Robotel DdG_2019

Projekt 3 3D Printed Prosthesis Hands Robotel Enes YÄąlmaz Design in der Digitalen Gesellschaft Erasmus Student

This project is done during 2019 Summer ERASMUS+ exchange Semester in Hochschule fĂźr Bildende Kunste Braunschweig by a third year Industrial Design student from Middle East Technical University - Ankara / Turkey.

The topic is decided with the help instructions of Dominik Harborth as a continuation of volunteer job in Robotel Ankara.

content introduction 03 research 09 analysis 19 ideation 23 prototyping 33 final 45 further on 49

introduction

Enabling the Future, also known as e-NABLE, is a volunteer community of individuals from all over the world who are using their 3D printers to create free 3D printed hands and arms for those in need of an upper limb assistive device.

They are people who have put aside their political, religious, cultural and personal differences – to come together and collaborate on ways to help improve the open-source 3D printable designs for hands and arms for those who were born missing fingers or who have lost them due to, disease or natural disaster.

The e-NABLE Community is made up of teachers, students, engineers, scientists, medical professionals, tinkerers, designers, parents, children, scout troops, artists, philanthropists, dreamers, coders, makers and every day people who just want to make a difference and help to “Give the World a Helping Hand.”

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With Amniotic Banding no two cases are exactly alike.

There are several features that are relatively consistent: -webbed digits, -distal ring constrictions, -deformity of the nails, -stunted growth of the small bones in the digits,

The Enable movement, started with two people posting their

-limb length discrepancy,

mechanical prosthesis online, is supported by people all around the

-distal swelling, and

world. One of the community, Robotel TĂźrkiye, is also aimed to print

-congenital band indenta-

3D printed hands for the children lacking hands or fingers due to ABS,

tions.

war or disasters.

-If a band wraps tightly around a limb, the limb

One of the common disasters, occurring nearly one of each 1200

can actually be completely

people, Amniotic Band Syndrome (ABS) is a group of congenital birth

amputated.

defects believed to be caused by entrapment of fetal parts (usually a limb or digits) in fibrous amniotic bands while in utero. These defects

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are shown as an irregular formation on the arm, varying in length and width.

-If the band is across the baby’s face it can cause cleft palate.

-In a large number of cases the baby is also born with clubfeet.

-ABS is also the cause of numerous miscarriages, such as when a band becomes wrapped around the umbilical cord.

In addition to Amniotic Band Syndrome, developing during pregnancy, the other factors, such as war and disasters, are happening in the world requires cheap and quick solutions as prosthesis, called Robot Hand.

Production of robot hands is done with 3D printing in contrary to the medical prosthesis. One of the reasons why it’s preferred is because of its cheapness and easy production. Thanks to global society, CAD models of robot hands are for free to use so, everyone can resize and print. It doesn’t require huge industrial production capacity and patents but a 3D printer and filaments selected according to children’s choice. Therefore, the size can be more suitable, customized for the receiver and the parts can be quickly replaced in case of growing up or breaking apart.

Process of making Robot Hand consists of four steps: measurement, selecting a model, customisation and 3D printing. Measurement is done with a simple ruler and a camera. Basicaly, it dimensions are

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recorded to put in computer and resize the model according to that, which leads to selecting a model.

Robot Hands work with the mechanical power of the joints. Basic models don’t consist electronical parts but work with shortening of the fishing line attached on elbow or wrist. Tension is provided with the elastic Selecting a proper model is determined by the type of condition that child has as the end of hand can vary. Some cases needs elbow powered and some needs wrist powered models.

bands on the other side.

Third, customisation is quite important as it has psychological effects on children. The model can be altered on computer or can be painted like a super hero arm or a comic book character.

It is also important as the model can be changed according to the need or type of use such as riding bicyle or playing an instrument.

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Lastly, 3D printing and assemly of these hands are done.

On the scope of this information, the possible problem areas and concepts are determined as the growth of the child, individual needs and grabbing problems.

Firstly, growing up requires some changes in robot hands. They need to be renewed periodically to ensure the right fit.

