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Canadian Prosthetics & Orthotics Journal. Volume1, Issue1, No 4, 2018. DOI: https://doi.org/10.33137/cpoj.v1i1.29970  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
 
 
 

 
 

 

 

 

 

 

 

 

  

PROFESSIONAL OPINION ISSN: 2561-987X 

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Fiedler G, Savage S, Schull J, Mankoff J. The Case For Broad-Range Outcome Assessment Across Upper Limb Device Classes. 

Canadian Prosthetics & Orthotics Journal. Volume1, Issue1, No 4, 2018. DOI: https://doi.org/10.33137/cpoj.v1i1.29970 
1 

 
OPEN  ACCESS 

The Case For Broad-Range Outcome Assessment Across Upper 

Limb Device Classes 

 

Volume 1, Issue 1, Article No. 4, August 2018 

 

  
PROFESSIONAL OPINION 

THE CASE FOR BROAD-RANGE OUTCOME ASSESSMENT ACROSS UPPER LIMB 
DEVICE CLASSES 
 
Fiedler G1*, Savage S2, Schull J3, Mankoff J 4 

 
1 Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, 

PA, USA. 
2  Human Computer Interaction Lab, Computer Science and Electrical Engineering Department, West Virginia University, Morgantown, 

WV, USA. 
3 e-NABLE, Rochester Enable Limited, Rochester NY. 
4 Allen School of Computer Science & Engineering, University of Washington, Seattle, WA, USA. 

 

 

So, how valuable are those 3D-printed devices really 

for their users, and – be extension – for society at 

large? Most reasonable people may feel that the 

truth, as for so many contested questions, is 

somewhere in the middle. The confidence boost from 

having a 3D printed superhero hand can be very real 

for a young patient, even if it is used only for short 

times. Affordable customizations tailored to special 

tasks, such as holding a musical instrument,8 can 

make a big difference for young users, even if there 

is little utility beyond that. Meanwhile, the  

e-NABLE community has progressed to be about 

more than mere device fabrication and distribution, 

with EnablewebCentral having become a 

sophisticated platform for tracking cases, recruiting 

follow up feedback, and even providing referrals to 

and coaching from Prosthetists. That devices 

produced by hobbyists would be able to outright 

replace much more expensive commercial 

prostheses is no longer  being  claimed by 

representatives of the e-NABLE community. Instead, 

a mutually beneficial collaboration between the 3D-

printing community and Prosthetics and Orthotics 

(P&O) professionals has been proposed.9

CITATION 

Fiedler G, Savage S, Schull J, 

Mankoff J. The Case For Broad-

Range Outcome Assessment 

Across Upper Limb Device 

Classes. Canadian Prosthetics & 

Orthotics Journal. Volume1, 

Issue1, No 4, 2018. DOI: 

https://doi.org/10.33137/cpoj.v1i

1.29970 

KEYWORDS 

Prosthetics, 3D-printing, upper 

limb prosthetic, amputee, e-

NABLE, low-cost prosthetic, 

prosthesis. 

*CORRESPONDING AUTHOR 

Dr Goeran Fiedler, PhD, Assistant Professor, Department of Rehabilitation Science and Technology, University of Pittsburgh, Suite 403, Bakery Square, 

6425 Penn Ave, Pittsburgh, PA 15206, USA. 

ORCID number: https://orcid.org/0000-0003-1532-1248   

E-mail: gfiedler@pitt.edu  

Tel: 412-624-6475 

DOI: https://doi.org/10.33137/cpoj.v1i1.29970  

 

 

The emergence of 3D-printed upper limb prosthetic devices a couple of years 

ago, spearheaded substantially by the e-NABLE community,1, 2 has triggered a 

variety of reactions, ranging from euphoric press coverage predicting a new age 

of low-cost universally obtainable prosthetic solutions to anxious reluctance by 

clinicians fearing the demise of high-quality professional health care  

provision.3,4 The circumstance that untrained volunteers produce e-NABLE 

devices on their hobby-grade 3D-printers5 was both hailed as a revolutionary 

paradigm shift suited to address a host of current challenges in health care 

economics, and derided as inappropriate intrusion into long-standing training 

and certification standards of a well-regulated profession. That many of the early 

generation e-NABLE devices targeted young patients with partial hand 

amputation6 was interpreted by proponents as finally offering this neglected 

population long-desired solutions, whereas skeptics felt that many of the 

recipients of such devices would traditionally have been deemed to have a 

residual functional enough to be a contra-indication for a prosthesis.7 

 

 

 

 

 

 

https://doi.org/10.33137/cpoj.v1i1.29970
https://doi.org/10.33137/cpoj.v1i1.29970
https://doi.org/10.33137/cpoj.v1i1.29970
https://orcid.org/0000-0003-1532-1248
mailto:gfiedler@pitt.edu
https://doi.org/10.33137/cpoj.v1i1.29970


 

 

Fiedler G, Savage S, Schull J, Mankoff J. The Case For Broad-Range Outcome Assessment Across Upper Limb Device Classes. 

