3D Printing Enabling War Torn Communities – Robohand and Project Daniel (Not Impossible Labs)

Written by Beth van As
7 January 2014

In October of 2013 Rich flew to Los Angeles, USA, to meet up with Mick Ebeling and the group from Not Impossible Labs.  His soul purpose was to teach Mick how to put together a Robohand and Roboarm.

The few short days they had in LA together were not enough to transfer the knowledge so Mick flew to Johannesburg, South Africa on his way to the Sudan to spend a few extra days with Rich to complete his training. The best was he had a live subject to practice on!

Mick’s journey began when he heard about Daniel Omar who was only 14 when he had his arms blown off in the Sudanese war. Once Robohand launched their Roboarm, Mick contacted Rich about Project Daniel where Rich designed a new hand for the Roboarm which has been called the “Daniel Hand”. The new signature for Roboarm.

Mick arrived at the Robohand workshop and not much sleep was had over the 3 days he was here. It was a whirlwind of activity and when I arrived home from work on day one, I was enveloped by Mick and put to work setting up all the laptops and equipment to ensure everything would be working correctly when they set up in the Sudan. There is no internet access in the Nuba Mountains so we needed to ensure that all automatic updates and any internet related system tech was turned off. We needed to download the correct software for the Makerbot’s that he was taking with him.

The workshop hummed and sang with all the printers working furiously, mostly 24/7, spewing out meters and meters of PLA, creating the pieces for the Roboarms for Mick to practice with, as well as stock to take to the Sudan. Learning how to ensure the sizing is correct, rendering the files and sending them to print. Unlocking all the SD cards and ensuring that Mick had all the correct files to print the Roboarm. When you don’t know anything about 3D printing these small things can seem a bit daunting.

Then it was ensuring Mick understood all the fundamentals of Roboarm; how the mathematics worked, so once fitted the arm functions; learning all the little things like molding Orthoplastic, stringing fingers, adjusting cables and assembly. A lot of knowledge to cram into a very short space of time. Rich was ever the teacher, instructing but also encouraging “out the box” thinking when Mick hit a stone wall. Rich teaching him to pull from his surroundings and not only rely solely on technology; be creative and use what is around you.

At the same time that Mick arrived, Ty from Altanta, was also at Robohand learning all she could to enable her to set up the Robohand clinic in Atlanta, USA. It was a crazy time in our household; very emotional hearing about Daniel as I know the joy when a person receives a device that can change their life forever.  When Mick fitted the Roboarm he had created to his guinea pig the tears were evident in the recapture at the workbench that evening. During our discussions there were some things that did not need to be said as the raw emotion was plain to see.

To be part of a project like this one with Daniel, took Robohand back to our roots. Helping others help others. Spreading the knowledge and enabling communities to help themselves. The hardest part for me is not having enough funding to do this all over the world.

Following are some of the pictures taken during our Not Impossible Visit.

2 Making the Roboarm mold 3 Molding Roboarm 4 Fitting the Roboarm mold 5 Fine Tuning the Roboarm mold 6 Fine Tuning the Roboarm mold2 7 Fitting the Roboarm mold2 8 Fine Tuning the Roboarm mold3 9 Fitting the Roboarm mold3 10 Mick and Rich 11 Assembling Roboarm 12 Fine Tuning the Roboarm mold4 13 Checking the Roboarm fit 14 Checking the Roboarm fit2 15 Big Discussion 17 Big Discussion3 18 Stringing the fingers 19 Training in Progress 20 Look what I'm doing 22 23 Just make sure... 24 Let me check 25 Looking good 26 Final fitting of Roboarm 27 Miles of Smiles 28 Miles of Smiles2

A Response to the “Open Letter”

When I logged in to our web content today, I was surprised to find a very long comment posted under our Open Letter blog post.  After reading through the content I got very excited and contacted the writer to enquire if I could re-post his comments as a full blog post. He gives good advice on how to use and mold the Orthoplast that Robohand use for making our mechanical devices and I think this will aid many of you that are trying this for the first time.

