Design, Engineering, Clinical Passion, and the Future of Patient Managed Comfort with Alex Dahinten

We break down what we saw at RAPID, from vapor smoothing and metal printing to reinforcement methods and silicone printing that could reshape interfaces. Then we talk with Alex Dahinten about building better socket comfort through real time adjustability and what it takes to get a new prosthetic solution into clinics through Medicare coding. 

• Vapor smoothing as a path to cleaner looking 3D printed parts and the safety tradeoffs behind different chemicals 
• What a smaller HP powder bed fusion machine could mean for clinic workflows and cost per part 
• Foil based metal manufacturing as an alternative to powder handling for tight tolerance small parts 
• Reinforcing thermoplastics by injecting fiber and resin into printed channels and why pricing matters 

We then hear:
• Alex’s path from biomedical engineering into prosthetics and orthotics 
• Upper limb prosthetics as systems integration with higher costs and heavier follow up burden 
• Capacity building in global health as the difference between short term missions and sustainable care 
• Why the socket interface drives outcomes and how compliance improves comfort without losing energy transfer 
• Ethnocare’s Overlay air bladder sleeve for residual limb volume management and the doffing effect problem 
• Medicare L5657 and the impact of a fee schedule on clinician and patient access 

Special thanks to Advanced 3D for sponsoring this episode.

Transcript

SPEAKER_01 0:01

Welcome to season 13 of the Prosthetics and Orthotics Podcast. This is where we connect with experts in the field, patients who use these devices, physical therapists, and the vendors who help bring it all together. Our mission remains the same: to share stories, tips, and insights that help improve patient outcomes. Tune in and join the conversation. We're glad you're here and hope it's the highlight of your day.

SPEAKER_03 0:25

Hello everyone, my name is Yoris Fields, and this is another edition of the Prosthetics and Orthotics Podcast with Brent Wright. How are you doing, Brent?

Rapid Show Tech Highlights

SPEAKER_02 0:32

Hey Yoris, I'm doing well, man. I was at Rapid this past week, and you know it was it was fun to kind of text you back and forth. But I was uh it was a it was a pretty cool venue. Uh huh. And uh man, it was it's actually a lot of stuff. So um what did you see? What what impressed you? So what impressed me, so you had sent me a couple things to go check out, and I did check them out. So the that company Repoly for the vapor polishing, I don't know how you found them or knew about them or whatever, but that is legit. They do not use heat in the process, and that is very, very cool. And the price point is also on point. So uh, and and the way that they can do small thin wall parts is pretty amazing. So I'd I'd I'd love to hear your scoop on the pulse of that.

Vapor Smoothing Benefits And Risks

SPEAKER_03 1:30

No, I think I think we've I've I've always been well, so uh just for the people that don't initiated, a lot of parts need to be smoothed. Uh part of that is just like you know, layers. We don't like the layers, right? And part of that is just basically for a more consumer-feeling product or consumer-level products, people expect certain looks and feels and you want to recreate them. And part of it is just like for a lot of medical stuff, maybe you want, you know, you don't want a dust buildup or something like that. So there's uh a couple there's mechanical polishing, uh, you know, basically stones in a turning thing. Or you can have vapor smoothing, which is a very exciting process. Also, I almost killed myself doing that once. My own house, which you should never do, by the way, uh side. Um, and vapor smoothing is is kind of a magical process, and they all work a little bit differently, but essentially the vapor is under some kind of pressure or heat or something, pumped into a chamber, and it takes it eats the outer layer away. And sometimes it eats too much away, sometimes it eats too little away, sometimes it's a relatively harmless alcohol solvent type of thing, sometimes it's a PFAS chemical that will eat away all sorts of stuff and interfere with your reproductive health. Uh, and the the so the key thing about vapor smoothing is to understand what it can do and what features it takes away, and also to understand what chemical is being used, because usually sometimes sometimes these are really benign, and other times they can be super evil uh kind of stuff. So it's a really exciting process if we're really going to that consumer level, consumer fit. And and you know, you had companies like Demention, you had um uh other other AMT other companies doing this, and now we've got a Chinese player, oh yeah, Lux Yours also did this, and then we've got a Chinese player hoping to kind of shake this up. And then so I was really curious how how how the part I'd never seen the parts for real and stuff, so I was really curious to see what did you say? Were you impressed by the parts and the setup and everything?

SPEAKER_02 3:12

Unbelievable, yeah. And the like I think what impressed me was the thin wall parts and anything with like through holes, you know, typical vapor polishing with the heat, you don't get much past kind of the visual line of sight of what you see. But with this part, he had like this long tube with probably a five millimeter, maybe even a little bit less of a uh an orifice. And uh, you know, as far as I could tell, it was smooth all the way through, which is unbelievable.

SPEAKER_03 3:40

So, yeah, that that's super exciting. I think I think it was uh inspired more or less by uh Luxures or something. That's a similar kind of uh technology. And they do smoothing with like you know, pumping different chambers or different densities in different chambers in different orders. So that gives you a bit of a more complex recipe to get that done. So I think that's really good. If you really want to get to smooth parts, it's a really exciting thing to see competition there. Anything else you saw that you really, really liked or didn't like, or what was not?

SPEAKER_02 4:06

Well, I have a I I do have a funny story for you. So about two weeks before the show, you know, HP was touting, you know, they're gonna be releasing something new, that sort of thing. And and um so I I think I told you that I bit the AI bug pretty hard. So I had my open claw server and I said, what would HP be releasing? And it scrubbed like Reddit, YouTube, any social medias, all that stuff, and it said, they're gonna be releasing a small machine. Really? Yep. Okay, okay. And uh, and lo and behold, they released a small machine. Well, I'm being there, Brunt.

SPEAKER_03 4:47

I'm being put out of the work, and you think that's funny. It's not good.

