Text: Carolin Manggold; Photos: Autodesk, Mecuris, Optimus, 

How 3D printing technology can profoundly change the everyday lives of people with disabilities

Emma is a cheerful four-year-old who loves to dance, climb, slide, and generally romp around with others her age. For little ones like her, simply having fun without a care in the world is a big priority. For Emma, however, it wasn’t always that way. Since she was born, she's had to deal with a disability: Amniotic band syndrome, a congenital disorder caused by the entrapment of fetal parts in fibrous amniotic bands, constricted Emma’s to the ankle joint and some of the toes of her left foot while she was still in her mother's womb. Luckily, Emma is a fighter by nature. At just six months, she received her first prosthesis – one that was produced using a highly complex plaster-printing procedure and cost a good deal more than those made for adults.

»We really believe that kids who have had amputations are entitled to take their first steps with confidence«

 It turns out that providing prostheses to children five and younger is extremely difficult, as Emma's dad René Siebenlist explains: »If you ask me, there are issues in how people are educated and advised on prosthetics and orthotics,« he says, adding that he believes insurance companies have a particular responsibility in this regard (despite the welcome fact that such cases are relatively rare).

Siebenlist also cites the experts who bemoan the lack of a specific ISO norm covering the size of children's feet. All in all, the situation was one that Emma's parents refused to accept. Believing that 3D printing technology could offer their daughter a higher quality of life, they followed the advice of their orthopedic specialist in turning to a newcomer in the field – Mecuris GmbH. Since mid-2016, this Munich-based company has been working to address the problems at hand with its FirStep model, which is designed to provide tailored prosthetic care to small children.


»Thanks to an additive manufacturing technique using selective laser sintering of synthetic (polyamide) powders, we were able to design and print a custom-fit prosthesis for Emma based on an entirely parametric CAD model of her foot,« reports Manuel Opitz, CEO of Mecuris GmbH. »Our 3D printing partner mainly uses machines from EOS – the P395/396 and P760/770, for example, which make it possible to produce an entire artificial leg of a single piece in a horizontal process.« And Emma isn’t the only one excited about the »new pink foot« that was 3D-printed just for her.


Mecuris’s model also stood out to the prominent jury members tasked with choosing the winner of the Purmundus Challenge design award at formnext 2016. In this competition, 18 finalists from all around the world presented their distinguished designs under the theme »3D Printing for the Mobile Individual«.

Mecuris GmbH ended up taking home the highly sought-after golden trophy for the forward-thinking concept behind FirStep 1.0. Those responsible for it have plenty of reasons to be proud of their 3D design.

Manuel Opitz explains how the latest 3D printing technology can fundamentally change the lives of many children, along with their sense of self-esteem: »We really believe that kids who have had amputations are entitled to take their first steps with confidence,« he says. »That means providing them with care that's not only functional, but appealing, as well. We wanted to come up with something attractive and age-appropriate that we could show to the world; the Purmundus Challenge offered an excellent platform for doing just that.« Equipped with additive manufacturing techniques and the digital quality controls they afford, Mecuris is promising to bring prosthetic care to children in ways that have never been seen in mass production.

»On our platform, we can use image data to design prostheses in the cloud and then have them printed on-site,« Opitz offers. »Instead of replacing the experts involved, it makes them up to 400% more efficient, meaning they can focus on their patients rather than on the production side.«


Meanwhile, Emma and her parents are thrilled with how quickly this additive technology can create a prosthetic foot right when she needs one. On-demand care of this kind presents a number of other big advantages, too, including all the trips they no longer have to take to their orthopedic technician.

It’s also important not to underestimate the cost factor at hand: According to Opitz, health insurers provide less coverage for children’s feet than for adults. And since Emma can’t seem to stop growing, she needs a new prosthesis every three to six months. In the past four years, a total of seven have been produced for her.

Mecuris states that the 3D-printed variant makes it possible to provide even more tailored care to children of all ages – and even more importantly, it can be created within a week at a lower cost than in conventional production. The company also reports that the carbon- or glass fiber spring built into its models provide for the same good energy-return characteristics available in some expensive prosthetic feet for adults.

