The Enable Community Foundation was awarded a $600,000 grant from Google.org in May 2015 to scale the work that the e-NABLE community does. Below you will find a summary of what the ECF hopes to achieve with this funding, how the ECF plans to attain these goals, and how we will measure outcomes of these efforts.
Make hyper-affordable prosthetics widely available for people with limb differences through open sourced product design and decentralized fitting and fabrication, ultimately transforming the mainstream prosthetics industry with disruptive technology.
How the ECF Plans to Achieve These Goals
e-NABLE will continue to grow its distributed design, fabrication and delivery of 3D-printed upper limb prosthetics. Funding will support robust self-service, scalable infrastructure that allows for improved hand designs, better fitting, and increased end-user delivery to serve the needs of varied populations with limb differences.
Limb differences present a particular challenge for children, as their steady growth necessitates regular upgrades to larger devices. Conventional fabrication technologies cannot produce prosthetic devices quickly or cheaply enough to be viable. In addition, the needs of individuals with limb differences vary dramatically depending on injury or congenital defect, the individual’s daily needs, and the socioeconomic and cultural environment. The Enable Community Foundation (ECF) and e-NABLE (the larger community including volunteers, and the ECF) aim to build on their existing work delivering low-cost 3D printed prosthetics to children.
Improved Hand Designs: Design improvements can have exponential impact. e-NABLE will improve its existing upper limb prosthetics designs and develop new models by:
- building tighter feedback loops between fabricators, recipients, and designers; and
- engaging more skilled designers through design challenges.
User feedback: Rigorous data from recipients and makers on performance and experience is important to validate designs, inform future design objectives, and build evidence to support the organization’s impact. e-NABLE will design and develop a system for collecting aggregated feedback on usage, ease-of-assembly, and user satisfaction. From fabricators, feedback will be collected on time needed for assembly and challenges encountered. From recipients and caretakers, feedback will be collected on activities of daily living (ADLs), hours of daily use, comfort levels, and incidents of mechanical failure or breakage. The system will also support simple industry-typical tests such as the box and blocks test, and incorporate other metrics and techniques used by medical professionals and prosthetists. Additional feedback that is important to understanding overall impact, such as changes in reported self-confidence or behavior, may also be collected through this process.
The data collection system will allow users to easily submit feedback, complemented by data from fabricators or other local volunteers, and will allow e-NABLE to analyze data against demographic information such as age, location, etc. In addition to assessing impact, the system will help guide hand design by supporting extraction of common issues and feature requests. Alternative designs will be compared using device A/B tests. e-NABLE will explore various strategies to determine the most scalable way to collect and use this feedback, including web, SMS, integration with sensors, etc.
e-NABLE will compile the data collected and produce an external report on the efficacy and impact of prosthetics designed and delivered through e-NABLE’s distributed model.
Design challenges and designer recruitment: e-NABLE will run a series of design challenges with small cash prizes and reputation-building opportunities to accelerate development of new designs and to recruit designers. Medical professionals, users, and designers who are already engaged with e-NABLE will generate design briefs based upon user feedback on the most important manual tasks for identified target populations, and on input from other organizations producing open source upper limb prosthetics. All challenges will require open source designs, rigorous documentation, and engagement with the e-NABLE community. In order to attract and engage design collaborators from other organizations, e-NABLE will engage and motivate these design-brief collaborators by making it clear that the competition is open to all who abide by the rules, not just e-NABLE community members. Challenges will be conducted through existing challenge platforms such as GrabCAD or Innocentive, and participation with be incentivized with cash prizes.
e-NABLE will begin classifying the types (transcarpal, wrist disarticulation, transradial, transhumeral) of upper limb differences it can address with specific designs. Currently, most e-NABLE devices are for individuals with ABS/symbrachydactyly, missing all the fingers on one hand while retaining wrist function of the wrist. In addition to improving existing body-driven designs for amputees, new designs will explore body-powered upper limb exoskeletons and orthotics, and transradial and transhumeral devices, in order to benefit a larger population and a larger set of needs. On a longer timeline, lower cost myoelectric technology technology may be explored, with emphasis on ensuring safety of recipients. Devices briefs may also include objectives to vary the form of designs to make them more appealing to other recipient groups. New designs will be evaluated through the feedback and data collection system described previously, further accelerating community engagement and productivity.
Finally, open source hardware design is currently hindered by a lack of licensing standards; existing software licenses do not adequately cover the nuances of hardware. e-NABLE will continue existing work to formulate licenses that could work for other 3D printed designs or products. e-NABLE will also explore potential partnerships to facilitate technology transfer out of its community and into industry and standard medical practice by working with partners in the commercial prosthetics space.
