Discover the transformative world of prosthetics and 3D printing alongside Josh Pelz, co-founder of Limber Prosthetics. We delve into the intricacies of designing lightweight, integrated prosthetic devices, exploring how simplification leads to enhanced user experiences.
• Introduction to additive manufacturing in prosthetics • The concept behind a single-unit prosthesis design • Importance of material testing and selection • Engineer-clinician collaboration in product development • Discussion of challenges in alignment and fitting processes • Future outlook for innovation in prosthetic technology
Special thanks to Structure for sponsoring this episode.
00:00:00.620 --> 00:00:03.810 Welcome to Season 10 of the Prosthetics and Orthotics Podcast.
00:00:03.810 --> 00:00:11.788 This is where we chat with experts in the field, patients who use these devices, physical therapists and the vendors who make it all happen.
00:00:11.788 --> 00:00:20.131 Our goal To share stories, tips and insights that ultimately help our patients get the best possible outcomes.
00:00:20.131 --> 00:00:23.207 Tune in and join the conversation.
00:00:23.207 --> 00:00:27.307 We are thrilled you are here and hope it is the highlight of your day.
00:00:27.327 --> 00:00:35.310 Hi everyone, my name is Joris Peebles and this is another edition of the Prosthetics and Orthotics Podcast with Brent Wright.
00:00:35.310 --> 00:00:35.930 How are you doing, brent?
00:00:36.151 --> 00:00:39.164 Hey, joris, I'm doing well, man, I do have a question for you, though.
00:00:39.325 --> 00:00:39.665 Okay.
00:00:40.569 --> 00:00:40.869 All right.
00:00:40.869 --> 00:00:44.722 So, ams, I'm starting to see this more and more.
00:00:44.722 --> 00:00:48.164 It seems like you have a really great line of speakers.
00:00:48.164 --> 00:00:59.469 I saw Jenny Chen and then his name is escaping me now on the, it's the straddling of the public and private sector, but I'm excited to hear and see some of these people.
00:00:59.469 --> 00:01:03.851 But for our listeners, can you, can you us what the goal is of that?
00:01:03.851 --> 00:01:15.477 I mean, it seems like it's a very intimate group, right, and it's more the realist side, it seems, at least from the outside, looking in on what is actually going on in additive manufacturing.
00:01:24.140 --> 00:01:31.605 Well, so for about eight years actually, we've been organizing at the 3D Printcom, we've been organizing additive manufacturing, manufacturing strategies, and for eight years it's been an intentionally small event, like, for example, whenever he's doing hybrid, we were like no, it has to be.
00:01:31.605 --> 00:01:38.507 Or now when, when post-covid, we were like, no, no, it has to be, everyone has to be live, you know, everybody has to be in the room.
00:01:38.507 --> 00:01:46.662 Uh, you know, it's kind of intentionally kind of an event that maybe doesn't appeal to everyone and definitely doesn't appeal to like casual people who are like, oh, I'll see what's up.
00:01:46.662 --> 00:02:16.727 And it's basically, yeah, let's say three, 400, maybe 500 people not more than 500 people in a room in New York, this time four to six February, and talking about strategies, talking about what's happening, talking like last year we kicked off and kind of in a in a very sad note where I was like, uh, you know, I opened up and I said like, okay, guys, this is going to be a very tough year and I think a lot of people this is really funny A lot of people disagree with me.
00:02:16.727 --> 00:02:27.201 Afterwards I said it was like a seminal year or something that is going to be a make or break year for additive and a lot of people disagree with me and I think I'm like, well, I don't know.
00:02:27.201 --> 00:02:31.610 Sometimes, you know, I'm not one of those like really demure people who would be like you know, I'm not going to do that.
00:02:31.610 --> 00:02:32.931 I told I'm going to do that, I told you.
00:02:32.931 --> 00:02:33.413 So you know.
00:02:33.413 --> 00:02:49.090 And then we had last year we had then Yoav, a strategist of view, and the other Yalov, nanodimensional Yalov, talking about his view on consolidating the market and all that.
00:02:49.090 --> 00:02:56.971 And if we see what happened with those initiatives and what happened to those big companies and stuff, yeah it's really exciting.
00:02:56.971 --> 00:03:00.009 So we're trying to get really literally everyone in the room and we're trying to get more.
00:03:00.419 --> 00:03:08.473 And the difference between other events, where AMUG is more like technical nitty gritty let's take the machine apart and Rapid and Formax are more events of like doing sales or meeting people.
