Yesterday I shadowed the hilarious Pankaj in fitting a bilateral below-knee amputee at the Jaipur Foot Clinic. On a day with more than 100 patients in line waiting to be fitted and about 20 technicians on staff, he decided to make a pair of open ended prosthetics (no full contact socket).

First the stumps are wrapped in cellophane and a plaster of paris mould is taken. They use cotton bandages they dip in PoP themselves, because pre-pregnated PoP bandages are relative expensive (~$2). Landmarks such as the patellar tendon are marked at this point.

A plaster positive is cast into the plaster negative, and is then modified to create a triangular shape by building plaster up over the shin, and plaster is removed from the patellar tendon, which will be a main contact point.

The positive is then extended, and the extension is grafted on with more plaster. The extension is what will give the rest of the leg shape. If we were dealing with a full contact socket, a polypropylene socket would be first vacuum moulded over the positive before extension, then the polypro socket would be extended.

A HDPE pipe heated to 200C for half an hour is slid over the positive and hand moulded into form. Extra attention is given to the pressure points around the patellar tendon and behind the knee.

The pipe is cut to shape and sanded to remove any sharp edges. A lot of the equipment the clinic uses is Otto Bock (a prosthetics and prosthetic tools company based in Germany), such as their sander, ovens and vacuum moulder, but a lot is also simply hand tools.

The final sanding is done with shards of glass, smoothing out the HDPE and removing any excess material.

Before fitting the feet, the socket is checked with the patient. The patient is given cotton liner socks to wear, not silicone or nylon.

If the fit is acceptable (tight and no painful pressure), the ankle is heated an a Jaipur foot is attached with screws, drilled into the wooden ankle block.

Alignment is done mainly by eye, the prosthetic should be able to stand freely.

The patient is given the prosthetics and encouraged to walk to the gait training area. Within the hours that I was there, the patient (who is over 50 years old) managed to start confidently walking freely. It was all in all, kind of amazing.

Last year, after setting up a FabLab at the COEP, I went to BMVSS, an organisation that provides low cost prosthetics to amputees in developing world countries. Since then, I’ve been slowly becoming more involved with working on medical devices. Last semester I was a teaching assistant in the class Developing World Prosthetics (taught by Ken Endo, PhD candidate in the Biomechatronics group), where I tried to share some of the FabLab processes to help with the design and prototyping of prosthetic limbs. I was the mentor for a team working on paediatric prosthetics in particular. The team consisted of Deema Totah and Cindy Oh, two awesome mechanical engineering undergrads.

Cindy and Deema on the right with a Jaipur foot, and then iterations on a theme made in the basement

Last time in Jaipur, dr. Pooja Mukul explained she was trying to make an extendable prosthetic for kids to use, but that she was running into too much difficulty getting a decent prototype together. We hope that at some point we can install a FabLab at BMVSS for this kind of R&D work, but meanwhile we played with the idea in our basement lab, with the intent of testing it in Jaipur at some point in the future.

Concept sketch and unbaked 3d printed pyramid connectors

In the DWP class, we had a bunch of cool guest speakers, including dr. Mukul, dr. Wu from Northwestern University, Bob Emerson, a prostheticist in Boston, and also Joel Sadler, who was on the team that developed the Stanford/Jaipur knee. Joel meanwhile graduated and started a company focussed on low cost prosthetic designs called (re)motion.

Hugh Herr and Joel Sadler

In India, I first visited the Delhi BMVSS clinic, where I was welcomed by Sanjeev Kumar and his crew. He’s been working with Ken Endo and others on another knee design, the Exo Knee. The Delhi Clinic is much smaller than the Jaipur clinic, but still sees 2-3 new patients a day and manufactures around 25 orthoses and 10 prosthetics a day.

Entrance to the Delhi Clinic

The Delhi clinic does not yet fit AK patients with the Stanford/Jaipur knee, although this may come in the future. Meanwhile they crank out a lot of these caliper knees, entirely hand lathed.

external caliper knee

The Delhi clinic deals with a lot of polio patients who are still looking for ways to be mobile. They manufacture orthosis using polypropylene sheeting moulded over nylon fabric, and fit the patients with those daily. The orthoses don’t have the rubber joints like they do in the US, they are hinged with rivets.

cutting the polypropylene to size

In Delhi, Dhananjay V. Gadre runs a mini FabLab working only on electronics projects. I visited his lab at NSIT, which was full of students even though it’s the middle of break for them. For prosthetics, Dhananjay has been working with Alex Schaub from the Amsterdam Fablab on making a low cost laser alignment system. Hopefully this can provide a spark for a medical devices and R&D FabLab in the future.

