A report on AbilityMate conducted in the context of the Open Design & Manufacturing project.

AbilityMate is a Sydney (Australia) based social enterprise whose mission is to help people with disabilities access the equipment they need. Their vision starts by making custom-made 3D printed Ankle Foot Orthoses (AFOs) available to Australian children! The enterprise’s approach is to use 3D scanning & printing technology to fabricate customised designs for AFOs. They are developing 3D scanning equipment and are making it widely accessible on the World Wide Web in 2018. The enterprise was founded by Melissa Fuller and Johan du Plessis.

3D printed Ankle Foot Orthoses (AFOs)

AbilityMate initially started by running design jams and projects at community makerspaces. The aim was to help people with disabilities by developing custom made 3D printed devices. In this early phase the AbilityMate community would work directly with people with disabilities to assess their needs and 3D print the devices that made them more independent. This has been exploratory and the AbilityMate community has co-created a number of different designs for people in need of assistive devices. These designs have been made available online.

Hack-a-Home Project

A more recent collaborative research project which is still ongoing seeks to test “what happens when you put the means of production in the hands of those who need it”, whether the production of custom made assistive devices could be moved to the community requiring them. The project entailed conducting trainings at various residences where people with disabilities live. People with disabilities and their carers were trained to do various aspects of the design and production of assistive devices, from body scanning to 3d modelling and 3D printing. Overall, this project seems to have had a low general impact, as coordination has been challenging and production has only happened when AbilityMate makers have been present. However, the impact is large for individuals when they experience the power of being able to produce assistive devices to cover their own needs.

Open Source 3D scanner

The Magic Shoes project  

In mid 2016 AbilityMate started receiving many request form families in the Cerebral Palsy community who saw 3D printing as solution to the challenges they face. Members from this community requested that they have a go at 3D printing Ankle Foot Orthoses (AFOs). AFOs are customised leg braces worn to support posture and mobility of kids and are used for corrective therapy. Currently AFOs are prescribed and hand fabricated by a medical specialist called an Orthotist. After looking into how AFOs are currently made they realised that their approach of using 3D scanning and 3D printing could potentially create a more pleasant experience for children and reduce the turnaround times and wait times experienced by these families. Because of the large amount of work and investment required to make this a reality, AbilityMate was joined by 6 other impact driven organisations. The project includes regulatory affairs, a clinical study with 20-30 children, development of an open source 3D scanner, the establishment of 2 orthotics clinics to make 3D printed AFOs available and the release of an open source package including blueprints of the 3D scanner and findings from the clinical study. A considerable financial investment of $600,000 is required for a project of this size. With a strong collaboration in place and a successful proof of concept AbilityMate has raised $400,000 through crowdfunding and philanthropic donations and still needs to raise $200,00 to complete the project.

Magic Shoes project team

The AbilityMate model

Having explored the production of a number of assistive and medical devices, AbilityMate came to the realization that it needed to create a viable business model. Once it has done this, it will be able to apply the same model to other types of customised assistive and medical devices. The current focus of AbilityMate is therefore to establish this new enterprise model around the customisation and production of AFOs. They’ve started with  “The Magic Shoes Project” and now have now begun to set up a sustainable social business.

AbilityMate are a For Purpose technology start-up that’s incorporated as a Proprietary Limited Company. They have modified their constitution in line with a Social Benefit Company. It permits and requires Directors to act to deliver the purpose and to consider wider impacts of their decisions. AbilityMate will be engaged in the customisation and digital manufacture of custom-made assistive devices. AbilityMate’s products help orthotists achieve the clinical results they expect and deliver effective, cutting-edge options and better experienced to their patients.

In their experience the interaction with orthotists is critical to the safe delivery of 3D printed AFOs because these devices are corrective by nature not augmented like a prosthetic hand for example. AFOs are traditionally prescribed and made by Orthotists, after careful evaluation of biomechanical needs.

