Will 3D Printers Make Our Profession Obsolete?

Photo of Ray GrottI want to talk about one big reason I’m pleased that RESNA’s upcoming conference will include courses and workshops on popular tools such as 3D Printing and Microcontrollers, along with presentations on the “Maker Movement” and AT&T’s Connect Ability Challenge. I don’t know about you, but it exasperates me when I see the media promoting yet another 11-year old who has designed a clunky 3D-printed plastic prosthetic hand that “promises to change the lives” of people in less-resourced settings. I have a hard time hearing about designers and entrepreneurs, however well-intentioned, who spend hundreds of hours re-inventing assistive technology devices that are already available at reasonable prices. 
 
I’m all for efforts to make lower cost options available to people who need them. I think it’s really positive that the DIY/Maker/Open Source movements have the potential to direct a lot of creativity and innovation towards addressing the needs of people with disabilities. We’ve all seen great home-grown solutions designed by relatives, friends, and end users themselves. However, too often it seems as if new initiatives are happening within a bubble of ignorance about existing technologies, people’s actual needs and priorities, and the realities of their environments. Fundamental design methodologies and long-established principles of “appropriate technology,” may appear old school in this era of 24-hour hackathons, but these and the deep body of knowledge held by prosthetists, rehab engineers, OTs, PTs, suppliers, and other designers and service providers are battle and time tested. How do we, as professionals, stay in the game when almost anyone can write an app or print out a hand?
 
The media will always be infatuated with new technologies and quick solutions, and our culture of disposability doesn’t value long-term durability or usefulness. We can point (plastic) fingers, but some of this is our responsibility as well. How many of us have gotten involved with local Maker groups, volunteered to advise students who’d like to work on projects for people with disabilities, offered to speak to campus engineering clubs, or taken the time to submit our designs to dissemination sites? Do we honor and promote the companies and entrepreneurs who are dedicated to providing quality products and services? Do we lobby for access to AT by the poor and underserved? How well do we promote our members’ achievements and innovations and the work of others in the field?
 
Fortunately, we have positive examples to point to. There are a number of great university programs introducing students to rehabilitation engineering and assistive technology. Members of our International Special Interest Group, including representative from Whirlwind Wheelchair International and HERL (U of Pittsburgh) have demonstrated how to design collaboratively with people in developing countries. Efforts like the RESNA Student Design Competition encourage creativity within a user-centered design process. The better hackathons and design challenges, such as the one led by AT&T, recruit people with disabilities and AT professionals to mentor and guide the teams. If we all do our part, we can educate the public about what we do and help guide  inventors of all ages and backgrounds, using whatever tools at their disposal, how to “do it right.”   
What do you think? How should our profession respond?
 
Ray Grott, MA, ATP, RET
May 7, 2015

Comments

Great post, Ray.

I'm excited to learn more about 3D printing at RESNA this year. I see 3D printing as a valuable tool in the tool bag for an AT professional, but only a piece of the puzzle in the context of a whole person's environment.

Submitted by Faith Saftler S... (not verified) on

We are using the 3D printer to fill in the gaps for mounting switches safely, mounting IPads, phones, speakers etc to residents in their wheelchairs. The printer has proved efficient and allows us to deliver with increased ease and timeliness. These are components that aren't readily available commercially or can't be obtained from funding agencies since they aren't medically necessary. Although I'm not involved with the actual design, I will take pictures of some of the items that have been developed by Don, my rehab tech at my facility to share at RESNA.

Thanks for articulating the frustration I've been feeling with so many headlines of 3D printed prosthetics. Same goes for innovative robots to care for elderly people, GPS-enabled canes for people with vision impairment, or another communication app by a parent who didn't want to pay the price for a really good one. Not all "new" and 'Innovative" stuff is going to prove its worth and have lasting value. I don't know how we as AT Professionals should respond, so I'm looking forward to a dialog on this topic. I don't think the advent of revolutionary new tech like 3D printers will kill our profession. Anybody can download and 3D print something, but it takes effort and insight to create something truly useful with this new medium. You're right Ray: We have unique experience and insight, and it's up to us to engage with the Maker movement and reach beyond our primary work spheres to extend our impacts.

Submitted by Brian Burkhardt (not verified) on

I think a lot of people and organizations are asking this same question. The VA is answering by jumping in with both feet! This week in Palo Alto the VA will kick off the Innovation Creation Series in the realms of Asistive Technology and Prosthetics. Check it out: http://www.innovation.va.gov/challenge/
It is open to everyone and is basically a 3 month long make-a-thon.

Ray has opened up a very important topic for discussion. There tends to be an infatuation with 3D printing and phone apps among other new technologies that often fails to distinguish where these technologies are useful and appropriate. In her comment, Faith Saftler S.... has described some examples where 3D printing does seem appropriate. My experience is that cost considerations and the inherent complexity in manufacture or repair limit the uses of many of these higher technologies to individuals who can afford it. Cost is certainly an all-important consideration in developing countries, but I suspect that as less and less government funding is available for assistive technologies and as health care costs remain high here in the US, there will be a re-consideration of the usefulness of these technologies and a more practical view of when and where they play a role. Where Ray's article strikes a chord with me is his view, arising from his long experience as a practitioner, that the value of most assistive technology lies less in the technology itself and more in the proper evaluation of the beneficiary and the proper pairing of the beneficiary's need with the right technology, which is often what we would label as "low tech." We should never forget that the most useful technology of all is the well-trained and experienced rehab professional/paraprofessional/technician.

