One wounded warrior wanted to amble around the hotel pool during his honeymoon without strapping on prosthetic legs. Another wanted ice skates to fit snugly onto his prosthetic feet so he’d receive the sensory feedback he’d come to expect when engaging in his favorite pastime. And yet another wanted to hold a fishing rod while enjoying full use of the hook where his hand used to be.
These requests for custom prosthetic attachments were fulfilled by the 3-D Medical Applications Center, or 3DMAC, at Walter Reed National Military Medical Center in Bethesda, Maryland. There, a small staff of engineers and technicians use advanced digital technology and additive manufacturing, also known as 3-D printing, to design and produce personalized devices quickly and cost-efficiently.
“We’ve made more than 100 unique devices to enable activities that able-bodied people often take for granted,” said Peter Liacouras, the center’s director of services who holds a doctorate in biomedical engineering.
The devices make it easier for amputees to engage in leisure activities they enjoy, Liacouras said, as well as routine things such as drinking a glass of wine or brushing teeth. Returning to their everyday lives helps wounded warriors overcome the physical and emotional trauma of limb loss, health care experts say.
Part of Walter Reed Bethesda’s radiology department, 3DMAC is located in a small suite of offices and computer rooms tucked behind double doors at the end of a long hallway. Although it’s an unassuming-looking place, what’s happening inside is state-of-the-art. Among the center’s many projects are surgical models to produce custom implants used in dentistry and oral surgery; skull plates for blast injuries; and other models to help surgeons prepare to perform intricate procedures, and to train the next generation of dental and medical professionals.
“We also have several research projects going on,” Liacouras said. They include 3-D surveying and mapping of the human face to create a digital archive of facial anatomy. This archive could be used to fabricate implants for reconstruction if a service member became disfigured in a blast injury. “The face is the most complicated region to reconstruct and, of course, it’s what everyone sees every day,” Liacouras said.
So 3-D printed cellphone and cup holders that attach to wheelchairs or other assistive devices “may sound like they’re on the lower scale of what we do, in terms of importance,” Liacouras said. “But they’re not, because they mean a lot to wounded warriors.”
The center fabricates by request from the Defense Department and Department of Veterans Affairs health care providers. When a request is received, Liacouras usually searches the web to see if the item already exists and can be purchased and adapted. If not, 3-D printing “enables us to create custom devices, making them patient-specific,” he said. The items are made from plastic or titanium.
The center’s first assistive technology project was “shorty feet” for the honeymoon-bound bilateral amputee, in 2002. “Wearing full prosthetic legs can be cumbersome and also, the full prosthesis for pool wear are very expensive and not necessarily 100 percent waterproof,” Liacouras said.
He and his team used computer-assisted design to plan the shorty feet, then printed a plastic prototype for a fit test. They made the permanent pair in titanium alloy.
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“They attach to sockets that attach to the stumps,” Liacouras said. “Think of it like walking on your knees.”
And though Liacouras admits “we didn’t fully understand the need at first,” the center has produced more than 70 pairs to date.
“They’ve really taken off,” he said, noting wounded warriors like to use them instead of full prosthetic legs if they need to get up after going to bed, and also to play with young children at the little ones’ level. Physical therapists use them to help new patients feel more comfortable and confident about getting up and moving again.
“Whatever our wounded warriors need, we’ll create,” Liacouras said.