Barbareschi, G; Daymond, S; Honeywill, J; Noble, D; Mbugua, N; Harris, I; Holloway, C; (2020) Uncovering unexpected impacts: the case of digital manufacturing of wheelchairs in Kenya. In: RESNA 2020 Virtual Conference - GAATO/RESNA Assistive Technology Outcomes/Impact Summit. RESNA (In press).

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Abstract

According to the WHO’s Guidelines on the Provision of Manual Wheelchairs in Less Resourced Settings a wheelchair must meet the user’s individual needs and environmental conditions, provide postural support, and be safe and durable [1]. The wheelchair must be also available and affordable and it must be possible to maintain the product in country through a sustainable system [1]. In Kenya, there are more than 500’000 people with physical disabilities, many of whom are likely to be wheelchair users in need of appropriate wheelchairs [2]. Although there are organisations and institutions in Kenya that have received WHO wheelchair provision training and are committed to providing appropriate wheelchairs, reliance on intermittent supply chains and the continued donor supply of inappropriate wheelchairs remain a very significant problem [3,4]. Currently, wheelchair provision in LMICs follow one of three models: 1) importation, or donation, of complete wheelchairs, new or recycled; 2) importation, or donation, of wheelchair components for local assembly, or; 3) local manufacturing of wheelchairs both at large and small scale. Overall, there is no model which consistently outperforms the others and all of them can be applied to provide good services. However, all of them are affected by unique challenges that can compromise their effectiveness. Models that are heavily reliant on imports are susceptible to supply disruptions which can potentially lead to the provision of intermittent services [5]. Furthermore, imported or donate wheelchairs designed for different environments can be unsuitable to the local conditions [4]. On the other hand, local manufacturing might fail to provide products that consistently meet standards of quality [6]. Leveraging the use of novel digital technologies could help to transform the way in which wheelchairs are designed and manufactured [7]. Through the use of Computer Aided Design (CAD) and 3D printing it is possible to manufacture bespoke assistive products in locum for a relatively contained cost [8]. This de-centralised approach to manufacturing could enable clinicians and technicians in LMICs to take ownership of wheelchair provision, with the potential to tailor appropriate solutions for the end user, manufacturing on demand and within proximity to their point of use. At the same time, the use of CAD software and digital manufacturing technologies would ensure consistent quality standards across different sites, minimising room for error. Such a model also lends itself to sustainability as the expertise for repair would also be locally based. Over the last three years, Motivation UK has developed a new method to design and produce custom wheelchairs using a parametric model that combines 3D printed nodes and metal tubes. The system enables clinicians to position and take accurate measurements of the client using a wheelchair simulator and input measurements and preferences of the clients in a simple computer interface. The programme feeds the data into a parametric model that creates different geometry of the nodes, constructing the full set of wheelchair joints in a file format suitable for 3D printing. The parametric model also gives the ‘blueprint’ for the chassis tubes in terms, enabling technicians to fully manufacture a wheelchair chassis locally with the desired specifications (see Figure 1). As the system is still under development, the model is currently only suitable for designing and manufacturing threewheeled wheelchairs. We carried out a 5-month research project in collaboration with Bethany Kids (Joytown, Kenya) to explore the acceptability and feasibility of this new wheelchair provision method from the perspective of both users and service providers, and to evaluate the quality of the wheelchairs manufactured with this method. A local team was trained to provide wheelchairs using this innovative model, and 8 local expert wheelchair users evaluated the service provision model alongside the products that were manufactured by the local team.

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