Pilot study of the wrist orthosis design processDavid Palousek Faculty of Mechanical Engineering, Brno University of Technology, Brno, Czech Republic Jiri Rosicky Faculty of Health Studies, University of Ostrava, Ostrava, Czech Republic, and Daniel Koutny, Pavel Stokla´sek and Tomas Navrat Faculty of Mechanical Engineering, Brno University of Technology, Brno, Czech Republic Abstract Purpose – The purpose of this paper is to describe a manufacturing methodology for a wrist orthosis. The case study aims to offer new approaches in the area of human orthoses. Design/methodology/approach – The article describes the utilization of rapid prototyping (RP), passive stereo photogrammetry and software tools for the orthosis design process. This study shows the key points of the design and manufacturing methodology. The approach uses specific technologies, such as 3D digitizing, reverse engineering and polygonal-surface software, FDM RP and 3D printing. Findings – The results show that the used technologies reflect the patient’s requirements and also they could be an alternative solution to the standard method of orthosis design. Research limitations/implications – The methodology provides a good position for further development issues. Practical implications – The methodology could be usable for clinical practice and allows the manufacturing of the perfect orthosis of the upper limb. The usage of this methodology depends on the RP system and type of material. Originality/value – The article describes a particular topical problem and it is following previous publications in the field of human orthoses. The paper presents the methodology of wrist orthosis design and manufacturing. The paper presents an alternative approach applicable in clinical practice. Keywords Reverse engineering, Rapid prototyping, FDM, 3D digitizing, Wrist orthosis Paper type Case study following one of two approaches, both of which are contact processes. The first approach entails the manufacturing of a negative plaster cast. It is then filled with plaster to produce a plaster model (copy). The plaster copy is then used for the formation of thermoplastic material (PE – polyethylene, CPP – copolymer polypropylene), manually or by means of a vacuum. A plastic shell is subsequently cut and ground to the desired shape and finished (adding padding, fastening straps, etc.). The second option uses low-temperature thermoplastic (“Aquaplast”), which is formed directly on the hand. Furthermore, it is necessary to complete the orthosis (trimming, hemming the edges, fastening straps). The described procedure is suitable only for the orthosis, which is not expected to significantly correct the problem. Both methods are not used in mass production. Digitizing technologies and RP allows contactless production, which can be less stressful for the patient and allows easy repeatability in case of failure of the product. This text focuses on the area of orthoses, that is to say, on the tools for maintaining mutually movable parts of the body in a fixed position. 1. Introduction 1.1 Motivation The current state of knowledge allows a solution of the production of upper limb orthoses using advanced technologies such as rapid prototyping (RP) and reverse engineering (RE). These approaches, nowadays in common practice, allow the realization of products on a higher level, especially in terms of design and comfort of use. The question is: are these technologies able to be effectively implemented to make an orthosis for the upper limb and thus improve its functional characteristics? Are the technologies effective and affordable and are the procedures reliable in results? Can the manufacturing process be significantly simplified? This case study tries to provide the answers to the aforementioned questions. The case study was developed in cooperation with a manufacturer of prosthetic and orthotic devices in the Czech Republic and focuses on the manufacturing process, and intends to explore the feasibility of the approach. 1.2 Manufacturing Orthoses are used for the immobilisation of the forearm, wrist and hand to relieve long-term conditions or support injured limbs. It also serves as a substitute for plaster splints after surgery. The production of the orthosis is accomplished by The work described in this paper was completed in cooperation with the orthotic-prosthetic facility ING Corporation, s.r.o. in Frydek-Mistek and the Department of Rehabilitation, Faculty of Health Studies, University of Ostrava and the Institute of Machine and Industrial Design Faculty of Mechanical Engineering, Brno University of Technology. The present work has been supported by European Regional Development Fund in the framework of the research project NETME Centre under the Operational Programme Research and Development for Innovation – NETME Centre, ED0002/01/01, CZ. 1.05/2.1.00/01.0002. All the authors declare that they have no conflicts of interest. The current issue and full text archive of this journal is available at www.emeraldinsight.com/1355-2546.htm Rapid Prototyping Journal 20/1 (2014) 27– 32 q Emerald Group Publishing Limited [ISSN 1355-2546] [DOI 10.1108/RPJ-03-2012-0027] Received: 7 October 2011 Revised: 26 July 2012 Accepted: 2 October 2012 27 2011). Cook et al. Besides the methodology of design and production of individual ankle-foot orthoses. additive-based molding. 