[MUSIC PLAYING]
Hello.
Thank you for that nice introduction.
I think I have some slides that should come up here
on the screen momentarily, but I'll
start by telling you a little bit about the project
that I'm working on.
I've been working with an NGO called--
there we go-- I've been working with an NGO called (cbm)
Canada, and Autodesk, a private company,
creating CAD-CAM software, to do a project basically developing
a prosthetics, a 3D printing prosthetics
solution for the developing world.
And the title of my talk, Without a Leg to Stand On,
actually refers to the domain area
that we're trying to solve.
We're actually trying to create legs for people to stand on.
But it also in some ways, refers to my own status
as a social scientist-- not a technologist, not an engineer,
not a medical researcher-- attempting
to intervene in this kind of technological landscape
through this 3D printing process.
But before I go into that, I'll talk
about that later in the talk, I want
to tell you a little bit about the project we're working on
and what we're trying to do.
So the World Health Organization has
estimated that over 30 million people in the developing world
need prosthetics or some kind of mobility aid,
and in response to this need, the International Federation
of Red Crosses and Red Crescent organizations
has developed a prosthetic tool chain, a process of making
prosthetics intended to help serve this need.
And in fact, Justine, that you see here on the screen,
was one of the people that was helped by this tool chain.
Justine lost her feet and her lower legs
to disease when she was quite a small child.
For many years, she walked around on her knees,
using sandals as a kind of a padding.
And she suffered a lot because of this, both
she suffered and her family suffered.
Her community suffered, because of that reduced mobility
that she had.
She had difficulty getting into society.
She had difficulty getting education.
She had difficulty taking care of herself,
and it really took its toll on both herself and her family
and her community.
She went to CoRSU Hospital, which
is one of the partners in the project that I'm working on,
CoRSU Hospital in Uganda, to go through this Red Cross
prosthetic tool chain and to get prosthetics.
That process starts with a manual plaster casting
of the residual limbs of the person.
That negative plaster cast is transformed
into a positive plaster cast, which is then manipulated
a little bit in order to basically customize it
for the production of a socket.
That is placed on a vacuum casting machine.
That's what you see here in this slide.
There's a series of other kind of manual tasks using
grinders and other kinds of equipment that
are done in order to basically prepare that.
It's fitted with a standardized pylon, which
is like the shank of the leg, and a standardized foot.
And then through a brief process of rehabilitation and training,
you end up with a patient with the ability to walk.
So here's a picture of Justine giving a high five,
she's walking just fine, and it's
a great-- it's actually a great story.
It's a great success story for this Red Cross process
and for these hospitals like CoRSU Hospital,
to actually deliver these kind of prosthetic solutions.
So that being the case, why is there any kind of need
for 3D printing, for any of these other kinds
of technological interventions.
And there is actually specifically two problems
with this tool chain that I want to highlight to you right now.
The first is that the prosthetic that I just described
takes about five days to produce.
There's a lot of manual processes involved.
There's a lot of steps.
And although five days is an extremely accelerated process
for the delivery of a prosthetic, at least
compared to the process here in Canada or in the developed
world, in which it might take two or three weeks.
And it's a much more comprehensive fitting process.
Five days is still a dramatically long period
of time to ask people who are living a subsistence
existence, to, in a sense, step out of their lives.
So five days actually dramatically
reduces the number of people who can actually
be fitted with these prosthetics.
And in fact, in our conversations with CoRSU,
they've informed me that in some cases,
patients are presented with their families
to get the prosthetic made.
They've been there for a couple of days.
They get about halfway through the process.
And then due to the contingencies of a subsistence
life, they are forced to leave.
That's a terrible outcome for two reasons.
First, obviously, the patient doesn't get a prosthetic.
But equally, the hospital who spent time and energy
developing it, it all goes to waste.
So that that's a really big problem, this temporality
of the prosthetic process, which needs to be thought about.
But the bigger issue-- and this is actually to some degree,
to me anyway when I learned this,
kind of surprising-- that prosthetic tool chain that I
just described, in fact, takes a skilled, trained, prosthetist
and prosthetic technician to carry out.
And the problem here is that the developing world lacks
these people, lacks these personnel.
In fact, the World Health Organization
has estimated that there's a 40,000 person
gap in the prosthetic, in the training and skilling
of prosthetists and prosthetic technicians.
And to take it even one step further,
that if they spent a lot of their resources
over the next 50 years trying to develop these people, the best
they could hope for was to get about 18,000 more skilled
professionals.