Second is different shape formations on the arm and their need for special editing. As ABS or the other diseases don’t create the same formations on the hand and arms, each case is different from each other. Although there are many models only specified for different uses, the number of models responding to different hands are limited or need editing.

The case in the photo is from a Syrian boy, who lost his thumb and index finger due to a bomb explosion.

The last area is problems resulted from having one grip. Unlike real hands, the prosthesis and robot hands are not sufficient enough to sustain some different kind of grips. Increasing different uses may also increase functionality.

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Consequently, all three concepts are based on the continuation of e-Nable and Robotel community’s existing process and solving the problems by changing the model used. Using 3D printer as the producing method by the volunteers are same in the problem description.

Even though the target group of the problem is seen as the people who need an assistive device, another group is determined as the volunteers. Because, the volunteers are the people who decide, prints and assembles the hand. However, they are not necessarily the expert on the topic but they are eager to do that. As a final view, the target group is unprofessionals who are preparing prosthesis for children with ABS or later acquired amputation.

research

The first part of the research was an interview. The reason interview was selected as the first step is to ensure the liability of background information obtained from observations, done during a volunteer job, and check them if they are true. So, Robotel Türkiye’s Ankara coordinator has accepted the request for an interview.

Melis had done her Bachelor’s degree in Interactive Media Design and she is making her Master’s in Industrial Design.

Regarding her design background and knowledge

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of her design research, questions of the interview are selected carefully not to direct the attendant. Open-ended and how questions are considered more suitable, and

Robotel Türkiye is the

conversation is kept like a chat but before interview main

representetive of Enabling

points that should have been got is determined.

Future community in Turkey. Ankara, as the sec-

The first question is aimed to be a conversation start-

ond biggest city in Turkey,

er and get into the topic. “Can you describe your work in

has a seperate team and

Robotel?”

branch to keep coordination easier. Ankara branch has more volunteer, compared to

.

Istanbul,

and

accept

cases from whole Anotolia (Asia Minor) and Syria.

It is important as Melis has seen different cases.

Robotel - Ankara Coordinator -distributing cases to the volunteer -conducting seminars to volunteers -finding sponsors for materials and printers

The models on the Internet are open-source. It

As it is known Robotel Türkiye is making prosthesis for children, “What is the problem of these children?” is asked.

means anyone can be able to use them freely. However, for the sake of storage

Most of them have hand and finger deformation from birth (ABS) and nearly %10 has later amputations (surgical).

and license, they are saved as mesh models which only has the coordination of the

The process and actors are asked in this volunteer community. “What is your process of selecting a model for a child?”

vertex points. So, they can’t be edited but can be scaled.

In the early years, it was the choice of children which is actually their

It is not possible to make

families. Flexi Hand was selected for the authentic appearance but it is

alterations without mode-

not functional anatomically with its thumb position.

ling from scratch.

After seeking new models, Phoenix Hand (Unlimbited) is found better as it is small, light and easy to assemble. This is the most used model unless there is not a situation such as a bomb explosion.

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It was decided to ask what is the response in case of the model’s not being able to be selected bu that point, determined prior, is mentioned

by Melis unknowingly. So, “How do you reply to these situations you mentioned before?” is asked.

If the deformation is different or if it does not result from ABS, there can be different formations such as a bigger palm than usual. It may not fit into existing models (Phoenix Hand) and modification on the model is required.

“Who does this job of modifying? And, what is the process of this modification?”

This job is mostly done by Industrial Design students or other volunteers in that area. They need to model it from scratch. Because, -Open-source models don’t allow to change.

-Only the ones who know the necessary programs can do that.

-It is a hard and time-consuming process.

-It is needed to be careful of little mechanical details.

Also, another problem is if the palm is resized according to anomalies, it changes all sizes and won’t fit the real size of fingers or hand.

“How do you treat to these cases?”

That’s why we don’t prefer to modify in models in Ankara. So, we don’t accept new cases with these conditions right now. We have tried to but before it wasn’t successful. Recently, we got a case from Syria, but we had to refuse.

So, it was confirmed that there is a problem in the area. To learn other possible problems, it is asked “Do you have problems in the application of these models to the children? If, yes what are those?”.

