Occupational therapy
Occupational therapy (OT) is the use of assessment and treatment to develop, recover, or maintain the daily living and work skills of people with a physical, mental, or cognitive disorder. Occupational therapists also focus much of their work on identifying and eliminating environmental barriers to independence and participation in daily activities. Occupational therapy is a client-centered practice that places emphasis on the progress towards the client's goals. Occupational therapy interventions focus on adapting the environment, modifying the task, teaching the skill, and educating the client/family in order to increase participation in and performance of daily activities, particularly those that are meaningful to the client. Occupational therapists often work closely with professionals in physical therapy, speech therapy, nursing, social work, and the community.
The term "Occupational therapy" can often be confusing. It carries the misconception that the profession’s focus is on vocational counseling and job training. The word occupation as defined in Webster’s Dictionary is "an activity in which one engages." Occupational therapists promote skill development and independence in all daily activities. For an adult, this may mean looking at the areas of self-care, home-making, leisure, and work. The "occupations" of childhood may include playing in the park with friends, washing hands, going to the bathroom, cutting with scissors, drawing, etc
3D Printing Technology Applications in Occupational Therapy
Introduction
Three dimensional (3D) printing is a novel emerging technology widely used for various fields such as medical, engineering, educations, and other industrial areas. It is the process of making three dimensional physical models by using 3D software, computer, and printer. The 3D printing technology is also called as by various names such as solid imaging, additive manufacturing, medical rapid prototyping, layer based manufacturing, laser prototyping, and solid free form fabrication. This technology has been wildly used for producing various types of customized low cost medical devices, but it is still in the infancy status in the research and clinical practice area of occupational therapy. In this review, we tried to explore the sources of three dimensional printing, 3D scanning method and the possibilities of future application of 3D printing technology into occupational therapy.
Using 3D Printing Technology in Health Care
With the rapid evolution of reverse engineering, 3D scanning or imaging technology and Computer Aided design, it helps to make three dimensional physical models of human body parts based on additive manufacturing method [2-4]. Outcome of 3D printing models has been used in medicine for various applications such as education and training tool, using in surgeries (Orthopaedic surgeries, spinal surgeries, customized orthosis and prosthesis), tissue and organ fabrication (heart, liver and pancreas), producing different types of medical implants, making of anatomical models of human body parts, stomatology, dental implants, hearing aids, and pharmaceutical research. In term of cost, 3D printing method for making medical devices or implants are considered as cost effective and can produce in less time. Therefore, it helps to increase the productivity of effective customized medical devices with low rate. There are number of methods used to create 3D printing physical model (RP model) such as selective laser sintering (SLS), stereo lithography (SLA), laminated object manufacturing (LOM), fused deposition modeling (FDM), Solid Ground Curing (SGC),
3D three-dimensional printing (3DP), Ink Jet printing techniques, vacuum casting and milling (VCM), two-photon polymerization (TPP), direct laser metal sintering (DLMS). In medicine, there are different types of materials are used to create rapid prototype model of medical devices and implants such as stainless steel, Cobalt Chromium alloys (Co Cr), titanium (Ti) alloys, Polycaprolactone scaffolds, polymer-ceramic composite scaffold with made up of polypropylene-tricalcium phosphate, Ceramic materials-Porous ceramics, Alumnia, Zirconia, Calcium phosphate-based bioceramic , other bone cement materials and other biocompatible materials.
In the 3D scanning technological point of view, computerized tomography (CT), magnetic resonance imaging (MRI scan) has been used to take acquire the 3D images of the body parts. Initially, the acquired three dimensional images from the CT and MRI will be analysed with 3D software such as Mimics, 3D Doctor and then it will be converted and saved as STL file. Finally, the STL file (format) is transferred into the RP machine to create the physical model. The following Figure 1 shows that 3D printing machine.
3D Printing Technology Application in Occupational Therapy
Although 3D printing technology are rapidly increasing to use in the medicine, its application in the occupational therapy research and clinical practice area is on early stage. Based on the literature search, there are only very few information collected through the online search and form the different databases such as PubMed, Scopus, CINHAL. One of the authors (Occupational Therapist) explored and described about the possibilities of 3D printing technology in creating of assistive technology for disabled persons such as ipad key guard for hand tremor, mouth stick holder. 3D printing technology can also be applied in the classroom setting those students are having problems of hand function such as 3D printed hand grips. The following different types of assistive devices were developed with occupational therapist suggestion and design for classroom setting: Highlter grip holder, Container grip, bottle grip holder, and rocker grip holding device, large crayon, and painting brush grip holder. However, Understanding of 3D technology and application of 3D software, and 3 dimensional prototyping is essential to implementing the design of desired assistive and adaptive devices. Assistive technology has very crucial role in daily life of disabled people to make easier to perform their daily living activities without any barriers.