00:03:08.473 --> 00:03:11.740 This is really like, hey, let's talk about the business, you know what I mean.
00:03:11.740 --> 00:03:13.887 Let's talk about like, how are people making money?
00:03:13.887 --> 00:03:14.870 Are we making money?
00:03:14.870 --> 00:03:16.419 You know, do we need to go into medical?
00:03:16.419 --> 00:03:19.984 If we want to go into medical, how do we go to regulatory approval?
00:03:19.984 --> 00:03:25.729 Or what are the challenges out there for like actually getting additive manufacturing hospitals, you know?
00:03:25.729 --> 00:03:32.882 So it's much more kind of like a C-level-ish kind of thing, I think, I guess, and a business people-ish kind of event, and that didn't exist yet.
00:03:32.901 --> 00:03:49.212 So when we started doing this, like eight years ago, and that's it, and I host it and I help with like a whole bunch of people Like the Barnes Group helps us Actually, cantor Fitzgerald helps us as well, am Ventures helps us as well, we help program this event and there's a ton of people like at 3Dprintcom.
00:03:49.212 --> 00:03:53.533 We're not on a really big team, so there've been a ton of people like Missy and John and stuff who've been working on this.
00:03:53.533 --> 00:03:55.805 Basically, we start on this a month after the event.
00:03:55.805 --> 00:04:08.705 So on March we start for the next like us, this is a huge thing.
00:04:08.705 --> 00:04:09.025 It's like a big, big deal.
00:04:09.025 --> 00:04:10.294 So I don't know if it's interesting to use it Like if people are listening to this and they're really about additive.
00:04:10.229 --> 00:04:23.028 I think it's a really great place to meet people and and to meet a lot of people and have really fundamentally interesting conversations probably the best event out there for that, you know, especially if you're doing that, you know if you want to have and and discussions.
00:04:23.028 --> 00:04:29.603 But there's more kind of about the the deep, deep look into the technology we're more like about, hey, the companies, what's going to happen?
00:04:29.603 --> 00:04:35.226 You know who's going to buy who, what's going to happen to the specs, that kind of thing, you know, and that's kind of what we're talking about.
00:04:35.226 --> 00:04:37.781 So really exciting for us and very it's.
00:04:37.781 --> 00:04:39.964 It's a you know, again, we're small organizations.
00:04:39.964 --> 00:04:41.387 It's like a make or break event.
00:04:41.387 --> 00:04:51.809 If it doesn't like go really pear-shaped or anything, then we're, you know, we're fine and we're much less stressed for the rest of the year, but now it's yeah, it's pretty much go time.
00:04:51.809 --> 00:05:06.925 It's about 20 days away now, and 20 days and 21 hours away actually, and so, yeah, it's very exciting and yeah, so I'm one of the two presenters of the event as well, and so I get to kind of introduce everyone and stuff and that's a lot of fun and I really love meeting people there.
00:05:06.925 --> 00:05:11.987 So it's more for you know, if you're like an orthotist and you want to stick to your practice, do 3D printing on the side.
00:05:12.048 --> 00:05:17.091 I think maybe you'd get more value out of going to an AOPA event or something like that or a place where you can just meet.
00:05:17.091 --> 00:05:18.452 Really cool for people if they're listening.
00:05:18.452 --> 00:05:20.574 Well, yeah, and it sounds like more the business side, right?
00:05:20.574 --> 00:05:32.062 Yeah, totally.
00:05:32.062 --> 00:05:34.353 If you want to know which SLA machine to buy, then totally go to AMUG, because that's going to be the better place.
00:05:34.353 --> 00:05:34.958 No, seriously, that's the place.
00:05:34.958 --> 00:05:35.339 We're around a bar.
00:05:35.339 --> 00:05:37.845 You'll hear what is the?
00:05:37.845 --> 00:05:43.586 What People say like no, no, this thing doesn't work, or I've returned it, or that kind of thing, or I've returned it or that kind of thing Before we get to our guest.
00:05:43.947 --> 00:05:47.814 I wanted to introduce our sponsor for this episode, and that is Structure.
00:05:47.814 --> 00:05:56.449 Structure has been making accessories for the iPad and iPhones for a long time and they've just released their Structure Sensor 3.
00:05:56.449 --> 00:05:59.879 This is a great way to get started.
00:05:59.879 --> 00:06:05.065 I always say that scanning is foundational to a great outcome.
00:06:05.065 --> 00:06:08.209 Attach it to your iPhone, attach it to your iPad.
