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VA Research Currents archive
November 1, 2016
A robotic arm grasps a 3D-printed basket in HERL's robotics laboratory. (Photo by Michael Lain)
Created more than 30 years ago, three-dimensional printing (3DP) has seen a sudden rise in interest within medicine, and VA has been tapping the technology to improve life for disabled Veterans.
3D printers can be used to design and create prosthetics and other assistive devices. At the Human Engineering Research Laboratories (HERL), a collaborative effort between the VA Pittsburgh Healthcare System, the University of Pittsburgh and the Rehabilitation Institute at the University of Pittsburgh Medical Center, researchers focus in part on 3D printing to improve the mobility and function of people with disabilities such as lost limbs and spinal injuries. HERL's 3D printers rely on technology so advanced they can print almost anything that can be designed on a computer, using plastic, metal, or rubber.
Dr. Brad Dicianno, a physiatrist, is the medical director of the Human Engineering Research Laboratories, home to the VA Center of Excellence on Wheelchairs and Associated Rehabilitation Engineering. He and Garrett Grindle, HERL's assistant director of engineering, co-authored a recent review of the topic in PM&R: The Journal of Injury, Function, and Rehabilitation. In a joint written response, they shared their insight with VA Research Currents on 3DP technology and its impact on Veterans with disabilities.
VA Research Currents: What is 3DP?
"Right now, 3D printers are excellent for fabricating highly customized parts that can be used for personalized assistive technology."
Dicianno/Grindle: 3D printing, also known as additive manufacturing, is a term that describes a class of machines that use a digital file to create parts by stacking thin 2D layers of material to make 3D parts. Right now, 3D printers are excellent for fabricating highly customized parts that can be used for personalized assistive technology.
To what extent is 3D printing used clinically in VA or in rehab medicine at large?
The medical community has benefited greatly from 3D printing as a development tool. Most new medical device prototypes use some sort of 3D printing while they are in the development phase. Also, using CT and MRI data to make individualized surgical models is a well-established process. Some orthopedic implants are 3D-printed to replace damaged areas of the skull or to fix fractured jaw bones. Those making dental implants are clear leaders in medical 3DP technology, with custom-printed implants being done on a large scale. In the future, we are likely to see 3D-printed scaffolds, individualized surgical tools, and other advancements, including the emerging area of 3D-printing biologics [genetically engineered proteins used as therapy]. It is possible that hospitals someday will have 3D-printing departments dedicated to making patient-specific devices of all kinds.
Scientists and engineers have been aware and have been using 3D printers for some time. I think the media and general public have taken notice more recently due to the availability of low-cost and readily purchasable hobby 3D printers. With 3D printing becoming more and more common, patients are beginning to ask questions about 3DP and experiment with DIY [Do-It-Yourself] printers or browse the web for DIY designs. However, in-home use of 3DP is only just beginning.
Other factors that have helped raise awareness of 3D printing are increased capitalization in this sector by investors; some of the seminal patents expiring, opening up more competition; and a renewed emphasis by policymakers on promoting manufacturing in the U.S.
There is often not an off-the-shelf device to meet a need. Traditionally, fabricating custom devices is time-consuming, expensive, and hard to maintain over time. 3D printing has the potential to change this.
What aspects or applications of 3DP are being studied at HERL?
HERL has been using 3D printers to develop new technologies for more than 15 years. We work on new assistive technologies to help Veterans with disabilities participate more fully in their communities. Designing and fabricating new assistive devices is tedious and is done in an iterative process. Three-dimensional printing speeds up this cycle. Since it is easier to manufacture complex shapes with a 3D printer than with more traditional technologies, we can often make the devices function better and be more aesthetically pleasing.
3D printing has been used to assist with developing technologies that have been commercialized at HERL, such as the virtual seating coach, a wheelchair seating technology that helps clinicians establish appropriate repositioning recommendations for patients. Components of the system mounted to a power wheelchair were made at HERL with 3DP. Three-dimensional printing has been an important tool for AT [assistive technology] developers to enhance the development process. However, its use in making custom parts for people is just getting started.
We are not focused on one type of disability. Our research is geared toward people with a wide variety of conditions, including spinal cord injuries, traumatic brain injuries, amputations, multi-traumatic injuries, and many others.
What do you see as the future of this technology?
For amputees, we think direct metal and composite materials [such as carbon fiber] 3D printing will change how components are designed in the long run. We think we will also see better-scaled components for kids and people with very specific needs who need specialized designs. 3DP will never replace the need for a specialist such as an orthotist or a prosthetist, but their tools will become more automated.
For wheelchair users, we think we will likely see more highly customized interfaces such as cushions, arm rests, postural supports, or head rests, for example. Custom handles and buttons might make power wheelchairs easier to operate for people with limited hand function. The emerging area of ceramics 3D printing could greatly improve bearing surfaces, leading to less maintenance issues with casters.
Tools are only as good as the people using them. If the proper investment is made in training, research and development, and access to the machines, then we will likely see 3D printing solve many modest problems and transformationally change a few others.