Without a leg to stand on — 3D printing prosthetics: Matt Ratto at TEDxUofT


[MUSIC PLAYING] Hello. Thank you for that
nice introduction. I think I have some slides
that should come up here on the screen
momentarily, but I’ll start by telling you a
little bit about the project that I’m working on. I’ve been working
with an NGO called– there we go– I’ve been working
with an NGO called (cbm) Canada, and Autodesk,
a private company, creating CAD-CAM software, to do
a project basically developing a prosthetics, a 3D
printing prosthetics solution for the
developing world. And the title of my talk,
Without a Leg to Stand On, actually refers
to the domain area that we’re trying to solve. We’re actually trying to create
legs for people to stand on. But it also in some ways,
refers to my own status as a social scientist– not a
technologist, not an engineer, not a medical
researcher– attempting to intervene in this kind
of technological landscape through this 3D
printing process. But before I go
into that, I’ll talk about that later
in the talk, I want to tell you a little bit about
the project we’re working on and what we’re trying to do. So the World Health
Organization has estimated that over 30 million
people in the developing world need prosthetics or some
kind of mobility aid, and in response to this need,
the International Federation of Red Crosses and Red
Crescent organizations has developed a prosthetic
tool chain, a process of making prosthetics intended to
help serve this need. And in fact, Justine, that
you see here on the screen, was one of the people that
was helped by this tool chain. Justine lost her feet
and her lower legs to disease when she was
quite a small child. For many years, she walked
around on her knees, using sandals as a
kind of a padding. And she suffered a lot
because of this, both she suffered and
her family suffered. Her community suffered, because
of that reduced mobility that she had. She had difficulty
getting into society. She had difficulty
getting education. She had difficulty
taking care of herself, and it really took its toll
on both herself and her family and her community. She went to CoRSU
Hospital, which is one of the partners in the
project that I’m working on, CoRSU Hospital in Uganda,
to go through this Red Cross prosthetic tool chain
and to get prosthetics. That process starts with
a manual plaster casting of the residual
limbs of the person. That negative plaster
cast is transformed into a positive plaster cast,
which is then manipulated a little bit in order to
basically customize it for the production of a socket. That is placed on a
vacuum casting machine. That’s what you see
here in this slide. There’s a series of other
kind of manual tasks using grinders and other
kinds of equipment that are done in order to
basically prepare that. It’s fitted with a
standardized pylon, which is like the shank of the
leg, and a standardized foot. And then through a brief process
of rehabilitation and training, you end up with a patient
with the ability to walk. So here’s a picture of
Justine giving a high five, she’s walking just
fine, and it’s a great– it’s
actually a great story. It’s a great success story
for this Red Cross process and for these hospitals
like CoRSU Hospital, to actually deliver these
kind of prosthetic solutions. So that being the case, why
is there any kind of need for 3D printing, for
any of these other kinds of technological interventions. And there is actually
specifically two problems with this tool chain that I want
to highlight to you right now. The first is that the
prosthetic that I just described takes about five
days to produce. There’s a lot of manual
processes involved. There’s a lot of steps. And although five days is an
extremely accelerated process for the delivery of a
prosthetic, at least compared to the process here
in Canada or in the developed world, in which it might
take two or three weeks. And it’s a much more
comprehensive fitting process. Five days is still a
dramatically long period of time to ask people who
are living a subsistence existence, to, in a sense,
step out of their lives. So five days
actually dramatically reduces the number of
people who can actually be fitted with
these prosthetics. And in fact, in our
conversations with CoRSU, they’ve informed me
that in some cases, patients are presented
with their families to get the prosthetic made. They’ve been there
for a couple of days. They get about halfway
through the process. And then due to the
contingencies of a subsistence life, they are forced to leave. That’s a terrible
outcome for two reasons. First, obviously, the patient
doesn’t get a prosthetic. But equally, the hospital
who spent time and energy developing it, it
all goes to waste. So that that’s a really big
problem, this temporality of the prosthetic process,
which needs to be thought about. But the bigger issue– and this
is actually to some degree, to me anyway when
I learned this, kind of surprising– that
prosthetic tool chain that I just described, in fact, takes
a skilled, trained, prosthetist and prosthetic
technician to carry out. And the problem here is that
the developing world lacks these people, lacks
these personnel. In fact, the World
Health Organization has estimated that
there’s a 40,000 person gap in the prosthetic, in
the training and skilling of prosthetists and
prosthetic technicians. And to take it even
one step further, that if they spent a
lot of their resources over the next 50 years trying to
develop these people, the best they could hope for was to
get about 18,000 more skilled professionals. So there’s this
incommensurable gap between the need and the
ability to serve that need. And really, that’s where
we’re attempting to intervene. And we’re attempting
to intervene using a series of
kind of commodity, or really, home-based
technologies. Now I’m gonna throw these out
for you guys to take a look at. Go ahead. And I’ll describe this
here in a process. I want them back at the end. So if what you could do is
kind of pass them around, whoever, how far they
get– at a certain point, kind of try to pass them
on back up to the front. That would be great. Now what we’re trying
to do is basically use consumer technologies,
readily available technologies, to help meet this
aesthetic need. I included this
very silly picture just because I think
it’s important to include these silly pictures. Our process starts by using a
Microsoft Kinect like the one here in my hand, as
a 3D scanning device. It’s connected to a laptop
running some specialized software. And here on screen, you
see my Ph.D. student Ginger [? Kuhns, ?] scanning my
leg as part of some testing processes we did
a few months ago. That scan is then brought
into MeshMixer software, and there you can see a positive
3D mesh of a residual limb. Now MeshMixer was actually
invented here at U of T by a computer science Ph.D.
