Digital Fabrication: The Potential for Improved Fit and Function

By Don Buethorn, CPO

I've been involved in the O&P field for almost 30 years. It's been an exciting process that has included lots of learning opportunities. As the years have changed, so too has the technology. And the changing technology has improved our ability to create even more effective ankle-foot orthoses (AFOs) for the children we see.

Recently, Cascade Dafo has increased the percentage of dynamic ankle-foot orthosis (DAFO) projects that we develop using a digital program, as opposed to the traditional hands-on manufacturing approach. While we are learning that this digital process offers capabilities that allow us to advance the fit and function of our DAFO system, there is still a lot to learn!

Opportunities Offered

Unlike the traditional fabrication model, where a patient's foot is cast and the cast is sent to us to begin production, the digital process allows practitioners to scan their patient's foot (or a plaster positive of the cast foot) and then electronically transmit the 3D scan to us. Custom modifications are then made using a CAD/CAM platform, and the brace mold is created by a fully automated carving machine, as opposed to our performing modifications by hand.

Like others, we have relied on traditional fabrication techniques for years, and we have confidence in our ability to create consistent, reliable results that help children with mobility challenges. However, with digital, we are also finding many opportunities.

The opportunities we've noted with the digital process so far include a greater level of precision in shaping the positive used to form the plastic AFO. Complex changes can be accurately repeated; manual steps can be converted into keystrokes, heavy plaster can be eliminated from the fabrication process, complex protocols can be designed in a way that are feasible to use in daily production, and the electronic transmission of shape information eliminates the cost of shipping casts and reduces the turnaround time.

Our Responsibility

Of these opportunities, we are particularly interested in using the precision and repeatability of the digital process to deliver improved fit and function.

We all are comforted by the fact that traditional bracing processes have, by and large, stood the test of time and have been passed down from teacher to student for generations. However, other medical professions we partner with have had to move beyond this type of justification, and we will all be asked to do more testing in the coming reimbursement environment. I would make the argument that the O&P industry has a responsibility to at least consider and research the ways in which digital fabrication, as opposed to traditional brace fabrication, can benefit the end user.

Our profession is acquiring and utilizing new technology, which creates an opportunity to design studies that can use precise measurement and repeatability and controlled variables in very practical settings. And that is exactly what we've decided to do. We recently began a controlled study with pediatric patients to better understand how we can leverage these digital capabilities to advance the art of making effective and comfortable AFOs for our customers and their patients.

From this study, we realized ways we could alter our current digital modification process for improved fit. In addition, we are using the knowledge we gained from this study to develop a protocol that reliably accommodates the distortion for casts that need to be corrected to the desired position for the AFO. This protocol will allow us to build better-fitting AFOs from less-than-perfect casts. And, as I said before, we're still learning.

I encourage others in the O&P field to do the same. Spend some time considering and researching this technology. You may be surprised to find out just how effective digital can be for your practice. It will take time and resources, both of which are likely already stretched thin, but I wager that you will be impressed with the precision and fit made possible by this technology, as well as by the time and cost savings offered in the long-run. If we can offer patients an improved bracing experience, isn't it our responsibility to do so?

Don Buethorn, CPO, is founder-owner of Cascade Dafo, Ferndale, Washington, and Cascade Prosthetics & Orthotics, with offices in Ferndale and Mount Vernon, Washington.