For Emma, this means that each new year brings new opportunities to live more independently and follow her dreams without being held back by her disability. Thanks to her 3D-printed prosthesis, »Emma can interact with others on the same level,« says father René, who adds that she has indeed become more independent.




Another person who has grown familiar with this newfound feeling of independence is 31-year-old Paralympic medal-winner Denise Schindler. After losing her right lower leg in an accident at the age of two, Schindler began relying on her own prosthesis, which has now also been supporting her professional athletic activities since 2010. Her interest in blazing new trails for other athletes with disabilities is a big part of why she keeps striving for technical perfection.


This general effort is focusing in particular on 3D-printing technology, as Schindler explained as a keynote speaker at last year's formnext powered by tct conference in Frankfurt am Main. In additive manufacturing, the cycling world champion sees a breakthrough that's »opening the door to a self-determined life for athletes with disabilities«.

Along with Autodesk, an American software company specializing in 3D design; and her own prosthetic manufacturer, Reha-Technik Wellmer, Schindler initiated a process she hoped would further her sporting career around two and a half years ago. Her goal? Adding more medals to her collection at the 2016 Paralympic Games in Rio de Janeiro.

Taking herself as an example, Schindler illustrated how additive technologies make peak athletic performances possible – including her own silver-worthy effort in last year’s cycling time trials. Several companies were involved in fine-tuning the ideal athletic prosthesis for her.

The process began with a laser scan that took precise digital measurements of the amputation point on Schindler's right leg. Paul Sohi, an Autodesk product designer from London, then used the software Fusion 360 to create a corresponding model, after which it took just a day for the prosthesis to be fabricated by a Stratasys Fortus 450 MC printer at Autodesk's Pier 9 workshop in San Francisco.


In total, more than 20 people worked on the project from across the globe. »The most exciting thing about this endeavor was that experts from all around the world were involved, and that we could contribute no matter where we were,« Schindler affirms.

She goes on to describe how the ability to access the necessary software in the cloud made times and locations irrelevant, which in turn led to a less complex and time-consuming digital manufacturing process. According to Schindler, the project team also had more freedom to experiment with the design and incorporate aerodynamic aspects in a more precise fashion. Here, she also had the support of the Berlin-based institute FES, which researches and develops sports equipment. The Autodesk software Within was also used to help keep the prosthesis as light as possible.


While manually produced prosthetics can take weeks to manufacture and require quite a few trips to an orthopedic technician, Schindler reports that it takes just 48 hours to produce her athletic prosthesis from polycarbonate. She explains that the process is based on a »digital plaster cast that lasts forever«, which makes it possible to apply any necessary changes digitally and adapt the prosthesis to specific stress tests during her training. This aspect is key, especially when it comes to preventing infections in her right leg.

Already squarely focused on her future, Denise Schindler believes plenty of potential remains untapped in 3D printing technology. She plans on being more prepared and motivated than ever to put some gold next to her silver and bronze medals at the 2020 Paralympic Games in Tokyo.

When the time comes, she’ll have an even better, more customized 3D-printed prosthesis to rely on. Schindler wants to encourage people with disabilities – especially little ones like Emma – to believe in themselves, take on challenges, and live their dreams. »If I can be an inspiration to them, even better,« she adds.

The example she has set could also help Emma forge down new paths with the help of digital 3D-printing technology. The four-yearold continues to receive support from Mecuris, which has already developed an improved version of her prosthesis (FirStep 1.1) and will continue to calibrate its new creative design processes going forward.

In particular, Manuel Opitz believes that the additive manufacturing of prostheses will be more the norm than the exception in just a few years, which should lead to significant opportunities. »We've already seen encouraging signs from other areas of medical technology, including the first 3D-printed implants on the market,« he reports. »Surgeons are already practicing operations on anatomical models produced using additive processes; 3D printers are manufacturing more and more hearing aids and dental implants, as well. And this is just the start of a trend whose scope we can hardly define at the moment.«



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