2005). On the basis of the surface model.763 polygons). A manufacturing process of ankle-foot orthosis with the aim of restoring the motion of the ankle-foot complex has been previously described (Milusheva et al. The limb position during digitization should be identical to the position inside the orthosis. A good example might be an article dealing with the construction of the ankle brace (Mavroidis et al. Faustini et al. RP and 3D digitizing are also applicable to the design of custom-made prostheses and orthoses. This FCS-100 scanning system is specifically designed to capture 3D surface images of human faces or the whole body. including direct manufacturing.g. which is determined by a doctor according to the type of disability. several approaches were considered. course of treatment. This technology can also serve for production of the master model. The results of the work show that the brace has almost the same biomechanical effect on walking as standard products. 2010). 2006). 2011).3 Current state of knowledge The area of 3D digitizing and rapid additive manufacturing for the manufacturing of artificial limbs and leg orthoses provides a good source of information in relation to the issues explored in this paper. 3D scanning was used in order to obtain the geometry. This paper describes a methodology for the production of an individual AFO with the use of 3D scanning. Germany). Using the software’s features. similar procedures are used (Toshev et al. The development was carried out in cooperation with a manufacturer of prosthetic and orthotic devices.. 94. 2. 2011). 6 surface finishing. 4 CAD design process. coloring. 2005). The article describes the testing of porosity of the models made by powder technology (Z Corporation) used for thermoforming of thin thermoplastic sheets. RP and mutual comparison (in terms of biomechanics) with the individual brace produced by a standard technique. Another example is the use of 3D digitization and RP for the implementation of transradial and transtibial patient wearing socket realized by use of the Z Corporation Inc (Burlington. attention is also paid to the manufacturing precision of RP technologies (Schrank and Stanhope. this process is much more complicated where the whole limb is required or when multiple captures have to be taken and aligned (Paterson et al. In the case of the upper limb orthosis. For the design of the orthosis. 5 RP of the orthosis. especially in the case of facial replacements (Sansoni et al. laser cutting of foam and several combinations of these approaches. which greatly facilitated the creation of new surfaces in regard to other design work in the subsequently used CAD modeler. which greatly accelerates and simplifies the whole process.. The production of prosthetic devices using 3D scanning technology and RP is relatively well described.. Interesting work is presented in a review article (Hieu et al. a construction of the brace is created in CAD. which states the construction of new custom-made elbow orthoses from 3D models of the elbow and fabricated by SSL.. one side type (Figure 5). The whole manufacturing methodology of this case study covers five main steps (Figure 1): 1 data acquisition of the upper limb – one side geometry. which is used for further processing. On the other hand. USA) Z402 3D printer (Herbert et al. the surface model was smoothed (Figure 2) as much as possible. 2009). All photos are captured at one moment and the model is then created in a few seconds.. closing holes and smoothing of the polygonal network was performed. (2010) deals with finding the ideal way of reproducing the rather complicated variable thickness pedorthosis geometry and using appropriate materials. 3 parametric surface generating. The 3D Systems Inc (Rock Hill. Figure 1 Design process of the upper limb orthosis 28 . where the analysis of network errors. 2 polygonal data processing. The cast of the upper limb is scanned and then transferred to the surface model. The primary objective of this study was to explore the feasibility of using a SLS.. The need of only one scan during the scanning procedure was taken advantage of. 2.. e. a scanned geometry of the patient’s legs and CT data were used. Volume 20 · Number 1 · 2014 · 27 –32 2.2 Polygonal data processing Data obtained by digitization of the limb were processed in ATOS 6. etc. It uses four 10 megapixel cameras to create 3D models with highly detailed texture maps (a resolution of up to 21 megapixels). and 7 testing..3 software (GOM mbH. Methods 1.Pilot study of the wrist orthosis design process Rapid Prototyping Journal David Palousek et al. USA) Selective Laser Sintering (SLS) was used for hard-shell manufacturing and SLA-5000 stereolithography for the soft inner layer. thermoforming of medical devices (Chimento et al.1 Data acquisition Scanning was performed with a di3D FCS-100 photo scanner from Dimensional Imaging. as a PD-AFO manufacturing process. The aim of this case study was to propose a suitable methodology of design workflow for the static individual human upper limb orthoses (WHO – wrist hand orthosis) by the use of RE and RP as the final production technology. because the design of the orthosis is similar to the design of a conventional orthosis. 