From Ideation to Actualization: A Remote Approach to Custom Orthoses

It began with a simple question:

“How can we provide rehabilitation services that would otherwise be unavailable to rural and remote communities?”

Okay, maybe it is not that simple of a question, but it is undeniably a question of great importance.

Patients living in rural Alberta often face challenges in accessing rehabilitation assessments and treatments. Such challenges include limited availability and expertise of local specialists, insufficient funding and increased costs of treatment, and lengthy travel requirements. Now, imagine then, if we are able to not only overcome these systemic barriers, but completely remove them.

What would result is a reimagined Alberta, where the quality of health care and rehabilitation services is not dependent on where you live. Our question serves to address rural and remote equitable access to health care, a core tenant of Canadian values.

Dr. Ferguson-Pell and the Rehabilitation Robotics Laboratory have begun answering the call to increase the access and scope of current rehabilitation services available in these communities. Their use of current and emerging technologies and processes in their Tele-Rehabilitation 2.0 Project will bridge and mediate the communication between remote patient and clinicians and urban specialists. It is here where my Stretch Experience grew from a seed of an idea into something tangible.

There is a critical need for low-cost, practical, customizable orthoses that can be fitted in rural and remote Alberta. Orthoses are medical devices that provide control, guidance, support or correction to one’s movements, depending on the user’s needs and abilities. Think stints, braces, or prosthetics, all which require custom fitting for their patients. On average, the process for orthoses development of rural and remote patients is as follows: one round-trip to collect patient measurements, a second round-trip to have the patient’s orthoses fitted, and a third round-trip to have the orthoses modified and altered. This labor-intensive process means that fewer patients are treated, turnaround times for obtaining required ortheses are longer, and ultimately rural and remote Albertans are not able to access the medical services they require within their own communities. Currently, there is limited literature and resources with regards to these challenges, not just in our province, but internationally as well.

So I figured out my current problem – the Billboard Hot Country Charts to my Lil Nas X, or the Game of Thrones Season 8’s Writing to my Everyone Who Watched Game of Thrones if you will. Time to tackle this issue, but now the next question is, how?

Phase 1 – Ideation (The “Imagining and Initiating”)

If the issues lie in the systemic barriers of current rehabilitation practices within rural and remote communities, then a solution to said issues should involve something that can be done within one’s community. In addition, this solution would allow for these communities to have access to the world class medical and academic centres found in Edmonton and Calgary, from anywhere in the province or beyond. 

Limited literature in the subject meant that in order to realize my idea, I would need to reach out and expand my mentorship circle. Through correspondence between occupational therapists, orthotists, and university researchers, the first eureka moment struck me once I put all my notes of the different messages, phone calls, and meetings together.

Question: What do 91.5% of Albertans have in common? 

Answer: A subscription to a mobile service, meaning that those same Albertans must either own or know someone who owns a cell phone! 

Now, a fun fact about our cell phones is that by and large, a single smartphone is millions of times more powerful than all of NASA’s combined computing power in 1969, the year we first set foot on the moon. Surely we can use all our phone’s computing power to transform cell phone pictures into 3D model renders and not just for social media, YouTube and mobile gaming (although I am guilty as charged on all fronts).

The first part of the Stretch Experience was formed! Dr. Ferguson-Pell posed an overlooked possibility: what if the orthotist needs to see the dorsiflexion (that is, the backwards bending and contracting of your hand or foot – for example, when you draw your toes back towards your shins)? In doing so, I had a second eureka moment which brought the whole Stretch Experience together.

To hold the user in place at a particular angle, I arrived at my potential solution: I was to make a platform. This platform would be able to adjust its angle and hold a cell phone, which would somehow have the ability to capture images of the user at varying angles. The 3D models resulting from these images could then be used by orthotists to remotely measure and fit custom-made orthoses, limiting the number of trips taken by remote and rural patients to urban centres for treatment.

Ok cool, I have an idea. A good idea, I think! But now the next question is, how do I make it more than just an idea?

Phase 2 – Development (The “Designing and Daring”)

This phase was the meat and potatoes of my Stretch Experience. Maybe I should not have been so critical of using my cell phone for watching YouTube! To have the ability to look up anything, virtually anywhere, in the span of a few seconds is pretty spectacular. 

There are great resources on YouTube and the greater Internet on how to use AutoCAD, a program that would allow me to design a 3D model of my low-cost scanner and allow for 3D printing. Now, prior to the summer, I had never used AutoCAD, so while the learning curve was steep, it was rewarding and worthwhile.  

