Prostheses and orthoses are trending towards digital methods and automation. Adopting these methods is especially a challenge at Frank Jol, a clinic where patients' wide variety in residual limb characteristics and high activity demands pose a challenge for digital workflows which utilise 3D scanning to arrive at a final prosthesis. This is because certified prosthetists and orthotists (CPOs) who design and produce prostheses, apply a series of tactile adjustments to the residual limb using plaster that result in a more optimal fitting and distribution of weight in the socket, which cannot easily be captured and digitised. In collaboration with Gyromotics, a high-tech prosthetic foot start-up, and Frank Jol, this graduation project is an exploration into the potential for a pressure-sensing textile tool to capture the tacit knowledge of CPOs in the fitting of below-knee prostheses.

The project begins with a detailed analysis. First, the clinical situation of the residual limb and the biomechanics of transtibial prosthesis is studied to understand what factors influence prosthesis fit, and how CPOs manipulate the residual limb to that effect. Then the process towards producing a prosthesis is analysed as it is executed at Frank Jol, in order to then compare to alternative processes that incorporate digital methods to understand the barriers and opportunities for intervention. Finally, CPOs and patients are interviewed to uncover their needs and values in the process. This analysis reveals the need for an intervention that captures and standardises the stump modification process in a digital way, while retaining CPO control and tactiliy, and keeping the patient in the communication loop.

The design result is PressFit: a pressure-sensing textile tool to be worn by the patient, which registers CPO applied pressures and provides visual feedback during stump measuring and plastering. PressFit is introduced as it fits into an envisioned future prosthesis prescription workflow. PressFit is developed through iterative technical development of the physical prototype, alongside development of the interaction for both measuring and plastering use cases. A co-design method with a CPO is followed throughout this development.

An evaluation is conducted with 5 CPOs at Frank Jol to assess the prototype's performance against design drivers. Results show that PressFit standardises the measurement process. All participants agreed PressFit is a helpful tool with potential to improve patient-CPO communication and bring traceability to the plastering process. Additionally, the tool shows promise for us as a training tool for new CPOs. As this thesis serves as a proof-of-concept for the application of pressure-sensing textile in the prosthesis prescription process, it concludes with recommendations for further development in physical prototyping (textiles), software, and user interaction.

This thesis is initiated by the Reinier Haga Orthopaedic Centre (RHOC) and shows the creation of a patient-centred healthcare network for orthopaedic hand and wrist care. A healthcare network can be defined as a group of interconnected stakeholders that directly or indirectly influence the patient’s care. In this project, the involved stakeholders are people undergoing treatment for their hand and wrist and healthcare providers from seven disciplines; orthopaedic surgeons, hand therapists, general practitioners, plaster technicians, orthopaedic instrument makers, rheumatologists and rehabilitation physicians. A literature review and a user research study sketch the context and underlying problem. The context is shaped by ongoing developments that cause an increase in the care demand, an increase in healthcare costs, empowered patients and digitalisation. This asks for care that is efficient and gives patients more control. Currently, both are lacking in orthopaedic hand and wrist care. The user research, which consists of interviews with the stakeholders, shows that patients are not feeling involved, and inefficient guidelines and lack of cooperation prevent an efficient treatment process. The hand and wrist is a speciality within the medical field of orthopaedics. It entails a wide range of care disciplines that could benefit a well-connected network, which is currently missing. This prevents effective cooperation, which research showed would lead to more efficient and improved care, fewer treatment sessions and a reduction in costs (Ypinga, 2018). The developed design aims to create more involvement of the stakeholders in the orthopaedic hand and wrist care and active participation of the patient. This design is developed through ideation using the “How-Tos” method, which resulted in three ideas that three healthcare providers reviewed. This approach gave insight into the aspects that were perceived as most relevant by them. These were: an overview of the whole treatment, which helps in contacting other healthcare providers, holistic treatment and patient involvement. In addition, allowing patients to set a goal for their treatment allows for more control and better treatment. With this input, the concept of WegWijs is developed and evaluated with patients. WegWijs means to be wise, informed and in control in healthcare. It provides all the stakeholders with the knowledge needed to create a holistic and patient-centred care process by providing an overview of the treatment process and the involved parties. The patient actively shapes their treatment by formulating a treatment goal and cocreating their treatment plan with the doctor. The care providers remain actively involved throughout the process and in close contact with each other, creating a well-connected healthcare network. Two patients and two healthcare providers validated these aspects. The established implementation strategy outlines the required steps that include the co-creation of new protocols and the execution of a pilot. However, further research is needed to develop this concept and implement it in the RHOC, and eventually in the wider healthcare system.