2005).058 points. (2008) addresses the use of SLS technology for the manufacture of passive dynamic ankle-foot orthoses (AFO-PD). For the creation of the pedorthosis. The digitized geometry of the limb surface was saved in a polygonal STL format (48. Braunschweig. there was no need to scan a limb from multiple sides to get complete scan of the limb. g. The orthosis is usually made from thermoplastic with a thickness of around 2-3. this step could be fully automated by use of smoothing algorithms together with the characteristic points (called landmarks) located in the problem areas of the scan. All edges of the hooks were rounded. painted with base filler and polished until smooth with fine sandpaper under water. the surface was converted to a format compatible with CAD systems – the IGES format was used.8 mm. the contour shape of the orthosis was created and the useless surfaces were removed. in the palm area of the orthosis. This RP technology has been used as a Direct Digital Manufacturing in the sense that the printed model was used as the final product.Pilot study of the wrist orthosis design process Rapid Prototyping Journal David Palousek et al.5 hours. because the contact area between the orthosis and the hand will be covered by a soft. For the possibility of further orthosis design by means of parametric modelers. The clearance of 0. Thickness was added to the modified surface of the future orthosis. the shape and size of the air vents holes were designed in the areas with low loading of the shell to not adversely affect the mechanical strength of the orthosis. After consultation with an experienced orthotics expert from a cooperative orthotic laboratory.4 Rapid prototyping The orthosis was printed on a Dimension SST1200 printer (Stratasys Inc. Creation of the ventilation holes also saves building material during 3D printing by RP methods (for some methods. Soluble technology allows the removal of support material without damaging the thin-walled products. For good ventilation of the skin of the orthosis user. the thickness of the orthosis was set to 3. When implementing the proposed process into practice. For the comfort and safety of the patient and to avoid catching objects on the sharp peripheral edge. 66 cm3 of ABS model material and 77 cm3 of support material were used. according to the required clinical individual needs. necessary for keeping the user’s hand in the desired position. the model was imported into the SolidWorks parametric modeler. the outline edge of the orthosis was rounded on both sides. two coats of paint and then a clear varnish were applied (Figure 5). 2. the existing polygonal surface was offset (in the direction from the palm to the observer) from the original area by about 1.5 mm. Hooks for the connection of the steel clips were created by using 2D sketches onto properly positioned datum planes and datum axis on the outer surface of the orthosis shell. The creation of properly placed hooks with respect to a suitable position of the Velcro straps and with respect to the hooks’ loading was the most time-consuming operation of the entire design process. Volume 20 · Number 1 · 2014 · 27 –32 Figure 3 Final CAD assembly Figure 2 Scan of the limb after smoothing Smoothing of the model surface does not have an essential influence on the orthosis and its fixation on the upper limb. in Toderan and Lunsford (1978) article. This design change was made to improve patient comfort and better the fixation abilities of the orthosis. Significant loading of the orthosis is not considered especially in case of treatment of postoperative and posttraumatic states. The wall thickness of the hooks was set to 3. e. Afterwards. The sharp edges of the holes were rounded to ensure smooth movement of the Velcro strap while wearing the orthosis. In the future. Ventilation holes were created in the same workflow as the aforementioned clamping holes. followed by the creation of the surface patch and subtraction of the patch from the shell to a depth of 3. Because.5 mm. For this reason.1 mm for the steel pin was used with respect to the RP manufacturing technology. Basic information about the forces in the wrist can be found. the strap connection cannot be made by clamping hooks and metal clips. This step was taken only to improve the presentation of the final product. Eden Prairie.3 CAD design process Once converted into IGES.25 mm. where volumetric data was constructed.5 mm. which gave the orthosis shell volume. a direct connection of the strap using holes produced directly in the orthosis shell was designed (Figure 3). For the creation of the orthosis prototype. one in the palm area and the second in the forearm.5 mm. the use Figure 4 Orthosis prototype made by FDM technology 29 . USA) using FDM technology (Figure 4). the building time was 9.8 mm to ensure user comfort. Holes were created using a sketch projected onto the shell surface of the orthosis. there is also a substantial reduction in production time). Based on experience. Each steel clip is connected by a pair of hooks. In the area between the forefinger and thumb. 