Moreover, many devices that are normally prescribed by health care providers have been subjected to clinical trials. Simply having a repository of open source templates for assistive and medical devices does not really suit a large percentage of the market. AbilityMate has learned that it has needed to create a model which incorporates the medical profession and clinicians that prescribe the devices. The new model has three basic aspects:

1. Open source body scanning devices;
2. A customisation and fabrication service (CFS);
3. A network of localised 3D printing facilities

Customization of AFO

The first barrier to overcome is the way in which orthotists develop AFOs in the first place. For things like AFOs, orthotists have traditionally used plaster casting which children tend to dislike. The first problem to solve is to find a way in which orthotists can digitize the production process. There are many types of body scanners, but they have not been widley adopted by the profession. Good scanners can cost between $20,000 to $30,000, and may not be made for scanning the legs of wriggly children. AbilityMate is therefore working on an open source scanner that will be available to anyone to make at a much lower cost.

Secondly, orthotists are not digital designers, they work with their hands, and do not normally have knowledge and experience with CAD and 3D printing. AbilityMate believe it is not realistic to expect orthotists to become experts at these. AbilityMate’s strategy is therefore to set up a customisation and fabrication service (CFS). This is currently the model used for orthodontics and other medical devices that require a high degree of customisation. The CFS would be an online platform set up and run by AbilityMate. AbilityMate would receive orders from orthotists based on digitised body scans and their prescriptions. AbilityMate will make arrangements to have the leg brace printed at a 3D printing facility located closest to the orthotist who placed the order. Before onboarding a 3D printing facility to join the platform, AbilityMate will ensure the facility has all the required quality control and regulation requirements in place.

Thirdly, to fund and protect users this model requires there are elements of open source IP and closed IP. By opening the IP of the 3D scanner they reduce barriers to 3D printing. It will also enable AbilityMate to reach kids in remote communities. They will also have to keep some IP closed. AbilityMate has received genuine concern from the medical profession about open sourcing templates and 3D designs for AFOs. Because AFOs are corrective devices there is a major risk in having an unqualified person designing and printing AFOs for already vulnerable members of the community. AbilityMate is also in the process of raising seed investment from impact investors. For them it doesn’t make sense to open the IP surrounding how to customise an AFO in CAD modelling. These barriers have really challenged their thinking about open design and cosmo localisation because their vision started out with ambitions to keep everything open! In reality this approach could have negative consequences on children and on AbilityMates’ ability to raise capital. As the business model evolves, they hope that the tensions between the vision for cosmo-localization and the practical considerations of AFOs and seed investors can be resolved and integrated.

Based on this three-part model their plan is to support the development of AbilityMate “Pods”. Pods would be localized operations that can support a number of territories in instantiating the model (a little bit like a franchise but using open source principles). AbilityMate would package as a service how to set up a full-fledged operation, which would include how to conduct 3D printing as a CFS, how to produce and use the scanners and upgrade orthotics clinics to digital workflows, and how to draw on an open design commons. AbilityMate would help people set up their own operations in different parts of the world to service their local areas.

Open clinical trials and university collaboration

AbilityMate have also learned that the production of medical devices based on open designs needs to be coupled with clinical trials and the validation of models and technologies of medical devices. In Australia, for example, clinicians/orthotists will not normally prescribe an medical devices that has not been validated through clinical trial. This means that from a medical profession point of view, there is no real value in having hundreds of innovative open source designs for medical devices if none of them have been trialled and validated. In addition to this, medical trials are very hard to do, they cost a lot of money because of the research costs involved. In their opinion, they believe that certain contexts warrant a more liberal approach to this. For AFOs, for example, it is better that kids have them than not. For other types of devices where there is higher risk, they feel clinical trials need to be strictly applied.

Therefore, the challenge is not just to cultivate an open design commons for assistive devices and medical devices, but to build an approach to prototyping, testing and trialling assistive devices and medical devices in conjunction with this design commons. This requires open data on clinical trials that others can build on, which allows for people to build on and create subsequent design optimizations. In essence there is a need to create a commons around clinical trial data and the validation of devices. AbilityMate have only just begun to have conversations with universities about this.

Values and principles and the role of the maker movement

AbilityMate is an expression of deep personal connections with the experience and challenges for people who are disadvantaged by disabilities. Johan’s grandfather, for example, had polio, which left him with an impaired limb. The social stigma of being cripple haunted his grandfather’s entire life, impacting his work opportunities, and had an impact on three generations of his family. Melissa has a cousin who was struck by a car and acquired a spine and brain injury, losing the ability to walk and speak. The state insurance, which was meant to last his whole life was quickly exhausted by medical costs for equipment, and she saw how her cousin’s family constantly improvised to figure out how to solve basic problems.

