Turning to tech for mobility solution

Sometimes serendipity knocks on your door. And then you follow it to wherever it takes you. Around 2016, Melissa Fuller was running a community maker space in Leichhardt in Sydney’s inner western suburbs.

Photo of Mel (left) and Johan (right)

“We had tools, equipment, space, and members who were engineers, makers, industrial designers, and it was all very well and good, but they were spending most of their time printing 3D Yoda heads,’’ Mel recalled.

“The members didn’t have enough meaningful applications to use their time and skills.’’ And then, through one of the makerspace’s members, Kin Ly, a bloke called Johan du Plessis turned up at Mel’s door. Five years later, Mel and Johan are the experienced co-founders of AbilityMade and Kin is still on the team. 

“Johan has a background in engineering: he’s a social entrepreneur and a genius guy and he got to a point where one of his many start-ups didn’t fulfill him,’’ Mel said.

“Johan was sick of solving commercial problems, and he decided to stop the business stuff for a while and become a disability support worker and teach kids how to swim. He was a support worker for kids with cerebral palsy and he was loving it. And he was helping with all the daily activities – getting out of bed in the morning, getting ready for bed at night, and so when he was helping them, he would see there was a handful of them who were wearing leg braces and one girl had a big scar on her leg from it, others had blisters, some kids never wore them. And that was just the start of it.’’

The braces are the key to this story. The braces - clinically known as ankle foot orthoses (AFOs) are custom-made devices, to help disabled kids with mobility and posture. They can help a child literally get back on their feet and experience the joys of simple activities - standing, walking, and sometimes, running.

Without the AFOs, some children will have to use a wheelchair daily or spend most of their time indoors. But for some kids, the braces are abrasive, uncomfortable and require particular expertise to fit them. And until Mel and Johan started to work together, there was no scalable, contactless way to fit a child for their appropriate support. For many kids, it was an extremely challenging task to encase a leg, ankle, or foot in plaster to make casts that sometimes didn’t quite fit.

That was the problem. But it took a little while for Mel and Johan to get there.

Soon after they co-founded AbilityMade, they became inundated with requests from families to make an array of technological adaptations or devise new concepts using their 3D technology that scanned and then printed the outcome. They simplified awkward plastic joysticks on wheelchairs and manufactured special drinking cups for those with neck injuries. It all came with insights into the cost and logistical difficulties families with disabled kids confronted. “The state of affairs around assistive technology for people with disability is dismal,’’ Mel explained. “It’s slow, and the supply chain is long and fragmented.’’

After some intensive lobbying from a group of mums at the cerebral palsy alliance in Allambie in Sydney, the direction of Mel and Johan’s collaboration started to become clear. “Johan got tapped on the shoulder after each shift and told: ‘Take a look at Ankle Foot Orthoses (AFOs) because they are horrible for my child for a bunch of reasons,’’ Mel said.

“We scratched the surface of that and then we asked more questions of the community of families and clinicians around that problem, [and] it was a problem that if we solved that it would help millions of people essentially,’’ she said.

The old way of creating a custom made AFO wasn’t centered on the special needs of the children requiring the device. For kids with sensory issues – especially younger children – it could be a distressing process to have to stay in a position long enough to enable the plaster mould to set. For other neurodiverse children who might be on the autism spectrum, for example, it was just too uncomfortable and unsuitable to achieve at all. For kids with some spasticity in their limbs, it posed a different kind of problem, trying to remain still long enough for the process to work.

It wasn’t that the medical profession hadn’t embraced the possibility of 3D scanning, but that the technology wasn’t sufficiently evolved to overcome the problems. A hand-held scanner still couldn’t capture the image of a child’s wriggling leg with sufficient accuracy to make a bespoke AFO.

“So, we responded to that need, and we built a purpose-built instantaneous scanner - a rig- where kids sit in their seat, put their leg in, a photo capture is taken, done. That’s what we invented,’’ Mel said.

Except it wasn’t quite that simple. “It was really hard. Our technical team had to take a piece of technology from here and another piece from there and put it together. So, the prototype came together very fast [but] making it a product that you can put in a commercial clinic was hard. And that took a lot of money and a lot of collaboration for that,’’ Mel said.

The philanthropic support has been diverse. Early backing came from Conroy Bradley, Cerebral Palsy Alliance, Dorman Family Foundation, the English Family Foundation, the Grace & Emilio Foundation, the Graf family, ING Dreamstarter, the Jack Brockhoff Foundation, Maria Manning, the NSW Government, the Percy and Ruby Haddy Foundation, the William Buckland Foundation, the Snow Foundation, Vasudhara Foundation and 310 community members who contributed to AbilityMade's 2016 crowdfunding campaign. 

