Design and prototyping by additive manufacturing of a

Design and prototyping by additive manufacturing of a functional splint for rehabilitation of Achilles tendon intrasubstance rupture Fernando Blaya Haro

Pilar San Pedro

Alonso Blaya San Pedro

Technical University of Madrid 28012 Madrid, Spain [email protected]


European University of Madrid 28670 -Spain [email protected]

Julia. Lopez-Silva


Juan A. Juanes

VisualMed Systems Group, University of Salamanca, Campus Miguel de Unamuno 37007 Salamanca, Spain [email protected]

ABSTRACT Technology allows the realization of individualized immobilization splints by Advanced Manufacturing techniques based on additive manufacturing, industrial digitalization and reverse engineering. In this sense, good results have been achieved in the optimization of the design process, the reduction of manufacturing costs, the development of materials used and the environmental impact. However, its definitive implementation requires other factors of improvement that take into account the initial sanitary use for which they were designed. The present study aims to provide functional characteristics in the initial design to a splint for rehabilitation of partial Achilles tendon rupture. The result allows applying simultaneous rehabilitation techniques during the immobilization stage of the affected limb in order to minimize the possible muscular, joint and vascular complications derived from the application of the classic retention devices in this phase of the treatment.

CCS CONCEPTS • Hardware → Bio-embedded electronics

KEYWORDS Splint, rehabilitation, Achilles tendon, advanced manufacturing. Permission to make digital or hard copies of all or part of this work for personal or classroom use is granted without fee provided that copies are not made or distributed for profit or commercial advantage and that copies bear this notice and the full citation on the first page. Copyrights for components of this work owned by others than ACM must be honored. Abstracting with credit is permitted. To copy otherwise, or republish, to post on servers or to redistribute to lists, requires prior specific permission and/or a fee. Request permissions from [email protected]. TEEM'18, October 24-26, 2018, Salamanca, Spain © 2018 ACM. ISBN 978-1-4503-6518-5...$15.00 http://dx.doi.org/10.1145/3284179.3284253

Roberto D’Amato


ACM Reference format: F. Blaya, Pilar San Pedro, A. Blaya San Pedro, J. Lopez-Silva, J. A. Juanes and R. D'Amato. 2018. Design and prototyping by additive manufacturing of a functional splint for rehabilitation of Achilles tendon intrasubstance rupture. In Proceedings of the 6th International Conference on Technological Ecosystems for Enhancing Multiculturality (TEEM 2018) (Salamanca, Spain, October 24-26, 2018), F. J. García-Peñalvo Ed. ACM, New York, NY, USA, 7 pages. https://doi.org/10.1145/3284179.3284253.

1 INTRODUCTION In recent years, the use and application of engineering knowledge in medical applications has made it possible to improve the performance of medical products and the life quality of patients. All this thanks to simulation studies on the dynamic behavior of human joints [1-3] that have allowed the development of high-performance materials for prosthetic implants [4-7]. Advanced Manufacturing (AM) techniques and Industrial Design allow to provide new applications and work methodologies to Medicine, within what can be called the discipline of Bioengineering. In this sense, good results have been achieved in aspects such as optimization of the design process, reduction of manufacturing costs, materials development and environmental impact [8]. Both Orthopedics and Rehabilitation are medical specialties that are very favorable and receptive to all kinds of technological developments or applications in I+D+i field. Advanced Manufacturing has allowed a recent emergence of solutions based on additive manufacturing [9] thanks to the use of different methods of Three-dimensional Industrial Digitalization and Reverse Engineering. These solutions have allowed a great breakthrough in mass use products such as splints, orthoses, prostheses or help devices, while they have revolutionized the applications to exoskeletons hand in hand with robotics.

TEEM 2018, October 2018, Salamanca, Spain It is applied on windows made on the splint according to Fig. 6. The results obtained from the functional immobilization splint for partial rupture of Achilles tendon have integrated the windows and accesses necessary for the application of the different physiotherapy techniques previously suggested and described. Fig. 5 schematically shows the size, shape and position of the windows required and performed. Figure 9 shows how the obtained result complies with the position and the geometry necessary to integrate the rehabilitation techniques described above (Fig. 5). The use of functional splints provides both the advantages of classic splints of immobilization by additive manufacturing to the initial sanitary use for which they were designed. The avoidance of hygienic and skin problems, the visual control of the evolution of the lesion or environmental facts are issues to be highlighted [8]. The integration of different features to a splint created by Advanced Manufacturing methods provides an added value that can be a key decision point for its implementation. There is a chance of designing functional splints for home use, in order to achieve rehabilitation techniques applicable in the immobilization phase that avoid the frequent journeys of patients to hospitals. This requires a design of the splint on the part of the specialists, and a specific development of medical devices adapted to the user-patient.

4 CONCLUSIONS The objective of this work is the study, design and manufacture of a functional splint for partial rupture of Achilles tendon. Technology allows the production of individualized immobilization splints by Advanced Manufacturing techniques based on additive manufacturing, industrial digitalization and reverse engineering. The treatment of conservative rehabilitation of intrasubstance rupture of Achilles tendon by functional splint of individualized immobilization made by additive manufacturing, allows the integration of the necessary features to use physiotherapy techniques in this stage. The application of physiotherapeutic techniques in the immobilization stage prevents possible muscular, articular, cutaneous and vascular complications derived from the employment of classic retention devices in this phase of the treatment. The advantages or improvements in the immobilization stage, thanks to the use of functional splints made by Advanced Manufacturing techniques, can be summarized in two groups: control measures and continuous monitoring, and the active techniques of the field of physiotherapy. Among control and monitoring measures, it is necessary to emphasize the visual control of the state of the injured area; the supervision of appearance of inflammatory, vascular and neurological alterations (effusions, Sudeck's disease), or dermatological control of the area affected by the immobilization (pruritus, eschar). 438

F. Blaya et al. The applicable physiotherapeutic techniques, thanks to their integration in the design of the functional splints, are aimed at the substantial reduction of the deterioration associated with the period of immobilization of the injury. In this way, concerns such as inflammation, pain, problems in the venous and lymphatic circulatory system or loss and atrophy of muscle mass are prevented, mitigated or avoided. Consequently, individualized immobilization splints (made by Advanced Manufacturing techniques, based on additive manufacturing) lead to improvements in the treatment of conservative rehabilitation of intrasubstance rupture of Achilles tendon. They allow the beginning of the functional rehabilitation phase with favorable muscular and joint conditions and achieve the shortening of the rehabilitation period and the total duration of the treatment.

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