Crispin Miller, an independent biomedical design professional has this to say:

“I have some tips to offer about forming Orthoplast, the splint/socket material you shape by softening it in hot water. (This stuff:

http://www.medical-supplies-and-equipment.com/product_more.wcs?pid=00001325
– though I don’t know this particular vendor.)
I worked intensively with this material for several months, making specialized splints and mounts for biomechanics experiments I conducted for my master’s thesis on prosthesis design.

I found it to be an extremely adaptable material, but this same versatility means that it takes practice and attention to control what shape you get. This was underscored to me ten years later when I found myself on the other side of the counter — getting fitted with a splint after I’d hurt my hand — and the young man making it had not been adequately trained for forming the material. I had to go home and re-mold the splint myself, to get rid of just such a pressure point as therapists Esham, Poole, and Scheuber are warning us against.

Here are some things I’ve learned:

1. To form a splint around any part of the body other than perhaps the straight part of the forearm, you have to create some “compound curvatures” — requiring stretched areas in the material. Otherwise when you try to put it around areas which narrow and flare (such as the transition from forearm to wrist to hand), it will form big folds or wrinkles, departing from the natural shape of the body part underneath (think of how some flexible-but-not-stretchy leather would behave) — and these rumples will have an obvious risk of being pressure points. This was the trouble with the splint I had to fix.

To avoid these mis-fitting areas takes attention and practice. Perhaps highly skilled practitioners can do it by themselves (as a single person working), but in my experience a good job on something like a whole-arm splint also required having four hands on the work. One forgiving aspect is that you can reheat the material repeatedly, so as to proceed in multiple steps — on the first heating, softening the material and wrapping it on, you probably just learn what size to trim it to. Maybe also you can see where you’ll need to stretch it, and maybe get it suitably stretched on the next heating. And if you’re lucky, then that time you may still have time also to take the piece, once stretched, and get it suitably wrapped around the limb, before it cools and stiffens up. Or you may run out of time and need to throw it back in the hot water, which means you lose some of your shaping work (but maybe not too much of the stretch) — and then you try again, making sure to position it the same as before so that the trimmed edges and the stretched area(s) are still where you need them to be.

2. We found that the work was easier if you did some extra temperature manipulation of the material –

– the simplest part of this was that once you do have the piece formed the way you like it, and you’d like to go ahead and firm it up, you can sponge it with cold water and then you don’t have to keep sitting there holding it in place for so long. So we prepared both a hot-water dishpan and a cold-water dishpan, with big sponges in both, and if we needed to buy extra time on some part of the piece, we could keep it warm with the warm sponge, and once we wanted to solidify it we could cool it with the cold sponge. Typically we had three hands holding the material and the fourth hand applying the sponge. There’s a significant time lag you need to expect, for either heating or cooling, because the material takes time to change its temperature all the way through.

– for the initial stretching, it helps to have the material soaked in hotter water than you’d use for fitting it onto the wearer — BUT you cannot wrap it onto someone’s arm when it’s that hot! Do the stretching you need, then cool it off and check it against your own (scrubbed) skin, then wrap it on.

– One way we learned to speed this up was to sponge the wearer’s side of the hot material with a quick, uniform wipe of cold water and then wrap it on, while the rest of the material thickness was still nice and flexible — BUT this was with a fully able-bodied volunteer subject with no sensory or circulatory impairment, who could let us know if the splint was feeling too warm and should come off — so do think carefully about this approach, and test it on yourself first, to learn for example whether the interior of the material may be holding more heat than you think. If you’re working with someone who has any damage to skin, or to nerves, or to circulation, I wouldn’t use this trick.

– unless you have a thermostat-controlled water bath, never wrap any piece of heated Orthoplast onto someone without checking the material temperature against the back of your own hand first.

3. A technique I haven’t seen clinicians do, but that I’ve found invaluable, is to do finishing details by local heating afterward, with the splint off of the wearer. This lets you soften and fix small areas without losing the overall shape. Two examples of things this lets you do are:

– flare the edges, at places that would poke or dig when the limb is pressing against them;
– soften the appropriate spot on top of the wrist and poke a good outward bulge into the surface there, about an inch wide, to avoid pressure at the place where the ulna makes a lump there (a lump which varies as you twist the wrist, by the way!)