Spinal cord injuries (SCI) occur when damage to any part of the spinal cord is sustained. Depending on what vertebrae segment the injury occurs, the patient will develop paraplegia or tetraplegia and have a complete or incomplete spinal cord injury. After sustaining a spinal cord injury, the patient must undergo rehabilitation.

For incomplete SCI patients, part of their rehabilitation is improving their mobility skills through gait training. To assess gait, the methods of the clinical eye and laboratory gait assessment are used. The starting goal of the project was to combine the quickness and easiness of conducting a gait assessment with the clinical eye with the objective data from a laboratory gait assessment into one system. This system consists of Xsens Awinda wireless motion trackers to collect the kinematic data and a user interface to view it.

User research was conducted in the form of questionnaires and focus groups. The research aimed to learn more about how physiotherapists and physicians within Rijndam Revalidatie currently assess gait, what features and parameters they would like in the user interface, and how they would prefer the selected parameters to be visualized (in numbers, graphs, or animations). Three physiotherapists and physicians were also interviewed to better understand the process incomplete SCI patients go through in gait rehabilitation and who is involved in each step.

From the results, a design direction and vision was created: “To develop an easy to use user interface that aids physicians and physiotherapists in selecting interventions for patients with incomplete spinal cord injuries in an objective and time efficient manner through intuitive data visualizations.”

Using design methods and tools, ideas for the data visualizations and the interface layout were formed, selected, and then made into concepts. The layout and visualizations concepts were evaluated through concept test sessions with physiotherapists and physicians. In the sessions, the interface layout was assessed in terms of usability and functionality. The data visualizations were evaluated based on if the participants, who had minimal pre-existing knowledge on gait analysis, could understand them. From the evaluation results, the final design of Gait Vision was created.

Gait Vision is an easy-to-use interface that allows physiotherapists and physicians to assess gait objectively and time-efficiently. It provides more accurate and objective information than can be obtained with the clinical eye, in a way that is more intuitive and comprehensible for clinicians with minimal gait assessment experience than laboratory gait assessment.

An interactive prototype of the final design was developed using Adobe XD. The interface prototype and the visualization concepts were evaluated through conducting individual user tests with seven physicians and physiotherapists. The interface and visualizations were tested with regard to usability, functionality, intuitiveness, and aesthetics. Overall positive feedback was received regarding the interface and visualizations. Testing was also conducted to compare gait assessment with the clinical eye versus with the interface. The interface was found to more objective than the clinical eye.

An implementation plan was developed to ensure Gait Vision survives in the long term. Future recommendations were also made to aid in the continuation of the development of Gait Vision.

This graduation project is on behalf of TU Delft and Zimmer Biomet in collaboration with Orthopedic surgeons from Bergman Clinics, Orthopedic Clinic, in Naarden. The aim of this master thesis was to design a product which could reduce the pollution of harmful noise during hip replacement surgery. Noisy workplaces and especially within this procedure carry a large risk of noise-induced hearing loss, as sound levels of more than 120 decibels are generated by the usage of (powered) instruments. In the analysis phase observations in the operating theatre and interviews with experts are conducted to get insights and background information about the total hip arthroplasty procedures. It was found that noise levels experienced during surgery generated levels above the human pain threshold, ranging between 120-130 decibels and caused temporary and long-term noise induced hearing loss. Via a design vision and a list of requirements multiple concepts where generated. In the embodiment and evaluation phase, cadaver and saw bone testing showed that the new instrument design functioned and implant parts and/or tools could be implanted successfully. The outcome of this project is a new surgical instrument, which can press-fit (impact) and extract various implant components used during surgery. The instrument has multiple unique selling points compared to the currently used mallet as it reduces the noise level with more than 15 decibels and scores better on aspects of safety when looking into the risks at musculoskeletal disorders by improving surgical ergonomics. The instrument could be improved further when looking at the design and the current surgical workflow. Further research and clinical testing is necessary to see if this product is suitable for hip replacement surgery.