00:06:08.209 --> 00:06:17.954 So if you're looking for a way to get going scanning, I highly suggest that you check out structureio and look at their Structure Sensor 3.
00:06:17.954 --> 00:06:18.975 Awesome, good.
00:06:19.214 --> 00:06:19.435 Awesome.
00:06:19.435 --> 00:06:22.750 So who is our mysterious, long-suffering guest of the day?
00:06:23.021 --> 00:06:39.882 Well, I'm excited to have Josh Pelz from Limber Prosthetics and you may have seen some of the stuff on LinkedIn, but they do and from the best I can tell and Josh will be able to explain more of it as we can go in but they do a single unit prosthesis.
00:06:39.882 --> 00:06:52.531 So the socket, what we would say is the pylon and the foot are all connected together and printed as one piece, and what that does is create a super lightweight, waterproof prosthesis.
00:06:52.531 --> 00:06:57.451 And obviously it does also come with its challenges, which I look forward to hearing about as well.
00:06:57.451 --> 00:07:17.028 But I love the concept of combining it all together, creating and really focusing on the design side of things and how do we harness and use advanced and additive manufacturing to create a prosthesis that is a final prosthesis or definitive prosthesis.
00:07:17.028 --> 00:07:22.427 So that's about the extent of what I know, so I'm really excited to be learning more as we go.
00:07:22.829 --> 00:07:23.771 So welcome to the show, Josh.
00:07:25.141 --> 00:07:26.565 Thank you, Joris and Brett.
00:07:26.565 --> 00:07:28.932 It's great to be here, Brett, you did a great job.
00:07:28.932 --> 00:07:30.523 I think my job here is done.
00:07:30.523 --> 00:07:32.187 You've explained the product.
00:07:32.187 --> 00:07:33.250 Nothing else to say.
00:07:33.250 --> 00:07:41.391 No, you know we're thrilled to be doing what we're doing, and I'm sure we'll get into this as we go through this podcast.
00:07:41.391 --> 00:08:22.531 By 3D printing the entire device, you know you hit on some of the value, you know, using lightweighting design methodologies, you know we're getting 25 to 40% lighter weight than a device that would be typically built with ultralight coats, and so that's just one of those kind of really interesting benefits that came out of the design freedom, the material freedom in additive, and one of the things that is probably the first item commented on by the user when they first put that device on is wow, this is really lightweight.
00:08:22.550 --> 00:08:23.273 That's super cool.
00:08:23.273 --> 00:08:24.168 I think we'll circle back to that.
00:08:24.168 --> 00:08:24.714 Well, we'll get to that.
00:08:24.714 --> 00:08:27.045 I think we'll circle back to that, definitely going to circle back to that a bit.
00:08:27.045 --> 00:08:31.250 But Josh, tell us first off, like, how did you get involved with prosthetics orthotics in the first place?
00:08:32.000 --> 00:08:32.662 Sure, sure.
00:08:32.662 --> 00:08:36.530 So I'm going to have to bring this way back actually to my childhood.
00:08:36.530 --> 00:09:28.793 So I grew up in the Pacific Northwest tons of mountains and forests and trees, but, being from Portland Oregon, there's a lot of rain, and so one of the things I loved doing, and I was lucky enough to do as a kid, was work in my dad's garage and get a real respect and love for craftsmanship, working with your hands, woodworking and metalworking and I actually think I can really tie all the way back to first loving working with my hands and building a product to really, I think, being able to relate to model airplanes, to all that in the garage, found a real love for engineering.
00:09:28.793 --> 00:09:43.261 That took me to college, you know, several steps later, grad school, and grad school is when I finally, at the University of California, san Diego, actually got connected with a prosthetist now one of my co-founders and business partners.
00:09:43.261 --> 00:09:47.951 That really brought me into the field and where I started learning somewhere between five and six years ago.
00:09:48.172 --> 00:09:48.754 That's super cool.
00:09:48.754 --> 00:10:02.725 And so let's talk a little bit about this integrated device thing, because that's like always kind of like well, it's kind of like when we have very complex devices or assemblies without manufacturing, well, always using them instead of a whole bunch of different parts is always what we want to do.
00:10:02.725 --> 00:10:04.868 It's kind of the holy grail, but you guys managed to do it.
00:10:04.868 --> 00:10:07.851 So, first off, you know why did you want to do this?
00:10:07.851 --> 00:10:28.644 And then the next question I kind of I think, on the back of that I was going to be like how did you do this, cause that's actually kind of difficult.