2. The surface was then manually sanded with emery paper. the orthosis was deprived of the support material used during construction by dissolving it in a special bath. Before assembly. In the RE software. The final CAD model of the orthosis without metal clips was exported into STL format and prepared for RP production. while the height of the layer was 0. an eyelet was created with a hole for a Velcro strap. breathable fabric with a thickness of 1. two air vents were designed in the shell. UK) and tensile tests of Aquaplast (Orfit Classic Soft. Measurements were taken according to ASTM D 638-03 and ASTM D 790-03. an RP technology ZPrinter 3D printing was used for verification of the design. It was possible to test the function of the connecting elements and verify the orthosis ergonomics. CAD modeling and RP. First.g. The application of the RE software and SolidWorks 3D parametric modeler allows faster design work and the creation of a high-quality geometric model. therefore the presented values have been arithmetically averaged. which is the production of a fully functional prototype. North Sea Plastics Ltd. a prosthesis interlayer between the brace and limb is usually used (e. six samples were used.v. Belgium) have been provided. the ZPrinter orthosis met the expectations. Glasgow. In this case. The work process of the modeling and creation of a 3D geometry of the orthosis from data obtained by scanning the upper limb was practically verified. has been presented. 3. It mainly concerns itself with optical digitizing. Figure 7 Load – extension test Table I Material properties ABS (FDM). For comfort during use. Three measurements of tensile test and three measurements of bending test were carried out with respect to the different orientations of the sample during building process (Figure 6). the fabric is used to secure user comfort and hygiene. A faultless geometry model is necessary for smooth transition to the next phase of the design process. for the second prototype. Discussion An innovative methodology of design and manufacture of the wrist orthosis using digital technologies throughout the whole design cycle.. lining of PE plastics). For each measurement. Volume 20 · Number 1 · 2014 · 27 –32 Figure 5 Final orthosis Figure 6 Test specimens of a colored construction material with minimal requirements for post-processing is expected to be used. Mechanical properties of layered ABS plastic were measured using the tensile and bending tests (Figure 7). Premium Grade copolymer polypropylene.Pilot study of the wrist orthosis design process Rapid Prototyping Journal David Palousek et al. the results of tensile and bending tests for high-temperature copolymer polypropylene (CPP. a more efficient use of time is likely to be found. For comparison. Wijnegem. Orfit Industries n. Thanks to ABS.5 X . the orthosis was more flexible and more resistant to bending stress.5 17 52 60 23 44. CPP and Aquaplast ABS Tension Flat position On the side Upright Bending Flat position On the side Upright 30 Ultimate tensile strength (MPa) CPP Aquaplast 25 30 12 26. In terms of ergonomics. Based on similar CAD applications. FDM technology that works with ABS plastic (a factory designation of ABS þ ) was selected. The values varied in the order of units. The demands on design and software skills of the designer entail basic knowledge of RE and an intermediate level of CAD. and also the connection hooks for the metal clips are not prone to cracking or breaking (Figure 6). The measured values of ultimate tensile strength are shown in Table I. Therefore. RE. including production. a surgeon. Rapidform. The shell would lay on the plane and with morphing. it is a negative deviation. During the first tests. The results of measurement suggest that the material properties are sufficient for use in this particular case. Conclusions The RP of orthosis or prosthesis itself significantly accelerates the process of the patient’s integration back into their social environment. and overall costs. Therefore. The idea is that the scanned data would be shaped by the base shell. a clinical validation will be necessary. This study does not aim to carry out clinical tests. Another way of automation and simplification could be the utilization of morphing. Although the deviation seems to be large. (2002).4 mm. it is necessary to answer the questions set