SPEAKER_02 4:51

Well, there was a leak somewhere for sure, uh, for the AI to uh pick that up. Nonetheless, I mean, I think uh you know, both people said that you know it's kind of the obvious that they need to go to a smaller machine, especially with the 580 out. And uh, you know, I would say it's it's neat, but it's small now. Um and it's it's still gonna be tough. You know, it's 2027 release date, PA 12 only. You know, it has a form labs-ish look to it, uh even down to some of the containerizing things. You know, there's a there's a lot that's could happen between now and 2027. And as 2000.

SPEAKER_03 5:30

I did I did see that, yeah. Okay, that's a good point. You're saying they're releasing it now, they give us a specs, and you think maybe somebody will sneak in there or something like that?

SPEAKER_02 5:39

Well, you know, you never want to be tied in, and it's kind of like the form labs when they said that they were gonna be releasing the the fuse at a$10,000 price point, and then it comes out and it's$25,000 plus all the accessories, and you're pushing 60. If HP is saying 60,000 now, it's a pretty aggressive target to say that you're still gonna be at that point in a year and a half.

SPEAKER_03 6:04

First above the 1200. This is an entry-level 60k LPVF machine. We would love for the OMP market to have PI11, obviously. But or or open material or stuff like that. What do you think? Do you think this if this if they stick to that price and if it kind of says what it does on the tin, kind of do you think this is gonna be a real contender for OMP clinics, like the individual clinic is saying, hey, I'm gonna drop 60k in this shit, this this thing, and then and then I'm gonna, you know, uh take stuff in-house? Or is then the build volume too small and you think it maybe won't work?

SPEAKER_02 6:36

Yeah, I mean, I think you've got to take a look at what the consumable costs and all that stuff, but I mean you are a hundred bucks a kilo, 80% recycle, or max 80% recycle, probably 60%, 60%, 60% is probably more likely.

SPEAKER_03 6:48

Yeah, it's kind of looking up.

SPEAKER_02 6:50

Yeah, I would say the build volume is so small for the O and P market, and we know that the polyamides are not great when you open up the sockets for like adjustable sockets and that sort of thing. I think that there's uh just too much potential for failure, just from what we know about the PA-12. Now, if they include the PA11, I think that gets interesting. I think it's also interesting for upper extremity prostheses, so any of the arms, braces, that sort of thing. So, and I think that there's a lot of opportunity with the idea of fusing agent, detailing agent, kind of like what they've showed with the dual tone stuff, like a grayscale that can be put on via detailing agent.

SPEAKER_03 7:38

No, I thought that was okay, so now yeah, okay, that's good.

SPEAKER_02 7:40

Yeah, so I think that's interesting. It's tough when you're when you're PA 12 only. I just don't think it's the right material for O and P, but you know, I'm just one guy. So anyway, but nonetheless, it was a neat and uh everybody was very excited. But they had some other things going on too with that dual tone and stuff that I think is more exciting. And as long as as long as, and I and I what I do appreciate is they see the value of a lower cost, smaller machine, because the reality is most people are doing small parts, they're not doing these massive parts. You're talking about fasteners and other little things that body clips and things of that nature on the industrial side. And I think that it is very compelling gateway drug, so to speak, to the powderbed fusion world. Yeah, I told it.

New Metal Printing With Foils

SPEAKER_03 8:32

I think they're really focused on cost for part. We all know that kind of on the secondary cost and HP can be very high, but on the front end, if you will, they're really focused on bringing down cost apart. And I think that's very laudable of them to do that and smart. Anything else that you you saw that you thought was really cool?

SPEAKER_02 8:47

Well, I think that the metal stuff was interesting. The one thing, and I I showed you the card and I I it was uh L A P I S, is that right? Lapis.

SPEAKER_03 8:58

Yeah, that's a very cool decade. Like, seriously, I'm not kidding.

SPEAKER_02 9:02

Their their metal stuff and the way they do that and the tolerance that he was holding was unbelievable. And what was crazy is it was just a chance, chance meeting. I was standing at a table and I pulled a Uris Peel. I'm like, who are you? What do you do? Tell me more. And so we ended up having a really good conversation. I got his card and we'll be um following up. But uh the technology is instead of powders, they use foils, uh very thin foils to kind of laminate a layer to layer. And through the magic of software and other things, they're really able to keep very nice tolerances. And when you don't have powder handling, that's that's pretty cool. And if the build volume is small, but a lot of this stuff is the parts you know that are interesting are are small anyway. So I was I was super impressed. Anytime that you see that stuff and you get to put it in your hands, that's pretty awesome.

SPEAKER_03 10:00

And so the LAP is possible, it's a it's a it's a Singaporean research project. They're kind of in a commercializing research stage. And it the foil is five bucks a kilo or something like that, five to ten dollars a kilo. So it's really cheap. And they laser a blade it, so they actually get really good surfaces and really good sides on it, and the parts look spectacular, and it's just spectacular and super cheap for small parts. You know, we don't know where that's gonna find a market, but I think I think it's really, really is one of the most amazing things I've seen for years. So I really, really like lapis. I like them a lot. Okay, cool. Anything else?

SPEAKER_02 10:30

I would say that's the the bigger one. I mean, I think that there was uh reinforced 3D was very, very cool. I um you know, I don't know, it's a pretty pricey technology, but I understand that there's a lot going on there and it's something that is needed for these thermoplastics. And it's a the reinforced 3D is a for lack of better term, it's a fiber and resins that can be uh injected almost like with a caulking gun uh into channels to reinforce specific areas of your print. And it's it is unbelievable, uh for sure. I think the pricing makes it difficult, but for those that are in like the UAV space and other things, I think it might be interesting. For the prosthetic and orthotic space, while it's interesting, I think it's definitely kind of priced out of the market there.

SPEAKER_03 11:29

Yeah. What were we worried about? Like the the materials price or the system? Is this the system too expensive? Do you think?