00:10:28.663 --> 00:10:30.831 So, first off, why did you want to make this out of like as few parts as possible, sure, sure, accessible device?
00:10:30.831 --> 00:10:31.714 And you know that was five or six years ago.
00:10:31.714 --> 00:10:32.999 We've evolved a lot from then, but I think one was accessibility.
00:10:32.999 --> 00:10:37.048 How can you make a device that's more broadly accessible, both in the US and abroad?
00:10:37.048 --> 00:10:40.982 But I think there's also a sense in engineering that sort of simplicity can actually be the best way to do something.
00:10:40.982 --> 00:10:44.707 That sort of simplicity can actually be the best way to do something.
00:10:45.229 --> 00:10:55.759 You know, actually, as a young engineer, I designed and built a really low tech but a hand prosthesis never worn by a patient, but I had the myoelectric activation.
00:10:55.759 --> 00:11:03.985 I could do a couple of different grip poses, and so I think that oftentimes people are really enamored by the cutting edge.
00:11:03.985 --> 00:11:08.625 Next cutting edge robotic hand, the actively powered robotic knee.
00:11:08.625 --> 00:11:11.371 But we actually really went the opposite direction.
00:11:11.371 --> 00:11:20.402 We said, hey, can we actually take the most simple but elegant approach right to creating a leg prosthesis?
00:11:20.402 --> 00:11:25.953 For one, can we take out points of failure right, joints are often stress concentrators.
00:11:25.953 --> 00:11:28.586 Two, can we create a really lightweight device?
00:11:28.586 --> 00:11:33.605 And then, three, can we create a device that can be sort of scalably manufactured.
00:11:33.846 --> 00:11:34.388 Okay, that's cool.
00:11:34.388 --> 00:11:36.472 And then, and what technology do you choose?
00:11:36.472 --> 00:11:40.801 Or how do you do you just happen to be working one three print technology end up using in the final device?
00:11:40.801 --> 00:11:42.283 Or how did you choose a different technology?
00:11:43.104 --> 00:11:43.384 Sure.
00:11:43.384 --> 00:11:47.870 So this is actually going back to my undergrad.
00:11:47.870 --> 00:11:57.413 So when I was doing a degree in material science I was doing some undergraduate research, actually in a ceramics lab.
00:11:57.413 --> 00:12:00.605 Now I've taken a real pivot towards polymer materials.
00:12:00.605 --> 00:12:06.797 But in that ceramics lab I was actually given a LulzBot TAS 4.
00:12:06.797 --> 00:12:10.344 You both may be familiar with their technology.
00:12:10.344 --> 00:12:13.630 I think they're now on the TAS 6 Pro or later.
00:12:13.630 --> 00:12:29.503 But when I was originally given that LulzBot TAS 4, that was sort of my first I think that was probably 12 years ago now to FDM, so filament 3D printing, and actually I used that same printer now move forward to a TAS-6.
00:12:29.562 --> 00:12:39.605 When I printed the very first prosthetic foot and part of the reason why we chose FDM and why we continue to use FDM was we were able to rapidly iterate.
00:12:39.605 --> 00:12:41.909 We were able to rapidly iterate.
00:12:41.909 --> 00:12:46.596 We were able to have a very broad material selection.
00:12:46.596 --> 00:12:54.679 I think some of the other technologies have started to catch up in terms of breadth of material selection, but FDM still has the most.
00:12:54.679 --> 00:12:59.591 And we were also able to have the build volume necessary.
00:12:59.591 --> 00:13:11.004 I believe that multi-jet fusion printers simply cannot, in terms of build volume, print an entire prosthetic leg, you know, with the trim line and the ears going up past the knee.
00:13:11.004 --> 00:13:17.975 We can be on the order of 650 millimeters in some of our tallest devices.
00:13:17.975 --> 00:13:24.010 In addition to that, just the idea of deploying the technology right, it's.
00:13:24.010 --> 00:13:39.169 It's a lot easier to deploy a printer and a material if you're not worrying about, you know, a liquid vat sloshing resin or a powder bed and some of the complexity, complexities of dealing with fine powders that's cool.
00:13:39.191 --> 00:13:58.177 And then I think, I think the one thing that you that you really pointed to, which I think makes a lot of sense given the nature of your device, of course, this wide material palette, the fact that you don't have a very few, well, kind of a couple dozen materials that are very, very similar, in case of powder perfusion, for example, but you have really literally hundreds of different materials.
00:13:58.177 --> 00:14:00.567 So how did you select the different materials you wanted to work with?