Trial and error is definitely your friend when using AutoCAD. If the answer to “How do I do this on AutoCAD?” does not exist, then an equally valuable question to pose is “What happens when I do this on AutoCAD?” 

A few lengthy design sessions later, and I finally designed my idea into fruition.

Phase 3 – Enhancement (The “Editing and Elaborating”)

Okay, maybe the Development phase of my Stretch Experience was not the meat and potatoes of it all. Once I felt comfortable with my design, I used the MakerSpace facilities of my friendly neighbourhood library to print out the initial test with their 3D printer.

Upon reflection, for every hour invested in learning how to manipulate objects and designs in AutoCAD, an equal amount of time was allocated to refining my designs post-print. 3D printers use PLA (a type of tough, yet light polyester) which is convenient and accessible as it comes out to 10 cents a gram.

Working in the telecommunications industry, I was able to get my hands on some demo smartphones to test out different cameras. A quick study on exporting images from the different smartphones and stitching them together to a 3D image resulted in very little variation between models. This was a great find, since that meant that the type of phone used does not drastically decrease the quality of the end result.

Iteration 9 was the last iteration before there was a complete overhaul.

In total, I developed 15 iterations of my idea, with each iteration extending past the limitations of the previous design. I got to Iteration 9 before I had a third eureka moment. One of those “everything that happens once can never happen again, but everything that happens twice will surely happen a third time” kind of moments. Starting from Iteration 10, I completely changed my design, and ended up with my current solution.

3D Rendering of Iteration 15 with all components.

The render above lays out all the components designed. The way the current design would be used is as follows: the patient or local clinician would place their phone in the holder, which has been designed to hold smartphones of varying sizes through a spring-controlled grip. Depending on the angle needed, the smaller pieces (which have a slope on the top) may be loaded into the center of the platform to change the angle of inclination. If no angle is needed, then no piece needs to be loaded into the platform. Once the needed angle is selected, the patient can then place their foot on the platform. 

With everything in place, the phone is then able to move along the track, as well as move up and down to capture images of the foot from above and at different viewpoints. These images can then be incorporated using third-party applications to create a .STL file of the scan. .STL files are one of the standard 3D modelling files which can then be used by an orthotist, no matter where they are located.

And tada – a low-cost, scanner using existing and new technologies was born! Through the creation of this low-cost scanner, an urban-based orthotist can create the orthosis design and send it back to the local specialist in a rural or remote setting where a 3D printer could then generate the orthoses!

Phase 4 – Actualization (The “Achieving and Adoption”)

At the time of this blog post, the actualization is still in progress! I am having a metal part machined and Iteration 15 is being 3D printed. But my hope is that, pending approval, this new technology will further bridge the gap to our remote and rural Albertans in need of custom orthoses.

Image may contain: one or more people and people standing
ATB Financial Future Transformer Summer Camp campers using virtual reality to create intricate designs.

In addition to my personal Stretch Experience, I was able to take part in other areas of the Rehabilitation Robotics Laboratory, including ATB Financial’s Future Transformer Summer Camp and Click N’ Push, a local startup. The former allowed us to collaborate with young minds on the use of virtual reality to creatively solve problems and find passion in STEM (Science, Technology, Engineering and Mathematics), while the latter provides wheelchair accessibility mapping so that its user may engage in their community without fear of difficult terrain.

The opportunity this Stretch Experience has granted me is one of great reward. This Stretch Experience has pushed me both analytically and creatively, has tested and strengthened my resilience in tackling unknown problems, and has inspired me to continue towards a field I am truly passionate about. I am appreciative of all the direct and indirect mentorship I have received as a result of this Stretch Experience, and would like to thank Dr. Ferguson-Pell, the Rehabilitation Robotics Laboratory, and PLLC. Future opportunities to continue with my Stretch Experience would allow me to extend the function of the low-cost scanner to include bigger scans for larger custom orthoses. With the skills that I have gained throughout the summer, I believe this is a very feasible possibility!

Carlos Jarquin is an Electrical Engineering – Biomedical graduate from the University of Alberta, and a current second year PLLC Scholar and industrial design student. Carlos has been involved with many organizations, ranging from the Electrical Engineering Club, the UAlberta Ambassadors, the Brain Awareness Movement and the Office of the Registrar. In his spare time, Carlos enjoys curating and playing his board games collection, shouting out answers while binging Jeopardy! episodes, and trying out new food places throughout our fair city.

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