One way to do this local heating is with a workshop “heat gun” (a hair dryer on steroids), but do be careful and patient, because a heat gun can scorch the material if you try to soften it too quickly.

One extra trick with a heat gun is that you can WELD this material, face to face, if you want to apply a thickening patch or splice a bracket on, or something. One of the two pieces should be softened so it will mate tightly, and then you quickly heat both faces strongly but briefly with the heat gun and press them together.

A kinder-gentler way I found for forming finishing touches, though, was to use a small steam jet. You still have to take care not to scald yourself, but you won’t scorch the material. What I rigged up was a Pyrex flask of water on a lab hotplate, with a one-hole stopper and a bent copper tube (to send the jet sideways so I could see what I was doing). Less elegantly, you could use the spout of a pressure cooker with the pressure weight removed.

If any of this leaves you questions, I’ll try to respond –

best regards and good luck,
Crispin Miller, PhD mech. engr’g
Lincoln, Massachusetts”

Open letter to Robohand DIYers

Important Safety Information for the Robohand 

Greetings, 

My name is Tyhanna Esham, OTR. I am an Occupational Therapist with twenty years of experience. For the past ten years I have specialized in hand therapy in Atlanta, Georgia.

Recently, I returned from Johannesburg South Africa where I studied Robohand design with its creator Mr. Richard Van As. Since his accident two years ago resulting in amputation of several digits, Mr. Van As (an amputee himself and having an intimate knowledge of the unique issues facing hand deficit individuals) has devoted much of his personal time, finances and knowledge toward developing cost effective, functional and safe uses for the Robohand design. 

Regarding Construction of the Robohand: 

  • Use Robohand design #44150 (thingiverse) for durability. The “Snap Together” Robohand model (thingiverse # 92937) was intended for demonstration use only. It lacks strong, secure hardware and is prone to failure with heavy use.
  • Use quality hardware as listed in the Assembly Manual. Lesser quality hardware may result in failure, rusting, poor cosmetics and most importantly a dysfunctional Robohand that could cause injury and infection. Stainless steel hardware with dome nuts must cover exposed screws to prevent injury to the wearer or others. Although stainless steel adds to the initial cost of a Robohand, it is stronger, safer and less likely to cause injury/infection making it more medically appropriate. Another benefit of stainless steel hardware is that it can be reused in upgrades as the child grows or as the Robohand is updated or replaced.
  • Custom moulded Orthoplast is medically appropriate for Robohand use, provides an excellent surface for pressure distribution during use of the Robohand, thus decreasing the likelihood of pressure areas and injury. It is recommended that an experienced Occupational Therapist or Hand Therapist do the moulding. PLA plastic should not be used on bare skin. Although low cost and somewhat mouldable when heated, the PLA plastic’s pitted surface will collect sloughed skin cells, becoming an excellent breeding ground for bacteria. Its’ rough edges, pitted surface and inferior custom moulding characteristics make it likely to chaff the wearer causing skin lesions that may become infected. Medical Orthoplastic, when used by an experienced practitioner, is easily moulded, modified and cleaned. Use of zip ties, duct tape, and ill fitting, make shift items, like shin guards are likely to cause pressure areas. With continued use, these inappropriate items are likely to impair circulation, irritate fragile skin, sensitive scars, compress nerves and cause skin lesions.

Regarding Application/Use of the Robohand: 

  • Robohand should only be used by children/individuals with good skin integrity and intact sensation who possess the mental capacity to safely wear and properly use it. Children should be of an age to request and understand the purpose of the device.
  • Wearers must inspect their skin regularly to ensure safety of fit. Any problems must be promptly addressed to prevent injury.
  • Amputations, crush injuries, burns and multiple or recent surgeries often result in fragile skin, compromised circulation, sensitive scars, and painful neuromas. These issues can take years to resolve and may result in a life long struggle. This last scenario is made more likely if an ill fitting device is applied or any device is applied when inappropriate. Burn victims and individuals with hyper sensation or lacking sensation are generally not good candidates for Robohands.
  • Please do not use children for R&D purposes as they are often unaware or unable to reliably report pain resulting from an ill fitting device.
  • Consult with an Occupational Therapist or Hand Therapist to determine suitability and proper fitting.