I’ll be here until August 5th, working on prosthetics and um, also finishing my thesis? Which (eek) is due far too soon.

I went back to Haystack Mountain School of Crafts for a wonderful week of craft, fablab, guitar, volleyball and lobster. Also the Deer Isle Independence day parade, in which I again found myself a sea creature.

My master’s thesis is on rapid prototyping with friendly materials: especially composites, which allow making large, light and strong structures. Going to Haystack involved me bringing several bales of natural fibres: sisal, cotton, hemp & kenaf; many gallons of low-VOC emitting polyurethanes and other 2 part plastics; and also some starches and proteins to try the less-durable kind of resin. At Haystack, I was going to experiment with what we could make with those materials and how they were to handle.

Leslie Tharp and Matt Bissett took Matt Hinçman’s mixed media session and made this amazing boat. They used the heavy duty cotton canvas and a polyurethane resin (smooth-on’s smoothcast 305) over a wooden shell. They did the entire thing in about 2 days, including the design.

Tom Spleth is a ceramicist who makes plaster positives, working with the plaster as it is setting to create architectural forms he later casts as porcelain. Here is a video I stole from Tim Ayer’s blog of Tom’s process of working with curing plaster:

Tom and Juan Torres took to the visiting artist’s studio deck to try to see what forms would emerge from them taking a similar approach with the same cotton canvas and polyurethane Leslie and Matt were using for the boat. Tom and Juan used the ultra-fast setting polyurethane, so that they could hold the canvas in place as it cured and thus shape a form.

Tom Spleth, friendly composites and Eames

Tom & Juan’s molding hands, discarded in the process

The canvas fabric is not ideal– better would be a more thinly woven fabric applied in more plies. Cotton however, is not a very strong fibre and might not withstand the process well if it were much thinner. A lot of the stalk and bast fibres I’m using are very strong– the sisal I use is on par with fibreglass for strength in tension. However, if set in a epoxy that cures at a high temperature, the fibres become damaged and do not work as well. Furthermore, it not easy to get cellulose fibres in nice weavings and tapes like carbon and glass fibres come in, so prototyping is limited.

Either way, with the raw unchopped sisal fibres I had, I knitted a swing while waiting for fab machines to finish running and my code to load onto the slow-ass avrs I was programming. I knitted using drumsticks that we also used for playing late night country music. My new favourite song is Jonathan Ward singing just because you’re better than me, doesn’t mean I’m lazy.

The swing however, is not a composite, or a particularly cool process. I’m not super enthusiastic about using the polyurethane– even though the polyurethane is not super toxic or bad to work with, it is hard to recycle and lasts for much longer than its general intended purpose. I’ve been trying different low-tech resin recipes, making corn starch and soy protein films, and melting tree sap roisins. Unfortunately the films dissolve immediately in water and the roisins remain sticky after the process.

You can however, laser cut the film.

ik wilde het opschrijven, zodat de absurditeit evident zou worden en ik daar vanuit weer verder zou kunnen.

ik weet echter ook niet hoe ik die verwachting gevormd heb.

Video by: Canay Ozden
Prostheses are critical body extensions. They should naturally fit the body, lend themselves to customization, and be affordable, none of which are provided by today’s industry. Nadya Peek, of MIT’s “Fab Lab,” takes us on a short tour of the world of those who seek lighter, cheaper, and stronger prosthetics.

Canay Ozden is a lovely PhD student in the Science, Technology and Society department at MIT, I was introduced to her by my favourite post doc, JB Labrune. At first we were going to make a movie about fablabs in general and include some stuff on me volunteering at the South End Technology Center Fablab in Boston or annoying the people at the AS220 Fablab in Providence, but all the planning didn’t work out, so it’s about prosthetics instead! Woohoo!

Some things which may not be clear from the video: the original design for the knee is by a team of Stanford students including Joel Sadler, and I’m not working on it, but other people at MIT are trying to improve it. In fact, I’m so not working on knees that in the video I’m holding it upside down. Oops.