Canadian Prosthetics & Orthotics Journal. Volume1, Issue1, No 4, 2018. DOI: https://doi.org/10.33137/cpoj.v1i1.29970 
2 

 
OPEN  ACCESS 

The Case For Broad-Range Outcome Assessment Across Upper 

Limb Device Classes 

 

Volume 1, Issue 1, Article No. 4, August 2018 

 

 News stories on the topic have recently become 

fewer and less sensationalist. On the other side, 

many prosthetics clinicians have come to realize that 

3D-printing technology does have the potential to 

substantially change fabrication methods in the field, 

and that there is good reason to embrace the 

associated technological progress. It can be argued 

that the development already has brought some 

benefits for the field:  

• The publicity, even if partly unwarranted, 

may have triggered a greater interest in the P&O 

profession, attracting more talented students, and 

motivating new research opportunities.  

• Some of the young patients who have been 

introduced to prosthetics through an, even 

unnecessary, e-NABLE device may be more likely to 

accept and use prostheses later on.  

• Limb loss management being the first 

prominent area of using crowd intelligence to 

address healthcare challenges,10 an approach that 

promises wide applicability in the future,11,12 gives 

our field once more a pioneering role within the allied 

health sciences. 

Still, while it may be easy to intuitively agree with 

many of those points, there is very little actual 

evidence on the underlying question of how effective 

3D-printed upper extremity devices are in achieving 

their intended purposes. Most of the research that 

has been published on the topic to date is limited to 

technical description and basic function testing of 

devices. There appears to be no pertinent outcome 

data of any kind for 3D-printed e-NABLE devices, let 

alone data that would allow comparison to 

conventional prosthetics.  

This gap can be addressed. The field of P&O has 

come a long way in establishing evidence based 

decision making. As new technology has been 

introduced in increasing frequency over recent 

decades, the necessity to demonstrate its benefits 

have yielded more and better research studies. 

Outcome assessment, as a key component of 

Evidence Based Practice, has rightfully become 

more and more important in the field over the past 

years. A great many different tools have been 

developed and are now available to allow for reliable 

data on most any conceivable assessment criterion. 

Much important work has been - and continues to be 

– done to determine validity of the various tools in 

different populations.13 While the availability of 

specialized outcome assessment tools is a benefit 

for the primary clinical purposes of documenting and 

monitoring individual patients’ rehabilitation 

progress, the respective data can – with limitations – 

also be useful to compare different interventions. 

Certainly, this falls short of the scientific rigor of a 

prospective study with randomized group allocation, 

but, with a sufficiently large response rate, can 

deliver relevant descriptions of real-life outcomes to 

allow fact-based answers to our question and to 

inform future work. 

A group of researchers and clinicians led by Jen 

Mankoff (University of Washington) and Jon Schull 

(e-NABLE) is pursuing this approach. Having 

devised a comprehensive online questionnaire, 

efforts are currently focused on collecting a sufficient 

number of responses from both users of e-NABLE 

devices and conventional upper limb prostheses.14 

This will allow a detailed, evidence-based, 

comparison between those device groups on a 

shared scale. As is common in prosthetics research 

in general, and in particular if targeting an upper limb 

loss population, it is a major challenge to obtain a 

large enough sample size to allow for generalizable 

conclusions. To address this issue, the survey has 

been translated into several foreign languages and is 

being advertised through a number of online and 

offline media. 

If it generates sound evidence on the effective 

differences between upper limb device classes, the 

respective discussion will become less biased and 

more constructive. Given the recent developments in 

the field and the expanding device options for people 

with limb loss, it would be dangerous to assume that 

nothing new can be learned from such data. Knowing 

what today’s patients want (or don’t want) and 

knowing what works (or doesn’t work) for them is 

important, not just for makers of 3D-printed devices 

but for trained prosthetists as well. Clearly, data-

based innovation in prosthetic care is accelerating.  