The use of these hands, as 3D printed prosthesis, is one week because they are not functional. They have already know how to use their arms.

The things they can do without the hands are so varied that they don’t need a prosthesis at all.

She mentions another problem as she tells she is also writing her Master’s thesis about that topic. “Does it apply all Robotels?”

It does for all hands, grabbing and holding in the same way with the one Robotel uses. So, the problem, the need for use, is holding or grabbing the child actually doesn’t need it. As an example, if she asks the children: “When do you use your Robotel and when you don’t?”

One replied, “I use it when I go to the shopping mall but if I visit the house of my friend I don’t.”

“Why don’t you use in the house?” asks she.

“Because I am more active in the house visit, I do many activities.

Robotel prevents me but in the shopping mall I am just walking so it comes with me.”

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So, Robotel is a stationary object for them rather than functional.

Some say, “I can’t use it when I am studying because it doesn’t fit into the desk. I needed to fold it but then my arm hurts.”

“I don’t use it when I am eating food as I need to fold it, it’s so huge. I can’t put it far and it hurts.”

So when do they use it? An original reply: “My Robotel can carry my water bottle, but it doesn’t help me to drink it. I can’t drink.”

It’s a thing makes children happy in a way as it’s a new toy, a new hand but after some points, it becomes something prevents the child to do things. Even in the first test, all is good and they can bend their elbows or wrist functionally, after giving it, they don’t use it, and it is not in only one case but more.

They can’t use it. But demand is so high. It won’t finish even though they know it. They see it as a necessity. It is not a functional necessity but a physiological one. And if there is a necessity, they will be produced.

“What do you thing about modification about models?”

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There is an example from another city. The condition is ABS but they couldn’t do it. It was even broken after some did and gave it. The model got broken. It is so hard to adapt. You can scale the size up to make the children hand to fit inside then you get a huge hand. When you make it smaller, the hand won’t fit.

When the actors in this context are considered, the children, who are

In the definitions of reg-

lacking hands or fingers, their families and the volunteers are seen.

ular and irregular forma-

From them, the children can be split two as the ones with Amniotic

tions, “formation” is pref-

Band Syndrome and the ones with later acquired amputations as well

fered among “deformation”

as ABS, which can also be categorized into two, regular formations

since they are sub-group of

and irregular formations.

ABS. So, both of this cases are happening during

For this project, it is defined that regular formation is the underde-

pregnancy before a com-

velopment of hand and fingers due to ABS but a case that the hand still

plete development of hand

can fit into common Robot Hand models. On the contrary, an irregular

and fingers. They are not

formed hand can’t fit into the models as it’s not a reducted version of

deformed but formed par-

a complete hand but has bulky parts or rotated fingers that colliding

tially.

with the parts of models.

Later acquired amputations are the cases resulted from war or natural disasters. They are not from birth, they obtained through injury and surgery.

To summarize, there is a demand on these type of prosthesis regardless functionality of Robotels. The community assesses these applications and decides if it requires special changes on the model such as irregular formations and later acquired amputations. If the case is regular, most volunteers can work on the problem since they just need to resize an existing model and test a few times, which doesn’t require extra skills.

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As one of the main actors, families’

opinions

However, if the case is other than regular, it needs a completely new

have

model from scratch. This model may resemble and be based on exist-

prominent effect on chil-

ing models yet it requires anatomy knowledge computer-aided design

dren.

skills and experience on 3D printers. In this scope, the volunteers can

Children’s

opin-

ion about selections don’t

do these jobs are also numbered.

determine the result as their families make them

During the interview, the process of Robot Hand-making is tried to

believe in the model which

be understood from a person who is not only making but also directing

is better and good looking

and assigns people who make these jobs. From how to select a mod-

for them.

el to how to react special cases are asked. Actors are learned. On the

Families consider authentic model more accept-

other hand, a new problem of Robot Hand’s being stopped using after one week derives.

able. They tend to select the models which has realistic fingers and even nails, even though those models perfom less functionally.

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They don’t use it because: -They are used to live without Robotel.

-Robotel doesn’t fit. It’s bulky and hurts.

-Robotel doesn’t help with grabbing and holding.