SPEAKER_02 11:36

Yeah, system, I mean, the system is is pretty pricey. Uh I mean, my understanding was somewhere uh, you know, 150k-ish. And um, it's one of those things that you just have to be super careful and intentional as well, which you know, we're not a big job house right now. So it's one of those things where you want to have a bunch of those jobs lined up, and this might be something that you do at the end of the day where you're just running this machine nonstop for a couple hours, filling all the voids. It's it's super cool. It's a very, very cool technology. And I would, I would love to have one. I can tell you that. But uh the price point right now for me is just a little bit high. Now, if I had a job come across my desk, that there probably is something that would pay for that. And uh I think that would be it's very cool.

Reinforcement And Silicone Printing

SPEAKER_03 12:25

Very cool. And I think I think yeah, by injecting these cavities after the fight, you can get like really different design things. And I think, yeah, I wouldn't really imagine that it would really suit like as somebody taking a loss of different jobs, but imagine somebody making like one of these more athletic-related devices or something like that, you know, just one little hinge part or one kind of really structural part, a tube-like part. Uh, that could, you know, just serious production of that part in different sizes sometimes that could be really, really nice. Or bikes or you know, stuff like that. If you do series of things, I think it could be in carbon fiber, I think it could be really exciting. But yeah, you're right. It's one of these technologies where it's like, it's so great, but where is actually who's actually gonna stomp down and invest in it? You know, that's uh their that's always gonna be their problem, I think, because it's it's it's also really new, so it that never helps, right? Yeah, yeah.

SPEAKER_02 13:11

Okay. So um and then and then rapid liquid print was very cool to see. They had the machine there, and as you know, I I uh do some liners with them and I got to talk with the main, the the main people there and talk about how we've been improving our process along the way, along with them and communication. So that was very cool.

SPEAKER_03 13:31

Yeah, I love I love rapid liquid print's MIT startup. Basically, they're extruding uh uh silicone into like a hydrogel type material that is right balanced, so it's kind of like a hair gel kind of thing. And basically that it acts as a support, so they can make really free stranding structures relatively cheaply. They're a beautifully made machine, also that has to be said. I love the team Shendy and all these guys are really, really nice, and I really, really like uh what they're doing, and they're really making elastroomeric parts durable. And perhaps even that's a system where there's other silicon technology, but then taking either it's not free for them enough or taking in-house would just be really complicated and expensive. This is something where maybe this is something maybe that you could buy that machine and you could actually make money off of it, I think uh eventually, if you had enough of like one family of product. I think that's and I really love what they're doing. I like their I think they're a really great team as well.

Meet Alex Dehinton

SPEAKER_02 14:22

Super, super impressed with their team. Yeah, yeah, totally cool. And uh, okay, so so we have a long-suffering guest. Yeah, so we have uh Alex Dehinton with us today. And I've known Alex for a long time, and uh it's been really neat to kind of see his uh trajectory. And uh, we've actually shared a little bit about the company that he now works for, so I'm hoping to get into that. But nonetheless, I want to also hear about his journey into the ONP space. And one of the things that I think is inspiring is you and I say it all the time, is it's amazing how people get into the space and really how everybody's story is a little bit different and their journey is a little bit different. And I think that's one of the things that makes our space uh very, very interesting and definitely having the the right people with passion in the field as well. So I'm I'm excited to uh hop into all that as well.

unknown 15:19

Cool.

SPEAKER_03 15:19

And then yeah, the most common modality is either did your parents do it or do you like to work with your hands and didn't you know what you were doing? Uh welcome to the show. And and Alex, tell us how'd you get involved with OMP?

SPEAKER_00 15:29

Well, thanks for having me. Um, I've been a fan of the show and I'm kind of pinching myself a little bit that I'm on it now. So uh this is really exciting. I got into it from an engineer's perspective. So I was went to school for biomedical engineering and then started a career in kind of the developing world, middle income, low-income country um environments and how to provide medical technology and build hospital uh capacity around medical technology in those spaces. Worked for nonprofits, and then most of that time I spent at Duke University working in the developing healthcare technologies lab under Dr. Malkin. Um, it really grew my um my ability to or my my awareness for how technology could be deployed in an appropriate manner in these environments that are often resource limited. Through that work, uh I did do some work at prosthetic clinics, mainly about uh surrounding inventories and how to how to keep track of uh equipment and tools. I started just becoming more and more interesting. I started seeing uh how I could use my skills, my uh my artistic background, but also my engineering knowledge and my just uh my uh desire to work with people kind of on a one-on-one basis. Uh and it kind of combined all of those things together. Uh so I started looking into a little bit deeper. I was living in North Carolina at the time. I came back, asked my boss, it's like, hey, if if uh if I would go down to four days a week and maybe shadow this prosthetic clinic one day a week, would that be okay? He's like, sure, but I'll only pay you for four days out of the week. Like, deal. So that's what what kind of got me into it. And then once once you're in a clinic, once you're surrounded by passionate clinicians and working with patients and kind of seeing that, it's it's hard to go back. So decided to go back to school, get a master's, and here we are.

SPEAKER_03 17:13

Okay, that was really cool. And coming from the we've always had this idea that a lot of like people in OMP do things kind of on feel or like not with FEA and stuff like this. And coming from the biomedical, doing the biomedical stuff first, did you find that weird? Or is that a very different approach you had than like, for example, as well as students or practitioners?

SPEAKER_00 17:30

Somewhat. I I will say I was always I was almost like an outlier, maybe in the engineering world, where I did, I did go off feel and I always wanted to to to um to to approach a problem, not just from a pure mathematical perspective, but also from a a user perspective. And how does this feel? How does when we design something, how does it, you know, what are the ergonomics of it? What is what is the overall experience of the person? So I I I did enjoy that side of the engineering, which translated really well into the prosthetic side. But yeah, there are some things where I'm like, how are we not quantifying this? How are we saying that this is better than something else when we don't have any data to back it up? So that definitely lingered for a while.

SPEAKER_03 18:12

And and uh and where do you did you where did you kind of like what did you special did you specialize in anything? Did you try to go really broad? What did you try to do when you were trying to like like set yourself up for a career in the field?