More Efficient Delivery
A more efficient device fulfillment process can reduce bottlenecks and help e-NABLE deliver more prosthetics quickly. The current process (outlined below) requires 5-6 man-hours per request and is largely led by e-NABLE. The end-to-end time to delivery averages 40-60 days.
- Recipient fills out a form expressing need
- Recipient is sent instructions for uploading photographs and measurements of the residual limb
- e-NABLE matching team reviews the data provided to perform a quick validation
- e-NABLE matching team contacts regional volunteers and institutional partners to see if one is able to take the request
- Volunteer and recipient are put in touch to meet, fit, and deliver the prosthetic. From this point onwards, the process is not closely managed by e-NABLE, but is rate-limited by communication lags and time required for printing, assembly, and fitting.
To increase reach, reduce delivery bottlenecks, and improve the quality of the end product and experience, e-NABLE will build self-service, scalable infrastructure that seeks to halve the number of volunteer hours required per device and to reduce the end-to-end time to delivery by 60%. Efficiency gains will include:
- Improving design discoverability;
- Improving automation of the fitting and customization tools; and
- Developing tools for (a trusted subset of) the volunteer community to operate with greater autonomy without sacrificing quality.
Design discoverability: A growing decentralization of CAD files and associated information has become a challenge for the e-NABLE community. Contributors sometimes create iterations off of older versions; makers sometimes access and print outdated designs. To make design efforts across the web more collaborative and additive, as well as easy to find and print, e-NABLE will undertake a project to tie together files and versions across the web. It will conduct user research to determine the best strategy to ensure a user can clearly understand versions and design trees to easily determine which design file is best to use. Building off of existing repositories such as the e-NABLE gallery in NIH 3D file exchange and Thingiverse, e-NABLE will use dedicated labels and nomenclature to more effectively house and deliver design files.
Fitting: e-NABLE has demonstrated early success in facilitating self-service customization and file generation with its open source and open access Handomatic tool. Handomatic walks the user through sizing and measurement to help linearly scale two somewhat configurable designs. At present, the linear scaling process leads to inconsistent mechanical performance of the devices and the current sizing process only addresses individuals who have a specific presentation of amniotic band syndrome. e-NABLE will develop Handomatic 2.0 to support true parametric manipulation (adding two or more additional variables, usually depth and height of the palm component) for a greater number of designs. Currently, some data from Handomatic design downloads are logged, but not enough to extract significant trends. Handomatic 2.0 and associated tools will be developed to capture user choices,recipient measurements, and design and performance feedback. Mobile integration for field use and capabilities for more advanced fitting using 3D scanning data may also be included in Handomatic 2.0.
For development, e-NABLE will draw from the community’s experience with the existing tool to write a phased PRD for a scalable and secure Handomatic 2.0 and Handomatic 2.0MOBILE, to be implemented by one FTE developer in collaboration with the volunteer Handomatic team. The first phase of development will prioritize basic parameterization of current and recommended e-NABLE designs (such as arms), optional transmission of data to a centralized database, as well as documentation of the design integration process for future designs. The second phase will focus on mobile devices for collecting recipient measurements, and to begin to automate more of the device fulfillment process.
End-user delivery: e-NABLE will codify the knowledge and processes currently used by the matchmaking team to deliver training to a limited, trusted base of makers (most likely schools and institutions that have been long-time members). This will allow the fabricator or other local volunteer to provide the higher touch that parents and families may need to get through the process. This will complement self-service components that can be accessed by anyone, and allow e-NABLE to explore further automation of matching and other processes that improve overall experience and scalability while keeping sensitive recipient data secure.
Where there are identifiable gains in increasing accessibility of these useful devices, the ECF will partner with organizations that can enhance fabrication, distribution, and other services. 3DHubs, for example, has a vast network of nearly 16,000 printers distributed around the world, and estimates that one billion people are within 10 miles of a 3Dhubs printer. They also have a basic quality assurance rating system, which can help improve overall device quality and performance. Partnerships will be particularly focused on reaching the most disadvantaged populations in need of prosthetics, significantly expanding the pool of fabricators and potential end users, and contributing diverse user feedback on the design and tools (Handomatic) to build understanding of the environments where the approach is successful.
