Clinician Insights Series 3, Episode 2
Welcome back to another series of Clinician Insights. If you’ve not joined us before, this blog series is brought to you by Radii, to open up conversations about digital tech and its role in O&P.
Once more, we’re joined by John Talbot, CPO from Portsmouth Enablement Centre, UK and Gary Marano, CPO and Director at OTF Prosthetics and Orthotics, New York. In the last instalment of this series, we heard about the beginnings of John and Gary’s careers, which together span 80 years of clinical experience. Now, they’ve shared more about the lay of the land in prosthetics today, from both the US and UK.Â
In this episode, we consider the role of digital technology in prosthetics: the present performance, and the potential for the future. How is technology such as 3D scanning currently being used, what benefits does it bring, and what are the potential drawbacks? We explore all this and more with our two clinicians.
As ever, we’re incredibly grateful to our contributors for sharing their insights and expertise. Gary and John have unique perspectives on the trends, developments and research happening in the O&P industry across the globe, and its ongoing mission to provide patients with better fit, more comfort, and the best possible experience.
John - I had a ‘through-hip’ patient in and I wanted to duplicate their socket, which would take a few hours with the traditional plaster alginate gel methods. But fortunately, one of our recently acquired prosthetists had the skills to be able to digitally scan that through-hip socket, which was then sent away for a cone to be made to the right shape. That was a massive, massive help from my point of view. It's superb—but somebody very clever has got to produce that to be copied, and this is where I would have usually relied on my traditional hand skills and methods to achieve the outcome.
Gary - I've been playing with making check sockets on a 3D printer, and I finally get decent results from it, I really do. You really have to sit down and learn and try it. It's trial and error until you are into a certain flow that works for you.Â
But the modifications are really good. In conventional plaster, when you spend most of your time with the physical, you’re able to feel the shape. Whereas the digital one is floating and you're rotating it, you're trying to see compression, and checking that you’re able to do it in a uniform way, the design is not warped per se, and that you're not putting more pressure on one side than the other.
I also use a desktop to do some of the modifications and then send them to splicing software. People forget that you need a splicer, you need a programme to understand the build out at the final stage, before you want to print a prosthesis. There are definitely three, and sometimes four pieces of software I’ll use altogether.
Gary - The ability to work from anywhere. You could take a laptop away with you, on vacation, in a hotel room, anywhere, and you don't need a work bench. It's probably the easiest portable way to design a socket and you could do it from anywhere. If you want to change something and you were at home or someone's on vacation or away, they're able to do it quickly.
John - The beauty of being able to scan something is you can change or enlarge the volume size, without having to add a lot of guesswork to a plaster cast. That has probably been the biggest advantage that I've had personally from using a 3D scanning method. Everything I produce by hand, I would scan. Hopefully it's successful, and then if in the future they might want a duplicate, brilliant. It might be unsuccessful, a bit too tight or a bit too loose, but I can adjust it with a fair amount of accuracy to produce another socket.Â
Providing I've got my initial casting, I feel the digital bit can help me do the other things I want. I haven't gone to the stage of creating anything digitally without my personal input, apart from if I had a transfemoral patient, a new patient, and they were unable to stand but had to have an artificial limb.
Gary - You’ve got to think practically, and know what to do next when a design comes back. This is the important thing. These prosthetics have to be corrected and cleaned afterwards. But there is a time factor involved—many people think you just press a button, like there’s a genie that's doing it for you. But that's only if you get the fit right, otherwise things could come back and then we need to do it again.
John - I've not met anything yet where I would use the digital technology straight away, rather than just doing a more traditional one. I'm not aware of how a digital scanning of a residual limb can give you an outcome, other than by hit and miss. How many check sockets does that need to arrive at one successful socket? I don't know how the digital technology has shown at the moment to have a more beneficial outcome to the patients, other than it can be made a lot quicker. You can send away a scan, but you can get unqualified people to make something at a much cheaper rate on central fabrication rather than paying skilled technicians in a workshop environment to complete. So, I’d find that a poor outcome from the introduction of digital technology into prosthetics.
John - From vast experience of many years, you hope to learn from when things go wrong. (Recording 4, 00:00:17-00:00:25) You develop your own system because you look towards doing things differently. Each patient will give you a different challenge, but nevertheless, you're trying to go through millions of options within your mind, you're going to flick through ways you can look at that challenge. This is exactly what a computer would try and do, ‘let's put all the information in and we'll give you the outcome.’ That’s what your brain does for you.Â
You’ve got to include a patient in how you're going to achieve an outcome for them. If the patient's not with you and they don't feel happy with where you're going, then stop straight away. If you've got that approach, then without doubt the patients are so much more forgiving, even if things don’t go right.
The option of a computer gives you so many things that you maybe haven’t got to think about it. It does it all for you. In my opinion, it's wonderful to have that technology to be able to do it, as an individual prosthetist, once you've gone down the route of getting the experience to be able mentally visualise where you want to get to. If you don't know where you want to get to and you can't see it in your mind you're never going to know when you've arrived.
So, how do I find digital technology could help me? It would help me in duplication. Quite how it's going to get me where I want to go quicker, I'm not quite sure yet! But that's probably because I still approach it with the experience of my mind, how I would look at somebody's residual limb, how I would look at an outcome. The best outcomes are those I will get from that. I don't think you necessarily have an idea of what to do right all the time. I think with experience you learn what's not going to work more quickly. You can knock out 75 percent, 80 percent, even 90 percent of what you'd never get away with. And within the parameters of where you're going, you've got to narrow it down to the outcome that you want. Then you can copy as many times as you want.
Gary - I think technology is good. Instead of going to a clinic where you have to have a hand cast, and then you have to come back another time, you could probably go to the clinic and right there, if you want to try something, OK. And then eventually, we’ll reach the day where these printers are going to be able to do something in an hour and a half. And while you wait, they get it done.
I definitely believe that it's the future. And it is here, now.
We hope that through following Clinicians Insights, you feel part of an ongoing conversation that furthers understanding of digital technology and research, supporting O&P practitioners who provide our patients with the best comfort, fit and socket fitting experience. If you’ve got thoughts, opinions or insight to share we’d like to hear from you; click the link below to get in touch:
Thank you Gary, thank you John and thank you to you, our community, for joining us. We’ll see you for Part 3, out January 23rd.
Speak soon,
Jenny, Josh and the Radii team.