SPEAKER_00 18:23

Uh yeah, so I I started I started at prosthetic heavy clinics. So mainly working with with the prosthetic side rather than necessarily the orthotic side. Later in my career, I did work more on the custom orthotic side. Uh I'd say most of uh what I've worked on has been lower limb, kind of prosthetic, prosthetic designs. Uh, but then at one of the clinics I worked at, we started seeing just a lot more uh upper limb uh users come in and and patients. So uh I think like most people, they find themselves just kind of catapulted into that role um unexpectedly. And then there comes a moment of a little bit of figuring out, uh a little bit of oh shoot, you know, where do I go from here? I don't really know what I'm doing. And then you lean on your your community and the the people around you and people who have been doing it for years. And so I started, I I I wouldn't consider myself an upper limb specialist, but I started seeing more and more upper limb as well during a period of my career.

SPEAKER_03 19:19

And is there like uh, you know, did you make the right choice? Are you like, oh my god, no, I should have never done this. What did you like it or or or or do you see a certain person gravitate toward upper or lower, or is it just really circumstance dependent, do you think?

SPEAKER_00 19:32

No, I I think I've seen more engineers maybe gravitate towards the upper. It is a little more hands-on as far as the electronics of it and and kind of the problem solving. You're you're working with technology and and how the technology communicates with each other on a maybe a deeper level than um a lot of the lower limb solutions out there or there right now at least. Uh so I do see more of an engineer mind toward uh gravitate towards that that upper limb. But yeah, a a lot of a lot of kind of uh overlap between um you know the services that you're providing. I will say for an upper limb, you do while you do have more of that technology focus, it's also a a a really intimate experience where you're working long term for long hours, especially at a time with a patient. I feel like a lot more things go wrong. And you're setting expectations in a way that maybe for for lower limb, you're not you don't have to set as strictly because things things will go wrong no matter what. So you're you're making sure that the patient understands that and and they're they're kind of part of that process from the beginning.

SPEAKER_03 20:36

I'm gonna go on a linear and say that like the upper thing is more like a systems integrator type of approach, you know? And then the lower limb people are more of a craft type of approach. But that's also really like super generalized, so maybe it doesn't even make sense, I think. Maybe.

Upper Limb Versus Lower Limb Work

SPEAKER_00 20:49

Yeah, I I I could I could see that. Um your I mean the craft is is there no matter what, right? We're working with the very dynamic human body and in some ways are using static principles to try to to try to work with that. That also is kind of a transition to what I'm doing now and and what I've experienced over the uh the career. You know, seeing the need for adjustable, flexible, malleable solutions that accommodates the patients, uh the patients as they change throughout the day, or as they move, as their muscles move and fire throughout the day. So those are those are things that I think are common uh to both of those industries. I think the the craft and the art and the problem solving is is definitely in both. I think with upper limb, you're probably maybe utilizing that in a more um mechanical electronic focus, maybe more of an engineering um mindset, though.

SPEAKER_02 21:41

So yours, I I think it's a pretty interesting way that you describe it as kind of a systems integrator for the upper extremity. And while the craft is definitely there for making sure the socket fits and such, it does become a system. You know, we've got all these hands, and we've talked about that before. And then the pattern recognition and different bioelectric. Signals, computers, wrist units, that sort of thing. And so you have to know a lot about how this stuff kind of goes together and truly getting everything to talk to each other as well as a systems integrator. And then the lower extremity stuff, I think you're right as well. Is this a weight-bearing surface? It is a uh, you know, it is is very technical. There's still a lot of things to do, but not the electronics that you have with some of the other stuff, other than, you know, say the microprocessor needs and such, which are always great.

SPEAKER_03 22:32

Yeah. So I love that. Does one of the two make more money than the other? I'm just curious. I don't know.

SPEAKER_02 22:39

So the upper extremity, the numbers are bigger, but your cost of goods is also very large. So when you look at the spread of uh, for lack of a better term, the profitability side of things, as when you look at it as a percentage-wise, upper extremity, while the numbers are big, would not be as percentage profitable as say uh lower extremity prosthesis. And the follow-ups, uh, especially on some of these myelectric arms, and you're dealing with small wires, and and there's there's just a bunch of things that can go wrong. So there are there's a significant amount of follow-ups that I would say that are involved with upper extremity that you don't necessarily have with the lower extremity because of the technology that's used. Now, when you talk about the actual number that goes into your bank account, the the profit, that number can be good. But it's one of those things where, especially with the US insurance market, you definitely don't want to be over-leveraged because insurance companies are you are guilty until proven innocent. And so they can take their money back, and then you have to go prove that you indeed did provide the stuff. So you don't want to be super leveraged on your cost of goods when you're delivering these things as well. So there it's a risk reward. And I will say that there are some companies that just do upper extremity and they're really good at doing it, and they have a good billing department and they have a very good track record, and and that works. But you're still it's still risky. It's just a matter of how much risk do you want to take compared to the lower extremity stuff. And you're much more likely to get audited on high-ticket items as well. So these are things that you just have to have all your ducks in a row ready to rock and roll.

Prosthetics In Low Resource Settings

SPEAKER_00 24:31

Another interesting kind of difference between the two is it's it'd be really hard to kind of exist on an island, if you will, as an upper, upper extremity provider. You've you've got to lean on your community, whether that's the clinical specialist, whether that's other other clinicians, you've gotta you've got to use that expertise and those mistakes that others have have made and can kind of teach you about. Whereas in in lower extremity, I feel like for the most part, you know, once you've once you've seen a few different presentations, you can you you have an idea of what you're approaching. It's always going to be a challenge and it's always different and unique. But in upper, it's just on a whole, whole different level. And there's people out there, and and that community is willing to share. That's the other thing I've found is that upper limb specialist does not live on an island. And you can reach out and you can talk to talk to people in in a way that's really um welcoming and builds an awesome community around patient care and getting better outcomes.

