Artec Eva helps create affordable prostheses for children in Guatemala

15/05/2019

A nonprofit specializing in prosthetics for children searched for an optimal way to create new individually-designed arms, legs, hands, and feet at very low costs and durable enough to withstand the harsh conditions of rural Guatemala.

In a remote village among the jungles of northern Guatemala, not far from ancient Mayan pyramids, Yari was waking up to a new day. The sounds of other children leaving for school echoed from house to house. They would soon be walking for miles over rugged, boulder-strewn roads and pathways tangled with roots and vines.

These kids were the lucky ones. Most of the village’s children had to go off with their parents to work in the coffee plantations, or sugarcane or corn fields, just so their families could survive another month.

Yari

But as for Yari, her day wouldn’t include either fields or school; not that day, not any day., Because Yari lost a leg to cancer at a young age, and in her village, as in most of Guatemala, disabled children face a bleak existence. The high point of her day was in the evening, when her exhausted mother returned from work and walked with her outside, where Yari hobbled on her crutches along the village’s one dirt road. 

The rest of her waking hours were spent pounding corn and grinding coffee, chopping wood on the floor with a small, rusty machete, or sweeping the floors of their mud-walled, often-smoke-filled, cinder block home.

That was the only life Yari had ever known. Even if a prosthetic leg had been available to her, at $15,000 for a simple AK (above the knee) prosthetic, with her family’s $50-$70 a month income, a new leg was simply an unreachable dream for her.

In a region with a 66% unemployment rate, where half of all children under 5 suffer from stunted growth due to malnutrition, with extreme poverty the norm, Yari’s parents were doing their best just to put food on the table and live to see another summer.

Typical kitchen stove in rural Guatemala

But then Yari’s family heard about a free rural medical center called Hospital Shalom, in distant San Benito. Rumor had it that there was a new prosthetic clinic that helped children like Yari. That was the day that Yari’s life changed forever.

Hospital Shalom

Over miles of bad roads, Yari and her parents made the long journey from their village to Hospital Shalom. Once they arrived, they were welcomed at the door and didn’t have to wait long before they were interviewed and Yari was evaluated. Just a few hours later, she was being fitted with a new leg and taking the very first steps of her young life.

Yari and Meredith Wright

Since that day, Yari’s life has been filled with hope. She’s attending school now, and when she grows up, in her words, “I want to be a teacher.”

With her family and everyone at Hospital Shalom to support her in this, it seems that nothing can stop her.

Yari and her new prosthetic leg

Yari and her parents

Hospital Shalom was started by two American missionaries, Tim and Doris Spurrier who, with their two children, hopped in the car and drove south from Ohio for five days. When they arrived in Guatemala, the family knew they had finally found “home.” They’ve been there ever since.

Eventually they decided to open a prosthetics clinic in their little hospital, and in 2006 they invited Brent Wright, a Certified Prosthetist and Board Certified Orthotist, to come down for a visit. He arrived and quickly organized the clinic, the first and only one of its kind in all of Guatemala.

Brent Wright, with one of his creations

Years later, in 2015, with the soaring need for help at the clinic, as well as with new ideas for making prostheses available to the needy across more of the developing world, Wright and others launched their nonprofit organization, LifeNabled.

But let’s return to 2006 for a moment. During his first visit to Guatemala, Wright immediately saw that the expensive prosthetic devices used in the US were not only stratospherically out of reach of Guatemalans, with prices ranging from $5,000 to $100,000 or more, but these devices were also simply not durable enough to survive long in the extreme conditions of rural Guatemala. The high heat and humidity, combined with the dirty environment and repeated impact and torque all took their toll on devices meant for a kinder, gentler way of life.

So, after Wright returned to the US, he sat down with Frank Hodges, owner of SunStone Lab, a central fabricator, and together they designed an alternative way of making prosthetics, where they would be not merely affordable, but also customized for each individual patient, as well as sturdy enough to withstand most anything the often harsh Guatemalan climate and their rural lifestyles could throw at them.

Over time they’ve refined the methods and materials used, and today they can produce custom, long-lasting prostheses at the following costs: a foot ($50), a knee ($70), a BK (below the knee) prosthesis ($150), and an AK (above the knee) prosthesis ($300).

And when it comes to 3D printing an arm, for example, the contrast in costs is striking: the traditional cost of materials for making a prosthetic arm is in the $800-$1200 range, but with 3D printing, which they began doing in 2016, “We can make an arm for approximately $4 in materials costs,” said Wright.

Two of LifeNabled’s creations

One of his dreams is to put prostheses within reach of everyone in need around the world, especially in destitute regions where only 1 or 2 prosthetic specialists exist in the entire country.

Wright said the timing is right for a revolution in prosthetics. “Only in the last 18 months have 3D printing materials really become capable of being used for effective and durable prostheses.”

Functional, comfortable, and stylish

Traditional prosthetics fabrication consists of using a fiberglass cast to create a plaster mold of a patient’s affected limb. From there, the mold is sanded down and adjusted, removing imperfections, giving some parts more room, some less, fine-tuning for stress points, etc.

Shaping a plaster mold

There employ calipers and rulers and other methods of measuring and checking. After this step, a sheet of thick copolymer plastic is heated up in an oven until it becomes pliable. Then it’s taken out and quickly stretched over the plaster mold.

As the plastic cools, it’s pulled down and vacuum sealed to the exact shape of the mold. This is what’s known as the “test socket,” and will be used for fittings and making adjustments, in preparation for the making of the final socket, usually fabricated from carbon fiber or a similar plastic.

Putting the finishing touches on a plaster mold

“It’s a highly labor-intensive way of making prostheses,” said Wright.

