Digitally Designing Prostheses by Collaborative Care: Can Telehealth Work for O&P?
October 2019 Issue
According to the Mayo Clinic, telehealth is "the use of digital information and communication technologies, such as computers and mobile devices, to access health care services remotely...." Telehealth systems are designed to connect patients with a broad range of wellness care; the current systems, however, have limitations for O&P. They are designed to upload the type of information required for physicians to diagnose conditions but fall short in supporting the broad range of tangible inputs required for our field. Currently, telehealth is cerebral and not physical, so it struggles with the hand skills used in O&P care.
Is there a place for telehealth in O&P?
To understand the value of telehealth in O&P, it's important to know that there is a shortage of providers, especially in developing countries. According to the World Health Organization, "only 5-15 percent of those who could benefit from assistive products, including prostheses and orthoses, have access to them," and "even in high-income countries, many people also struggle to access these services." A major bottleneck to providing these services is the shortage of trained clinicians to provide the care in rural and developing regions.
Telehealth has the potential to open this bottleneck, allowing clinicians to have a broader reach. As software advances, clinicians will be able to use more of their physical skills in a digital (virtual) world. This allows them to essentially be in multiple places at once and provide their services anywhere in the world.
Can it work?
The telehealth network described above sounds futuristic, so can it work today? Last year I assisted with the design and fitting of a transradial prosthesis for Mohammad, an 11-year-old boy in Nigeria who lost his arm to Boko Haram violence. For the project, an intern named Fricis Pirtniek digitally scanned the patient's residual limb in Nigeria and emailed the scan to me in New York. I modified the socket with CAD tools and emailed the socket file back to Nigeria where it was then 3D printed. Within a day it was diagnostically fit and digitally combined with a prosthesis, in time for Mohammad to shake hands with the vice president of his country.
This project used all the elements required for a functional O&P network and was successful because we worked collaboratively. The evaluation and design were done in the digital world, while the fabrication, fitting, and follow-up were done in the physical world with digital supervision. Communication and documentation were essential to keep everyone on the same page. 3D printing was utilized because it is easiest way to digitally design then physically fabricate, but it's not required for all collaboration projects.
What is needed?
It is clear that there is a benefit to a telehealth network for O&P and multiple cases have shown that it can be done with current digital capabilities; however we are lacking the structured network and workflow required for it to be efficiently and sustainability used. An O&P network requires collaboration because not all the hand skills can be communicated virtually, and current telehealth networks are not sufficient in this capacity.
Operation Namaste intends to remove this bottleneck in O&P care by building this collaborative care network.
Jeff Erenstone, CPO, is the founder of Operation Namaste (www.operationnamaste.org) and owner of Mountain O&P Services, Lake Placid, New York.