In-kind contributions that helped AbilityMade’s vision come to life came from Northcott Disability Services, Northcott Innovation, Autodesk’s Impact Entrepreneur program, Engineers without Borders, Sydney University, UNSW’s Michael Crouch Innovation Centre, and dozens of volunteers. And it doesn’t stop there - the organisation is in midst of a new round of impact investing. Mel, who spoke on behalf of her team, said: "The generosity of the human spirit has been portrayed countless times by Australia's philanthropist and volunteers. Every day we get out of bed knowing that we're working towards a better future for our children. On the hard days knowing that we're not alone on this journey makes a difference. We are very thankful for the support."

The prototypes were rudimentary - made from laser cut plywood and fixed with raspberry pi cameras that had a motherboard sitting under it. “It worked but it would barely survive a car trip in my Hyundai i30,’’ Mel said. “It was enough to prove the concept though.’’

The refinements over time made it more robust and the evolved technology of what is described as the “world’s first instantaneous 3D scanner for paediatrics’’ has won innovation awards on the International Day of People with Disability and national product design awards. It has been used in three NSW country towns as part of a tele-health trial in collaboration with Northcott Innovation. Thanks to the scanner, a child requiring an AFO needs to be still for less than half a second. And the production turnaround of the 3D printed AFO takes only two weeks on average but can be as quick as 48 hours.

“I wouldn’t say we were the first to produce a 3D printed AFO fitted to a child, but I would say we were the first in the Southern Hemisphere to produce a 3D printed AFO that had been rigorously mechanically tested,’’ Mel said.

 “We’ve written theses and papers about the rigor put into our work – and we’re the first to be listed on the Australian Therapeutic Goods Administration list. And our scanner was a world first – I’ve never seen another instantaneous capture in that profession,’’ she said.

The global need for AFOs is significant. Demand exponentially outstrips supply: the World Health Organisation estimates there are 100 million people in the world who need prostheses or orthoses but only one in ten are getting the equipment they need.

In Australia, there is a significant shortfall in the specialists needed to deliver the service, which translates into delays in providing the mobility devices, especially in rural and regional communities. Tele-health solutions could offer a way around that.

“For the telehealth pilots we had to train up the parents and local allied health. We had to use video conferencing technology and the video imaging on our scanner in a sort of a quasi-tele-health appointment,’’ Mel said of the trial in regional NSW. “We had mixed results...the business case was validated, and the technical feasibility was promising so to make such a social innovation happen identifying and locating allied health assistance is key.’’

“Our customers are actually the clinical prosthetists/orthotists (CPOs), and so in terms of demand there are approximately 400 of them in Australia, half of who are practising orthotists. So, the market size by customer is relatively small but the demand for our offering is massive and driven by clients and their families,’’ Mel explained. “Essentially, we take away the technical work without taking away the clinical element. What we’re doing is actually creating an army of virtual technicians to support the incredible work done by orthotists.’’ 

If there is one element that is clear from this innovation, it is the potential for its capability to be expanded – the AbilityMade team are speculating on embedding sensors in the modular design, step counters, audible training that emits noises and sounds that could help change a child’s neural pathway.

“The 3D Printed AFO is a platform for connecting a bunch of tech that can improve life outcomes for a kid,’’ Mel said. “That’s exciting and once we’ve mastered AFOs, there are so many other custom devices we could focus on. In terms of growth as well, there are massive supply shortages all around the world. In places such as the Pacific Islands, I think our technology could make a profound impact.’’

Philanthropy has already helped support the AbilityMade technology, exercising its own capacity to respond quickly to an opportunity. “Philanthropy was able to back our very early stage, risky but high impact potential, whereas the impact investing was more risk averse,’’ Mel said.

But AbilityMade’s challenge is that they are a med-tech social enterprise that doesn’t quite fit into any legal model in Australia and so it has created its own constitution to ‘mission lock’ the business. “Sometimes we’re between a rock and a hard place – we get treated like a For Profit tax wise but at the same time we decided not to back the vision with in-patient capital from venture capital because our purpose is so close to our hearts and like all social innovation what we do is hard and complex,’’ Mel said. “If an entrepreneur's aim was to start-up and exit with a truckload of cash fast, they wouldn’t start a business like this,’’ Mel said.

While the organisation is by Mel’s assessment “not profitable yet’’, there is plenty of evidence to show just what a difference it has made to kids’ lives, with Australian orthotists supported to provide more than 500 3D printed AFOs for 200 kids since Johan walked through the door at Leichhardt. 

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