00:14:00.567 --> 00:14:03.089 Is it really breaking making parts and breaking them?
00:14:09.620 --> 00:14:11.125 Or how did you kind of come up with the final materials you use right today?
00:14:11.125 --> 00:14:11.767 Yeah, no, that's a great question.
00:14:11.767 --> 00:14:16.120 So one of the reasons that I loved doing the degree I did, which was material science, is mechanical testing.
00:14:16.120 --> 00:14:19.346 I mean, mechanical testing is just plain fun.
00:14:19.346 --> 00:14:32.753 You create something, often a mechanical test specimen, such as a dog bone, right Tensile dog bone and you break it and then you look at process structure property relationships.
00:14:32.753 --> 00:14:35.427 What material and what process did you make it?
00:14:35.427 --> 00:14:38.107 With what structures does that material have?
00:14:38.107 --> 00:14:45.485 Everything from macro structures so things like fillets that can reduce stress concentrations, down to microstructure.
00:14:45.485 --> 00:14:46.745 And then you look at properties.
00:14:46.745 --> 00:14:52.291 You know how did it perform, what was the strength versus elongation and some of that.
00:14:52.291 --> 00:15:06.902 So obviously I was able to bring that into Limber right, taking that really deep understanding of how do you go through a process structure property study and how do you find the right sort of material and the right process right.
00:15:06.902 --> 00:15:09.708 Those go hand in hand for a specific application.
00:15:09.929 --> 00:15:18.452 So when we started out, actually our very first device we ever made, we printed out of PLA and then out of PETG.
00:15:18.452 --> 00:15:26.966 Petg was like that, that sort of that small improvement in, you know, slightly tougher than PLA but but still fairly brittle when it comes to the material we use today.
00:15:26.966 --> 00:15:29.893 And I remember we've been lucky enough.
00:15:29.893 --> 00:15:41.740 So my partner, herb Baric, a certified prosthetist and orthotist, practiced for several decades in Southern California, so we always had access to patients and were able to actually work with the end user.
00:15:41.740 --> 00:15:49.809 But on that first device we had sort of that first oopsies moment, right, where we were aware the device may not be strong enough.
00:15:49.809 --> 00:16:00.924 It was printed from literally a prototyping material, right, and you know it's kind of started loading the footage just like snapped in half, right, because it was obviously a brittle material, a prototyping material.
00:16:00.924 --> 00:16:07.985 That was more about understanding can we print it, does it fit, can we get alignment, you know, dialed in.
00:16:07.985 --> 00:16:35.672 But really that moment was like geez, we never want to have this happen again, right, you know, I think for the amputee and I'm not an amputee myself, but I'm sure there'd be a certain level of like you don't want to feel it re-break, right, you know, if you've had a traumatic, you know amputation for example, and so that was sort of an interesting experience for us, probably more than four years ago now, when we sort of used that prototyping material and we're like well, we'll just test the fit.
00:16:35.672 --> 00:16:42.629 And it was like you start loading that thing and as soon as you get past a certain level, you know it just kind of literally fails.
00:16:42.830 --> 00:16:53.253 And so that really took us down a multi-year sort of experiment right, a study into, I mean, probably a hundred different materials.
00:16:53.253 --> 00:16:55.488 You know we weren't doing everything.
00:16:55.488 --> 00:17:00.563 There are certain materials you can knock out right away because they're just you know they're not going to meet the.
00:17:00.563 --> 00:17:09.853 You know, maybe the temperature resistance, right, like you know something like PLA, even PETG, right, you could have issues with softening if it's sitting in a hot car.
00:17:09.853 --> 00:17:15.171 But we basically started going through that process and we tested just a ton of materials.
00:17:15.372 --> 00:17:43.133 Being at the university, we had ready access to mechanical testing equipment and so we were able to do really some of the very early on tests where we were taking them up to the ultimate loads, the ultimate P5 load, where you know you're just putting it under load with specific setup and boundary conditions, and we would just break things over and over and over and over again, and that sort of allowed us to kind of narrow in on a general property set.
00:17:43.133 --> 00:17:45.773 We actually use a proprietary material today.
00:17:45.773 --> 00:17:52.604 You can't create a proprietary material if you don't know what you're going for, if you don't even know what properties you're targeting.
00:17:52.604 --> 00:18:20.586 And so really to get to where we are today, where we have very tight control over the material we use, required us to take a really a broad look at what properties actually matter, what properties maybe seem like they could matter but don't, and then start narrowing in on that kind of final material and property set that really works for this kind of unique application of additive in printing that full prosthetic leg.
