Providing Hand Prosthesis for Amputees in

Low-to-Middle Income Countries (LMIC)

May 3rd – 4th , 2017

VHP Mission:

• Our mission is the provision of upper-limb prosthesis to amputees in need, focused in developing countries where amputees have limited or no access to prosthetic care. With our body-powered prosthesis, amputees can regain ability for home and work-related tasks, and improve their quality of life.

• Our scalable provision system has three key features:

A transferable production/fabrication system to make 3D printed prosthesis within countries where they are needed;

Professional provision of prostheses to amputees through clinical/medical practitioners;

training and ongoing support for both the production network and the clinical provision network.

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Need for Accessible Prosthetics:

• The ISPO and WHO estimate that 80% of amputees live in low income countries, yet only 5% of amputees have access to prosthetic care [1].

• Poor, developing nations such as Cambodia, Guatemala, Haiti, Nepal receive no support for prosthetics from government.

• VHP aims to help poor nations, by introducing a sustainable clinic that can meet local needs;

• Our program has the ability to generate future prosperity in those communities through technology transfer.

ISPO - International Society for Prosthetics and Orthotics, WHO - World Health Organization [1] http://www.ispoint.org/sites/default/files/img/ispo-who_training_guidelines.pdf

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Need for Accessible Prosthetics:

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Need for Accessible Prosthetics:

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The Need: Cambodia, Guatemala, Haiti, Nepal

• These countries’ current healthcare systems are severely underfunded and can not support amputees needing prosthesis.

• For people missing an upper-limb, lack of a prosthetic is a major disability that affects their quality of life.

• Missing limbs can lead to social exclusion from community, and can be a burden to the supporting family.

• Missing limbs make it very difficult to gain employment.

• Daily hardship for simple tasks such as eating, cooking, dressing, washing, personal hygiene, transportation, etc . . .

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Need for Accessible/Affordable Prosthetics:

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• The standard of care (Canada, US, Europe) for provision of upper-limb prosthesis is expensive:

• $3,000 to $5,000 USD [2] for a simple body-powered split hook (includes device plus clinical costs)

• $10,000 to $20,000 USD [3],[4] for basic electric-powered pinch-type motorized hand with myoelectric control (includes device plus clinical costs)

• Costs are usually covered by medical insurance (government based or private)

• Such costs are impossible for amputees in LMIC.

• The fragile/underfunded healthcare system of LMIC cannot afford the

costs of standard western-grade devices.

• Few/No trained prosthetists and orthotists are available in LMIC.

• As a result, upper-limb prosthetic deployment for low-to-middle income

countries is stalled, and the current situation is poor.

The Current Situation in LMIC Nations:

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• Today, (without the VHP system) when an amputee approaches a health institution in a low-income country for prosthetic care, they are often sent to NGO’s within that country.

• The NGO have various professionals who assess the amputee’s need, and write their name on a waiting list of patients needing care. The wait time can range from six months to 1 year, or more.

• These NGOs are in contact with North American or European healthcare institutions, and collect used (second-hand / donated) prostheses.

• When the used devices arrive, they come in various levels of condition, ranging from broken, in need of minor repairs, or in good condition. The nature of the devices is also random.

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• The NGO’s must repair/convert/rework the “used” prosthesis parts and pieces into usable systems, to meet the needs of amputees.

• The NGO’s must still make custom limb-sockets using traditional methods. Presently, the tools and methods to do this are low-tech, and very labor intensive.

• Often, the solution provided less-than-ideal, but it is sufficient to meet the need. If any of the prosthesis parts break after the amputee receives the prosthesis, replacement parts are very difficult to find.

• Since the NGOs require financial support, a fee is sometimes needed. The amputees may or may not be asked to contribute money towards their care (this varies from organization to organization).

• In many cases, this small fee will prevent many amputees from approaching the NGOs for care. As a result, many amputees have no prosthesis at all.

The Current Situation in LMIC Nations:

The Victoria Hand

• A complete, low-cost, custom-fit, 3D printed hand prosthesis.

• Its made for children and adults, and is body-powered by cable (no electricity needed).

• Designed it for fabrication within the developing nations where its used.

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Implementation

• We are presently operating in 5 countries: Guatemala, Ecuador, Cambodia, Nepal and Haiti

• By Nov 2017, VHP will have provided/fitted approximately 70 amputees with 3D printed prosthesis systems.

The Victoria Hand: Overview

The Victoria Hand Prosthesis:a Low-Cost, High-Function Design

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Complete Prosthesis System: Consisting of the hand unit, rotatable wrist unit, customized limb-socket, and shoulder harness.

High Function: • Adaptive grasp to conform around various shapes• Rotatable thumb for different types of grasp• Ball-and-Socket wrist to orient the hand• Back-lock mechanism to lock-onto objects

Custom Fit Limb-Socket: 3D scanning captures an amputee’s limb-shape, to 3D print a custom socket.Durable and Serviceable: Hybrid 3D printed + metal re-enforced design will last years. Should any parts fail, they can be 3D printed on-site within hours.