With the participation of traditional clinicians, 

professional prosthetic services could both benefit 

and contribute. 

REFERENCES 

1. Tanaka KS, Lightdale-Miric N. Advances in 3D-printed 

pediatric prostheses for upper extremity differences. The 

Journal of Bone and Joint Surgery. 2016; 98: 1320-6. DOI: 

10.2106/JBJS.15.01212 

https://doi.org/10.33137/cpoj.v1i1.29970
https://doi.org/10.2106/JBJS.15.01212


 

 

Fiedler G, Savage S, Schull J, Mankoff J. The Case For Broad-Range Outcome Assessment Across Upper Limb Device Classes. 

Canadian Prosthetics & Orthotics Journal. Volume1, Issue1, No 4, 2018. DOI: https://doi.org/10.33137/cpoj.v1i1.29970 
3 

 
OPEN  ACCESS 

The Case For Broad-Range Outcome Assessment Across Upper 

Limb Device Classes 

 

Volume 1, Issue 1, Article No. 4, August 2018 

 

 2. Zuniga J, Katsavelis D, Peck J, Stollberg J, Petrykowski 

M, Carson A,  Fernandezet C. Cyborg beast: a low-cost 3d-

printed prosthetic hand for children with upper-limb 

differences. BMC research notes. 2015; 8: 10. 

https://doi.org/10.1186/s13104-015-0971-9  

3. Kesselring J, Fiedler G. Prosthetist’s Assessment of 

Additive Manufacturing as an Alternative to conventional 

manufacturing techniques in P&O. 42nd Annual AAOP 

Meeting and Scientific Symposium. Orlando, FL 2016. 

4. Hofmann M, Burke J, Pearlman J, Fiedler G, Hess A, 

Schull J, Hudson S, Mankofet J. Clinical and maker 

perspectives on the design of assistive technology with 

rapid prototyping technologies. Proceedings of the 18th 

International ACM SIGACCESS Conference on 

Computers and Accessibility. ACM, 2016, p. 251-6. DOI: 

10.1145/2982142.2982181 

5. Foster KR. 3-Dimensional Printing in Medicine: Hype, 

Hope, and the Challenge of Personalized Medicine. 

Philosophy and Engineering. Springer, 2017, p. 211-228. 

DOI.org/10.1007/978-3-319-45193-0_16. 

6.Burn MB, Ta A, Gogola GR. Three-dimensional printing 

of prosthetic hands for children. The Journal of hand 

surgery. 2016; 41: e103-e9. doi: 

10.1016/j.jhsa.2016.02.008 

7. James MA, Bagley AM, Brasington K, Lutz C, McConnell 

S, Molitor F. Impact of prostheses on function and quality 

of life for children with unilateral congenital below-the-

elbow deficiency. The Journal of Bone and Joint Surgery. 

2006; 88: 2356-65. DOI: 10.2106/JBJS.E.01146 

8. Hofmann M, Harris J, Hudson SE, Mankoff J. Helping 

hands: Requirements for a prototyping methodology for 

upper-limb prosthetics users. Proceedings of the 2016 CHI 

Conference on Human Factors in Computing Systems. 

ACM, 2016, p. 1769-80. DOI: 10.1145/2858036.2858340 

9. Schull J. Toward Collaboration: The 3D-Printing 

Community and O&P Professionals The O&P EDGE. 

2015, p. 88. [Available at:  

https://opedge.com/Articles/ViewArticle/2015-04_12] 

Accessed August 5. 2018. 

10. Schull J. Enabling the future: Crowdsourced 3D-printed 

prostheticsas a model for open source assistive 

TechnologyInnovation and mutual aid. Proceedings of the 

17th International ACM SIGACCESS Conference on 

Computers & Accessibility. ACM, 2015, p. 1. 

11. Gleason C, Ahmetovic D, Savage S, Toxtli C, 

Posthuma C, Asakawa C, et. al. Crowdsourcing the 

Installation and Maintenance of Indoor Localization 

Infrastructure to Support Blind Navigation. Proceedings of 

the ACM on Interactive, Mobile, Wearable and Ubiquitous 

Technologies. 2018; 2: 9.     DOI: 10.1145/3191741 

12. Savage S, Monroy-Hernandez A, Höllerer T. Botivist: 

Calling volunteers to action using online bots. Proceedings 

of the 19th ACM Conference on Computer-Supported 

Cooperative Work & Social Computing. ACM, 2016, p. 

