This paper proposes an approach to the development of a customized 3D printed multi-material cervical
orthosis that combines new production techniques with smart materials and biomimetic structures. It suggests
a lightweight, waterproof, ventilated, hygienic and comfortable orthoses designed specifically for each patient in
collaboration with doctors, additive manufacturing specialists and designers. The combination of innovative production
techniques with smart materials can generate an enhanced product, whose added value can be perceived by
differentiated attributes and applications

Prates, A.

IC-online

Self-adjusting orthoses designby A. PRATESCentre for Rapid and Sustainable Product Development,Polytechnic Institute of Leiria, Marinha Grande, PortugalAbstract: This paper proposes an approach to the development of a customized 3D printed multi-material cervi-cal orthosis that combines new production techniques with smart materials and biomimetic structures. It suggestsa lightweight, waterproof, ventilated, hygienic and comfortable orthoses designed specifically for each patient incollaboration with doctors, additive manufacturing specialists and designers. The combination of innovative produc-tion techniques with smart materials can generate an enhanced product, whose added value can be perceived bydifferentiated attributes and applications.Keywords: Human factor in design, Customized and personalized product development, Smart product engineer-ing.1 IntroductionThrough many years orthoses had no apparent innova-tion. The traditional manual methods for creating cus-tomized orthoses have many drawbacks including theintensive work, time-consuming and imprecise processwhich may affect the comfort of orthoses and limit treat-ment quality. Today designers are taking orthoses to an-other level with the use of forward thinking methods, in-tegrating both innovative technologies and new materi-als, contributing to a more accurate treatment. There isa large variety of cervical collar orthoses with differentcharacteristics for different clinical indications, of variousmaterials, prefabricated in different sizes. Focusing on themost commonly used cervical collar orthoses and theircharacteristics and purpose we will explore a new solu-tion of orthosis trough the introduction of novel productdevelopment techniques meeting the user’s morphologyinstead of purely adjusting a standard solution.The integrated methodology approach of medical im-age processing and reverse engineering can be appliedto construct 3D printed models with biomimetic struc-tures and smart printed material/shape memory materialwhich are programmed to respond as desired. In the fol-lowing sections, these topics are described in detail, re-ferring to the corresponding stage of the development. Ingeneral, the result is a 3D printable material that when incontact to the user’s body temperature, changes itself intoan ergonomic shape. The organic structure is developedbased in strategies of growth of the coral reefs.2 Cervical Collar OrthosisAn Orthosis is an external medical device designed tostabilize, immobilize, prevent deformity, protect againstinjury, or assist with the function of a body part. Thepurpose of cervical collar is to alleviate instability of acompromised cervical spine, while being patient-friendly,lightweight and economic. The most commonly usedsemi rigid cervical collars are the Aspen, Malibu, MiamiJackson, Nec Loc and Philadelphia collars, as pictured inFigure 1.(a) (b)(c) (d)(e) (f)Figure 1 - (a) Aspen; (b) Malibu; (c) Miami Jackson; (d)Nec Loc; (e) and (f) Philadelphia.Scripta-Ingenia, Winter Solstice, December 21, 2014. (ISSN: 2183-6000)m http://cdrsp.ipleiria.pt T (351) 244-569441 B scripta.ingenia@ipleiria.pt Page 34 BIOMIMETICThere are some known problems usually associatedwith its use:• Muscle atrophy• Heavy• Odor• Skin rash or breakdown• Psychological dependence• Soft tissue contracture• Pain• Lack of hygiene• DiscomfortThe pressure applied in soft tissues and poor circula-tion is a high risk for developing ischemic wounds andcause of discomfort and pain. The psychological depen-dence and the sensation of movement or strain of theneck especially in cases when the collar is worn over alonger period of time as well as muscle atrophy, skin fric-tion and facial hair growth in men, should also be consid-ered.Combinations of rigid and flexible materials in collartypes of cervical orthoses are usually the choice to pre-vent pain. Comfort is also an issue and for that reasoncervical motion restriction efficacy is often sacrificed. Themore effective ones are frequently more uncomfortable.In general, the cervical orthoses are more effective in re-stricting the flexion and extension than restricting lateralbending and axial rotation.The adequacy of the orthosis must be followedwhether its purpose is to support, prevent, immobilize orcorrect the spine. For this matter we will focus only onthe first two alternatives. It is also essential to determinethe degree of freedom and in which motion of the spinewould be controlled, flexion, extension, lateral bendingor axial rotation. The rigidity of the components at thechin and the occiput along with the increase of the verti-cal length, are the main elements in restricting motion.3 Design MethodologiesWhen we talk about methodology, we refer to the processthat is used to reach a solution. Centered on the