SPEAKER_03 25:23

And I think one is a one thing that's interesting, like because you work before on these emerging markets or developing nations or stuff, delivering like other medical stuff. How do you feel about how good the industry is at delivering medical care or prosthetics essentially in medical care to yeah, like uh in less privileged places, let's say the poorer countries? What's your perspective on that?

SPEAKER_00 25:44

At the core, it's well-intentioned, right? I don't think anyone goes in and has ill, ill will, ill intentions, people want to help, help, help the uh, the people that need the help. I'd say one thing that I have learned over time, and this is even before prosthetics, is your ability to capacity build that predicts the long-term success of and the number of patients that you can build in that in a region like that. So one thing that we really concentrated on is we would partner oftentimes with big corporations and industries that maybe even had a long-term interest in in certain areas where, in that case, medical technology wasn't as well developed, because you're building the the infrastructure and the ability for those countries and uh people to purchase in the future, even though that might not be there now, uh by building that that network. So in our case, we collaborated really closely with the GE Foundation, who long term saw many of these countries as uh future customers. But the way they approached it through us was we uh collaborated with technical schools, ministries of health, we educated local technicians on how to repair, maintain um, and and set up infrastructure at these hospitals to accommodate medical technology that wasn't available necessarily widely at the time. And then slowly over time, once you have the capacity to maintain, provide, and really set the foundation for that to exist. Now you're working with the ministries of health, see a lot more opportunity and a lot more benefit to investing in these projects. And we saw it just explode exponentially. Our role there, too, I'll say, was to educate these groups and eventually hand over to the local uh, again, technical schools, ministries of health, whoever was managing it in those countries, whoever was the right partner. And then we would stay for about five years, monitor, evaluate those programs, make sure they were effectively running, and then give a big hug, high five, and move on to the next region or next country and build capacity there because we evaluate that it was sustainable long term. I would love to see something like that or some of that thinking implemented a little bit more in the prosthetics market and industry rather than what we see a lot of times is treating individuals and having giving them access to a leg or an arm, if you will, but then maybe not thinking big picture what happens long term as far as taking care of them and also others in the future.

SPEAKER_03 28:17

I know I like that because it dovetails really nicely with with like Brent, who's always like when you hear about when he comes back from Guatemala, you hear about like we did this many procedures, you know, but he's most proud. I think, I think, I think you are, I don't know, correct me if I'm wrong, but you see him much more proud of like, you know, it's actually we trained this person, he can do it now, or she can do it now. And that seems to be like much more like like what you're really excited about long-term, right?

SPEAKER_00 28:42

Yeah, and it it it's it's hard, right? Because we prosthetics is built around these consumables and these these liners and sleeves and socks that wear out and they break. And and how do you not only build the capacity to provide them and and design a prosthesis, but then also have access to the components? And how do you at the same time, the same conversation also involves how do you build the fabrication and the manufacturing, either in in the country or in the region, to accommodate that at a price point which is which is realistic for um what the market is.

SPEAKER_02 29:15

Yeah. And for me, I mean, the biggest thing is support. I mean, I think COVID pretty much exposed almost all NGOs that did not have a local presence. And um and so, I mean, it was some of these countries were closed for literally years. I mean, a year or two. I know Guatemala, it was a year and a half before we went back. But I mean, I think one of the things that we loved is there was a well-stocked lab and a young man down there that took care of the patients during these times, made new prostheses, and that's the way it should be. But when you take a look at flights and hotels and food and all that stuff, and you you have uh say a large group go somewhere, you take a look at that, and you if you take that same amount of money and you invest it into a local talent or supplies, it really would go a long way. And I think a lot of um uh you know NGOs would benefit thinking about that in that way.

SPEAKER_00 30:11

Yeah, I early on in my career when I was, again, selling medical equipment, we ran student programs where American, European students would would come to Tanzania, they'd come to Honduras, come to uh Rwanda, and we would partner them up with local students and they would they would information tier, they would learn about medical equipment, how to repair it, all those things. But one of the conversations I had with them early on as well was, you know, you're gonna don't overlook what you're getting out of this as well. And if you just come here and and the priority is to, you know, we fit a couple patients or we fixed a little bit of equipment and made a minor impact, that that has value. But if you can take that mindset and you can take the culture and you can take the the connections you made and the things that you saw and and maybe some ideas on how to how to improve in a future, if you can take that back with you, that's that's powerful in itself and shouldn't be overlooked. So I think that that's really where those those types of experiences can have an impact. We see it across the board. We see students that go that all of a sudden their minds are opened and they they maybe pivot their career slightly to to uh to something that they solve, which they're passionate about. That's an important, I think part of these that I hope uh people going on these trips, especially if they're kind of once or twice in their career, that they can internalize and take with them for the rest of their career.

SPEAKER_02 31:37

Yeah, I think one of the other things, uh Alex, and I'd love for you to share on this. I mean, you touched on it a little bit, glossed over it because it was kind of a normal thing for you, but this idea of compliant prostheses, prostheses that move with you. Uh I just wanted to hear your kind of take or philosophy on what a prosthesis is, uh, especially after hearing you kind of describe it that way.

SPEAKER_00 32:02

Yeah. So the, I mean, at its core, really, we've got we've got something that is so that that's a moving target constantly, right? The the the limb that's um no longer there. We're trying to replace that with things that are in its core very static and and not not not at all really what the human, not at all really great, great things to to replace all the complexity of the human body. And we try to get as close as we can. At at its core, there's the technology is is is great, the all the electronics and all the microprocessors that we have access to now. But really at its core, it's it's how the interface and how the socket interacts with the the human portion of the residual limb. And improving that has been something that I've been passionate about and kind of sought out in my career, whether that's employers, whether that's on the side, just learning more about how the body moves and how we could use materials to replicate that. And I just keep going back to the socket and and how the socket is the middle ground or the part that translates what the what the mind and what the human body wants to do into the static components that need to be told what to do. And if that connection isn't strong and isn't comfortable and isn't compliant to some degree, then it's not um it's not going to be the kind of outcome that we're hoping for.