Thanks Marc, and thanks Ray for starting this discussion that I've only just come across. Marc, what you termed "low tech" sounds like what we call "soft technologies". See definitions here http://www.arata.org.au/download/arata_flyermay2012.pdf and here http://change.mooc.ca/post/367
More than 20 years of research into AT provision suggests that the high-rates of non-use (often between 30-80%) are more related to the soft technologies (or their absence!) and policies for access and funding than the products themselves. For examples, I gather that GPS-enabled canes were first developed in the 1950's, but without funding and systems for potential users to discover and trial them, there was very low uptake. Great to read this blog and comments about user-centred design and knowing which wheels have already been invented.

Submitted by Joe Hill (not verified) on

No more than the iBot wheelchair being under every client now. For years all I ever heard was did I provide the stair climbing chairs. It was wonderful technology, a possible game changer but reality had other ideas. I embrace new technology and hope for even greater advances in genetics, this is where we need to place our hopes for those with SCI. Reality will be that we will always be necessary to assist those less fortunate.

No!

I was involved with a project focusing on AT design using 3D Printing in an attempt to engage our students at Hereward College in Coventry UK (many of whom has disabilities) in STEM subjects. The project was in conjunction with the University of Warwick in the UK.

http://www2.warwick.ac.uk/fac/sci/wmg/research/net-shape/3d_printing/ass...

During the project we learned many valuable lessons and I would say one such lesson that is relevant in terms of the question you pose in your article is that many of our students were able to articulate what they did not like about their existing AT. However, when they were asked what they would do to make it better, many students did not have the capacity to articulate their needs in design or engineering terms and as such needed some guidance or facilitation before we got to printing any meaningful devices, which we did in the end.

I would say there is space in this arena for the informed amateur to use 3D printing as an alternative to the "curse of velcro" but in many instances it would perhaps be a good idea to use 3D printing as a means to engage the user in the design of personalised AT in conjunction with a professional.

It is always scary when new technologies arise and seem to be the "solution for all problems", just as is happening with 3D printers, not only in our industry. I think this new technology is a good opportunity for us, professionals, to educate patients and their families for them to be able to determine an appropriate low-cost choice, versus a non-appropriate higher-cost.
It also brings the responsibility to us to be updated and know what to add to our tools in rehab, and what NOT to add and explain why.

I just had a discussion about this, and after realizing the amount of hours, cost and limitations that nowadays 3D printers have, I realized it is not yet a threat, and we have the opportunity to speak-up and guide new inventors to collaborate to find useful and clinical appropriate solutions.

If we are able to balance new technologies with our professional knowledge, our patients will get the benefit.

Submitted by Dave Jaffe (not verified) on

Thanks for your blog post, Ray.

As a long-time follower of "advances" in assistive technology, I find a certain repetition in some of the prototypes presented to "change the lives" of people with disabilities and older adults. One recent example is the "ultrasonic cane" reinvented by a 13-year-old in San Jose.

http://www.nbcbayarea.com/news/local/San-Jose-13-Year-Old-Invents-Device...

"Old-timers" might remember the Nurion Laser Cane circa 1974, now out of business.
http://www.rehab.research.va.gov/jour/74/11/2/443.pdf

The point is there is a process that should be followed in designing assistive technology devices that includes:

0) working with knowlegable mentors / coaches

1) identifying a real problem (also called ethnography)

2) understanding the problem (talk to many users) (also called empathy)
Understanding the problem includes: 1) questioning, 2) observing, 3) listening to users' stories, and 4) "entering" into their world.

3) researching what is already available and why commercial products don't solve the problem
(Many efforts fail this step.)

4) analyzing the information

5) describing the need (including design specifications)

6) brainstorming and evaluating potential design concepts
Brainstorming can be defined as identifying and exploring the potential solution space.

7) selecting a project design concept(s) to pursue

8) fabricating a prototype (initial prototypes must be made rapidly out of low-cost materials)

9) testing and analyzing the function and performance of the prototype with users

10) iterating the fabricating, testing, and analyzing steps until time or $ runs out
(I have come to realize that everything is a prototype.)

11) presenting the project (perhaps at a RESNA conference or Student Design Competition)

12) writing a report

13) reflecting on what has been done

and then comes the really hard part:
14) pursuing commercialization

as Krista Donaldson said last night:

- If a product [or design] doesn't scale, it is a prototype
- If a product doesn't reach people, there is no impact

Allen Hoffman and I had suggested a RESNA workshop on this engineering design / development topic.

3D printers and laser cutters are convenient and low-cost fabrication tools that can be used to realize prototypes.

Sorry if this is too long - but it is important

Dave

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