A. Chu, L. Ragni, S. Dlugasz, C. Stoffel, D.A. Sala, V. Bill, G. Cammarata, Z.E. Parrott, E.M. Parrott, R. Sukhov
Rutgers-New Jersey Medical School,
Keywords: additive manufacturing, 3D printing, cerebral palsy, upper extremity, orthosis, arm, hand
Summary:A functional dynamic 3-D printed upper extremity (UE) orthosis was designed, fabricated and used by children with cerebral palsy (CP) with severe unilateral involvement. The Airy Arm 1.0 open source design was used as a starting point, and the components were manufactured in a Makerspace. The three main 3-D printed components of the device included: the upper arm, the forearm, and the fingers. The materials used were polylactic acid (PLA) and polyurethane (TPU). Additionally, an occupational therapist fabricated a separate static, custom forearm thumb opponens orthosis from thermoplastic material Five patients, ages 13-17 years, were enrolled. The dynamic upper extremity orthosis was used during 8 one-hour occupational therapy sessions targeting bimanual UE training. Overall, higher post-treatment outcome scores were found for the majority of participants. Improvements were seen in the body functions and structures as well as activity domains of the International Classification of Functioning, Disability and Health (ICF). Gains in overall activity were not clinically significant, while mixed results were found in participation. This feasibility study showed that this design of a 3-D printed, dynamic upper extremity orthosis, in conjunction with goal-directed therapy, was associated with positive changes for a small sample of children with CP who have moderate to severe unilateral hand impairment. However, the fabrication of the device was limited by the materials and process available in the Makerspace, and broad scale applicability of this device would not be possible. One material which may improve fabrication is Xkelet, a material used for cast bracing which is closely applied to the skin for long periods of time. We will discuss materials such as Xkelet that can be used in the process of creating UE splints for patients with CP.