Parting Thoughts: 

Robohands are a tool that can enhance performance of certain tasks; they should not be presented as a panacea. We need to be mindful of not creating unrealistic expectations. Sometimes other devices or adaptations are more helpful. 

While I admire and encourage exploration of 3D printing technology to expand ways to help people with limb deficiencies find functional, low cost, life enhancing devices, I recommend the use of consenting adults who will participate in follow-up during the R&D process. 

I too am excited about the new Robohand technology, but I must emphasize caution and discretion with its use. Children, their parents, and adults with limb deficiencies may be experiencing physical and emotional difficulties that people with normal limbs cannot imagine.

Let us all tread lightly and first, Do No Harm.

Sincerely,

Tyhanna Esham OTR/L Robohand USA 

Lynda Poole, OTR Paediatric Occupational Therapist 

Grae Scheuber BSc(Hons), Robohand Australia 

Some things you should know about Robohand devices

Robohand uses 3D printing to provide functional, safe, cost effective upper extremity assistive devices to help enable any individual with an upper limb difference. 

 

Overview and Expectation of Robohand devices:

Device

Assessment Criteria

Benefit

Robofinger(The Tradesman Finger) If people are missing the PIPJ[1] & DIPJ[2]  then your MCP[3] (knuckles) needs to have equal to or greater than 300 (degree) motion Improved Fine Motor Skills
Robohand If people are missing all or partial fingers and/or partial hand, your wrist needs to have equal to or greater than 300 (degree) wrist motion) Provides gross grasp (All fingers open/close together)
Roboarm If people are missing fingers / hand and wrist your elbow needs to have equal to or greater than 300 (degree) motion Gross grasp as above with palm up and down capabilities

 

Functionality – The design of Robohand uses the motion of existing joint(s) to mechanically move (or drive) the custom made device. Robohands are not myoelectric[4] and do not require invasive surgery. Nor do they have motors or battery packs that add weight, require maintenance and increase cost.  They are environmentally friendly as the PLA they are 3D printed with is biodegradable.

 

Safety – Robohand creator, Mr. Richard Van As, has dedicated much of his personnel time, energy and financial resources to further his personnel belief that his inventions “DO NO HARM”.

Robohand uses medical Orthoplastic that is custom molded to the wearer to limit the possibility of skin lesions, infection and injury. The Orthoplastic used by Robohand is breathable, washable and medically approved for this type of use.

A Robohand device is custom fitted which adds to client comfort. A proven statistic is 25% of people with prosthetics do not wear them due to the fact they are uncomfortable. Using medical Orthoplastic ensures Robohand will remain medically fit for use and long term wear.

Robohand uses stainless steel hardware that is less likely to fail or break, does not rust or discolor and decreases the risk of infection/injury. Dome nuts are used to decrease the likelihood of injury to yourself or others. Stainless steel is more medically appropriate than cheaper hardware. Many of our clients like to swim and bathe in their Robohands and the stainless steel does not rust or discolor.

 

Cost effectiveness – Every effort has and will continue to be made to keep Robohand devices cutting edge with innovative designs to increase function and manage cost while maintaining Robohand’s devotion to high product standards with the safest materials available. 

Robohand’s mission is to help enable people with an upper limb difference, be more independent and interact with the world so that they might live a full and joyful life.

 


[1] PIP: Proximal Interphalangeal Joint – this means the middle joint of your finger

[2] DIP:Distal Interphalangeal Joint – this means the end joint of your finger

[3] MCP: Metacarpal Phalangeal Joint – the joint between your hand and finger (knuckle)

[4] Myoelectric definition: A prosthetic control technique which utilizes skin surface EMG muscle potentials for the actuation and movement of an electric powered prosthetic component)

Grand Opening! Robohand USA

It is with the greatest of enthusiasm and pleasure that we are able to announce that Robohand are opening a branch in Atlanta Georgia, USA!

Tyhanna Esham has been working tirelessly to set up a Robohand Clinic over the past few months. Skype is just no longer a viable option so Ty will be coming to South Africa in October 2013 for 10 days of intensive training on how to put Robohands and Roboarms together.