SPEAKER_02 33:27

Yeah, well, I mean, I think the compliance side of things is so important. And when you take a look at the history of where that came from, even in the early or late 1800s, early 90s, people were trying to get these flexible and did it through a myriad of ways in the patents, at least that I saw. So I think that's a really great take. And I think that's pretty exciting with the way materials are going with the way now, you know, you've got something like a rapid liquid print, some of the nitro stuff that we do, some of the Velcro, uh, not Velcro, the adjustability, enhanced fabrics, 3D knitted fabrics. I think that there's a lot of things that is a wide open white space for prosthetics.

SPEAKER_00 34:08

Yeah. What's really what kind of the exciting and also the challenge in all of this is we want to make it like if we could strap a pillow to someone's leg, they'd love it, right? It's super, super comfortable, super uh compliant, and and uh, but they'd follow every step because there's there needs to be some energy energy transfer, some way to transfer that that energy effectively into the foot and into movement without sacrificing the comfort. And that's where that where you're constantly going back and forth and in some ways maybe feeling like you're compromising because you need to achieve this other result. But it also opens up opportunities for us to continue to develop and and uh problem solve and and get better at it. And that's that's an really exciting part of the field.

SPEAKER_03 34:50

And and I think I think that's an interesting take. I think it's also really interesting. This idea, like just philosophically, is it like, you know, what is the best prosthetic? Is it something that works with the leg or with the existing part of the leg or arm or whatever? Or is it something that replicates the functionality as it was, or is it something that does the situation, uh, you know, that deals with that situation to the best ability, you know? I remember we had a conversation about this uh with Brent uh a long time ago in the beginning of his podcast, where well sometimes the hook is actually kind of easier than some kind of super gizzy, you know, super uh sophisticated uh robot in hand thing. What are your thoughts on this kind of like, you know, what is the goal actually like from as a technological system? Is it something to integrate with the human? Is it a separate system?

SPEAKER_00 35:33

Yeah, it fortunately we have so differ so many different approaches nowadays where it's really up to us to understand what the goals are, right? What the patient wants to be able to achieve and and how to translate that and also how to communicate that in a way that they maybe had certain expectations coming in which are which need to be slightly um you know slightly updated, if you will. Yeah, that makes sense.

Ethnocare Origin Story

SPEAKER_03 35:56

So tell talk us a little bit about what you're doing right now and where you work and what you're what you're what you're doing there.

SPEAKER_00 36:01

Yeah, I joined uh Ethnocare. It's actually only been about a month, but I've known the guys for going on to about two years. So Ethnocare is a company based out of Montreal, and they had a really interesting start. It was started by three friends at university who uh were studying design. And they just come from a design background, an engineering design background. And one of their mothers, she underwent amputation about 12 or 13 years ago, bilateral transtibular um amputee. And being such a personal story for Lewis in this case, he started looking into that and he started seeing some of the challenges that she was having on a day-to-day basis with regards to her socket fit, with regards to stability, with regards to getting wounds, frustrations because she wasn't in control, as in control of her prosthesis as she might be with her her shoes, right? You can change your change your shoes if they're uncomfortable, you can tighten the shoelaces if they're not fitting right, you can add a different insert to your shoes, but with her prosthesis, that was a little more challenging on a day-to-day basis. So they started looking into those issues and noticed that it wasn't just his mom that was having these issues, it was a it was the big, the wider community that was often expressing similar challenges. So they did something which I learned this recently. They did they they looked into something called ethnographical research, which is also where the name comes from. And they really uh wanted to understand the prosthetic user, the population as a whole, their issues, behaviors, and needs. And that was done in a qualitative manner. So it was done through interviews, it was done through through conversations. And then these topics started to emerge where people were having, were expressing the same um frustrations. And that's where the name ethnocare comes from, from that research that then is applied to healthcare and medicine and kind of the orthopedic uh solutions in general. But ethnocare to me was really interesting uh because initially I thought it was kind of a maybe, and we'll talk a little bit about the actual product, but it was more of a one-product company. So I didn't I didn't see where things were going. And over time I started to really understand it's not just about designing this one product and then coming up with a solution for a single issue. It's actually more of a platform to innovate for the prosthetic and orthotic and orthopedic industry. So we're looking at because they're engineers, I'm an engineer, we got a a great RD team as well. That's actually fantastic. We're looking at these issues more from a design approach or an engineering approach where we figure out what the problem is, uh, figure out solutions for it, and then apply that to the the users that were calling for this rather than maybe some other approaches, which would be come up with the technology, come up with something new and innovative, and then try to find the industry that that may apply to.

SPEAKER_03 38:56

Yeah, I think it's this is like you know, an additive. We were we're you know, a lot of companies get started just like we we invented a box, let's see what we can do with the box. Uh so uh you know, it's kind of a bit of a you know, the the story is actually maybe just too familiar. It sounds like if you say it's like it's super obvious, why doesn't everyone do that? But I think it's actually a lot of innovation, like usual that innovation I think is a really, really important thing, especially for stuff you have to live with every day.

SPEAKER_00 39:21

Right, right. And then the the the team that's assembled around this is is really unique. You know, they they don't have an OMP background. I'm actually the first first clinician or someone with an OMP background to join the team. Um so they're coming at this purely from a a design, and here's the here's a problem, what's the solution type perspective? You know, the the R the RD director, he he worked for CCM, designing helmets that need to be super snug and super tight because you're you don't want that movement inside of the helmet, but still comfortable enough to wear. So that's that's the approach that we're taking and applying that kind of thinking into the OMP industry.

SPEAKER_03 39:59

That's super cool. And and and talk us a little bit about your uh the the product you have right now, and then maybe some of the product, I don't know if you can talk about that, but the products you're gonna come up with.