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Victoria Hand Compared to Other Prosthetics:

Key Benefits: • Locally-made, Locally fit, Locally serviceable• Low cost! $100 in parts, $110 to build, $110 to fit = $320 total!• Available on demand! No waiting for second-hand part donations.

How it works: VHP & ROMP in Guatemala

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Development with Clinical Partner (ROMP):• Established a sustainable model for prosthetic delivery

• Refined prosthetic delivery process with two clinical trials

• Work with local entrepreneurs who will operate the print centers, and have a vested interest in producing quality prostheses

Operations: Flow of Services:• Amputee approaches ROMP and provides $320** fee

• ROMP staff measure amputee and makes limb-impression

• ROMP orders Victoria Hand from Print Center

• Print Center 3D scans limb-impression and produces complete 3D printed & assembled Victoria Hand Prosthesis

• Print Center is self-supporting business that pays for materials and technical support to VHP team

• ROMP receives prosthesis, fits patient, and trains on use

• VHP team provides on-going technical support

** Efforts are made to serve any amputee regardless of their ability to pay. Presently VHP works together with various donors/agencies to provide this fee by donation, on a per-amputee basis.

Competitive Edge of Victoria Hand Project:

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Proven Prosthesis Design

• N. Dechev developed the TBM-Hand (original prosthesis design) in 2001 on which the Victoria Hand is based, with over 270+ citations in other conferences and journals. Original design was too expensive to manufacture, but recently, due to 3D printing technology, can now be manufactured at very low cost

Substantial Development & Testing, but no repayment needed

• VHP began in a University of Victoria research laboratory, where we heavily leveraged existing research capacity and facilities

• Won a $112,000 grant from Grand Challenges Canada in 2014, and $71,500 in 2016, to support bold ideas with big impact in global health

Not-for-Profit Teams, Student Volunteers and Amputee Volunteers

• Recruited top-talent engineering designers, students and volunteers with combined total of 7500+ hrs development, 2000+ hrs testing.

The Teams:

VHP Team:• Nick Dechev, Leader of VHP• Joshua Coutts, Lead Designer• Alex Burden• Michael Peirone• Alastair Kuzmick• Angie MacDonald• Pranay Shrestha, B. Eng• Aislinn Sirk, Ph.D.• Sukhi Singh

20+ Dedicated VHP Volunteers• UVic Students: engineering,

humanities, science• UVic Faculty and Staff• Community volunteers• UVic alumni• International volunteers

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Collaboration Team:

Range of Motion Project (ROMP)Nepal Orthopaedic Hospital (NOH)Cambodian School of Prosthetics and OrthoHelping Hands Haiti (HHH)Enable International: Haiti

Partners and Sponsors:

• Google.org• Grand Challenges Canada• University of Victoria• Queen Alexandra Hospital, Victoria, B.C.• Ultimaker 3D Printers• Enable Community Foundation (Haiti)• NSERC

Improved Quality of Life and New Possibilities

The Victoria Hand Prosthesis will:

1. Empower amputees who previously had no prosthesis

2. Give greater access to meaningful employment

3. Enable amputees to provide a better quality of life for themselves and their families

4. Perform everyday, important tasks

5. Increase amputees independence and self confidence

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The Victoria Hand will enable amputees to help themselves by functioning more effectively in society, which in turn creates better communities.

Nepal Participant, July 2015 Trials

The Victoria Hand: Testimonials

“Not only will the Victoria Hand improve employment opportunities for many of these amputees, but it also will likely improve their quality of life.” – Andrew Wheeler, 3Dprintingindustry.com

“Traditionally, prosthetics are very expensive . . . and also very difficult to get to the communities in which most amputees reside in the world. That’s the promise of 3D printing. With it, we’ll be able to design, fabricate and deliver useable, cost-effective prosthetic solutions exactly in the communities that need them most.” Patrick Mathay, Executive Director of ROMP.

“Nepal being a developing country, the prosthetic and orthotic care is very basic. So if we have this center here in Nepal, with the 3D printers and the scanner, it is going to be an affordable and very useful solution for people in Nepal”, Dr. Anil Shrestha, Orthopedic Surgeon.

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The Victoria Hand: Guatemala

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The Victoria Hand: Guatemala

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The Victoria Hand: Guatemala

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The Victoria Hand: Cambodia

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The Victoria Hand: Cambodia

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The Victoria Hand: Nepal

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The Victoria Hand: Contact Info

Website: http://www.victoriahandproject.com

Facebook: https://www.facebook.com/victoriahandproject

Twitter: https://twitter.com/victoriahandprj

Email: victoriahandproject@gmail.com

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Questions?

References:

[1] http://www.ispoint.org/sites/default/files/img/ispo-who_training_guidelines.pdf

[2] http://health.costhelper.com/prosthetic-arms.html

[3] https://www.nist.gov/sites/default/files/documents/tip/wp/pswp/239_limb_prosthetics_services_devices.pdf

[4] http://www.rehab.research.va.gov/jour/10/474/Blough.html

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