Ty has an Indiegogo campaign running at present to raise funds for the initial set up costs of the Clinic in the USA. We would appreciate if our supporters, especially those in the USA, check out her campaign and donate where possible and share the link with your friends and families.

http://www.indiegogo.com/projects/robohand-usa-clinc

Robohand is growing and we hope to ENABLE many lives going forward. We cannot do this without YOUR support, so thank you!

Family Ties

We shared the pictures of Johann receiving his Roboarm, but the story behind the story is what makes it real for us at Robohand.

Suzanne contacted Robohand inquiring about a hand for her brother. As it turned out she was in Australia and he was in South Africa. Suzanne and her husband were coming to South Africa on holiday to visit all the family and she requested if we could do Johann’s Roboarm while she was here.

We worked out all the logistics and the day before Suzanne was going to leave Australia her daughter told her that the reason they wanted them to come on holiday was that she was getting married!

So it was a double whammy holiday! After Johann received his Roboarm we asked Suzanne if she wouldn’t mind giving us some insight into her experience with Robohand. This is what she had to say:

“Around 6 weeks ago my brother Johann’s right hand was amputated at his wrist.  At that time I heard about Rich van As and started the search and made the eventual contact – all the way from Australia!

My husband and I traveled to South Africa and together with Johann and his wife Melindi, met with Rich to discuss if he could help.

On Tuesday, 27th August 2013, Rich welcomed us to his workshop to fit a hand for Johann.  During the preceding weekend, “Maggie” the 3D printer produced the components of a new hand for Johann. 

Rich assembled this and on Tuesday, spent the day fitting the hand and fine-tuning the settings.  On Tuesday afternoon, Johann managed to pick up a small ball, a roll of kitchen towel and almost hold a cup. After three days he is almost completely independent again and he proudly announced on Friday that he can sign his name!

This has made a significant difference in his life and we would like to thank Rich and everyone involved in the development for the opportunity for Johann to be the recipient of a Robohand. You are special people helping those with disabilities to regain their will to live and work.”

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Not a doubting Thomas

Meet Thomas

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Thomas is 7 years old and is in Grade 1. Thomas was born with ABS like so many other children that have visited Robohand.

He is a very excited young man and chatters on and on about all sorts of things. He has a very vivid imagination. We think he just likes the sound of his own voice.

The family Brian, Mariska and Sarah-lee came to visit a few weeks ago for a fitting and to see if Thomas is a candidate for a Robohand. Since then Thomas has told his entire school that he is getting his Robohand today and everyone will be waiting patiently for him on Monday morning.

When the family arrived this morning Thomas got straight on the chair and started chattering away about getting his Robohand. As usual Rich starts with the fitting of the hand cap and gauntlet which is the most tedious and lengthy process.

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When Thomas was here for his fitting, he put in a request for red and white fingers. Rich duly obliged.

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It is the middle of winter here in Johannesburg at the moment and Rich’s workshop is freezing. So after some nice hot coffee and hot chocolate, we carried on with the fitting.

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Thomas enjoys cricket which is his favourite activity. He can’t wait to play cricket with his new Robohand and we are hoping that it will be an extremely positive thing and he will grow from strength to strength. Thomas also believes that you shouldn’t do any running if there is no ball involved. His sister did cross country at the beginning of week and his mom asked Thomas if he would like to join in the running. Thomas’ response was “But there’s no ball, so why should I run?”

Thomas’ other pass time is Video games. He love shooting games the most but also enjoys driving games. He enjoys soccer too.

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Thomas is very popular and has lots of friends. He told us that he has a girlfriend who he is going to marry but he is going to stay with his mom and dad so he doesn’t have so far to travel to school. He is good at Maths and hates vegetables, especially peas and green ones.

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After another long day for Rich, Thomas has a happy grin when he leaves with his Robohand.

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Tragedy Strikes but Miracles Happen!

Meet Esethu.

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Esethu is 13 years old and on the 25th December 2012 was in a horrific Taxi accident in South Africa where she was flung from the taxi through a window. Due to this accident Esethu lost her left hand completely from the wrist and her baby finger on her right hand. She also had her hip dislodged which causes her incredible pain and she battles to walk.