SPEAKER_00 40:10

Sure, yeah. So the the product right now, kind of the flagship product is called the overlay. And it's a fabric sleeve that uh you pull over the liner, hence the name overlay, and it's got an air bladder system built into it that the user can pump up or deflate as needed throughout the day. So we know one of the biggest issues, right, is that a prosthetic user, they're gonna shrink down, they're gonna swell up, depending on their condition, depending on what they eat, depending on if they have a beer for dinner or not. Right. So we're we're constantly chasing that moving target. And typically or historically, that approach has been using socks where you take your prosthesis off, you put on another sock or take a sock off and then put it back on. And kind of there's a little bit of hoping that it's gonna fit just right. In this case, you're wearing the system inside of the socket. It's got a little manual pump at the top. I think like a re the old Reebok pump shoes. I don't know if you're you're familiar with those, but you you kind of pump it up, pump it up. And as soon as you feel the kind of sensation that you're looking for in the socket, then uh you go about your day. There's also a manual pump that each one of the manual pumps that's separate. Each one of the manual pumps is about 10 individual integrated pumps. So for users which do have a lot of volume fluctuation or change a lot throughout the day, carrying that around has been a time saver at the very least. The neat thing about the product too, which is which which helps it really stand out against other solutions, is that it can accommodate volume fluctuations up to 15 sock ply. And that's kind of unheard of. When you're in 15 sock ply, chances are you're you're getting a new socket anyway. But I've had multiple fittings where patients have come in wearing 10, 12, 15 sock ply and put the system on, pump it up a few times, and take the pressure off those sore spots, are able to control their prosthesis a lot better and get by.

SPEAKER_03 42:13

And this is one thing I'm interested in. Like everybody's always saying that there's like, you know, it's super variable how you know this how much you fluctuate when whatever's going on, all that stuff. But you know, once given the ability to pump up and and deflate this thing at will, how often do people use this typically? Or is there there's like a huge range, or or how's that work? How often during the day? Yeah, how often during the day? Is like or is there a typical number, or do you do you just see that fluctuate? Or is it like you know, some people three and the other like 300? Or what are we talking about here?

SPEAKER_00 42:43

Pretty much it it it's it's so individualized for the patient. I mean, you've you've got some patients who are on dialysis or um are taking diuretics where they they could their limbs shape, if you were to take a picture of their limb shape and you know, hour one and then hour two, it'd be you'd think it'd be a whole different person. And then there's others, so they would need, they're constantly kind of trying to find the right solution, the right fit during the day. So they're using it really quite frequently. And then there's others where maybe during activity, you know, we see a lot of really active folks as well gravitate towards this because they might just need a little bit, a little bit of tightness on their run. They might just need a few little pumps to get a little bit tighter. And uh 30 minutes later, after they've sweat some and you know, maybe you know, find that their socket fit is starting to get a little bit looser, then they might pump it up another one or two times, but they're not seeing those major volume fluctuations. So it really is for both populations. Um another thing that's really, really interesting that I learned that I wasn't aware of um before getting into the space is the doffing effect. We see in the clinic, but we we don't really quantify or or look at systematically. We just kind of deal with it's when when some when a prosthetic user, when they take their prosthesis off, the research shows that within five minutes. Their residual limb um circumference or volume can change anywhere from 0.2% to 17%. So just by taking the pressure that was on their limb off, the body kind of resets, fluid rushes back into certain areas that maybe it was it was getting pumped out of previously. So now if you're thinking, if you're extrapolating that thinking and and and uh applying that to socks, you're taking your prosthesis off, potentially changing the entire uh leg shape and now trying to put it back into the same environment either by adding or removing a sock, but you're you're you're changing the entire um you're you're changing the uh limb shape and the and kind of the inputs, if you will, into the into the system. A really nice thing about this approach, and ethnocare and the sleeve is by no means the only solution out there on the market. And it's not it's not like everyone needs to be in this, right? There's there's different the beauty in all of this is there's different solutions for different patients and preferences. That said, the benefit of having something where you're uh changing your fit and getting real-time feedback how of how that modification changed how things feel is so, so important. You take your leg off. We as clinicians, we've all we've seen it time and time again. We educate patients on sockware, we have them take their prosthesis off, add a five-ply sock. They're like, nope, now it's too tight. So you take the prosthesis off again, you put on a three-ply. It's like it's better, but still kind of loose. You take the prosthesis off, you put a three-ply, and then you combine that with a one-ply or a lightweight sock. So you're you're constantly trying to understand where you need to be without, yeah. It's almost like an unfair, unfair uh game that the amputees or the users have to have to play. So if you get that real-time feedback, you're like too loose, too loose, too loose, too loose, just right. And then you stop, and then you can, it's it's just a lot more intuitive and a lot more user-friendly, and really empowers the patient to take control of their prosthetic effect.

3D Printing And Consumer Tech Future

SPEAKER_03 45:59

That sounds really cool. And then what are your things like we yeah, we talk about here, we talk about CAD and 3D printing and and and and uh 3D design and and and uh scanning a lot. What are your thoughts on that? Is that gonna change the industry industry completely, or do you see it just a more of a prototyping tool? Or what do you would do what are you feeling on that?

SPEAKER_00 46:18

We use it heavily for prototyping. There's so as a as a company where our goal is to come out with somewhere between two to five products every year. And there's there's so much in the in the woodworks, and we use it almost on a daily basis back in Montreal. It's I I really I'm really and you you mentioned it earlier. I'm really interested and excited about the um the silicone printing, the uh the product out of out of MIT. You know, I kind of been observing that from the periphery, but that I think has huge applications in the field, especially when we talk about interfaces and being able to integrate that into these systems. Um I love it. I I never really I say I never got the opportunity. I could have obviously pursued it more heavily, maybe, but I never was at a clinic where we where we heavily had 3D printing integrated, but I was always curious about it. And I'm seeing all these these great outcomes. So beyond having my personal printer at home, really I I personally haven't dabbled too much when it comes to using it for sockets or using it for for other things in the industry beyond prototyping. I think the opportunity is there and it's definitely moving towards it.