Years before the recent earthquake in Haiti, there was talk about putting a fablab in Port-au-Prince. There has never really been enough critical mass to start a Haitian fablab though. After the earthquake, with so much attention focused on Haiti, it was a good time to ramp up the work on a Haitian fablab. I started a website detailing the possibilities of a Fablab, seeking stakeholders for a Fablab and raising funds for a Fablab.

Based on my experiences with the Fablab in Boston and beyond, I gave a Pecha Kucha talk at the 15th Boston Pecha Kucha: the format was 20 slides, 20 seconds per slide. It was very stressful, but since I made notes beforehand, it’s easy for me to put the condensed talk online. I reposted it here, for your enjoyment.

Hi, I’m Nadya Peek, I’m a student in this building in the Physics and Media group, involved with Fablabs and the Developing World Prosthetics class in D-lab.

In this photo you can see the materials for a fablab arriving at the College of India, Pune, Maharastra. Fablabs don’t always arrive in truckloads, each Fablab is built in a different way.

a Fablab contains, amongst other things, a 3 axis router, a small 3 axis mill, a laser cutter, a vinyl cutter and a full electronics workbench. The idea is that with a Fablab, you can make almost anything- furniture, electronics, prosthetics.

the Fablab in Pune took us 5 days to set up, and that was because there was no wiring, plumbing or floor when we showed up. We set up the large 3 axis mill first, and used that to make furniture to put the rest of the stuff on.

There are more than 30 labs around the world, sometimes it can be hard to set one up, sometimes it can be easy. This picture shows the mobile Fablab, which drives around the US and is currently in Ohio. It can be self powered, and although it is easier to set up, it’s much harder to take down or away– people rarely want to give it up!

A Fablab is not only machines though, and the machines are certainly less important than the people who help run them. Here you see us at the last Fablab conference, where people from Fablabs around the world showed up to teach each other how to make things.

Each lab is in a different place and will focus on different things. North American Fablabs are generally part of community centres and educational spaces. Here on the right you see AS220 in Providence, RI, they generally have a younger crowd of high school students working on computer and engineering skills.

These are images from the CabFabLab in the Hague, the Netherlands, where girls spent a day making customised keychains on the laser cutter. The event was part of a teach a girl about engineering program.

these images are from a Fablab in Soshangove, South Africa, where this girl learned how to connect and program all kinds of input and output devices to AVR microcontrollers. She now knows more about practical electrical engineering than many electrical engineering concentrators at MIT!

The Fablab can also be used for larger things. Here is a project by Larry Sass, a disaster response house made entirely on a Shopbot 3-axis mill and friction fit together using rubber mallets.

This Shopbotted structure is a current contender for this years Solar Decathlon in Europe.

The oldest Fablab is in Pabel, India, and focusses on agricultural education. Here you can see Yogesh Kulkarni with biofuel cells and a biofuel composter.

Here you see Kipp Bradford from the board of directors of the Providence based AS220 lab testing the Vigyan Ashram lab’s solar cooker (and learning that hot things are hot).

A cycle powered drip irrigator and a 2000 dollar tractor!

And here Bamboo greenhouse– none of these projects are based on the Fablab, but the Fablab houses the tools that help make them.

These are photos I took this summer at the Jaipur Foot Organisation. I’m currently working with them and a team of MIT undergrads as part of d-lab’s Developing World Prosthetics class.

We have funding from MISTI to explore rapid prototyping possibilities for prosthetics. We are currently working on children’s prosthetics in particular.

Fabfi is a project that originated in the Fablab Jalalabad, Afghanistan. There is one big satellite downlink, but not a lcoal infrastructure to get the internet around. So they designed these directional antennas for linksys routers to beam internet around to the places they needed it.

Keith Berkoben showed the routers to people in India and Afghanistan and now they are all able to make these en mass on their own.

After they got annoyed with material and the design, they were able to make their own antenna with the same basic principles and unsaid oil cans! Their antenna was only a few dBs off from the original design.

There’s been we’ve been talking a lot with different people who can be stakeholders for a Fablab in Haiti. Without people to support it, the machines in the Fablab are useless. We started a blog about our efforts and accepting donations for the Fablab.