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However, this brave young girl embraces life with a gorgeous smile and a thankful heart that she is alive, able to walk, talk and still do some of the things she could do before.

Esethu is in Grade 8 and attends a school in the Kempton Park area. She loves Maths in which she does extremely well. She has lots of friends who are incredibly supportive since her accident and when she grows up she wants to be a Civil Engineer.

Esethu and her mom Ncedeka came to see us a few weeks ago. Esethu met a young doctor at the Chris Hani Baragwanath hospital where she was being treated for her injuries. Dr Amy had heard about Robohand but because Esethu had lost her hand above the wrist and did not have the movement there to use a Robohand she wasn’t sure if we could help. But she contacted Rich anyway and they came for a consultation.

We are very proud to announce that Rich has developed Robohand further than just the wrist and it can now operate from the elbow and shoulder.

Below are the pictures documenting the creation of Robohand using the elbow to drive the mechanical device.

Creating the gauntlet

Creating the gauntlet

Creating the Upper gauntlet

Creating the Upper gauntlet

Full gauntlets

Full gauntlets

Adding the hinges

Adding the hinges

Adding the hand to the gauntlet

Adding the hand to the gauntlet

Hand on the gauntlet

Hand on the gauntlet

Fitting the entire arm

Fitting the entire arm

Fitting and adjusting

Fitting and adjusting

See that happy grin!

See that happy grin!

Rich and Esethu after a long day

Rich and Esethu after a long day

Smiles all round!

Smiles all round!

Esethu and her mom with Bev and Alec who brought them to Robohand HQ

Esethu and her mom with Bev and Alec who brought them to Robohand HQ

Please visit our You Tube account to see the video’s of Esethu using her Roboarm: https://www.youtube.com/channel/UCnMi2JjodBWItWmE-zdZmBw

Xixi gets her Robohand

Following our initial post about Xixi in the USA sending us molds of her hand to South Africa, we got feedback today that her Robohand arrived and she is actively using it on the first day!

When Rich received her molds he set about creating her Robohand without her physically present to fit it. There are always concerns when fitting on a hold as you cannot see how the wrist moves or if there will be any chaffing in areas.

Here are some pics of her molds when they arrived in SA.

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Xixi's Mold

Some pics of her Robohand being created.

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Xixi has been trying out all sorts of things with her new Robohand. Her brother was helping her to play with a Rubiks cube; she was stacking and picking up a Coke bottle. We are so excited that her Robohand fits well and that she is using it to do all sorts of things! Well done Xixi and welcome to the wall of fame!

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A Hand for Junior

Meet Junior

Junior

Junior

Junior and his Mom, Thandi, saw Richard’s interview on eNews (the local TV station in South Africa) a couple of months back and Junior got very excited and asked his Mom to contact us and see if there was a possibility that he could receive a hand.

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We have been in discussions since then and Junior finally arrived for his fitting. He is a very quiet spoken young boy of 9 years old. He loves to play soccer (football) and tennis at school. His Mom says that he’s even played rugby.

It was a very long day as Richard could not get any measurements before Junior arrived so could not pre-print a hand (which takes about 5 hours), but luckily after Junior was measured up, Richard disassembled a hand he had in stock that was the right size so could use that for Junior.

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Due to the odd shape of Junior’s hand, Richard had to do some customising for the hinges and you will see from the picture above that it bends round the top of the hand cap.

In conversation with Thandi, Junior’s Mom, she had no idea while she was pregnant that there was a problem. Like so many children born with ABS, the parents have no idea until they see their child for the very first time. No one could tell her why or what his condition was called and through all these years she felt so guilty, that she had done something wrong.

Thankfully ABS is becoming a more well know condition and more spoken about among communities.

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Junior has many friends and hopefully he will now become the coolest kid at school. He has to practice extensively to utilise just his wrist to get his new hand to open and close.

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Thank you to Junior and Thandi for giving Robohand this opportunity of enabling Junior to use his hand.

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Watch a video of Junior using his Robohand for the very first time.