SPEAKER_03 47:25

And what are your feelings just generally about, you know, we think about this a lot about this industry where you know there's so much going on in robotics, there's so much going on in electronics, chips, all that kind of stuff. What are your feelings on on the industry, uh, you know, OMP colliding with that consumer electronics world and just the the future of everything?

SPEAKER_00 47:42

I mean, it's it's it's here, right? I mean, we I was at the airport the other day and um I looked around me and just everyone waiting for the plane was on their phones. So we're we're interconnected, we're constantly getting these these these inputs, and it's just natural for us to want to integrate that into our prosthetic one design process. Um, because what gets overlooked a lot of times is the the maybe the patient, the patient experience is so first and foremost. But one thing we try to look at as well is what's the clinician's experience as far as fitting, as far as being able to obtain the device, and how can we make that easier using available technology and how can we develop technology to make that easier for the user? One thing is our sizing. We have this really nifty kind of sizing tool on our website, which has really helped clinicians more accurately measure for patients. On the back end, we're using, and I know the team has integrated AI into a lot of our internal processes. So I think that's another opportunity, not just for the for the actual prosthesis and the technology in uh integrated into the prosthetic device, but actually for the processes that allow the clinician, the manufacturer, whoever it is, to get to that end product. I think that that's really exciting as well.

SPEAKER_02 49:02

So we know all the benefits of having the ability to adjust for volume changes for the for the patients and such. But this journey with uh Ethnocare for this sleeve has not been the easiest journey, right? There are some bumps along the way. I'm sure there was uh some coding stuff and all that. Can you just share a little bit about that that journey? And uh it seems like now you guys are at a reasonable spot, probably not where you wanted to be, but a reasonable spot.

SPEAKER_00 49:29

Yeah, that's and what a journey it's been. So when when we designed this solution, you design, you have the like we talked about earlier, you have the problem, and then you design a solution for that. And now you have to get it out there into the market and make sure that people can actually access it. Typically in our, at least in the US, you know, what you what you want to have is you want to have some kind of a code that describes that system, an L code, right? That allows the clinician to one get paid for providing this service. And and what that leads to is really just the patients getting access to this type of of device. So initially, when we started in the US, uh it didn't have a code. So it was it was what you consider a 99 code or a miscellaneous code. Clinicians were getting really excited about this, patients were asking for it, and it was it was really starting to gain traction. But because clinicians weren't necessarily guaranteed payment on it, it was considered maybe more of a niche device, or more of one of those, like, hey, this is a really challenging to fit patient, maybe this could be a solution for them, or this is you know, maybe a one-off or the patient really wants this, so I'm gonna provide it to them. But it wasn't seen as like a global solution. As of April 1st, and it was no April Fool's joke, Medicare now, first of all, in in about October of last year, they actually allocated a L code, the L5657, for this device. It's uh um uh in an addition to code that describes a uh uh a device that uses air to accommodate volume fluctuations. And uh so with that code, however, they didn't allocate a fee schedule. So they didn't say, hey, if you bill this code, we're gonna pay you this and this much. Clinician were billing um MSRP and and and really sometimes getting paid, sometimes not. Um, as of April 1st of this year, 2026, they did allocate a fee schedule towards it. So now clinicians can go into this with a lot more um security, knowing that they're gonna get paid for the services that they're providing and provide the service to the best of their abilities. Right? Because this is just like anything in prosthetics, you need to educate, you need to familiarize yourself with it, you need to problem solve, um, you need to change, adapt, and constantly be on your toes when you're providing these types of devices. But really, at its core, the the fee schedule has opened up a clinician's access to this technology and a patient's access to being able to uh to utilize this as a really an everyday solution.

SPEAKER_02 52:06

I think that's man, what a journey. I can't imagine, and it's multi-year journey and multi-the-the involvement of you know getting the code and then not having the pricing quite right, and then finally getting that corrected to the best uh you know potential outcome. I think that was a really good thing. And I and what I love is this is a great foundation for you guys to keep on going. Now, I mean, I don't think it can get any harder than this this product. And and now you guys kind of know the the path forward if you're gonna bring something innovative to the market that doesn't exist, which is always uh a risk, but there's uh there's there's a massive amount of white space for things that help patient outcomes, but people are scared to bring that to market. So I I think that's a one really cool thing about the company that you're working with is not well, you always want to get paid, right? But it's hey, these are things that will make patient outcomes much better and truly solving a solution and not looking at the L code. So it's it's the road less traveled for sure.

Closing Thoughts

SPEAKER_00 53:20

Yeah, and it's it's it's really it's a huge, it's a huge opportunity and it's it's a really exciting time to join the company. I I probably did it the wrong way because I joined them a week before Medicare actually announced that it was giving it a fee schedule and what this feature fee schedule was going to be. So for me personally, I believed so much in this product and knew that we were gonna figure out a way of of improving that access, whether it was with the fee schedule that we hoped for, whether it was, you know, some way around that. But then my first week, I was actually in Montreal when they made the announcement when they when they got back to us. So within that first week, you know, it was a really a sigh of relief in the end, um, because it could have gone a lot worse. Um, of course, you wish for it to be better. But um overall, I think we're just we're so excited to in a way close that chapter and be able to move forward with with that code and with the fee schedule and and really seeing more and more patients have access to this technology.

SPEAKER_03 54:20

Yeah, that's great news, Alex. And and thank you so much for being here with us today uh uh here at the Prostetics and Orthodox Podcast. Thank you guys. It was a lot of fun. And yeah, Brent, thank you for being here once again.

SPEAKER_02 54:31

Yeah, this was great. And hearing Alex's journey, the journey of the company, and uh really pushing to get great outcomes for patients is very inspiring.

SPEAKER_03 54:40

Totally, totally. And thank you for listening to another episode of the Prostetics Anatolics Podcast. Have a great day.