virtualmodel of the patient body and with specific medical data,the main object is to develop a cervical collar with highlevel of customization in order to satisfy functional re-quirements and an adequate immobilization or supportwith maximum comfort and with specific motion control.Starting from the customer/patient needs and the dis-advantages/cons of traditional orthoses and the desirablefeatures for developing a novel orthosis based on medi-cal data, reverse engineering, 3D printing and smart ma-terials, some solutions are explored in order to create afunctional, more accurate and comfortable model.Desirable features:• Prevent muscle atrophy• Ventilated• Lightweight• Customized• Waterproof• Recyclable• Localized intervention• Hygienic• ComfortableThe design intent is building a lightweight, washable,most accurate and ventilated orthosis designed especiallyfor each patient that is both comfortable and functionalwith particular goals:The design intent is building a lightweight, washable,most accurate and ventilated orthosis designed especiallyfor each patient that is both comfortable and functionalwith particular goals:• to innovate and optimize the product (materials se-lection, manufacturing, use, end of life)• to improve custom-fit product process• to increase the sensation of comfort• to reduce costs (efficient use of materials)• to reduce manufacturing times4 BiomimeticThe combination of 3D technologies and new design in-spired in algorithms that mimic patterns and processes innature, give us new ways of thinking about form, materialbehavior, structure performance, etc. The main thrust ofbiomimetics is also to transfer functions, mechanisms andprinciples from one field to another. Inspired by the algo-rithmic structures of coral reefs and the systematic explo-ration of how pattern and form emerge in nature and itsstrategies of growth, we’re interested in using these samerules of growth for design, instead of merely mimickingnature.A smart material with streching memory effect thatwhen in contact to the user’s body temperature, changesitself into an ergonomic shape. Surfaces of multilevelbranching fibers with specialized tips that helps reducethe risk of shear and control friction, suggesting a "body’snatural (biological) cover". Reduction of the adhesion,using a material inspired in nano filaments of lotusflower with hydrophobic characteristics that allows skinto breath and perspire without getting wet; promotes amore comfortable orthosis.Scripta-Ingenia, Winter Solstice, December 21, 2014. (ISSN: 2183-6000)m http://cdrsp.ipleiria.pt T (351) 244-569441 B scripta.ingenia@ipleiria.pt Page 45 CUSTOMIZATION(a) (b)(c) (d)(e) (f)Figure 2 - (a) Euphyllia glabrescens; (b) Euphylliaparadivisa; (c) Turbinaria sp; (d) Faviidae;(e)Gardineroseris; (f) Diploastrea heliopora.(a)(b) (c)Figure 3 - (a) Hidrophobic lotus leaf effect; (b) Skeleton ofEuplectella sp, showing the lattice-like skeleton of fusedsiliceous spicules; (c) Stretching memory effect.The skeletal structure of the glass sponge Euplectellaaspergillum displays a remarkable multi-level hierarchi-cal design that gives it superior structural properties. Alsoin nature we find fractal honeycomb structures which areresponsible for excellent stiffness, various patterns andforms with an economic design.Analyzing this pre-optimized structures from natureand their functional properties we can get to a hyper-structural carcass and a super hydrophobic surface withshape memory material organic behaviour and with ma-terial being efficiently applied, only where it is necessary.5 CustomizationCustomization of orthoses design can also bridge the gapbetween personal and technological fields assuming anextension of the user style and personality. Used tem-porarily or for long periods of time, these medical devicesreveal also a social burden of a negative impact.The negative impact may be reduced when the iden-tity of the user and their lifestyle is reflected, unitingthe technological and social aspects. The cervical collaris custom-fit with the ability to adequate the users per-sonality in the design stage. In this phase the user canintroduce some personal details in order to change theway he will perceive and relate to the final product with-out interfering with the functional characteristic of themodel.With the customization of this medical device, we canenhance the therapeutic treatment, having the ability tolook at a patient on an individual basis allowing a moreaccurate diagnosis and specific treatment plan. In thismodel, the structure will be reinforced in the injury lo-cated area and restrain motion where is necessary withhigher accuracy, tailored to each individual patient. It isthrough the diagnostic that is selected the appropriateand optimal treatment based on the context of each pa-tient.Figure 4 - bioinspired patterns.Scripta-Ingenia, Winter Solstice, December 21, 2014. (ISSN: 2183-6000)m http://cdrsp.ipleiria.pt T (351) 244-569441 B scripta.ingenia@ipleiria.pt Page 56 THE DEVELOPMENT OF A NEW DESIGN FRAMEWORK6 The development of a new designframeworkAs indicated, the development of the cervical collar issupported in the patient’s treatment plan and the type oflesion to be intervened. This will start at first in the hos-pital and will end in a custom application orthosis manu-factured by 3D printing.The inner surface of the structure with strechingmemory effect and hydrophobic