A pilot study in the application of texture relief for digitally designed facial prostheses

This pilot research aims to identify and assess suitable technologies that may be used to capture, create, and produce fine textures and wrinkles that may be incorporated into computer aided prosthesis design and production techniques. A range of suitable technologies is identified and two methods that may be used in different prosthetic rehabilitation situations are assessed: the creation of three-dimensional relief in a computer aided design environment and the capture of facial anatomy and texture using fringe-projection surface scanning. Patterns were produced using the suitable rapid prototyping processes identified, and these were assessed by a qualified and experienced prosthetist. The suitability of the technologies is commented upon, limitations discussed, and future directions identified

Infant mental health home visiting therapists- reflective supervision self- efficacy in community practice settings

In recent years, there has been an increase in the research on reflective supervision, including the development of tools designed to measure reflective practice in the context of reflective supervision. The Reflective Supervision Self- Efficacy Scale for Supervisees (RSSESS) is a self- report measure that has been used in previous evaluations and is designed to assess perceived reflective practice self- efficacy for Infant Mental Health- Home Visiting (IMH- HV) therapists. Properties of the RSSESS including factor structure and reliability are explored in a first study that lays the foundation for the use of the RSSESS in an IMH- HV evaluation in the State of Michigan. IMH- HV therapists completed the RSSESS at 4 time points over a 12- month period and also completed a Clinician Profile Form that included questions about their IMH background and their work experience, including job satisfaction and burnout. Results indicated that the RSSESS is a reliable tool to measure change in reflective practice skills. IMH- HV therapists demonstrated growth in their use of reflective practice skills with families and their observational skills over the 12- month period. In addition, results indicated correlations between reflective supervision self- efficacy and job satisfaction as well as burnout.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154909/1/imhj21834.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154909/2/imhj21834_am.pd

Rapid prototyping technologies in soft tissue facial prosthetics: current state of the art

Purpose – Maxillofacial prosthetics is faced with increasing patient numbers and cost constraints leading to the need to explore whether computer-aided techniques can increase efficiency. This need is addressed through a four-year research project that identified quality, economic, technological and clinical implications of the application of digital technologies in maxillofacial prosthetics. The purpose of this paper is to address the aspects of this research that related to the application of rapid prototyping (RP). Design/methodology/approach – An action research approach is taken, utilising multiple case studies to evaluate the current capabilities of digital technologies in the preparation, design and manufacture of maxillofacial prostheses. Findings – The research indicates where RP has demonstrated potential clinical application and where further technical developments are required. The paper provides a technical specification towards which RP manufacturers can direct developments that would meet the needs of maxillofacial prosthetists. Originality/value – Whilst research studies have explored digital technologies in maxillofacial prosthetics, they have relied on individual studies applying a single RP technology to one particular aspect of a prosthesis. Consequently, conclusions on the wider implications have not been possible. This research explored the application of digital technologies to every aspect of the design and manufacture of a series of maxillofacial prostheses. Unlike previous research, the cases described here addressed the application of RP to the direct manufacture of substructures, retention components and texture. This research analyses prosthetic requirements to ascertain target technical specifications towards which RP processes should be developed

Evaluation of direct and indirect additive manufacture of maxillofacial prostheses

The efficacy of computer-aided technologies in the design and manufacture of maxillofacial prostheses has not been fully proven. This paper presents research into the evaluation of direct and indirect additive manufacture of a maxillofacial prosthesis against conventional laboratory-based techniques. An implant/magnet-retained nasal prosthesis case from a UK maxillofacial unit was selected as a case study. A benchmark prosthesis was fabricated using conventional laboratory-based techniques for comparison against additive manufactured prostheses. For the computer-aided workflow, photogrammetry, computer-aided design and additive manufacture (AM) methods were evaluated in direct prosthesis body fabrication and indirect production using an additively manufactured mould. Qualitative analysis of position, shape, colour and edge quality was undertaken. Mechanical testing to ISO standards was also used to compare the silicone rubber used in the conventional prosthesis with the AM material. Critical evaluation has shown that utilising a computer-aided workflow can produce a prosthesis body that is comparable to that produced using existing best practice. Technical limitations currently prevent the direct fabrication method demonstrated in this paper from being clinically viable. This research helps prosthesis providers understand the application of a computer-aided approach and guides technology developers and researchers to address the limitations identified

Rapid manufacture of custom-fitting surgical guides

Purpose – The computer-aided design (CAD) and manufacture of custom-fitting surgical guides have been shown to provide an accurate means of transferring computer-aided planning to surgery. To date guides have been produced using fragile materials via rapid prototyping techniques such as stereolithography (SLA), which typically require metal reinforcement to prevent damage from drill bits. The purpose of this paper is to report case studies which explore the application of selective laser melting (SLM) to the direct manufacture of stainless steel surgical guides. The aim is to ascertain whether the potential benefits of enhanced rigidity, increased wear resistance (negating reinforcement) and easier sterilisation by autoclave can be realised in practice. Design/methodology/approach – A series of clinical case studies are undertaken utilising medical scan data, CAD and SLM. The material used is 316L stainless steel, an alloy typically used in medical and devices and surgical instruments. All treatments are planned in parallel with existing techniques and all guides are test fitted and assessed on SLA models of the patients' anatomy prior to surgery. Findings – This paper describes the successful application of SLM to the production of stainless steel surgical guides in four different maxillofacial surgery case studies. The cases reported address two types of procedure, the placement of osseointegrated implants for prosthetic retention and Le Fort 1 osteotomies using internal distraction osteogenesis. The cases reported here have demonstrated that SLM is a viable process for the manufacture of custom-fitting surgical guides. Practical implications – The cases have identified that the effective design of osteotomy guides requires further development and refinement. Originality/value – This paper represents the first reported applications of SLM technology to the direct manufacture of stainless steel custom-fitting surgical guides. Four successful exemplar cases are described including guides for osteotomy as well as drilling. Practical considerations are presented along with suggestions for further development

Reflective Supervision and its Impact on Early Childhood Intervention

This chapter charts the recent evolution of research focused on reflective supervision provided to practitioners delivering services to young children and their families through early intervention programs. The authors explore research focused on defining reflective supervision, identifying five essential elements or “active ingredients” of reflective supervision as a professional development model and demonstrating the impact on practitioners. The impact studies described in this chapter have produced empirical data demonstrating an increase in reflective supervision behaviors as a result of participation. In addition, the studies provide qualitative accounts of practitioners’ experiences, conveying positive effects on intervention practice and reduction of practitioner job stress