student, Ryan Schmidt. Dr. Schmidt now
works for Autodesk, and MeshMixer has now
become an Autodesk product. And it’s available
for free to anybody who wants to download it. So you’ve got the Kinect
now as a consumer-available technology. You’ve got MeshMixer as a
consumer-focused available technology as well. Now with MeshMixer,
which has really been developed to
simplify and accelerate the process of manipulation
of 3D scan data, we actually, in a
semi-automated way, turn the positive 3D mesh that
I just showed you, into this, into the 3D socket that some of
you actually have in your hand. I’m going to hold one up here
like the one on the screen. Now this has actually both been
generated from that positive 3D mesh. It’s also been manipulated in
ways that basically turns it into what is known as a
PTB, or patellar tendon. That’s the thing right below
your knee, below your kneecap, bearing socket, a PTB socket. This is actually much more
comfortable type of socket to wear than just kind
of the shape of the leg as a surface scan
would generate. So this has been
manipulated to create this. It’s then printed on a MakerBot,
again, a home-based technology. The ones in your hand,
the one in my hand, is all basically the same,
printed from that same process. It’s got a fixture
on the end of it that we incorporate during
the development process. That fixture basically
allows us to attach it to pylon and feet, which are
standard issue from the Red Cross pylons and feet. And the result is basically a
prosthetic with a customized socket, standardized pylon,
and standardized feet, which can be then fitted to
a patient in the same way as the standard process that
the Red Cross has currently developed. Now we are about
four months away from testing of the
solution here in Canada, six to eight months away
from testing in Uganda. That’s about our timeline. But so far, it looks like
we’re going along pretty well. And the solution does provide
some additional capacity for hospitals like CoRSU. In particular, it solves
a couple of problems. One there’s a lot
less manual work involved in this production. So there’s much less chance
for error to creep in. And also, there’s a lot more
time for these technicians to basically do
other kinds of tasks. So it reduces the labor
necessary to produce a socket. And importantly, it also
dramatically reduces the time. So instead of five days,
which is what the Red Cross standard process
involves, including the drying in the
African sun, as they say, of the plaster casts,
we can do this process in two days, less
than half the time. And so that really
resolve that time problem that we just described. It also requires much
less manual skill in order to produce it, which it solves
that prosthetic technician gap problem. There are a number of
issues that remain. We’re still working on
creating robust technologies, so making sure the
MakerBot is robust, making sure the Kinect scanning
is robust and reliable for use in contexts in the
developing world. Now we are putting these
things into hospitals, so it’s not just in any context. But these are things we have
to take into consideration. We are working on making sure
the sockets are themselves strong enough, so
if you squeeze it, you can see about
how strong it is. And potentially changing the
material geometry of this object in order to
increase its strength. We’re working with mechanical
engineering here at U of T to make that happen. And again, it does reduce these
training needs that I described before, but it doesn’t
eliminate them altogether, which means that we
can’t just consider this a technical
solution, we have to also consider a lot of social
factors in the kind of work that will take to implement
and scale out this work, because that’s
ultimately our goal. It’s not just to create
a one-off process, but to in fact, scale
it out globally. Now if that was the
only story that I was going to tell you
today, you might say well, I’ve seen this before. I’ve seen a lot of
similar stories, such as the Not Impossible
Lab’s 3D prosthetics process, where they’re printing
prosthetic arms in the Sudan, or potentially also
the Robo-Hand project that maybe some of
you had seen as well. And in fact, our project kind of
fits within some of that logic is well, the idea of using
this emerging technology, this developing
technological interventions, to basically resolve some
kind of social issue. So it fits well within that. But interestingly
enough, it’s actually not much of a
technical invention, or involving technical novelty. In fact, if you look at the
literature from the prosthetics and orthotics
context, what you find is work being done on
computer-aided design and computer-aided
manufacturing, it dates back to the
1980s, the first paper being published in 1984. That’s a long time ago. Right? Moreover, if you look
into those papers, what you find is some of
the same kind of stuff that we are doing in
MeshMixer was already being done in computer
software as far back as 1989. So this is actually a screen
shot of a computer interface where they’re doing the kind