00:18:21.990 --> 00:18:51.007 I think that's an interesting way to look at it too, and I think it's always nice to have another set of eyes kind of come in like what you've done and really take a look at what is important what prosthetists have done with you know we can go you know wood to laminations, to you know some of the different materials that we use in the traditional side of things.
00:18:51.007 --> 00:18:59.176 What have we gotten right and what have we not gotten right?
00:18:59.176 --> 00:19:10.983 When it takes a little, when we're taking a look at traditional manufacturing materials and then like, can you tie any of that to the feedback that you're getting now from your proprietary material, the feedback that you're getting from patients?
00:19:14.577 --> 00:19:20.170 I don't know that I so much can comment on what was done right and wrong in terms of material.
00:19:20.170 --> 00:19:29.213 I would imagine that there was sort of a time and place and an evolution where wood probably was the right material at a certain point.
00:19:29.213 --> 00:19:34.346 There simply wasn't the way to process composites.
00:19:34.346 --> 00:19:35.990 At the time wood was used.
00:19:35.990 --> 00:19:46.076 Actually, funny enough, we have an ancient wooden prosthesis in our lab and it's like one of those things where Herb will Herb will sometimes joke.
00:19:46.076 --> 00:19:58.919 You know, herb started his career carving wood, carving wooden sockets, and so I think that maybe it's not so much a right versus wrong choice as it is kind of a combination of like.
00:19:58.919 --> 00:20:15.763 Just because you have a material available, you know you kind of have to have both the material, but you have to have the process, you have to have the right tool set and those things kind of go hand in hand before you can, you know, safely and responsibly bring you know new materials, and I think it's really cool.
00:20:15.763 --> 00:20:19.295 I mean, my original passion was actually in aerospace.
00:20:19.295 --> 00:20:34.234 I always wanted to fly and I think it was very, you know, really amazing that prosthetic and orthotic the field kind of embraced those aerospace type materials for sort of the cutting edge foot now, which is that forged carbon fiber material.
00:20:34.634 --> 00:20:54.923 I think when it comes to material selection for additive, I definitely have more opinions there and one of the things I think with additive, simply because of the fact that you are, I think there's always more of a chance, regardless of additive technology, that you could have defects or flaws in the build.
00:20:54.923 --> 00:21:04.537 When you're 3D printing that holds true whether you're using a filament machine cheap, super expensive or a multi-jet fusion machine.
00:21:04.537 --> 00:21:09.030 I think that's when material selection needs to be really tight.
00:21:09.030 --> 00:21:19.221 I think the knowledge base around wood you know you're not going to make a thin wooden member and expect it to not fracture you know same thing with carbon fiber.
00:21:19.221 --> 00:21:28.381 I think that as those materials were used, there was enough knowledge around them and probably enough of a factor of safety built into those devices that those were the right materials at the time.
00:21:28.381 --> 00:21:41.392 But I think now, with additive manufacturing and being able to so quickly iterate, maybe it's good to now step back, put a little bit more thought into the combination of properties that can make a safe, effective device for a patient.
00:21:41.632 --> 00:22:04.298 Yeah, one thing I think is really cool is that you have a co-founder who's a prosthetist, and we've have we've seen it so many times that startups they say, oh, like and it's alluding to what you said before like we have the mega robot arm and then they just like, they blaze in there with their mechanical engineering, robotics expertise or whatever, and they just forget that this whole orthotist product group, people can exist Right and and and.
00:22:04.298 --> 00:22:09.115 And you said one thing it's like you have access to patients and I like the fact that early on you can test things.
00:22:09.115 --> 00:22:10.961 You can say, hey, does lighter even matter?
00:22:10.961 --> 00:22:15.582 You know, maybe these guys are like I don't want lighter, you know I don't care, so I like that.
00:22:15.582 --> 00:22:19.295 But that could seem to me, would seem one definite advantage.
00:22:19.295 --> 00:22:22.398 What are the other advantage of having like a prosthetist as a co-founder?
00:22:22.940 --> 00:22:23.621 Sure, sure.
00:22:23.621 --> 00:22:25.403 Well, just a kind of a funny story.
00:22:25.403 --> 00:22:36.699 When I first started first learning about prosthetics, my assumption actually was that you would want to have a prosthetic limb that is the same weight as your sound side.
00:22:36.699 --> 00:22:40.012 Yeah, I said okay, otherwise you'd be off balance, right.