So, a new spectrum of Robot Hands is shaped as functional or cosmetic. As the second step of research, literature is skimmed to figure out why rejection is happening.

Patterns of Acceptance and Rejection of Upper Limb Prostheses (1985) is a research done in a group of people who has prosthesis from New Zealand clinic. According to research,

“...there is no doubt that the acceptance rate of prostheses is “woe­ fully low.” The factors that Wilson sees as causing this low acceptance are the func­tional capabilities of the prosthesis and technical difficulties, such as malfunc­tioning joints and poor fitting to the resid­ual limb.”

It is found out that the acceptance rate of people who has one functioning arm and hand is lower than the ones who don’t have any.

Because of the facts that

“...development of one handedness which removes the functional need for the prosthesis, lack of sufficient training or skill in using the prosthesis, poor comfort of the prosthesis, the unnatural look or profile of the prosthesis, and the reactions which wearer gets from other people.”

One of the reasons for this lack of research into recipients’ attitudes may stem from the emphasis on the technical aspects of prosthetics.

When approached from such a perspective, the way to overcome problems of rejection or non-use is seen to be by improving the function and design of the tool. Earlier fitting, better cosmetics, or more training are also seen as possible an­swers.

Consequently, the general approach to problem stays as improving the mechanical properties although the process to get used of it is also important.

Closely related to functionality is the matter of training in the use of the prosthe­sis. McKenzie says, “Learning to use an arm prosthesis never comes instinctively and its effective use is an acquired skill, so much so that no worthwhile return in the way of function is apparent to the user, and rejection may result.”

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Prosthetic Restoration and Rehabilitation of the Upper and Lower Extremity (2013) point out the difference of emotional and psychological issues between congenital and acquired deficiencies.

Congenital -Typically children do not deal with any sense of loss. They frequently reject prosthetic limbs if not introduced early secondary to development of their own natural compensatory strategies.

-If prosthesis truly assists in function it will be accepted.

-If parents do not accept the prosthesis it is unlikely that the child will.

Acquired -Children with acquired limb deficiency will require significant family support.

-Degree of limb loss has been shown to have no prognostic value with relation to anxiety or depression.

-A child’s level of anxiety, depression, and self-esteem appears to be more related to marital discord of the parents and paternal depression.

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-The single biggest prognostic indicator for acceptance and positive adaptation to an acquired limb deficiency in a child is the family’s (parent’s) ability to accept and adapt to the trauma and/or change.

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analysis

The research showed there are problems to work on in this area. Two of these problems, however, were prominent. First one is the availability of Robot Hand with different formed hands. The second is Robot Hands’s not being used after one week of handling.

However, to decide which way to go on, it needed to be answered a question, which is if Robot Hands are cosmetic toys for children to improve psychology by creating social status among their peers or a functional tool to help them to grasp objects and use them.

As stationary toys, Robot Hands, are used in short terms due to some problems. no sense of loss lack of training habits they don’t use it

made bigger to fit individual formations

bulkyness pain

doesn’t have function

stationary/ cosmetic

prevent the feeling of skin

The first and obvious one is that they are not functional enough for a child without a functioning hand. Although Robot Hands fulfill the duty of basic grabbing, it is not a level up for a kid who developed alternative ways of doing daily tasks. It more appears on the children with congenital conditions as they don’t have any sense of loss and it’s a part of their habits. However, even people who have amputations later in their lives prefer using their arms as an extension and find different solutions rather than using prostheses. Their mouths, armpits, and elbows became their fingers to grab and hands to hold. Even people without two hands can do some task such as combing their hairs, writing text or using touch screens.

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The second problem is the bulkiness of Robot Hands. Especially in the cases with different conditions such as a bigger formation in palm area or partial finger formations, it requires special edits on the model which is not an easy task as it means remodeling from scratch. So, the basic solution is to resize the model and scale it up so that the hand can fit inside, resulting in a heavy model for a kid which doesn’t even fit between desk and chair while sitting.

The last problem area is the lack of training. Even with a model, properly fitting, children are stopping to use their Robot Hands after a short time. This may be caused by not having an exercise with a prosthesis before handling other than regular tests for fit and functionality.

