“Do you think my pink ones will still fit?” asks Mimi, a 10-year-old girl trying on her new two-tone pink 3D printed leg brace for the first time, hoping her matching trainers will fit. Orthotic comfortably strapped on, she struts off, poses in front of the camera and beams: “I love it!”
That experience is precisely what Samiya Parvez and Naveed Parvez, co-founders of London-based healthcare technology company Andiamo, set out to inspire when they launched a successful crowdfunding campaign back in 2014 in a bid to provide an alternative to the current painstaking process of delivering orthotics to young patients.
Their mission was inspired by their son Diamo who sadly passed away in March 2012. Diamo was diagnosed with cerebral palsy and severe developmental delay, requiring full-time care and a number of orthotics to support his posture and help with basic everyday tasks. Getting those orthotics right was a constant challenge for Diamo and his family as each limb required a different team of clinicians and multiple appointments, repeating the process over and over, and preparing for the inevitability of another appointment if the device wasn’t correct first time. Very often, by the time a new brace had been delivered, Diamo had already outgrown those measurements.
The traditional method of producing and delivering an orthotic device is long and the experience can be stressful for patients with complex healthcare needs. Clinicians take a negative plaster cast of the wearer’s body to create a mould which plastic is then shaped over by hand to form the final brace. This can take months and, like Diamo, there’s always the possibility that the child may have outgrown the original cast by the time it is fitted. If an orthotic doesn't fit properly, it's not going to work effectively. Deploying a combination of artificial intelligence, 3D scanning, simulation and 3D printing, Andiamo says it can deliver custom fit Ankle Foot Orthosis (AFO) that are both thinner and up to 65% lighter in under two weeks.
3D printed custom fit ankle foot orthotic
The motivation to use 3D printing was ignited during a conference when the company’s co-founders saw how the technology had progressed to a point where manufacturers were now using metals. Surely, polymer additive manufacturing was now good enough to apply to orthotics? They did some digging and found that there wasn’t currently anyone out there addressing this huge worldwide challenge with this sort of technology.
“If you approach it purely from a business perspective, it doesn't make a lot of sense in terms of the way healthcare is paid for but if you approach it from the experience and the impact on that child and the family's perspective, it completely makes sense,” Naveed told TCT. “What we saw was everyone approaching it from a purely business perspective and not really finding solutions but you can find solutions when you approach from the other angle.”
Though 3D printing may be the hook that has earned Andiamo a bounty of headlines in the tech sector, it is merely the vehicle which allows the company to manufacture custom implants both quickly and on demand. “That’s been a smokescreen we put up on purpose,” Naveed explained. Andiamo is a platform as a service and its real expertise lies in all of the parts of the process that go into making that final part a reality. To that end, they have developed a software platform which standardises the patient's clinical information using AI, automation and humans to turn data into something that can be manufactured.
The process of getting an Andiamo orthotic to the end-user has been made as pain free as possible, without a strip of plaster cast in sight. The patient comes in, their limb is 3D scanned in under 10 minutes to generate a 3D model and the file is then transferred into Altair HyperWorks to simulate and optimise the design to meet the necessary clinical requirements and patient needs. This combination is something Andiamo refers to as the balance between orthotics and the human body, producing a device that delivers the best clinical outcomes but crucially, is also comfortable and functional for the wearer.
"We're trying to find that happy place," Naveed said. "You don't want something that's completely useless and can cause harm but you don't want something that's so clinically restrictive that it disables the person further."
Altair's simulation technology is applied to identify pressure points.
Altair’s simulation tools allows engineers to identify where pressures might build that may lead to bruising and discomfort. Martin Kemp, Global Practice Leader at Altair explained further:
"Naveed's initiative was to bring in some technology [I suppose] that has grown up in aerospace and automotive industries to actually model the human body, use the scan data as a basis for defining the external surface. To model the human body, to model the external structure and all of its stiffness and pretensioning and to capture the behaviour of the two together so that we could do things like predicting whether there would be a potential weakness in the structure by looking at stresses or by looking at comfort, which is just so important in this process."
The optimised design is then sent for manufacture in Nylon 12 using outsourced EOS powder bed systems. The company currently has operations in the UK, Nordics and will shortly be expanding to the Middle East but the goal is to grow Andiamo into a global operation and plug into local manufacturing closer the point of need to provide greater access.
“We are a global company from day one, this is a global problem that needs a global solution," Naveed explained. "If you look at the numbers, there are about a billion people [with] a disability. What's particularly scary is 80% of those people can't afford or access the healthcare or the expertise that they need. Then you have a clinician shortage of 7.2 million and that 7.2 million is just for the 20% of people who do get healthcare. So, if you're talking about delivering healthcare to everybody - the real shortage is somewhere between 60 and 100 million clinicians. It’s a terrifyingly enormous number which is why we set ourselves up in a certain way and we are absolutely focused on building a company that can solve it globally.”
The company’s ambitions extend further than geographical expansion. Naveed explained how Andiamo is also starting to implement sensors into orthotics in order to better understand their impact in the real world and refine their design for the individual wearer.
“We believe with that sensor data, we can start to bridge that gap and that should lead to not just a better wearable or better orthosis but better treatments in general," Naveed continued. "For example, if you had a certain type of physio, maybe we could improve your flexibility by a certain amount or we can reduce your pain by X. When you can combine all of that together, we think that's going to be a very, very powerful combination."
3D printed back brace
There are also future opportunities around big data to enable predictive sizing to improve the refitting process and open up conversations with families about potential outcomes of certain types of treatment.
“The vision is for clinicians to be able to kind of sit down with that family and go look, if we do this type of treatment, this is what we think is going to happen,” Naveed explained. “I think one of the things that people have found very difficult is it's really hard to visualise this stuff especially when sometimes it's like, this will happen in five to eight years, some of the stuff will happen in 20 years … the visualisation of those models is a really powerful tool.”
Andiamo is of course not the first company to offer custom 3D printed orthotics but the availability of these devices still remains limited, despite their myriad benefits to the patient in terms of fit and reducing visits to the clinician. Currently, in the UK, printed orthotics are not available via the NHS and Andiamo’s all-inclusive service (meaning you pay once during the lifetime of each device) will cost patients £750 for a consultation and one orthosis. As to why the technology has not become widespread for this particular market, Naveed believes a lack of knowledge on additive capabilities and CAD expertise, coupled with the expense and hesitation around overhauling a traditional process, are key barriers.
“The exact words I've heard from a major 3D printing provider is, the customer said, “I will not buy one of your printers, until I have a magic button that I can press that turns my 3D scan into something that can be manufactured” because they don't want to build a software team. They don't want to build an engineering team, they don't want to understand material science, they really don't want to do any of that stuff. So, the overheads are really, really a huge barrier.”
Last month saw the official launch of the Andiamo Clinic, the first of its kind in the UK to offer Andiamo orthotics. Though it's still in the early stages of adoption, the team has aspirations to treat millions of children over the next decade.
