A Mission to Lend a “Helping Hand”
Renowned as an institution without walls, Einstein faculty, staff, and students frequently interact across disciplines to collaborate on promising discoveries and projects. This approach extends to work members of Einstein do with associates at Montefiore. In a recent example of such fruitful collaboration, medical professionals from Montefiore teamed up with a librarian and a medical student from Einstein to meet a technical challenge: creating a printed 3-D robotic arm from scratch and delivering it quickly to Felix Morris, a 45-year-old amputee in Jamaica.
When Mr. Morris lost his right arm in an accident, he was unable to find work and struggled to support himself and his family. Advances in prosthesis technology offer practical solutions for many amputees and people born without limbs, but for millions living in poor communities, access to prosthetic limbs is limited. The dedicated Einstein-Montefiore team overcame multiple challenges to bring hope to Mr. Morris.
Making the Initial Connection
Montefiore started using 3-D printing to create inexpensive, limited-function prosthetic hands in early 2016. Members of Montefiore’s department of physical medicine and rehabilitation (PM&R) residency program regularly undertake medical rehabilitation missions; one goal is to introduce 3-D printing of medical equipment to less-developed regions.
That summer, Mr. Morris became a candidate for a prosthetic arm when a PM&R team went to Jamaica to speak on basic 3-D printing at the Sir John Golding Rehabilitation Center. Einstein’s Dr. Stephanie Rand, assistant professor in the Arthur S. Abramson Department of Physical Medicine and Rehabilitation and of anatomy and structural biology, and associate director of the PM&R program at Montefiore, immediately took an interest.
“Upper-extremity prosthetic limbs are not covered by Jamaican health insurance, and Felix did not have the money to cover the cost, so he did not have any prosthesis,” she said. She was “instantly on board to help coordinate, design and print an arm for him.”
Because his injury was complex, Mr. Morris required a myoelectric prosthesis, which “works by converting muscle signals into motions of the hand through electrical circuit boards. When you squeeze your muscle, there is electrical activity. The sensors pick that up and turn it into motion,” explained Dr. Matthew Bartels, professor and chair of PM&R, who heads the team’s missions. “We set a goal to create a unique myoelectric arm and deliver it to Felix during our 2017 mission to Jamaica,” he added.
A Summer at the Printer
The task of designing and building the device was given to a research fellow, Dr. Vishal Chandel and Einstein third-year medical student Tushara Surapaneni. Tushara also traveled to Jamaica with the Montefiore team supported by Einstein’s Global Health Fellowship program.
“I was looking for a summer research position that was more clinical than bench research, particularly something that involved technology,” said Ms. Surapaneni. “I was excited about the 3-D prosthesis project because it had a tangible deliverable that would be fitted directly to the patient.”
She helped construct several prostheses, spending most of the summer at the 3-D printer at Jacobi. “I experimented with different filament types and printed a couple of different ‘backup’ prostheses” that could be powered mechanically by the body.
The process was full of trial and error. “Every small failure and small success meant that much more,” she said, because she knew that “the prosthesis could greatly improve Felix’s quality of life.”
When in Doubt, Ask Your Librarian!
When Montefiore’s 3-D printers were fully booked, the team had to look elsewhere. Luckily, Einstein’s library uses a 3-D printer to create models of human organs. Dr. Chandel asked Winifred King, Einstein’s digital-initiative librarian, if she could help create the prosthesis; she had extensive experience with 3-D printing (and troubleshooting). Ms. King accepted the challenge and worked with Ms. Surapaneni to print the small parts that made up the hard shell housing the myoelectric arm. Some 40 hours of consulting, testing and printing later, they were successful.
Racing against time, Dr. Chandel then assembled the prosthesis and fit it with the necessary electric circuits. After rigorous testing, the prosthetic arm was ready for delivery.
A Rewarding Outcome
The team flew to Jamaica and presented Mr. Morris with his new arm.
“I could see how happy Felix was when he tried the prosthesis and successfully used it to grip objects, hold them and move them around. He referred to the prosthesis as his ‘robo-friend,’” said Ms. Surapaneni. “The whole experience was rewarding and incredibly memorable.”
She hopes to participate in the department’s future projects, including improving the design and functionality of the myoelectric arm.
While prices typically range from about $3,000 for a body-driven prosthesis to $10,000 or more for a myoelectric one, Mr. Morris’ printed prosthesis cost less than $500, which was covered by Montefiore. “This offers an affordable alternative for millions of amputees and people born without limbs, said Dr. Bartels, “especially in places where financial considerations are a major hurdle.”
Editor's Note: In the summer of 2018, PM&R sent a different team to deliver an updated myoelectric prosthesis to Mr. Morris after learning his daughter had accidentally spilled water on his hard-drive. While the team has printed two to three other body-driven prosthetic hands and a few other miscellaneous orthoses (braces), Mr. Morris is the only patient in Jamaica to receive a prosthesis printed by the team, and the only patient worldwide for whom they have printed a myoelectric prosthesis. During their 2018 trip, they also delivered a 3-D printer to the Golding Center and trained the Golding staff on its use. To date, the Golding staff has printed more than a dozen orthoses, mostly wrist splints. Another Einstein student, Richa Sheth worked with the team, primarily on Mr. Morris' second prosthesis. The medical team has presented an abstract about the project that includes Ms. King's contribution. They also sent a team to Jamaica again in 2019, specifically to conduct trainings.
Posted on: Wednesday, January 15, 2020