To solve at least some of the problems, it is come up with a threestep solution. It proposes a timeline starting with a creating a new Robotel, adaptation process and new uses.

First of all, a new model, consisting of modular and omittable parts, is required to have a tight fit and reduce bulkiness for children with 20

individual formations.

Secondly, a process/game, adapting kids to use Robotel, is thought to teach how to use and defining new uses for all children with ABS or hand-finger loss.

Lastly, a new model, letting the child feel with his/her arm, is considered to increase the sensation and functionality for the children don’t use it functionally.

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ideation

It is started with sketching some hands irregularly formed due to Amniotic Band Syndrome. The real cases obtained via Robotel Ankara is used as models. Those are the hands of the children who couldn’t get Robot Hands due to their irregular formations.

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Even though some of the hands look like amputated hands, which don’t have irregular bumps or bulkiness, not all the hands have regular formations.

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The model used in many of the cases in Robotel’s Ankara branch has a space in the middle and walls on four sides of hands.

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The first idea is to reduce all the parts that aren’t needed other than fingers and the parts they are connected. It’s planned to be modular so only the fingers required could be attached.

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If the uncovered skin area can be increased, the usability of hands can also increase.

Parts are not durable enough when they are scaled-down and printed. So, the idea is to use bigger parts on smaller hands to have bigger joints. To achieve that the number of fingers can be decreased.

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targe

t gro

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up

The variety of the hands were needed document as to see what are mak ers a nd u the main differences. To analyse it, the cases are limited to the chiln for c hildr proffesio en w nalsdren who have a wrist and a formation on the hand side. ith w havin g a w ABS or ho are pr later epar rist a in a nd a form cquired a g prosth es ation m on th putation is e han , d sid e

On the formations, the palm and fingers are the main elements. On palm spectrum, size is the most important factor as well as its shape and irregular bulkiness. But, extensions on the thumb and pinky finger side are common.

Fingers create the difference as which finger is developed varies.

Another concern is how much a finger is grown out and if it is still functional.

The idea developed itself as a planar surface covering back of the hand, having two parallel concentric hinges and assumed finger joints. The planar surface let the hand pop up from the thumb area and pinky finger side.

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Next, three major ideas appeared. First one is having a modular base that a joint for fingers riveted on top. The aim is to reduce a big hinge to a different interchangeable part, selecting according to each case separately.

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The second one revolves around the structure of the planar surface.

To increase the durability of the part, it offers a conic dome structure by thermoforming a planar printed part. When pushed from the side, it gets s a dome shape and gets locked with a part, which lets fingers to attach.

31 The third one is an alternative for finger joints. Fingers can attach a part which connects the base with a hinge. This hinges can allow a different layout of fingers to connect. In small hands, bigger fingers can be attached on the bag points and it will only have three fingers.

palm size

palm size

number of fingers and their placement

number of fingers and their placements

number of fingers and their placement

prototyping

It is decided that the target group of the hand is the unprofessional people who are preparing 3D printed prosthesis for children with ABS or later acquired amputation, having a wrist and a formation on the hand side.

As a result, it isn’t proposed a new organisation system for foundation, Robotel, but a new model especially for children who have an irregular formation on their hands.

3D printing stays as the main way of production so the ease of production is also a concern.

There are two proposals for the printing of the base part. One is having a flat surface and bending it with hot water. The biggest advantage of this method is a prominent decrease in the pace of printing.and the amount of material used. It may require perforations on top to define the directions to thermoform.

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The second way is printing it upside down and already bent which provide a more durable structure of dome but the waste for support material is higher. The surface finish would not be clean due to these supports.

The advantage of printing the base as a planar object is to be able to bend it according to the irregular hand. As those hands can vary especially in size of palm, it can wrap around the irregularities and have a better fit to the hand.

34 The implication of a pattern of perforations on base is thought to increase the options to attach different numbers of fingers. This alternation is important because smaller hands can have bigger finger modules, which is stronger, but in a less number.

One of the other decision points is the attachment of thumb to the base. There are two ways are considered since its position doesn’t allow to be connected the same way as the other fingers. So, the first one is to have a built-in joint one model and one without this connection. This requires two base models’ being modeled and to be decided which one would be used.

