Sunday, 6 November 2016

URI mechanical engineering students creating scoliosis brace that focuses on comfort, fit, design

Brace is students’ senior design capstone project

Braces for people with scoliosis can be awkward, cumbersome and even painful. A good fit is crucial, especially since the brace is often worn day and night.
Mechanical engineering students at the University of Rhode Island are collaborating with a local doctor and a Rhode Island company to create a brace that, well, fits like a glove—and is just as comfortable.
Gabriella Devine of East Greenwich, Thomas Brey of Manorville, N.Y., Dan Cross of Northborough, Mass., and Christopher Viveiros of Attleboro, Mass., are working on the project with a doctor from Rhode Island Hospital and SIMULIA, the Rhode Island branch of an international computer software company called Dassault Systèmes.
The students are creating the brace for their senior design capstone class in mechanical engineering, which requires students to solve real-world problems with viable products. The students expect to have a prototype in April, after months of research.
“This project will have an impact on patients’ lives so it’s very rewarding for all of us,’’ says Devine. “It’s exciting to combine engineering skills and new technology.’’
The project involves three fields: mechanical engineering; computer simulation; and medicine. To be competitive in today’s workforce, the students say it is crucial to get hands-on experience in fields outside their concentration and keep pace with cutting-edge technology.
Scoliosis is a curvature of the spine that usually occurs during puberty. There is no cure; however, it is treatable with a brace and, in extreme cases, surgery. Without treatment, the condition worsens and can be disabling.
There are two commonly used scoliosis braces: the Boston brace and the Providence brace, both of which could be improved, say the students.
The Boston brace, also called the underarm brace, is usually prescribed for curves in the lumbar or thoraco-lumbar part of the spine. It is typically worn most of the day under clothing and removed for gym class or sports. The Providence brace, also called a nighttime brace, is worn while sleeping.
“Because they’re bulky, sweaty and restrictive, kids—young girls especially—don’t want to wear them,’’ says Viveiros. “They feel self-conscious in public. We’re trying to make something a little more discreet—and breathable.’’
Now, most doctors use padding to customize a standard brace for each patient. That technique has flaws, say the students. The process is time consuming for the patient and requires many medical visits to make sure the brace is fitting properly.
“This can be an inconvenience for teenagers,’’ says Viveiros. “And the brace itself can prevent kids from participating in activities that their classmates are doing.’’
The URI students’ project involves the latest technology. The students will use a 3D scanner to get the patient’s precise body shape—“and that, we hope, will result in a brace that is completely personalized and form-fitting, yet still effective,’’ says Viveiros. Patients will also be required to get X-rays to determine the extent of the curve.
The students will use a 3D printer to make the brace, and the prototype will be made with plastic. “The plastic could come in different colors, so patients can chose their own color—sort of like braces for teeth,’’ says Viveiros. “We’re adding a little bit of fun to an otherwise difficult situation.’’
In addition to SIMULIA, the students are also receiving guidance from Dr. Craig Eberson, chief of the division of pediatric orthopedics at Hasbro Children’s Hospital in Providence. They met with him not long ago to learn how scoliosis braces are fitted and what can be done to improve them.
At SIMULIA, the students are learning how to use engineering design software that makes the brace as effective as possible with the least amount of material. The new brace will have a lattice-like structure instead of a solid-shell, which requires more material.
“The software is smarter than a human,’’ says Cross. “It’s doing thousands of calculations in an instant, recognizing where the pressure needs to be on the brace to correct the curvature. This is the wave of the future in medical care—using software to solve health problems.’’
The new brace could also be less expensive. Brey says that 3D printing is cheaper because less material and labor are involved. “Right now, 3D printing is pretty much used just to make prototypes. We’re trying to bring 3D printing into the mainstream to produce an actual product that meets industry standards.’’
The students say they are thrilled to be working on a project that will improve lives.
“Our professors are devoted to us and want us to succeed,’’ says Viveiros. “This project is a great start to our professional careers.’’
“Everything we’ve learned in the College of Engineering is being put to use,’’ says Brey. “The college is preparing us for an actual job. When we graduate we can be helpful to a company—and society.’’
On Nov. 8, voters in Rhode Island will be asked to approve Question 4 on the ballot. If passed, the investment will pave the way to attract businesses and create the high-paying, high-skilled jobs Rhode Island needs by authorizing $45.5 million in bonds to expand URI’s highly successful College of Engineering ($25.5 million) and create a URI-affiliated innovation campus program ($20 million) that will pair cutting edge research with private sector investments to create the jobs of the future.

