to the hospital with his arm barely hanging on; his hand was soon amputated, and his mother says that he “refuses to talk about the accident.”

MSF has used 3D printing to help all of these patients, and will hopefully continue to do its good work for as long as it’s necessary.

Note: Some of the patient’s names were changed on request.

Discuss this story and other 3D printing topics at 3DPrintBoard.com or share your thoughts below. 

[Source: Al Jazeera / Images: Elisa Oddone]