The second way is making thumb connection modular and held it from at least two points for the durability.

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Connections of the fingers to the main base can differentiate. First one is sandwiching finger bases to the main part as it was proposed earlier. It increases the thickness of hand and bulkiness.

The second option is using pins to attach. They have strong bodies to hold. However, snap-pins are prone to break easily due to their thin structure.

The third way is using holes and nailing another part through them to lock. As shear force won’t affect it in all direction, it would be secure in any position. But, fingers can be applied to different forces, which reduces the safety of its endurance.

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Consequently, a new joint is necessary for fingers, which can endure forces from different directions and won’t have small parts to be applied force. Human hands are taken into consideration, which proposes a longer base for fingers to reach nearly wrist. It can carry and distribute the weight of the fingers more than one point, attaching from at least two points to the main base.

The main model of Robot Hand used in Ankara branch of Robotel. It uses the force coming from the elbow.

With the string attached, it pulls off the fingers and hand closes. When the force stops and elbow turns into the first position, elastic strings on fingers contract and the hand shift an open position.

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First developed mock-ups for a deep linear joint of finger base is a slider has teeth on top. The idea is developed, thinking the way base is thermoformed according to hand shaped like a dome. So, in order to have a singular approach in the assembly of the hand and have consistency, slider locks itself when bent. First, the slider, which is connected to the finger base, is inserted in the channel, on top of hand base, as much as needed. While bending the base, the slider is also bent, which causes the fold of the base secures the teeth on the slider.

As a result, it provides a fully adjustable position for the finger.

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The biggest advantage of this joint is it doesn’t require support to have a hanging structure, which reduces the printing time and ease the cleaning.

The slider joint when bent in different ways. The hold is not only coming from the teeth but also from the bending of the slider. It is not bent a perfectly circular shape, so the slider can not come out from its channel.

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When another teeth layer added inside, the support need of the leaned structure is diminished and the increased contact surface area helps to bind two folds more.

Even with its advantages, the slider joint failed when it is printed in smaller sizes. Teeth were too small for printers to prints and hold the weight of fingers. It thickens the base if a stronger connection wanted.

Applied to a smaller model, joints were able to move out easier even without fingers attached.

Hand patterns are determined using paper tapes on a hand to unfold and stretch its organic form to a planar surface. As it is impossible to bend a planar surface to spherical again, some slits and holes are added, which is later thought to give reference how to form it, unconsciously.

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The

base

has

holes,

arranged linearly, for finger module to attached. Finger module has a comb shape and when inserted and bent, it stays in its place.

Final model before Rundgang, in which all five fingers attached and functioning.

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final

The model uses thermoforming after the print. Firstly, the parts are printed planarly, making them stronger and faster to print. After inserting the finger module on top of the plane, with the help of a cup of hot water, planar parts are bended, helping to lock the modules inserted. Those parts supports the dome structure as well as enabling fingers to attach itself.

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The model should be easy to assemble by every volunteer regarless of their expertise. So, the modularity on the assembly of hand is a key.

As ABS is congenital and affected by amniotic bands, there

is no common type of hand shape. According to tangles, formation on the hand can differ. This requires a new models for those and people who knows how to model on computer.

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To reach more children, it is an easier process for volunteers as they all don’t have knowledge on computer drawing programs. So, more volunteer can be able to reach more children, which have got no robotel before because of their different formed hands.

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further on

At last, the project is not finished for further development. There are many ways to improve and test, which can be grouped into two categories.

The first issue is the mechanical properties of the hand.

In the test prints, it is seen that its modules don’t have a proper fit, its adjustability of the position is not possible and it is not practical to assemble. So, it is thought to return to the idea of the slider but with bigger teeth to ensure a more secured lock but it is also necessary to increase the alternatives for joint and test them on different variety of volunteers as the target group of the project is those unprofesional people, who would assemble them. This method is believed to improve the ease of assembly.

Second is to test these alternatives on the kids with different conditions. The project can be improved according to the feedback of those children. Now in Ankara, it is possible to reach them.

With the assistance of Robotel Ankara, the project can help those children, who need “a helping hand�.

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