813-22. doi>10.1145/2818048.2819985 

13. Lindner HY, Nätterlund BS,  Hermansson LMN. Upper 

limb prosthetic outcome measures: review and content 

comparison based on International Classification of 

Functioning, Disability and Health. Prosthetics and 

orthotics international. 2010; 34: 109-28. 

DOI/pdf/10.3109/03093641003776976.  

14. Mankoff  J, Savage S, Eckert S, Ngo C, Fiedler G. User 

Experiences With Traditional And 3d-Printed Upper 

Extremity Prostheses, Development Of A Comprehensive 

Survey Instrument. Canadian Prosthetics & Orthotics 

Journal, Volume 1, Issue 2, 2018; Abstract, Poster 

Presentation At The AOPA’s 101st National Assembly, 

Sept. 26-29, Vancouver, Canada, 2018. 

https://doi.org/10.33137/cpoj.v1i2.32009 

 

 
AUTHOR BIOGRAPHIES 

 Dr. Goeran Fiedler, is a 

credentialed prosthetist and 

orthotist, who holds additional 

graduate degrees in Clinical 

Engineering and Health 

Sciences. He has worked as a 

clinician and later researcher 

in the field of P&O for more 

than 25 years, and currently 

serves as Assistant Professor in the Master of Science 

Prosthetics & Orthotics program at the University of 

Pittsburgh. His research interests are in assessing and 

improving prosthesis utilization, alignment, and 

prescription. 

 

Dr. Saiph Savage is an 

Assistant Professor of 

Computer Science at West 

Virginia University (WVU) 

where she directs the Human 

Computer Interaction 

Laboratory (HCI @ WVU 

Lab). She is also a visiting 

professor at the Human-

Computer Interaction Institute at Carnegie Mellon 

University (CMU), a J. Wayne and Kathy Richards Faculty 

Scholar, and adjunct professor at the National 

Autonomous University of Mexico (UNAM). Her research 

in Social Computing and Crowdsourcing focuses on the 

design of systems that spark better coordination of 

volunteers and empower communities to reach more 

complex goals.  

https://doi.org/10.33137/cpoj.v1i1.29970
https://doi.org/10.33137/cpoj.v1i2.32009


 

 

Fiedler G, Savage S, Schull J, Mankoff J. The Case For Broad-Range Outcome Assessment Across Upper Limb Device Classes. 

Canadian Prosthetics & Orthotics Journal. Volume1, Issue1, No 4, 2018. DOI: https://doi.org/10.33137/cpoj.v1i1.29970 
4 

 
OPEN  ACCESS 

The Case For Broad-Range Outcome Assessment Across Upper 

Limb Device Classes 

 

Volume 1, Issue 1, Article No. 4, August 2018 

 

 Dr. Jon Schull, Founder of e-

NABLE: Volunteers designing 

and delivering free 3D-printed 

prosthetics worldwide. A 

biological psychologist, 

inventor, entrepreneur, human-

computer interaction 

researcher, and digital 

community organizer, Dr. Jon 

Schull is the creator of e-

NABLE, an online philanthropic community that designs, 

customizes and fabricates open-sourced affordable 3D-

printed prosthetic hands and arms for children and adults 

with upper limb differences. In past lives, Schull was 

founder of SoftLock.com aka DigitalGoods 

(NASDAQ:DIGS) a seminal digital rights management 

company, professor and former director of the Center for 

Student Innovation at Rochester Institute of Technology.  

His current base of operations is the Rochester Enable Lab 

at Vertus High School.  

 

Dr. Jennifer Mankoff is the 

Richard E. Ladner Professor in 

the Paul G. Allen School at the 

University of Washington. She 

earned her B.A. at Oberlin 

College and her Ph.D. in 

Computer Science at the 

Georgia Institute of Technology. 

Her research focuses on 

assistive technology for access, health and wellness, and 

takes a multifaceted approach that includes machine 

learning, 3D printing, and tool building. Her research has 

been supported by Google Inc., the Intel Corporation, IBM, 

Hewlett Packard, Microsoft Corporation, and the National 

Science Foundation. She was awarded the Sloan 

Fellowship and the IBM Faculty Fellowship. 

https://doi.org/10.33137/cpoj.v1i1.29970