So there's this incommensurable gap
between the need and the ability to serve that need.
And really, that's where we're attempting to intervene.
And we're attempting to intervene
using a series of kind of commodity,
or really, home-based technologies.
Now I'm gonna throw these out for you guys to take a look at.
Go ahead.
And I'll describe this here in a process.
I want them back at the end.
So if what you could do is kind of pass them around,
whoever, how far they get-- at a certain point,
kind of try to pass them on back up to the front.
That would be great.
Now what we're trying to do is basically
use consumer technologies, readily available technologies,
to help meet this aesthetic need.
I included this very silly picture
just because I think it's important to include
these silly pictures.
Our process starts by using a Microsoft Kinect like the one
here in my hand, as a 3D scanning device.
It's connected to a laptop running some specialized
software.
And here on screen, you see my Ph.D. student Ginger
[? Kuhns, ?] scanning my leg as part of some testing
processes we did a few months ago.
That scan is then brought into MeshMixer software,
and there you can see a positive 3D mesh of a residual limb.
Now MeshMixer was actually invented here at U of T
by a computer science Ph.D. student, Ryan Schmidt.
Dr. Schmidt now works for Autodesk,
and MeshMixer has now become an Autodesk product.
And it's available for free to anybody
who wants to download it.
So you've got the Kinect now as a consumer-available
technology.
You've got MeshMixer as a consumer-focused available
technology as well.
Now with MeshMixer, which has really
been developed to simplify and accelerate
the process of manipulation of 3D scan data,
we actually, in a semi-automated way,
turn the positive 3D mesh that I just showed you, into this,
into the 3D socket that some of you actually have in your hand.
I'm going to hold one up here like the one on the screen.
Now this has actually both been generated from that positive 3D
mesh.
It's also been manipulated in ways that basically turns it
into what is known as a PTB, or patellar tendon.
That's the thing right below your knee, below your kneecap,
bearing socket, a PTB socket.
This is actually much more comfortable type of socket
to wear than just kind of the shape of the leg
as a surface scan would generate.
So this has been manipulated to create this.
It's then printed on a MakerBot, again, a home-based technology.
The ones in your hand, the one in my hand,
is all basically the same, printed from that same process.
It's got a fixture on the end of it
that we incorporate during the development process.
That fixture basically allows us to attach it
to pylon and feet, which are standard issue from the Red
Cross pylons and feet.
And the result is basically a prosthetic with a customized
socket, standardized pylon, and standardized feet,
which can be then fitted to a patient in the same way
as the standard process that the Red Cross has currently
developed.
Now we are about four months away
from testing of the solution here in Canada,
six to eight months away from testing in Uganda.
That's about our timeline.
But so far, it looks like we're going along pretty well.
And the solution does provide some additional capacity
for hospitals like CoRSU.
In particular, it solves a couple of problems.
One there's a lot less manual work
involved in this production.
So there's much less chance for error to creep in.
And also, there's a lot more time for these technicians
to basically do other kinds of tasks.
So it reduces the labor necessary to produce a socket.
And importantly, it also dramatically reduces the time.
So instead of five days, which is what the Red Cross
standard process involves, including
the drying in the African sun, as they say,
of the plaster casts, we can do this process
in two days, less than half the time.
And so that really resolve that time problem
that we just described.
It also requires much less manual skill in order
to produce it, which it solves that prosthetic technician gap
problem.
There are a number of issues that remain.
We're still working on creating robust technologies,
so making sure the MakerBot is robust,
making sure the Kinect scanning is robust and reliable for use
in contexts in the developing world.
Now we are putting these things into hospitals,
so it's not just in any context.
But these are things we have to take into consideration.
We are working on making sure the sockets are themselves
strong enough, so if you squeeze it,
you can see about how strong it is.
And potentially changing the material geometry of this
object in order to increase its strength.
We're working with mechanical engineering here at U of T
to make that happen.
And again, it does reduce these training needs that I described
before, but it doesn't eliminate them altogether,
which means that we can't just consider
this a technical solution, we have
to also consider a lot of social factors in the kind of work
that will take to implement and scale out this work,
because that's ultimately our goal.
It's not just to create a one-off process,
but to in fact, scale it out globally.
Now if that was the only story that I
was going to tell you today, you might say well,
I've seen this before.