characteristic, adapts tothe patients neck making it more comfortable, allowingfree skin perspiration, as well as the daily hygiene, with-out requiring removal. The rigid outer structure fulfills itsimmobilizing function.The necessary elements for the development of theorthoses can be provided through medical imaging andpatient’s data identified by the doctor. This can be alsocomplemented through 3D scanning tools.The CAD / CAM (Computer Aided Design / ComputerAided Manufacture) for orthopedics are a very promisingtechnology. The RX is still the most frequently used examin cervical trauma. However, the use of CT scan allowsrapid acquisition of images in axial and sagittal and coro-nal reconstructions, although the risks linked with highlevels of radiation, that the patients are subjected to.These are the main steps of the development proce-dure that can be followed after an injury occurs:First diagnose in the hospital Identification of the ex-act injury location by an orthopedist with medical imag-ing (Figure 5). A computed tomography (CT) scan is animaging method that uses x-rays to create pictures ofcross-sections of the body, typically called slices. Three-dimensional models of the body area can be created bystacking the slices together.CT scan is saved as a 3D medical data model of af-fected soft and/or hard tissues.(a)(b)Figure 5 - Diagnosis.Digital 3D model Together with medical data, we canreproduce a structure related to the area to be intervened.Through a 3D scanning equipment, it is possible in a fewminutes to acquire the patient 3D surface coordinatesgenerating a three-dimensional geometry data. This twoapproaches can be complementary (Figure 6).(a)(b)(c)Figure 6 - 3D model.Development of a pattern structure Directly relatedto the injury location, following biomimetic principlesalong with full evaluation by an Orthopedics Doctor, theAdditive Manufacturing Technician generates a structurebased on medical data and planning, through 3D scan-ning and 3D modeling tools (Figure 7).Figure 7 - Bio inspired structure with medical evaluationScripta-Ingenia, Winter Solstice, December 21, 2014. (ISSN: 2183-6000)m http://cdrsp.ipleiria.pt T (351) 244-569441 B scripta.ingenia@ipleiria.pt Page 67 FUTURE WORKModel is sent to multimaterial 3D printer The cer-vical orthoses will be 3D printed with multi-material. Inthe inner surface a shape memory and flexible materialwould continuously optimize its shape in response to theuser’s body temperature. The outer structure would keepits rigid status so the immobilization occurs making itboth effective and comfortable (Figure 8).(a)(b)(c)Figure 8 - AM printingApplication to the patient This custom-made orthosesmay be immediately applied to the patient after 3Dprinted, providing a more accurate and comfortable treat-ment. The patient will be able to use it throughout per-sonal hygiene routine and won’t be concerned with theodor addressed to perspiration being lightweight throughevery day usage (Figure 9).(a)(b)Figure 9 - Application of final orthosis to the patient7 Future WorkNowadays we’re living in a manufacturing revolution thatpromises to change the way we make things. After 3DPrinting becoming increasingly accessible and optimized,4D printing will unquestionably make the difference ex-panding the boundaries of “making”.The 4D printing concept was initially proposed byMassachusetts Institute of Technology faculty memberSkylar Tibbits earlier this year. The 4D printing conceptproposed, allows materials to “self-assemble” into 3Dstructures. The few existing studies are now being devel-oped. These recent studies represent strong advances inadditive manufacturing with programmed shaped mem-ory polymer composites using glass fibers.Last October 2013, researchers at the University ofColorado Boulder have demonstrated the importance offibers location and orientation within the composite ma-terial, in order to determine the degree of shape mem-ory effects like folding, curling, stretching or twisting andthe ability to control those effects by heating or coolingthe composite material. For future work we intend to in-tegrate into the product development of the cervical or-thoses this novel approach and innovative concept.Scripta-Ingenia, Winter Solstice, December 21, 2014. (ISSN: 2183-6000)m http://cdrsp.ipleiria.pt T (351) 244-569441 B scripta.ingenia@ipleiria.pt Page 7REFERENCES8 ConclusionThe collaboration and inputs brought into design devel-opment starting from medical ground to designers, en-gineers, manufacturing specialists and the product useritself, can generate an enhanced product. Also the com-bination of innovative production techniques with smartmaterials, whose added value can be perceived by differ-entiated attributes and applications.References[1] Academic Journal of Manufacturing Engineering.Tarnita, Daniela et al. 2013. Orthopaedic Proto-types Obtained by 3D Printing Technology, s.l. : Aca-demic Journal of Manufacturing Engineering, 2013,Vol. 11.[2] Applied Physics Letters. Ge, Qi et al. 2013. Ac-tive materials by four-dimension printing, s.l. :AIP Publishing LLC, 2013, Vols. 103, 131901. Beil-stein Journal of Nanotechnology. Ensikat, Hans J. etal. 2011. 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Self-adjusting orthoses design

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Self-adjusting orthoses design

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