Technology – between vision and implementation - Scans and CAD/CAM
Scans and CAD/CAM
Dan Swatton, Delcam's technical product manager, summarized how digital technologies have changed the world of aids and appliances in the last century. He feels it is a challenge for these technologies to give inexpensive digital tools to the industry enabling the manufacturers of aids and appliances to work at the same or even higher level than with traditional technologies. To make the changes clearer, he contrasted the steps of the traditional workflow to those of digital processes and measured the time saving for each step. Swatton also analyzed where the development would lead to: Better materials and improved machine technologies are intended to lower the costs. The market for semi-fabricated aids and appliances will grow, because these can be adjusted to the data of clients. He also sees an expansion of direct distribution via retailers in the area of sports and sandals, because in-situ-manufacturing will be easier. With additive production, the finish could be minimized and new markets could be opened, Swatton stated.
Nachiappan Chockalingam from the Staffordshire University in Stoke on Trent, UK, continued with a report on how technologies could be applied in clinical practice, using the example of the treatment and care of diabetes. One of the main goals of his work is the development of an integrated system that helps to assess the diabetic foot and to prescribe treatment and care with shoes. With the understanding of the inner tensions and strains of an individual foot, the material for orthotics can be optimized, according to Chockalingam.
He heads an international research team working at the implementation within the so-called "DiaBSmart"-project. The proposed approach can have consequences on the diagnosis of the diabetic foot and on the prescription of corresponding shoes – and thus it can have considerable consequences on the reduction of ulcerations in diabetic feet, according to the researchers. The first results of the project show that stiffness and thickness of the heel cushion influence the plantar pressure, but they do not have any impact on the optimization of the orthotic's features. But the loading seems to influence these features considerably. According to the present results, parameters like the patient's body measures and the loading of the foot during the stance phase should be considered when selecting the materials for the orthotic.
Miguel Oliveira from the Portuguese CESPU (Cooperativa de Ensino Superior Politécnico e Universitário) talked about his study on the analysis of the gait cycle and the plantar pressure in diabetic patients with "walkinsense" – a portable measuring system that measures the plantar pressure distribution in the shoe in a dynamic state. The goal here is to relate the pressure changes that can be observed with the step frequency, the step duration, speed and plantar pressure in type-2-diabetic patients. According to the results, patients with diabetes have modified kinematics as opposed to non-diabetics and also patients with neuropathy show different kinematics compared to non-affected persons. He said that the average maximal pressure was highest in diabetic patients without neuropathy. Trends concerning the foot pressure during the gait cycle depend very much on the step duration, length and speed and thus have to be further analyzed, as Oliveira emphasizes.