Other partnerships would prioritize leveraging the complementing skill sets of our community and the partnering organization. International development organizations are one example of such partners. The ECF would look to partner with an international organization that has experience with supply chain logistics, distribution strategies in developing countries, and a track record of responsible and thoughtful support. These institutional skills could be coupled with the e-NABLE community’s agility and passion to address the challenge of low-cost 3D-printed prosthetics in the developing world. Such a partnership would likely begin with an information-gathering phase to understand user needs, followed by a small pilot program, with the long term goal of larger distributions.
The Enable Community Foundation will hire full-time staff (configuration TBD) to help the community of volunteers self-organize and more efficiently co-develop, problem-solve, utilize, and address emerging tools and opportunities.
- 6,000 new recipients using 3D printed devices over the next two years
- 10,000 new fabricators or functional equivalent (such as high-bandwidth automated fabrication via an industrial partner) engaged over the next two years
- Reduce delivery time frame by 60%
- Incorporating lessons from new delivery environments
- External report of successes, failures, best practices, and potential extensibility of our model(s) to other domains
- Rigorous feedback collected from 100 users through implementation of a data collection process and associated systems
- 300 new designers (people committing ideas to 3D models that can be printed) engaged with the community, both by publishing models and by participating in the community design/feedback process
- 50 new designs generated through first design challenge, at least 10 taken through full user and fabricator testing to achieve “current and recommended” status on e-NABLE website and to be integrated into Handomatic
- Measurable improvements to the Raptor Reloaded and other designs
- Further reduce cost of assembly from $45 to $25 with goal of getting costs as close to the base 3D printed material cost
- Further reduce complexity with print-in-place mechanisms, more readily available hardware
- Improve durability of device by redesigning problem areas in the device
- Improve modularity and (single-handed) self-serviceability, including individually removable fingers, simpler tensioning systems, and no hand tools needed
- Support the grasp of the hem of garments, zippers, and eating utensils (oppositional pinch grip)
- Support the easy use of mobile electronics, bottles, and cups (cylindrical grip)
- Support the manipulation of irregularly shaped objects (differential grasping, metacarpal arch integration)
- ECF and community will characterize all functional improvements using methods adapted from evaluation procedures like the Southampton Hand Assessment Procedure, the “box and blocks” test, the University of New Brunswick Test for Prosthetics Function, or numerous other evaluation protocols. The ECF will share illustrated guidelines for these procedures and encourage their use in the field
- Log actual distribution of hand sizes fabricated to estimate the probability of need of certain hand sizes.
- Use this figure to inform “hand-drives” and “print-a-thons” to produce hands
- Use this figure to figure to support a distributed inventory within the community
- Publish a weekly summary of inputs that produced a download, with general geographic regional data based on IP address
- Estimate design preferences by total numbers of downloads of each design
- Estimate component durability based on number of re-downloads of the same file
- Total number of system users to estimate active fabrication force
- Capture number of daily visits to web-based tools to track increases in visibility
- Summer 2015
- Plan first global design challenge
- Phase I of Handomatic 2.0 development
- Focus on reducing backlog in matchmaking/device fulfillment system
- Piloting fellowship program at a small number of partner labs
- Begin engaging international aid organizations to learn more about the space, partner with one or two who have skills that complement those of the e-NABLE community
- Fall 2015
- Run first global design challenge
- Phase II of Handomatic 2.0 development
- Begin developing tools for matchmaking/device fulfillment automation
- In collaboration with international aid partners, develop design guidelines for devices for pilot international program and prototype devices for use in pilot program
- Winter 2015
- Work with community to further develop winning designs from design challenge
- Invite engagement from potential partnering universities for fellowship program
- Open applications for fellowships
- Work with international aid partners to collect feedback from small pilot programs
- Spring 2016
- Work with community and select partners to integrate pilot program feedback into devices designed for the specific problems faced by international recipients in the pilot program
- Summer 2016
- Plan second global design challenge incorporating what was learned from the first design challenge and the results of the previous six months of exploration of designing devices for use overseas in developing countries.
- Second year of fellowship program with more partnering universities.
- Develop plan for responsible and monitored distribution of devices in second, larger international pilot program
- Fall 2016
- Run second global design challenge with design for multiple distinct user groups.
- Distribute international pilot program devices and begin collecting feedback
- Winter 2016
- Work with community and international aid partners to further develop winning designs from design challenge using feedback from second international pilot program
- Spring 2017
- Work with international aid partners to plan larger distribution programs
$600,000 will primarily support hiring of 3 full-time staff equivalent and related operations. At least 2 FTEs will be technical and include UX, software development, and 3D modeling expertise.