Crafting custom orthotics and prosthetics (O&P) is hard work – it balances art, science, and business, to ultimately offer life-changing care to those who need it most. While technologies that facilitate this process have been developed, hesitancy in adopting them remains. As this pattern is prevalent in other industries as well, reflection on why this is the case can illuminate paths toward greater tech adoption and ultimately, user satisfaction. Here, I argue that 3D scanning, 3D printing, and artificial intelligence (AI) for 3D modeling, offer many benefits and do not pose a threat to the craft of O&P.
The takeaway is that although the tools have changed, the craft remains. Yet, before trusting tech, we can look at other cases where a craft was threatened and yet persisted. As we will see, this requires us to look within, isolate, and defend our core values – our identity.
Lessons from Hennessy
How does Hennessy relate to prosthetics? Both require a high level of craftsmanship yet have benefitted or had the potential to benefit from cutting-edge technology, all the while, without losing their way.
The identity of the craftsman has been defined over decades – by sets of values that have stood the test of time. As an article by Wired describes, it is the strong identity of companies like Hennessy that makes them able to embrace and adapt to new technologies and value systems, while staying true to themselves.
Their use of data and AI may help in the blending process for example, but decision-making falls in the hands of the master taster, who ensures quality and considers other factors, for example, those associated with production feasibility. A product judged by human taste can be controlled by nothing but that – human taste.
Nonetheless, as organizations debate the adoption of certain tech – they should remember “there is no tech for tech’s sake”. Some will tinker out of curiosity, but the majority need it to be practical and aligned to their value system.
Tools – not threats
There are a variety of different paths to creating custom orthotics and prosthetics. The most advanced approach involves using 3D scanning technologies to enable prosthetists to generate a digital file of the patient, around which a product can be morphed digitally, then 3D printed.
Furthermore, the recent advent of AI-powered design software enables repetitive and tedious manipulations to be automated, allowing the medical professional to focus on improving design and performance. Some of these gains will only be attainable however if we embrace certain technologies.
I believe in this process and support its adoption as it does not go against the value system of O&P and rather, builds upon their value system; (i) the wellbeing of, and connection with their patients, (ii) their craft, and (iii) business viability, which I previously wrote on here.
Medical care depends on so much more than what is accomplished by tech; patient care is gravitating toward the greater connection between the caregiver and their patient, and this can only be achieved by humans. Hennessy requires the sense of taste of master tasters, while medicine requires a human connection, that which cannot be replaced by technology.
Optimizing and democratizing the craft
As AI can automate mundane and repetitive tasks in the digital design process, it can liberate time for the highly trained medical professional to focus on improving features or to simply produce more units, while ensuring consistency. As such, techniques gathered through generations of practice can be further improved upon and democratized by allowing for greater production capacity, essentially eternalizing the craft.
Nonetheless, the optimal product may require manual interventions during the design process in some cases. Hence, various design software workflows can be developed as semi-autonomous to allow for those holding tacit knowledge to integrate their modifications.
A multi-layered solution
Novel manufacturing processes also hold various advantages. In essence, rapid prototyping and more specifically, 3D printing (also known as additive manufacturing) for custom orthotics and prosthetics allows for more rapid iteration as well as for more inspiration and client input to be integrated without impacting manufacturing feasibility.
Furthermore, it can allow for the incorporation of intricate designs that were not possible to produce previously and can be done so with little, if any, added effort in the production process.
As described by Avi Reichenthal here, the perennial nature of craft can be seen in various areas, for example in the work of Italian designers such as Selvaggia Armani, who applies 3D printing to create beautiful products that are the embodiment of Italian style.
In another anecdote, Reichenthal refers to his grandfather – a cobbler. While the production of shoes was taken over by large corporations that could afford the efficiency maximizing machinery, 3D printing now offered an opportunity to return their entire production to local artisans, offering custom and highly complex products at viable costs. In this sense, 3D printing has in fact returned the craft to the craftsman.
3D printing is not a threat, it is simply a new craftsmanship tool. By expanding the possibilities, this technology in fact augments the craft!
Defending the values
To further engrain the value system and more specifically the care of patients, efforts are underway to develop standards for 3D printed orthotics and prosthetics and identify gaps in the research to improve them.
As mentioned in a recent edition of the O&P Almanac, this is exactly what the Association for Orthotists and Prosthetists of America (AOPA) is doing in collaboration with ISO and a variety of experts. These will increase the ability of the practice to benefit from the economics, design freedom, and prototyping abilities of tech while minimizing negative consequences for the safety of patients.
Furthermore, the American Academy of Orthotists and Prosthetists (AAOP) just recently published a position statement stating “3D printed orthoses and prostheses should be administered by a Certified/Licensed Orthotist/Prosthetist” and listing recommendations to place the safety of the patient as a priority in the adoption of 3D printing.
These actions demonstrate the industry has leadership and medical professionals that hold this value system dear, and as such, that tech offers a minimal threat to, but rather, augments the craft.
In summary, the establishment of a value system in O&P will allow the trade to benefit from technology without threatening its identity; it liberates the practice of orthotists and prosthetists by offering a highly creative platform on which medical devices can be optimized to benefit the patients with no compromise to business viability. This is of course assuming that the right tools be used at the right time, and only when truly needed – for again – there is no tech just for tech’s sake.
The craft is dead, long live the craft!
About the Author:
Jacob Lavigne is a Ph.D. graduate from the program of Experimental Surgery at McGill University. His research interests include orthopedics and associated technologies (algorithm development, 3D printing/additive manufacturing, simulation, and targeted drug delivery) as well as innovation management and marketing practices. Lavigne currently holds the position of community engagement manager at Shapeshift 3D, a software development firm empowering orthotists and prosthetists to create optimized products through the use of AI and 3D technologies. He also works as an independent innovation consultant working to facilitate the adoption of various technologies and the paradigm shift to personalized medicine. He achieves this through knowledge development and dissemination, partnership development, advocacy/lobbying, and product development.