New prostheses waiting for fitting

The search for a better way finally led him to 3D scanning, and with the expert help of Bo Helmrich at Artec Gold Certified Reseller Digitize Designs, Wright was introduced to Artec 3D’s professional handheld scanner Artec Eva. Used across a variety of industries, from healthcare to reverse-engineering, for digitally capturing objects in high resolution color 3D, Eva was a breakthrough for Wright and for the clinic.

But that doesn’t mean it was an out-of-the-box solution for them. Wright believes in achieving the highest levels of precision in his work, especially with the most challenging of prostheses.

Brent, Yari, and Meredith

“3D scanning is great at capturing shape, but it doesn’t necessarily do a great job of capturing shape under load, or what the underlying tissue structure is, so I’m still a firm believer in making a good cast,” he continued, “But we’ve developed some techniques for scanning the outside or inside of casts. What this does is gives you the underlying anatomy and the actual volume of the patient’s limb under tension.”

Carlito’s new leg

Referring to non-contact 3D scanning, Wright said, “Any time you do a direct scan of a patient, you are making a guess as to where that underlying anatomy is and what the limb’s true volume is under load…and when it comes to prostheses, I would rather not guess.”

Meredith and Jazmin

“With Eva, the scanner is amazing, but the software, Artec Studio, is even better. After I pull off the cast, I cut it into two halves. With Eva, I quickly scan both halves, and then in Studio, I easily put them back together into one highly accurate 3D model. This way gives me the best of both worlds, a precision 3D scan, combined with the accuracy of having made a cast of the patient’s limb under load. So the final 3D model will be perfectly anatomically correct and include the proper volume dimensions, which a non-contact scan simply isn’t capable of.”

In Hospital Shalom, fitting the new prostheses

“And Artec Eva scans the insides of casts better than anything else we found…it’s the only 3D scanner that does this flawlessly,” said Wright.

To reach this point of the “3D scanning” version of the process, in comparison with the lengthy and labor-intensive traditional method of making prostheses, the entire sequence consists of making a fiberglass cast of the patient’s affected limb, properly wrapping and marking it (to indicate bony protrusions, patella, pressure points, etc.), waiting 3-4 minutes for it to dry, and then cutting it off and readying it for scanning.

The scanning is done directly in Artec Studio, where the object being scanned appears on the screen in real time, so you can immediately see that in only a few seconds, you’ve scanned the entire cast from top to bottom. From there, you simply align the scans into one model, then export it over to other applications, such as CAD/CAM software.

“I just export the model as an OBJ file over to Geomagic Freeform, which is amazing for doing the kind of design and modification work that I need to do. I use it with a haptic device, so right there under my hand, I can feel all the curves and undulations of the object itself. I love it,” said Wright.

He also uses Fusion 360, for designing joints and many custom features of each device. While the traditional method of creating prostheses will always have its place, for LifeNabled, 3D scanning has opened a door that has forever changed both how they work and the speed and flexibility that they have.

“The beautiful thing about making prostheses this way, with Eva and then digital processing, is that I can do it anywhere, literally. Once the scanning’s done, and it’s done fast, I can even sit down in front of TV with my laptop and do the rest of the design work right there,” said Wright.

Designing a new prosthesis

“And what this means in the clinic is that we can have something for a patient to walk out of there with in just one hour.”

That doesn’t mean that everything is as he would like to see it, though. They still need technicians skilled in making prostheses, which although it may look easy, is actually a demanding profession. One year of practical training combined with intense fieldwork is a minimum for becoming functional in prosthetics. “It really is hands-on in this work,” said Wright, “There’s so much more than textbook here.”

“But then, after they’ve been trained and they know what they’re doing, it’s hard to keep these people around, because with this kind of professional expertise, they will be in such high demand anywhere they go, either locally or off to another country…these are highly sought after skills they’re learning.”

Which means LifeNabled is constantly in need of volunteers to come to the clinic and help out, either locally or from abroad. As their operations expand, they’re also in real need of donations and materials from organizations as well as people.

Fitting a lower arm prosthesis

Since 2006, Wright and his wife Meredith have been traveling to Guatemala twice a year and packing everything they can fit into their suitcases and carry-on bags: Artec Eva,  two 3D printers (Filament Innovations), a high-powered Alienware laptop, aluminum pylons for prosthetic legs, plastic filaments for the 3D printers (CF PETG, PETG, polycarbonate, etc.), prosthetic knees, Niagara feet, fiberglass for casting, and much more.

During their 6-7 days there, together with the others at the clinic, they help 40-50 patients, which includes making new prostheses, adjustments, repairs, etc. In total, that means 30-40 new prostheses being designed, produced, fitted, and walking out of the clinic. They leave behind extra parts at the clinic for their helpers there, for minor repairs as needed.

Over the years, they’ve provided more than 400 prostheses to amputees in Guatemala. Many of their patients have since grown up and are on the threshold of adulthood. Once hopeless and often feeling worthless and ashamed or even cursed, these same young men and women are today actively pursuing careers as teachers and doctors, business people, and workers.

Veronica on her way to work

Their dreams are becoming a reality, which is no small feat in this impoverished land of jungles, volcanoes, and decaying Mayan temples. For them and their families, their new arms and legs have brought them new hope, greatly increased self-worth, and new lives.

LifeNabled’s future plans include offering CE accredited prosthetic based 3D printing courses, as well as creating a training program that will make it possible for organizations to gain the skills and expertise for making prosthetics available to the needy in their regions around the globe. Ultimately, LifeNabled plans to offer both full training and prosthetic components worldwide, so that amputees are able to receive affordable prostheses regardless of income or distance from metropolitan areas.