in the motivation. the software programs Rhinoceros. or high-temperature thermoplastic or laminate (5-10 hours). The orthotics are responsible for the technical performance of the orthosis. hooks for straps. it should be also noted that in the finished orthosis. but it is clear that they are irrelevant for the orthosis shape design. and thus the shell would copy the surface geometry. as indicated in the introduction.8 mm soft interlayer fabric between the limb and the orthosis.3 Patient The implementation of CAD and Additive Manufacture in the production of orthoses could contribute to increased speed of production and patient comfort.). which already has pre-created features such as a cut out for the thumb. Ultimate Tensile strength was determined from an average value of eleven measurements as Rm ¼ Fmax/S. in the near future. it does not affect the main function of the orthosis. Large deviations can also be seen (Figure 8) between the fingers. used building materials and their properties. A deeper analysis of the anisotropic behavior and comparison with other standard plastic materials can be found. because the thumb is eliminated in the subsequent designs. would be wrapped on the scan. which is not essential. Unfortunately. Figure 8 Deviation between orthosis and hand scan 31 . e. 4. of course.2 Implementation The implementation of this workflow in practice depends primarily on the development of 3D printers. etc. The costs of using digitization technologies and additive manufacturing are. It could considerably speed up the design process. the position of the limb) are prescribed by specialists (orthopedist. Volume 20 · Number 1 · 2014 · 27 –32 Aquaplast showed enormous enlongation during the tensile test. no conflict of pressure onto the tissue surface was found. relatively high. 3. Direct Digital Manufacturing. this is not a common practice in orthotic and prosthetic companies.g. rehabilitation doctor) who are responsible for its clinical efficacy. therefore a bending test was not carried out. this procedure is not economically feasible in comparison with standard manufacturing methods of similar orthosis types (Table II). In conclusion.g. However. Time cost of the standard procedure depends on whether it uses low-temperature plastic moldable on the hand (1-3 hours). Rm ¼ 17 MPa. etc.Pilot study of the wrist orthosis design process Rapid Prototyping Journal David Palousek et al. the smoothed area is above the real geometry and does not touch the wrist surface. That means that relevant deviations are within 2. In the case of the production of custom-made WHO types of orthoses (or similar types) in larger quantities. An aim of all medical centres and organizations is to increase the patient’s comfort and improve the environment in which the orthotic or prosthetic devices are developed and tested. The largest deviations were found in the thumb. which requires expertise and knowledge of CAD modeling. In practice (Czech Republic) clinical requirements for the orthosis (effect of the orthosis. which is the fixation of the position of the wrist and the forearm. The possibility of a combination of the rapid manufacture of orthoses and patient comfort without reducing the quality of the final products could bring the interest of medical facilities to the ideas of the implementation of new technologies such as 3D scanning of the human body. 3. At present. it would be advantageous to automate some of the design phases using macros by a modeler which allows their creation (e. air vents. if the presented methodology would be used in practice as an alternative method of production. The creation of macros in CAD is one possible way. deviations between the smoothed and the original shape were analyzed. 3. the manufacturing of functional prototypes by RP methods or.1 Quality control To determine how the smoothing of polygonal data affects the resulting geometry. which partially eliminates shape deviations. in the article of Ahn et al. there will be a 1. Regarding the deviations. the cost of materials and operation are not insignificant.C..D. and Dimov.. (2005). Vol. as stated in Wohlers (2011) Report. C. R. pp. B. Zlatov..Y. Rizza. Drillio. shows an increase in global sales of RP materials. Vol. pp. 8 No. P. Montero. 387-392.2 1 2 6 9. T. Further Reading Jain. Toderan. 48 No.C. The resulting additively manufactured orthosis compared well with the standard item and was deemed fit for purpose by appropriate experts. and Bonato. “Additive fabrication of custom pedorthoses for clubfoot correction”.T. Vol. Rapid Prototyping Journal. Virtual and Physical Prototyping. Roundy. Milusheva.g.. Virtual and Physical Prototyping.. (2005). Cavagnini. Hieu. D. and Gastaldi. Tosheva. integrated mounting.L. X.J..H. S..E..C. 189-193.J. coloring). pp.E. W. Y. Khanh. “Manufacture of passive dynamic ankle-foot orthoses using selective laser sintering”.. G. and Stanhope. Intelligent Production Machines and Systems. pp. Robotics and Computer-Integrated Manufacturing. 