00:22:40.012 --> 00:22:43.851 Now you know, come to know, now it's really about you know, balance of the weight.
00:22:43.851 --> 00:22:47.215 You've got a lot less leverage in that amputated side.
00:22:47.215 --> 00:22:48.878 Your muscles have obviously been cut.
00:22:48.878 --> 00:22:50.662 That is so true.
00:22:50.962 --> 00:23:24.884 Is, you know, assumptions, right, assumptions can really bite you and obviously nothing's going to replace the benefit of working with both the customer who's the prosthetist for limber, as well as the end user of the patient, but I think, always being surrounded and not just surrounded right, because it's one thing to have an advisor, I think it's another thing to have someone that's, that's, you know, literally running the company with you really helping to, to create directionality in the way the business thinks and operates, the DNA of the business.
00:23:25.369 --> 00:23:29.435 Right, and I think that was critical in us now successfully being in the market.
00:23:30.178 --> 00:23:53.117 We were selling product the Unileg, this fully 3D printed below knee prosthesis, into the US market and we're selling it to the clinician and I think it would probably be very likely that we would have missed on a lot more had we not had that prosthetist, that clinical mindset kind of built into everything that we've done.
00:23:53.318 --> 00:24:21.759 So actually, the very first devices that we delivered now almost three years ago were in Ensenada, mexico, and so one of the really cool things is that we've had such a breadth of experiences both with clinicians but also patient populations, and I think that was really important also is understanding how to make a device that can be sort of diverse in terms of the patient populations that can consider.
00:24:21.759 --> 00:24:27.035 That was actually one of the reasons we decided originally to focus on a bologna prosthesis.
00:24:27.035 --> 00:24:36.316 You know, bologna prosthesis to us was a way to, with a single device, help the most people possible get back on their feet.
00:24:36.316 --> 00:24:56.699 So I think my answer to that kind of in short is it's not just having someone that can do clinical design and socket rectification, it's not just having someone that you know provides access to patient population, but it's actually baking that mindset of patient first, patient outcome first into the DNA of the business.
00:24:56.699 --> 00:25:00.377 I believe that's one of the reasons why we've been able to get to where we are today.
00:25:01.903 --> 00:25:11.407 Yeah, no, I think that's a great point, and also the point of having that person as a co-founder as opposed to your first hire or a contractor or something like that, I think is a really, really big, big difference as well.
00:25:11.407 --> 00:25:12.029 Absolutely.
00:25:12.029 --> 00:25:14.217 So talk to us about designing this thing.
00:25:14.217 --> 00:25:16.532 I mean, first of all, what just really practical?
00:25:16.532 --> 00:25:19.357 What tools or software did you use to design LIM and iterate?
00:25:19.357 --> 00:25:23.203 You know, from, like you know, cad to slicing and all that stuff in between?
00:25:23.825 --> 00:25:33.289 Sure, so I think you'll both be very familiar with most of these software packages, don't say Mesh Mixer, because Joris will lose his mind, lose his mind.
00:25:33.410 --> 00:25:35.298 Well, we actually do use Mesh Mixers.
00:25:35.298 --> 00:25:36.896 For certain Mesh Mixers.
00:25:38.509 --> 00:25:45.217 This whole industry is running Mesh Mixers Is running Mesh Mixers, so, but actually we didn't start with mesh mixer.
00:25:45.217 --> 00:25:50.758 We actually started our design process very much kind of away from the mesh side of this.
00:25:50.758 --> 00:26:08.351 Like the mesh modeling was actually a, I think, probably a lower lift for us than some of the parametric and topology optimization design that we went through, because at the end of the day, for us, the socket rectification that's actually not.
00:26:08.351 --> 00:26:13.561 We haven't really taken it upon ourselves to change how sockets are rectified.
00:26:13.561 --> 00:26:19.931 I mean, you know the great work that you know people like you know, I think, josh Steer at Radii is doing.
00:26:19.931 --> 00:26:22.657 You know there's a lot of people interested right in.
00:26:22.657 --> 00:26:28.352 You know how do you bring data and some of that into prosthetic socket design.
00:26:28.352 --> 00:26:33.492 But actually that's something that we've said hey, we don't need to reinvent the wheel when it comes to socket design.
00:26:33.492 --> 00:26:48.792 We're really going to focus on a holistic design approach for the device and sort of design for manufacturing, right, because the way a traditional pylon and connector and foot are made does not necessarily lend itself to 3d printing of that.