The challenge is to be the first to submit the locations of 10 moored, 8-foot, red, weather balloons at 10 fixed locations in the continental United States. The balloons will be in readily accessible locations and visible from nearby roads. https://networkchallenge.darpa.mil/Default.aspx

When I first read this announcement, I thought it would start many funny types of sabotage I would later read about on BoingBoing. I also thought about my access to red weather balloons– this happened to be plentiful at the time. Then, a week before the day the balloons were to be out, I was invited to sign up on a website to join an MIT Red Balloon team, the URL being http://balloon.media.mit.edu, suggesting that it was affiliated with the research lab I am part of at MIT. The site described the team joining procedure as follows:

We’re giving $2000 per balloon to the first person to send us the correct coordinates, but that’s not all — we’re also giving $1000 to the person who invited them. Then we’re giving $500 whoever invited the inviter, and $250 to whoever invited them, and so on… (see how it works). http://balloon.media.mit.edu/mit/payoff/

A pyramid scheme for collecting eyes across the US, with monetary payoff as the incentive. Hm. I’m pretty sure this is illegal in many European countries, and although unfamiliar with American law, I really doubt that research groups at universities like MIT can start websites like this without approval from committees like MIT’s Committee On the Use of Human Subjects as Experimental Subjects. Turns out, the post-doc that started the website was part of the same group that was monitoring social interaction of the undergraduate inhabitants of an MIT dorm by monitoring the bluetooth interaction of their cellphones. How surprising.

Preparing for the battle against the minions of elected mediocrity! Also known as those who like wearing fluorescent and extra reflective outfits.

Either way, I wasn’t terribly worried about it, or at least I wasn’t led to more action then arguing with a few of my friends who had signed up (because they thought they could make a buck, or because they thought it was a ‘cool project’). Instead, I joined a small team of subversives in placing fake balloons around the greater Boston area.

We had a good time romping about and sending balloons up in Cambridge, Belmont, Somerville and some other places. We didn’t have time to stick around and pretend to be DARPA employees, but once back home, we uploaded some photos from iphones with hacked exif data to modify the GPS coordinates.

Later that day, it turned out that the MIT Red Balloon team won the Network Balloon challenge. So much for people who wrote computer vision scrapers to look at public webcams and teams that were trying to win and donate all the money to charity. No, really, the best motivator was a pyramid scheme. Yay.

Now, all of this government-funded research I did not support was painful, but then the worst part came when the director of our lab sent an email to the lab-wide list (hundreds of people) inviting us in all-caps and with 11 exclamation marks (misuse of punctuation of course added injury) to a celebration of the research group’s victory.

During the cake and bubbly celebration, the research group poses for the press

Seriously? We have people in our lab working on all kinds of very cool things– electric cars, smart prosthetics, cheap laptops, new kinds of imaging, more natural interfaces… and we bring in funding for our research on a regular basis. And now instead of celebrating a MacArthur or Knight Foundation grant, we’re eating cake and opening bottles of bubbly for winning money which has already been promised into an unregulated human experiment? We’re ok with people signing up for this so they can gamble with their private data (losing it to a military research agency)?

By sharing information on how we now communicate while under time pressure with a common goal, we’re providing the military with information with which they can better understand technologies of dissent. This is the same government that requested GPS location data from Sprint customers 8 million times and arrested people twittering about locations of police during the 2009 G20 summit. I’m not saying we should be dropping defense research, but can we at least not pretend it’s all a game, and that anyone can be a piece?

Having fun in Belmont

While thinking for a wedding present for the awesome Sajid Sadi I decided to revisit my experiments in double cups and persuasive objects. Nowadays, I know how to throw ceramic things on a wheel at the MIT clay studio, so I thought I would make a new kind of double cup with more flexibility than the rigid handled one.

The unglazed wet cups

It was thrown from white clay with hand-built handles. I glazed the insides with rosey dawn, the outsides with volcanic green and double dipped the tops in verdigris. With my congratulations and best wishes to Sajid and Farhana!

The final cups. Photos in use to follow.

The foot manufacturing process is swift, with each worker making between 4 and 6 feet daily.

