Technological advances have revolutionised the manufacturing of orthoses and adaptive devices, but the one-size-fits-all approach often overlooks individual needs.
The Adaptive Design Association in New York has teamed up with international healthcare organisations to revolutionise care by making devices from abandoned and recycled cardboard.
The project, with partner organisations including the World Confederation for Physical Therapy, Glasgow Caledonian University and the World Confederation of Occupational Therapists, aims to increase mobility and independence for disabled children, adults, and people experiencing functional decline in locations across the world.
"The issue for us is that people aren't identical," says Tracey Howe of Glasgow Caledonian University. "People's needs aren't identical and their environments aren't identical. Yet what you get in the catalogues or what's produced commercially tends to be one size fits all."
Customised devices made from cardboard have been used successfully for more than a decade
A physiotherapist by background, Howe first met with the Adaptive Design Association while visiting New York as part of a Winston Churchill Fellowship in 2016. Under the leadership of Alex Truesdell, the agency has been making custom devices since 1998.
Adaptive Design Global would allow designers to customise devices such as seating and spinal supports to body shapes and sizes of all kinds.
"The beauty of this project is that it's about customised adaptive products. It's person-centred. Devices are built in co-production with a whole team that might involve the family, teachers or therapists coming together and asking 'What's really possible? What would you like to do?'"
WCPT President Emma Stokes welcomes the project. “This is an exciting opportunity for WCPT to be involved in and an area where physical therapists can make a key contribution," she says.
"The project fits with the mission and purpose of global organisations, allowing high standards of innovative practice – and future-oriented practice – to cascade down to professional bodies around the world.”
The project aims to create a global network of designers and therapists to help adults and children of all ages
Fiona Moffatt, programme lead for the physiotherapy BSc at Glasgow Caledonian, offers an example of the benefit of customised devices. "In one instance, adaptive design helped a child with cerebral palsy," she says. "He had an ordinary tray on his wheelchair, but with his increased tone his arm tended to fall over the side of the chair.
"The association made a tray which had gutters on the side. As simple as that. It meant things didn't slide off, and he was able to keep his arm from falling to one side. But this wasn't something you could buy. It had to be custom-made."
The association has already enjoyed significant success using cardboard devices, with therapists and designers producing items that have had more than a decade of everyday use. In contrast to plastic or aluminium, cardboard offers a greater degree of comfort as well as being cool, light and recyclable.
"Everywhere I look I now see cardboard," says Howe. "People keep sending me pictures of cardboard in the streets."
The current challenge is one of scale. At the beginning of the year Adaptive Design Global competed with 2,000 other projects for a $1 million grant from the MacArthur Foundation.
While unsuccessful in this particular bid, the executive team's ambition is undimmed. To develop an awareness of adaptive design's potential, Howe aims to modify educational provision to make adaptive design part of curricula across the globe.
"We could have thousands of new therapists every year with an awareness of adaptive design," she says. "It will take quite a long time to get to that level, but for every subsequent year you've got about 100,000 new therapists being aware of adaptive design.
"Our proposal is to create hubs of specialist activity on each continent. Even in a small village you have people who can make things. Some are highly-skilled craftsmen with fantastic skills – but they might never have thought of using cardboard."
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