00:26:48.792 --> 00:27:08.592 And so I would say actually that the big challenges for us were was not how do you print a socket, but actually was was how do you design and print the pylon ankle foot, and so the software that we used for that a lot of fusion, 360 and topology, and then altair inspire, kind of three different packages, that sort of we.
00:27:08.592 --> 00:27:23.391 We blended together to create our kind of base model, which now we, we sort of make patient specific through the use of parametric equations um, uh, you know as well as different things.
00:27:23.391 --> 00:27:33.455 So we're we're pulling in different patient data goes into our equations and that informs everything from foot length, thicknesses of the struts and how those different things are shaped.
00:27:33.455 --> 00:27:44.516 But I think one of the coolest things about the way our device is made and this allows me to nerd out a little bit is actually the bio inspiration that was baked into the device.
00:27:44.516 --> 00:28:17.722 So my co-founder, luca De Vivo, he's a PhD, he has a PhD in structural engineering and one of his papers that you know you can find this this is published in a research journal is actually on understanding structure property relationships for the cholla cactus, based in Southern California, and if you go out into the desert you might see a cactus that's sort of got some of its flesh, you know, dried or rotted away, and underneath you'll see this woody skeleton and that woody skeleton has this really interesting curving geometry.
00:28:17.722 --> 00:28:36.686 It's ultra lightweight and really strong, really resilient, and so he actually took some of that fundamental design motifs within the Cholla Cactus and we used that to inspire the design of our pylon, which is so critical to the weight and the functionality of our device.
00:28:36.686 --> 00:28:41.419 So that was one of the really cool things and we did that through topology optimization.
00:28:41.419 --> 00:28:44.660 And I'll just clarify sort of definitions real quick.
00:28:44.769 --> 00:28:49.622 I think bioinspiration versus biomimicry not a lot of people understand the difference.
00:28:49.622 --> 00:28:53.440 Something like Velcro is actually biomimicry.
00:28:53.440 --> 00:29:05.241 So someone for you know, velcro is one of the really classic examples where biomimicry is really taking geometry or shape or function and trying to copy it.
00:29:05.241 --> 00:29:17.000 Where bio-inspiration, you could create something that looks completely different but you've taken principles or ideas or inspiration from those natural structures.
00:29:17.000 --> 00:29:20.411 So if you look at our pylon, it's tangentially similar.
00:29:20.411 --> 00:29:36.058 It's got holes in, it sort of looks like a lightweighted structure but it doesn't actually look like a cholla cactus right, whereas Velcro, on the other hand, they actually took, you know, these natural materials that had these hooks and they really copied it to create that.
00:29:36.058 --> 00:29:49.798 That's one of kind of like the classical examples of biomimicry versus bioinspiration where you can just really take even a single idea or thought or concept it and, and you know, kind of iterate off of that I think it's good you bring it up.
00:29:49.818 --> 00:30:03.736 By the way, I like the idea this guy was apparently walking with like a sock or something and a seed bird got caught in the in the thing and that's happened to me and then I think about this happened to thousands of people and that guy ended up like you know what, I'm gonna make a material out of this.
00:30:03.736 --> 00:30:10.445 So I love velcro as an example here and, uh, you know from a point of this is, is I like this whole generative stuff.
00:30:10.445 --> 00:30:12.953 It's all very tempting, implicit modeling very tempting.
00:30:12.953 --> 00:30:16.321 Did you think of like developing your own like design system?
00:30:16.321 --> 00:30:23.615 Very long, like saying, oh wow, we're just gonna put it all in grasshopper and just like you know, infinitely various, because I do this for certain things.
00:30:23.615 --> 00:30:26.260 But but I mean, did you guys tempt, tempted lot by that?
00:30:26.260 --> 00:30:28.586 Are we really trying to make a single design that worked?
00:30:28.586 --> 00:30:29.832 You know what was your path to this?
00:30:30.653 --> 00:30:31.938 That's a really good question.
00:30:31.938 --> 00:30:39.001 So I, being the nerd I am, would love to be generating a unique structure for every single patient.
00:30:39.001 --> 00:31:14.803 I think there could be a reality where we go there, but today that would be very difficult to qualify and have a high enough level of confidence that the software is actually taking into account all the intricacies of you know this is a material that's additive manufactured, additively manufactured in layers, with, you know, all sorts of complex relationships with the environment, to expect that a software package could generate, 100% of the time, a safe and functional device.
00:31:14.803 --> 00:31:16.493 I'd love it If that were the case.