4. D. 3. Annual Worldwide Progress Report. Journal of NeuroEngineering and Rehabilitation.. and Soroka. N. P. R.. Sansoni. 253-257. (2011). a gradual reduction in prices can be assumed. 25 No. However. Caddle. “3D printed tooling for thermoforming of medical devices”. and Cambell. 2. CO. IEEE Transactions on Biomedical Engineering.). A. L. E. Paterson. However. “Tissue pressure tolerance as a guide to wrist-hand orthosis design”. Journal of Rehabilitation Research and Development. In terms of time consumption.. and Stanhope.P. Amsterdam. (2002).. Docchio. References Ahn. 141-146. M.. 32 No. J. (2010). Vol.M. S.V.J. Wohlers. 5 No. D.K. Vol. J. the proposed process is longer. Bibb. A. L. 201-207. Elsevier. M. Stefanova.R. Kamara. The pilot study shows that digital technologies can be used for the production of wrist orthosis. Eldukhri. Sivak. Herbert. Fort Collins. S. 4. (Eds)..5 5 23.. S. 4. Highsmith. 248-257. 11. Patritti.. R. in Pham. 17 No. R.B. pp.H..J. D. M. 55 No. P. G. Corresponding author David Palousek can be contacted at: palousek@fme. “Virtual modeling of an ankle foot orthosis for correction of foot abnormality”. pp. Volume 20 · Number 1 · 2014 · 27 –32 Table II Duration of whole process (first processing) Faustini. 5. S.. whereas the rehabilitation benefits are mainly in the contactless data capture and also contactless manufacturing (in comparison with the Aquaplast method). and Crane.emeraldinsight. Hieu. Kouzmanov. the software processing time can be reduced by the aforementioned software automation. Vol. W. 3. 2. Vol. N... N.. N. and Vyas.I. V.. “Medical rapid prototyping applications and methods”. Moreover. 1.E.. In the future. Intelligent Production Machines and Systems. 16 No. 37-43. Simpson. P. pp. It has not yet been tested and it gives more opportunities to develop the topic. Rapid Prototyping Journal. pp. and Liu. 217-226. pp. A. Orthotics and Prosthetics.. Time (h) 3D digitizing. (2005).. M. Assembly Automation. Also. S. Sivak. K. 42 No. structureshaped shell. T. 284-292. E.. 4 No. (1978). pp. Vol. “Patient specific ankle-foot orthoses using rapid prototyping”. (2011). Bohez...g. (2009). Journal of Rehabilitation Research and Development..H. 8.. Rapid Prototyping Journal. Govind Dhande. and Toshev.G. J..L. Oxford. Wohlers Associates Inc. R. (2010).7 The process requires an investment in machinery as well as in software. F. Vol. (2011). Tosheva. Hieu. Odell.cz To purchase reprints of this article please e-mail: reprints@emeraldinsight. Y. R..com Or visit our web site for further details: www. 4.V.. Elsevier. L. Wohlers Report. and Wright. 27 No.C. and Toshev..J.Pilot study of the wrist orthosis design process Rapid Prototyping Journal David Palousek et al. “Personalised ankle-foot orthoses design based on reverse engineering”.. E.. Vol. “A review of existing anatomical data capture methods to support the mass customisation of wrist splints”. p. Chimento. Sloten. L. It is assumed that the procedure can be applied to limbs of different sizes (different thicknesses of the orthoses can be used for a child’s and adult’s hand). Ranky. R. market development in additive manufacturing. Spence. 2. lightweight shell. (2011).. DiPisa. L. Oris. Zlatov. Toshev. etc.. pp. G. 784-790. Gervasi.C. Govoni. “Anisotropic material properties of fused deposition modeling ABS”. L. (2008).S. (2006). Crawford.vutbr. L.. Mavroidis.L. “Reverse engineering and rapid prototyping for new orthotic devices”. Vol. Cook. In comparison with the classical manufacturing process. S. Gilhooly. Binh. Neptune. Y. Vol. E.S. (2011). N. Zlatov. S. D. which are not necessary in terms of functionality (e. however the required time can be reduced by use of faster RP production technologies and a minimization of part surface finishing. Schrank. in practice the manufacturers of prosthetic and orthotic devices have at least some of these technologies or cooperate with institutes which are equipped with these technologies. M. M. S. 31-42. post-processing Polygonal data processing Surface generating CAD model creation (primary) RP FDM part building Surface finishing Total 0. Lancia. Of course.. and Lunsford. N. and Ion. the use of digital technologies for orthosis manufacturing opens up a possibility of further functional and structural modifications that cannot be implemented by standard technology (e. “Virtual and physical prototyping by means of a 3D optical digitizer: application to facial prosthetic reconstruction”. 257-260. “Dimensional accuracy of ankle-foot orthoses constructed by rapid customization and manufacturing framework”.com/reprints 32 . E.T.Y. “A preliminary investigation into the development of 3-D printing of prosthetic sockets”. pp. the proposed procedure is complicated and requires knowledge of CAD systems. . users may print. However. or email articles for individual use.Copyright of Rapid Prototyping Journal is the property of Emerald Group Publishing Limited and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. download.
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