The Jaipur Foot organisation produces the most low cost lower limb prosthetics in the world, fitting around 200 patients a day with above the knee or below the knee limbs. Their famous Jaipur foot is made of closed cell microfoam and rubber, hand carved and moulded in house. Together with the fitted leg and knee, each limb comes out to about 30 dollars in cost. They might not be the most high tech of limbs, but they are helping hundreds of amputees around the world each day.

The rubber rolling process

Besides making the prostheses in house, they make many of the materials they need in house too. They roll their own rubber (which they can tint themselves depending on the colour they think is most like the patients they will be having that week), recycle their own plaster for casting, build their own tools.

Not all of the legs turn out, and there is still a reasonable amount of waste from the process.

The shafts of the legs are made from high density polyethylene, a thermoplast they bake in large German-made precision ovens and then fit around the plaster of paris mould they have taken of the leg stump. The workers who do this are part trained medical staff and part untrained workers who have built up years of skill in the fitting of prosthetics.

There are two kinds of knee joints that Jaipur foot fits: endoskeletal and exoskeletal. The exoskeletal joints can sometimes be locked into place because if the patient would be standing for a long time, it might be easier to lock the leg into the standing position instead of risking the leg suddenly giving way.

The endoskeletal knee that Jaipur foot is now providing was designed by a group of Stanford students in ME382: Biomedical Device Design, taught by Mechanical Engineering Professor Tom Andriacchi. (Although there is some speculation about the originality of their research). It is a cnc-routed poly-propelene knee which is load bearing in the standing position but will swing with the weight of the foot while walking.

The Stanford knee in testing

Some fifteen percent of the patients that come to Jaipur Foot have what the doctors call and “unfittable stump”. Most of the people in India who lose limbs lose them to trauma, unlike in the US where most limbs are lost to diabetes. In the emergency situations of trauma cases, sometimes there is no amputation doctor available, and doctors will just try to save as much of a limb as possible. This can however result in a stump very unsuited for fitting with a prosthetic.

About ten percent of the patients are children, who have special needs for their prosthetics because they are still growing and might not be able to use a normal prosthetic for very long before adjustment.

In cases like these, Jaipur Foot offers other things to help the patients, for instance, they make their own hand-powered tricycles, with racks on the back which the patient can use to transport their belongings or set up a market stall with. Jaipur Foot will also give patients sewing machines or other objects to jumpstart a new career for the patients.

All the tricycles are painted bright yellow, and are really quite lovely objects.

I was visiting instead of Neil Gershenfeld, to see if Jaipur Foot would be interested in developing a Fablab-style research branch for rapid prototyping of prosthetics. One thing is setting up a research facility though, and the other is having people with time to do the research. The doctors I spoke to were all very keen, but simultaneously did not seem to have much time to spend making prototypes or an inclination to work with machining. It all left a big impression on me though, I hope I can work with them in the future.

Dogs sleep as boys knit… the way things should be?

Vigyan Ashram means science village, and is a rural educational institute located near Pabal in Maharashtra, India. They teach a 2 year program to local people interested in what science and technology can do for them. Vigyan Ashram has had a fablab since 1992, and even though they do not have reliable grid electricity they manage to run a laser cutter, mill, vinyl cutter, scroll saw, soldering tools, etc.

cycle-powered watering crop and bamboo greenhouse

Most of the people who come to study at Vigyan Ashram work in agriculture, and a lot of the inventions that are made there have to do with agriculture. Above you can see Vigyan Ashram’s director Yogesh Kulkarni pedaling a cycle-powered watering system for the vegetable garden, next to a simplified greenhouse made from bamboo. The bicycle is next to a solar sill, which purifies rainwater to make it safe to drink.

Solar panels, DIY tractor, cookies!

Students learn how to build and fix their own tools, down to their homebrew tractor, which was made from 2000 dollars of locally sourced parts. Even if they could bring up the money to buy a ready-made tractor, it would be hard to get it all the way to Vigyan Ashram.

Yogesh demos his cow dung biofuel cells as Kipp Bradford burns some newspaper.

Students also learn how to make solar cookers, biofuel cells and biofuel generators, and geodesic dome homes. The curriculum is as far as I can tell incredibly well tailored to the student’s needs: agriculture and rural living. The students and instructors are very resourceful and inventive, and grow and make delicious food too. I <3 Vigyan Ashram a lot!

More reading on Vigyan Ashram…