of modifications to that socket that we’re doing in MeshMixer. So it’s not exactly
an entirely novel technological
intervention in the way that you might think it is. Instead, I actually
think it’s much more an example of the value of
a kind of democratization of technology that
we might associate with something like
the Maker Movement. The kind of
technologies that we’re making use of, the 3D
printers, the scanners, and things like that,
have actually all been developed because
of individuals working to open and democratize these
technological interventions. So the RepRap Project, an open
source 3D printer project, which in a sense, is the
foreground to the MakerBot, they kind of bounties
put on opening up the Microsoft Kinect which
was a closed system, done, these bounties being
provided by people like Limor Fried of Adafruit Open
Source, hardware and software advocates. And even MeshMixer itself,
this design software, being produced and distributed
for free by Autodesk, in a sense, to generate kind
of a new audience, new groups of individuals
engaging in 3D design. That’s really I think, a
big part of this story. And the prosthetics
project is an example of what happens when you have
those kinds of capabilities. But I want to take
it one step further and return a little bit back to
that Without a Leg to Stand On, because again, I want to remind
you that I am not an engineer. I’m not a medical researcher. I’m in fact, a social
scientist, and in fact as social scientists,
we are not supposed to be able to
explain electricity or deal with technologies
in a kind of a real way. Instead, we’re supposed to
be able to explain people. Now I do think that’s
relatively true, and I do think that being
able to explain people is very important. But in fact, what
I want to argue is that there is a new kind
of group of social scientists and humanities
scholars like myself, who are interested in taking
that understanding that we can derive from the deep
understanding of society that comes from fields like
sociology and anthropology and history and philosophy
and all these other areas and actually use those
understandings to facilitate and create technological
interventions that fit well into particular social context. Now I coined a term in 2007
called “critical making,” and I’ve been studying what
it means to in a sense, develop technological and social
understandings simultaneously. And that’s really the
focus of my research. And the prosthetics
project is, in a sense, a sign of that kind of work. And in fact, our
understandings of prosthetics– where we start from
for this project– emerged from a
series of workshops we’ve held over
the last few years where we brought in artists
and designers and makers and prosthetic wearers
and medical professionals all together to explore through
both thinking and making, what prosthetics are
and what they mean. This involved casting, this
involved experimentation with micro-controllers,
and the development of these kind of
funny little one off, “makery” kinds of prototypes. But It was through that
work that we really developed an understanding
of the relationship between prosthetics,
communities, society, and individuals
that has served us well in the construction
of the project that I’ve just shown you. And in fact, I want
to end by using that to respond a little bit
to a recent statement done by our honorable
Republican representative from Virginia in the United
States, who basically said, “funds currently spent by the
government on social science would be better spent helping
find cures to diseases.” And what I want
to say about that is, well actually,
Elliott, those two worlds are maybe not quite so
far apart, that in fact, the social sciences,
and investing in the social sciences, and
carrying out social science research can actually
in some cases go a long way towards
in fact, curing the social ills, including
things like disease that we currently face. So in fact, I think that
maybe I have more legs to stand on than I
thought, so to speak, because it’s really this focus
of both having a leg of kind of technical understanding,
proficiency, and expertise, and a kind of leg of social
understanding and analysis that really gives us
the ability as a society to move forward and address
these critical issues that we as a society face. And here I want to end simply
by thanking the partners on this project, cbm Canada,
Autodesk Research, CoRSU Hospital, and groups
like the Canada Foundation for Innovation
and the Ministry of Research and Innovation, and direct
you to the Critical Making Lab or the Semaphore
Project at U of T if you want to find out
more about what we do. Thank you very much.

One Reply to “Without a leg to stand on — 3D printing prosthetics: Matt Ratto at TEDxUofT”

  1. I think it is great how people that have all their limbs think and help others that don't. I am 43 and became  a triple amputee when I was 37 losing both legs below knee and right forearm. Before that I never once thought about a prosthetic'

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