The maker movement has also had a big impact on the values and thinking of AbilityMate. Before starting on this journey, Melissa did a tour of 40 makerspaces / tech shops / Fab labs across the United States. Realizing the massive impact of producing material things, and the possibility this new model could have has been a motivation as well. The way in which the maker movement merges the idea of the user with the designer and the consumer has been significant. In 2014 Melissa started a community makerspace in Sydney which is where she and Johan met.

Fairness is also a key concept. AbilityMate do not want to do charity, but rather create a more fair and equitable system. They feel that the emergence of a global design commons levels the playing field and creates fairer opportunities for people to have access to assistive devices and equipment. Fairness also means the price of assistive devices. The current high costs of assistive devices adds yet another burden to people with disabilities. The global design localized production model provides a way to lessen that cost burden.

Overall, they feel four words help to express their values and principles:

1. authentic-ness;
2. transparency / openness;
3. courage;
4. fairness.

Team, skills and decision making

Melissa comes from a design and manufacturing background, and Johan comes from a computer science and startup background. There are 4-5 other people they work with. Their backgrounds include industrial engineering, marketing and product management, CAD modelling and UX design. There are also volunteers that are connected with local maker spaces, and some interns with a biomedical background. Overall engineering with a scientific approach is valued, the ability to test hypotheses and conduct rapid prototyping, engage in user centric design, entrepreneurial skills and fund-raising. Areas where they may need future support include legal, fund-raising and finance. But the intangibles are critical in their opinion. They feel that people must have a personal connection with the area, and they are always looking for people who understand the “why” behind why they want to be involved. Often there is a personal story or connection with the disability area.

In terms of work style they prefer to cultivate a culture of co-learning rather than hierarchy. Decisions are made in different ways depending on the context. Most the time there is a team conversation which is open. Meetings are weekly. If there are more urgent decisions to make then less people may be involved in a decision. They use Loomio’s method of working groups and ensure decision-making is transparent, documented and as open as possible. Overall they try to be as organic, open and inclusive in their decision making as they can. While Melissa and Johan are the driving force, they try and distribute this as much as possible, for example by trying to rotate pitching for money or when applying for competitions.

Strengths and weaknesses of open design logic and the future

One of the biggest challenges that they face is in articulating the benefits of an open design business model. There has been lots of scepticism on the part of potential impact investors and it has been hard for people to understand why they would want to give away their “IP”, a constant need to explain and educate people on the benefits of equity fundraising. Alternatively, the benefits of working within the open design business model is the clear resonance it has with many people, associated with its altruistic dimension and potential for social impact. People have been very attracted to the model and have wanted to help, which has made it easier to establish strong partnerships. This has also helped attract talent which has become part of the team.

They feel the open design business model is a critical strategy in addressing the many challenges that we have. They do not feel approaches that rely on patents and tight intellectual property will make enough of a difference. They feel the future of open source hardware is bright if people take the open design pathway. They are optimistic and feel the changes will come from the bottom up.

They see the outlines of a virtuous cycle developing across the open design distributed manufacturing development space. There needs to be ways to circulate value from users and clinicians back through designers and platform developers. As well, learning from other open design enterprises is critical, as the verification of such models helps to create knowledge and legitimacy. They feel it is a bit like social bootstrapping. When there are not a lot of cases it is hard to articulate the benefits of such a model and harder to get resources and people behind it.

At a social level they see an economic virtuous cycle emerging. When a valuable design is added to the global design commons and the benefits of that design begin flowing into the local community, then it frees up people and their time to do others things, and people can apply yet more open source strategies, in a virtuous cycle of economic benefits. As open design enterprises get on their feet and produce results, they capacitate communities to do more. This can include strategies for building circular economies into this model. Finally without a global design commons, local production is not possible, and without local design production then the global commons is not possible. Creating such virtuous cycles is key.

This report on AbilityMate was conducted by Jose Ramos in the context of the Open Design & Manufacturing project, co-funded by the Erasmus+ programme of the European Commission.