E-resources of 3D Printing in Occupational Therapy and Clinical Applications
Based on the on hand-Google search, there are number of customized three dimensional products has been made by occupational therapist or biomedical engineer such as finger guide for pen, BIOT hand prosthesis, glass holder for poor hand function, and hand grip holder for eating utensils. These online resources might give the idea for occupational therapists to create new assistive devices at any kind of design according to the requirements of the physically impaired patients.
Process of 3D Printing
The three dimensional printing technology involves with several steps such as obtaining, 3D scanning, processing the acquired images by 3D software, 3D printing and clinical application in different conditions and as per needs of the patients such as assistive devices of stroke and other neurological patients, splints for hand problems, learning aids for special needs children. Also, designed prototyped-anatomical body parts, 3D model can be used as teaching aid for the occupational therapy students. The process of 3D printing method is described below in Figure 6. Commercially available 3D scanners are expensive. Therefore, in occupational therapy practice, we can use lot of commercially inexpensive 3D scanner to obtain the 3D images of the products such as Kinect Xbox, Structure 3D scanner, iSense. Intially, Kinect Xbox was used as video game. However, recently it has been used as a one of the inexpensive 3D scanner and even used
as clinical diagnostic tool in the medical field. One of the study used Kinect as 3D scanner to obtain the 3D images of the clubfoot to design the braces. The obtained images from the kinect or other 3D scanner will be saved as obj file. Then, Artec 9 studio 3D software would be helpful to design the 3D model by global processing and texture mapping methods and it can be converted and save as STL file. As a final stage, STL will be transferred into the 3D printing machine with the help of computer aided design (CAD) software to get the 3D medical, assistive devices in any design.
Advantages of 3D Printed Devices in Occupational Therapy Practice
Application of bracing or splinting (wrist splints, finger splints, cast replacements, and other types of orthotic and prosthetic devices) is one of the common intervention practices in occupational therapy to treat the patients with acute and chronic conditions. Using 3D printed medical devices has lot of advantages when compared with making of assistive devices or medical devices by conventional methods such as comfort, fit, aesthetic features, and it makes faster recovery from physical impairment due to the design. For example, compliance of the splints or braces has very crucial role to improve the function and recovery of the patients. However, previous study reported that around two third of the clients had noncompliance of splints or braces. There are number of factors determines to achieve the successful wearing of splints treatment regime to improve faster recovery from the physical impairment of the patients.
French Occupational Therapists Create 3D Printed Joystick for Wheelchair
3D printing has affected manufacturing and designing to the point that nearly everything that can be made is either now rolling off of a 3D printer or will be soon–and usually in some very improved or unique fashion. We follow 3D printing in nearly every sector, from automotive to medical, with everything in between covered–and plenty coming from desktops, labs in universities, and a variety of makerspaces.
Seeing 3D printing technology help those with physical challenges, however, is immensely inspiring. And numerous innovators and medical professionals have been inspired to put their creative minds to use at the 3D printer to help make life that much better for people of all ages with many different challenges.
Recently, two occupational therapists in France decided to refine a wheelchair design to help a paraplegic patient (at the C5 level, meaning the individual can still use arms and hands) who would benefit from great ease in getting around. Guy Ehretsmann (Pôle-Ergo) and Jean-François Bodin (ITSR Lyon – HCL Hanry Gabrielle Lyon) created a 3D printed joystick printed in NinjaFlex. Originally this was a test to see if indeed they could replace a traditional joystick successfully with 3D printing and improve directional mobility for the user.
While at first they were going to fabricate a chin-driven apparatus, that was discovered to be much too inefficient, so they forged ahead and created a hand-maneuvered 3D printed joystick with special thermo-plastic molding, designed in Meshmixer, a free 3D design tool that allows users great latitude in coming up with completely unique designs for 3D printing.
While the project is still ongoing, at this point, they have created a very functional, flexible joystick attachment which allows the user to fit his hand inside the flexible 3D printed material and move it easily as required.
Control of the wheelchair appears to be seamless, and much greater comfort and ergonomics are attained due to the comfortable and pliant material. Testing so far indicates to the therapist/innovators that not only is this a product that has great potential, but they believe that the 3D printer is indeed ‘a tool that deserves to be in the toolbox of the occupational therapist.
The overall mission is to use digital design and the power of 3D printing to bring greater autonomy to those using electric wheelchairs–and Ehretsmann reports that he is currently teaching the technique to his occupational therapist students at the University of France.