Source : URI , 2nd Nov 2016 

Young Girl With Scoliosis Recovering Nicely Thanks to 3D Printed Surgical Guides from Anatomiz3D

Scoliosis is one of those conditions that can range from barely noticeable to completely debilitating. I have a very slight case myself, and it doesn’t affect me in any way that I’m aware of, but in some cases, the person suffering from the disease can be left unable to stand up straight, to walk, or even, in the most severe cases, to breathe properly. While the condition, in the past, could be at least somewhat corrected or at least stopped from progressing by braces, those braces could be large, clunky, and uncomfortable – not to mention embarrassing to the children for whom they were most often prescribed.
3D printing has done quite a bit to make scoliosis treatment less agonizing for even severe cases. 3D printed braces are becoming more commonly used, and they’re worlds better than more traditional braces – they can be customized to perfectly fit the patient’s body, in addition to being made lighter, thinner, and overall more comfortable (and even stylish).
In the most severe scoliosis cases, however, sometimes surgery is the only option. Back surgery is never a minor procedure, and scoliosis surgery is especially tricky, as it requires screws or wires to be placed throughout multiple vertebrae and then connected to stabilize the back. (Okay, now my back is starting to hurt just thinking about it.) Determining the correct placement of the implants requires a lot of skill, and it isn’t always successful, unfortunately.
Complications or incorrect placement of implants require revision scoliosis surgery, which is even more tricky than the original procedure, as the first implant must be removed and replaced. Because the spine will likely have adjusted slightly thanks to the first implants, it can be even more difficult to determine the proper angles at which to place the screws – and if a screw is incorrectly placed, it can even damage the spinal cord and nerve.

That’s a scary proposition for anyone, but especially for a ten-year-old girl. I can’t imagine being that age and having already undergone multiple back surgeries, but that was the case for a young girl who came to Lilavati Hospital in Mumbai, India in September. The girl had a severe curvature of the spine, and had had several unsuccessful surgeries, leaving her spine even more deformed and damaged. The surgical team at Lilavati, led by Dr. Abhay Nene and his assistant, Dr. Kunal Shah, knew that the surgery was going to be especially difficult due to the previous damage, so they turned to healthcare technology company Anatomiz3D for help.
Anatomiz3D, also based in Mumbai, is the healthcare division of tech company Sahas Softech, and their expertise in the creation of 3D printed surgical models has already improved or saved the lives of many. Three days before the 10-year-old girl was scheduled for surgery, the Lilavati team approached Anatomiz3D with the patient’s CT scan. Using Materialise Mimics Innovation Suite 19, Firoza Kothari and Devarsh Vyas of Anatomiz3D identified the laminar defects and pedicles where the implants would need to be placed, then carefully designed and 3D printed the drilling guides that the surgical team would need to insert new, properly placed implants.

It was still a challenging surgery, requiring removal of the previous implants before inserting the new ones, but thanks to the precise, properly sized 3D printed surgical guides, the surgical team was able to place the screws accurately, and the girl is now recovering well from what may have been the first scoliosis surgery performed in India with 3D printed surgical guides. It certainly won’t be the last, though – the Lilavati team stated that the use of the guides will be extremely helpful in surgeries to correct deformed vertebrae particularly in children. Already, Anatomiz3D has worked on another case with the Lilavati team, which offered feedback on how to improve the snap fit of the guides, and they will continue to work to improve spinal surgeries and, consequently, the lives of many scoliosis sufferers. Discuss in the Scoliosis Surgery forum at 3DPB.com.
Completed placement of surgical screws

Source : 3d Print , 4 Nov 2016 

3D-printed back brace offers "fashionable" solution for scoliosis sufferers

Young girls that suffer from spinal curvature will soon be able to wear lighter and more stylish 3D-printed braces to treat their condition. UNYQ AlignTM

The UNYQ Align is described as a "personalised, fashionable and breathable" back brace by its makers UNYQ.

