Design of a 3D-printed, open-source wrist-driven orthosis for individuals with spinal cord injury

Alexandra A Portnova, Gaurav Mukherjee, Keshia M Peters, Ann Yamane, Katherine M Steele, Alexandra A Portnova, Gaurav Mukherjee, Keshia M Peters, Ann Yamane, Katherine M Steele

Abstract

Assistive technology, such as wrist-driven orthoses (WDOs), can be used by individuals with spinal cord injury to improve hand function. A lack of innovation and challenges in obtaining WDOs have limited their use. These orthoses can be heavy and uncomfortable for users and also time-consuming for orthotists to fabricate. The goal of this research was to design a WDO with user (N = 3) and orthotist (N = 6) feedback to improve the accessibility, customizability, and function of WDOs by harnessing advancements in 3D-printing. The 3D-printed WDO reduced hands-on assembly time to approximately 1.5 hours and the material costs to $15 compared to current fabrication methods. Varying improvements in users' hand function were observed during functional tests, such as the Jebsen Taylor Hand Function Test. For example, one participant's ability on the small object task improved by 29 seconds with the WDO, while another participant took 25 seconds longer to complete this task with the WDO. Two users had a significant increase in grasp strength with the WDO (13-122% increase), while the other participant was able to perform a pinching grasp for the first time. The WDO designs are available open-source to increase accessibility and encourage future innovation.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Metal and 3D-printed WDOs.
Fig 1. Metal and 3D-printed WDOs.
(A) Traditional WDO fabricated from the Jaeco kit. (B) 3D-printed WDO from this research.
Fig 2. The experimental setup of the…
Fig 2. The experimental setup of the study with 3D-printed WDOs.
(A) P&O student fabricating a 3D-printed WDO using the device manual. (B) User performs the writing task of the JTHF test with a 3D-printed WDO.
Fig 3
Fig 3
Exploded (A) and assembled (B) view of the CAD model of the 11 pieces of the 3D-printed WDO.
Fig 4. Selected design improvements in the…
Fig 4. Selected design improvements in the 3D-printed WDO.
(A) Additional linkage between the thumb and the finger piece. (B) Curved thumb piece. (C) Elongated palmar piece.
Fig 5. Device scores from testing with…
Fig 5. Device scores from testing with P&O students and users.
Scores from P&O students (gray boxes) rating the 3D-printed WDO on fabrication speed, function, aesthetics, and comfort (1 = poor/slow, 10 = great/fast). Scores from the three individuals with SCI (colored points) rating the function, aesthetics, comfort, ease of donning, and suitability of the 3D-printed device to their daily needs. Only results from the last visit are shown for each of the users, to account for the iterative modifications to the WDO design.
Fig 6. Users’ performance with and without…
Fig 6. Users’ performance with and without 3D-printed WDO.
(A) Performance during JTHF Test. (B) Performance during Box-and-Blocks Test. Users’ average pinch force during a (C) key grip without the WDO and (D) during a three-jaw chuck grasp with and without the WDO.
Fig 7. Comparison between visits 2 and…
Fig 7. Comparison between visits 2 and 3 for P2 and P3.
(A) JTHF Test. (B) Box-and-Blocks Test.

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