I've seen a lot of similar stories,
such as the Not Impossible Lab's 3D prosthetics process,
where they're printing prosthetic arms in the Sudan,
or potentially also the Robo-Hand project
that maybe some of you had seen as well.
And in fact, our project kind of fits within some of that logic
is well, the idea of using this emerging technology,
this developing technological interventions,
to basically resolve some kind of social issue.
So it fits well within that.
But interestingly enough, it's actually
not much of a technical invention,
or involving technical novelty.
In fact, if you look at the literature from the prosthetics
and orthotics context, what you find
is work being done on computer-aided design
and computer-aided manufacturing,
it dates back to the 1980s, the first paper
being published in 1984.
That's a long time ago.
Right?
Moreover, if you look into those papers, what
you find is some of the same kind of stuff
that we are doing in MeshMixer was already
being done in computer software as far back as 1989.
So this is actually a screen shot of a computer interface
where they're doing the kind of modifications to that socket
that we're doing in MeshMixer.
So it's not exactly an entirely novel
technological intervention in the way
that you might think it is.
Instead, I actually think it's much more
an example of the value of a kind of democratization
of technology that we might associate
with something like the Maker Movement.
The kind of technologies that we're
making use of, the 3D printers, the scanners,
and things like that, have actually all
been developed because of individuals working
to open and democratize these technological interventions.
So the RepRap Project, an open source 3D printer project,
which in a sense, is the foreground to the MakerBot,
they kind of bounties put on opening up
the Microsoft Kinect which was a closed system, done,
these bounties being provided by people like Limor
Fried of Adafruit Open Source, hardware and software
advocates.
And even MeshMixer itself, this design software,
being produced and distributed for free by Autodesk,
in a sense, to generate kind of a new audience, new groups
of individuals engaging in 3D design.
That's really I think, a big part of this story.
And the prosthetics project is an example
of what happens when you have those kinds of capabilities.
But I want to take it one step further
and return a little bit back to that Without a Leg to Stand On,
because again, I want to remind you that I am not an engineer.
I'm not a medical researcher.
I'm in fact, a social scientist, and in fact
as social scientists, we are not supposed
to be able to explain electricity
or deal with technologies in a kind of a real way.
Instead, we're supposed to be able to explain people.
Now I do think that's relatively true,
and I do think that being able to explain people
is very important.
But in fact, what I want to argue
is that there is a new kind of group of social scientists
and humanities scholars like myself,
who are interested in taking that understanding that we can
derive from the deep understanding of society that
comes from fields like sociology and anthropology
and history and philosophy and all these other areas
and actually use those understandings to facilitate
and create technological interventions that fit well
into particular social context.
Now I coined a term in 2007 called "critical making,"
and I've been studying what it means to in a sense,
develop technological and social understandings simultaneously.
And that's really the focus of my research.
And the prosthetics project is, in a sense,
a sign of that kind of work.
And in fact, our understandings of prosthetics--
where we start from for this project--
emerged from a series of workshops
we've held over the last few years
where we brought in artists and designers and makers
and prosthetic wearers and medical professionals
all together to explore through both thinking and making, what
prosthetics are and what they mean.
This involved casting, this involved experimentation
with micro-controllers, and the development
of these kind of funny little one off,
"makery" kinds of prototypes.
But It was through that work that we really
developed an understanding of the relationship
between prosthetics, communities, society,
and individuals that has served us
well in the construction of the project
that I've just shown you.
And in fact, I want to end by using
that to respond a little bit to a recent statement done
by our honorable Republican representative
from Virginia in the United States, who basically said,
"funds currently spent by the government on social science
would be better spent helping find cures to diseases."
And what I want to say about that
is, well actually, Elliott, those two worlds
are maybe not quite so far apart, that in fact,
the social sciences, and investing
in the social sciences, and carrying out social science
research can actually in some cases
go a long way towards in fact, curing
the social ills, including things like disease
that we currently face.
So in fact, I think that maybe I have more legs
to stand on than I thought, so to speak,
because it's really this focus of both having a leg of kind
of technical understanding, proficiency, and expertise,
and a kind of leg of social understanding and analysis
that really gives us the ability as a society
to move forward and address these critical issues that we
as a society face.
And here I want to end simply by thanking the partners
on this project, cbm Canada, Autodesk Research, CoRSU
Hospital, and groups like the Canada
Foundation for Innovation and the Ministry of Research
and Innovation, and direct you to the Critical Making Lab
or the Semaphore Project at U of T
if you want to find out more about what we do.
Thank you very much.