The Seattle- and Seville-based company, which specialises in orthopaedic and prosthetic products, worked with 3D-printing pioneer Francis Bitonti and technology company Intel on the product.

Braces are a common treatment for scoliosis, which affects an estimated 6 to 9 million people in the United States.

"The condition typically develops in 10-15 year olds, occurring equally among both genders," said UNYQ in a statement. "Young girls, however, are eight times more likely to progress to a curve magnitude that requires treatment."

As members of this demographic can be particularly self conscious about their appearance, the goal was to create a more discrete brace that wearers would feel comfortable in.

Typically, the apparatus has to be worn for up to 18 hours a day to be most effective.

"Traditional braces, which have not been advanced for half a decade, make it difficult for patients to reach the minimum recommended bracing period per day because they are constricting, bulky and perceived as unattractive," said UNYQ.

Using digital design and algorithms, Bitonti's studio was able to create a lattice that has 75 per cent less material than its predecessor – the Boston Brace – but still provides the necessary support.

The new form gives better manoeuvrability and looks less obtrusive, the team claims.

"The first patient to try it on was very happy that she could actually bend from her waist when wearing it," Bitonti told Dezeen, "something she had never been able to do before."
The brace is also embedded with tiny data-capturing computer modules developed by Intel, which allow the user to monitor their progress via an app.

It debuted during an event at the White House earlier this year, and was presented as part of the FashioNXT event in Portland last month.
"It's not everyday you see a medical device launch at a fashion show," said Bitonti. "UNYQ AlignTM demonstrates how innovative technologies, designers, and technologists can combine to revolutionise treatment of medical conditions and dramatically improve the lives of the people who rely on assistive devices."

UNYQ Align will be available from a select number of hospitals in the US from early 2017 through a charter programme.

"It's a momentous step forward and the launching point for further innovation to continuously advance scoliosis treatment," said UNYQ CEO Eythor Bender.

3D-printing is being used for a variety of medical purposes. Similar to the brace, the technology has been proposed for lattice-like casts for fractured bones.

More complex applications involve printing replacements for missing sections of bone or whole body parts, and even internal organs – though the latter is still under development.

Source : Deezen , 4h Nov 2016

Magnetic technology for early onset scoliosis

In October this year Ella Hammond was booked in to see her orthopaedic surgeon in Sydney for a procedure that had her mother excited but edgy.

Three-year-old scoliosis sufferer Ella Hammond.

The surgery was to lengthen the rods that had been implanted in the three-year-old’s back months earlier to help straighten a severe spinal deformity threatening to crush her tiny heart.

Ella has early onset scoliosis (EOS), a rare spinal disorder that affects about one in 1000 children aged under 10. Major surgery can correct the curve, but traditionally it requires repeated operations – sometimes up to 20 – to lengthen the rods to keep up with a child’s growth.

For Ella, however, the treatment was vastly different: her implanted rods grew inside her at the tap of a button with the whole procedure over in five minutes.

“It was amazing,” says her mother, Sheree Hammond, of Maitland near Newcastle. “Ella sat on the edge of the bed while her surgeon dialled up a few numbers on a hand-held device and ran it down her back.

“It sounded a bit like a vacuum cleaner, and you could actually see the rods extend under Ella’s skin.”

The Magec system used on the infant relies on “live” rods that can be magnetically lengthened by an external remote control. First used in Australia in 2011, the American technology is proving to be the most significant breakthrough in EOS in the past 50 years, with potential for further medical applications.

Rare earth magnets inside the Magec rods communicate with the hand-held controller allowing up to 4.5 centimetres of growth on a standard-issue rod before they need replacing.

“They have been transformative for young children with scoliosis,” says Australian Orthopaedic Association president Ian Incoll. “They circumvent the trauma and cost of multiple operations and lengthy admissions required with the older implant technology.”

Idiopathic scoliosis, which is characterised by a sideways curvature of the spine with no known cause, is broken down into many varieties.

The most common, adolescent idiopathic scoliosis, affects mainly teenage girls. While their curves should never be ignored, intervention in the form of bracing or surgery is only required in about one in 100 patients. And usually for cosmetic reasons or pain relief.

