Sitting on Dr. Peter Liacouras’s desk is a razor, a stick of deodorant, and a partially built prosthetic arm. Behind him, several 3D printers buzz away, creating contraptions in plastic, nylon, and titanium. Today he is working on creating a custom device that will allow a wounded service member to get ready in the morning by themselves. We take it for granted, but this can be a daunting and consuming task for those who have lost a limb. As the director of service for the 3D Medical Applications Center at Walter Reed National Military Medical Center, Liacouras uses cutting-edge technologies to improve people’s quality of life by pushing the fields of prosthetics and orthotics forward.
His goal is simple: to allow wounded service members to do the things that they used to do before getting injured. A provider recently asked if he would like to help an injured veteran play ice hockey again, and he gladly accepted. To do this he will have to study the biomechanics of the activity, examine how body weight shifts while skating, create anatomical models with a CT scanner, and then involve his whole team to brainstorm ways to give each individual patient the best possible outcome. As Liacouras detailed, these procedures allow for the creation of a customized treatment for each service member, “in amputee care we’ve created all sorts of different devices that allow them to go fishing again, rock climbing again, skating again, kayaking again. These are a different type of patient from the past; these are young, active patients that like to take part in complex activities. And this has really filled that gap of where normal prosthetics stop, and specialty prosthetics start.”
Two decades ago, much of this would not have been possible—the technology just wasn’t available. 3D printing, also known as “additive manufacturing,” has come a long way since Walter Reed first started experimenting with it in 2003. The printers themselves have become cheaper, faster, and better able to handle stronger materials. The technology’s adoption in healthcare has taken off. Batteries have gotten smaller, and equipment lighter. Even the components inside the prosthetics now include microprocessors and advanced sensors. But more important than the technology itself, it’s what has been done with it that has pushed the boundaries of what anyone thought was originally possible.
“The majority of our active duty patients this week are in Colorado skiing as part of their therapy,” Dave Laufer, the director of Orthotic & Prosthetic Services at the Department of Rehabilitation, proudly told me. He has seen the field of prosthetics change and grow over time from a manual, artisan process to one that is becoming inundated with technology. While some of this is “technology for technology’s sake,” when digital methods do work effectively they can be extremely helpful. At best, these tools can make prosthetics less apparent and more intuitive. Microprocessors in artificial knees, for example, have allowed the injured to stand with minimal effort—a game changer in the field. 3D printing can allow for prosthetics to be comfortable and symmetrical to existing limbs, which can play a major factor in whether people actually use them.
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