However, in small children the early onset variety can cause serious health and developmental problems if not corrected.

“It is rare but it is the most vexing scoliosis to treat,” says Ella’s surgeon, Dr Angus Gray, who is attached to Sydney Children’s Hospital at Randwick. “The problem we have is that scoliosis is a spinal deformity driven by growth, and the more growth you have left, then the more opportunity for that deformity to go bad.

“Some of these little kids will die in their middle adult years because the normal development of their hearts and lungs has often been constrained.”

The Magec system was specifically designed for this age group with the help of world-renowned pioneer in advanced treatments for scoliosis, Dr Behrooz Akbarnia, who is based in California.
Gray had met Akbarnia at an orthopaedic conference in the United States in 2009 and shared his enthusiasm for the innovative magnetic technology.

As it turned out, Gray was able to use the Magec system for the first time in 2011, three years before the Food and Drug Administration in the US gave its long-awaited approval.

“I had been in contact with New Zealand surgeons who had put in a few already,” he says. “On that basis, I thought it reasonable to recommend the new rods to the parents of my first patient.”

With special circumstances approval from the Therapeutic Goods Administration (TGA), Gray surgically implanted the Magec rods into a Melbourne eight-year-old.

“I was sort of intrigued,” says Gray, who had been operating with the old rods since 2000. “Josh’s curve was severe, around 80 degrees, and it had not responded to bracing or plaster cast.

“He turned up months after the surgery with his parents … I dialled up how much length we wanted to put on his back, the machine made a funny whirring noise and you can see the numbers coming up on the LCD display – it went fine.

“Josh said what is commonly said by other patients since, that he felt a slight odd burning sensation between his shoulder blades, but it quickly disappears. I took him down the corridor to X-ray and you could see the rods had elongated. It was very, very satisfying.”

Josh is now 14, and only weeks ago reached an important milestone when he was transferred to a fusion system.

“The rods have done their job and the fusion will give Josh better and stronger correction for the final phase of growth,” says Gray.

One of the difficulties for surgeons operating on young children with scoliosis, whether using old or the new “live” rods, is bending the rod to the shape needed when these children are very small and have stiff spinal curves.

“The added challenge with the Magec rods is that you can’t bend the section that holds the motor,” says Gray. “That section is about 120 millimetres long, which is quite long in a little back, so you have to be a bit clever on how you bend the rod above and below that section.

“After each bend we have to put the magnet back on the rod and spin it to confirm the rod mechanism is still intact so it takes a lot of fine-tuning to ensure it will do the job when required.”

Of Gray’s eight young patients who have so far received the implants, three have had to have revision surgery: one because the hooks holding the rod had pulled out, one failed to telescope and the other had jammed.

“I can bear those failures because it’s much better than repeatedly taking these kids back to theatre for a two-hour lengthening operation and two or three days in hospital,” he says.

“It was awful on the kids because they remember.

“Under the old system surgeons had to repeatedly cut through old scar tissue, and you have to create more scar tissue every time you go back which increases the chance of infection.”

Despite Magec’s advantages, the cost – $22,000 a rod – did not initially excite the health insurance sector, but they soon came on board.

“Magec rods are far more cost-effective when you consider a five-year-old needing this system until he or she is 11 will now undergo about two rod replacements compared to about 11 or 12 lengthenings of the past,” says Gray.

California-based NuVasive, which has taken over from Ellipse Technologies – the first company to adapt the magnetic technology into a reproducible and commercially viable product – says the Magec system is a work in progress.
“We are continually working to make the devices smaller and less invasive, which would potentially decrease the need for replacement,” says senior director of marketing Ross Sylvia.

He says the technology is expected to have further applications and is already being used in non-invasive limb-lengthening procedures for the femur and tibia in cases of chronic fractures, congenital abnormalities and malunions.

Meanwhile, little Ella Hammond’s world has opened up beyond her mother’s expectations.

“Ella’s a different kid now because after three years of hell she’s relatively free of pain and has been fitted with special shoes to help her learn to walk, something we never thought she’d do,” Sheree says.

 “Our hope is to have her walk through the door when she starts kindy in just over a year, and her surgeon believes that’s achievable.”

Source : The Saturday Paper , 5th Nov 2016