Je schoenen mag je passen. In een orthese moet jij passen.
Daar sta je dan, midden in een schoenwinkel. Rijen vol schoenen strekken zich voor je uit: kleurrijk, stevig, sportief, trendy. Je voeten worden gemeten, je looppatroon geanalyseerd. Wat goed voelt mag mee naar huis. En volgend seizoen? Dan kies je weer wat nieuws.
Beeld je nu in dat je niet mag kiezen wat je draagt, ook al hangt je mobiliteit ervan af. Dit is helaas de realiteit voor veel mensen die aangewezen zijn op een enkel-voet orthese. Hoewel dit hulpmiddel bedoeld is om het stappen te vergemakkelijken, wordt het vaak op één moment ontworpen, zonder mee te groeien met het lichaam of het leven van de gebruiker.
Waar het schoentje wringt
Een enkel-voetorthese, kortweg EVO, is een beugel die de enkel ondersteunt en de voet helpt afrollen tijdens het stappen. Voor mensen met spierzwakte of verlamming, bijvoorbeeld na een beroerte of door een neurologische aandoening, maakt een EVO het verschil tussen een rolstoel en opnieuw zelfstandig kunnen stappen.
Figuur 1: Enkel-voet orthese
Toch zijn er nog heel wat pijnpunten.
Een voorschrift garandeert immers geen goede orthese. Er bestaan nauwelijks richtlijnen over hoe een EVO precies ontworpen moet worden. De uiteindelijke vorm hangt af van de ervaring en voorkeur van de orthopedisch instrumentenmaker. Zelfs de stijfheid, die een invloed heeft op hoeveel energie het stappen kost, wordt vaak puur op gevoel gekozen.
Veel aandoeningen waarvoor een EVO wordt voorgeschreven zijn dan ook dynamisch: mensen herstellen, hervallen, verliezen spiermassa of komen net aan. Alsof dat nog niet genoeg is, verandert het lichaam van de gebruiker vaak sneller dan het hulpmiddel dat moet ondersteunen. Terwijl de noden snel kunnen evolueren, blijft de orthese wat ze was op het moment van aflevering. Door strakke terugbetalingsregels en beperkte aanpasbaarheid zit de gebruiker vaak jarenlang vast aan een hulpmiddel dat al lang niet meer bij zijn lichaam past.
Ontwerpen voor verandering
Die vastgeroeste realiteit vormde het vertrekpunt van mijn masterproef. Wat als een orthese niet ontworpen wordt om te blijven, maar om mee te bewegen? Wat als we vertrekken van verandering in plaats van een momentopname?
Samen met Materialise en orthopedisch experten onderzocht ik hoe een enkel-voetorthese flexibeler ontworpen kan worden, zowel in vorm, werking als gebruik. Niet als één eindproduct, maar als een systeem dat ruimte laat: voor herstel, voor aanpassing, voor verschil.
Met 3D-printing, krachtsimulaties en parametrisch ontwerp verkende ik hoe stijfheid, pasvorm en samenstelling beter kunnen worden afgestemd op de noden van de gebruiker en vooral: hoe dat sneller en eenvoudiger kan worden bijgestuurd wanneer die noden veranderen.
Niet passen, maar aanpassen
Het resultaat is een modulair opgebouwde orthese die bestaat uit drie hoofdelementen: een voetplaat, een verbindende spalk en een bovenstuk rond het onderbeen. Elk onderdeel is ontworpen om apart te kunnen worden aangepast of vervangen, zonder de hele orthese opnieuw te moeten maken. Zo wordt een onveranderlijk product een flexibel product systeem, dat bijgestuurd en afgestemd kan worden op de actuele noden van de gebruiker.
Figuur 2: Finaal prototype
Aan de hand van een aantal digitale en fysieke prototypes onderzocht ik hoe variaties in vorm, stijfheid en materiaalverdeling invloed hebben op de eigenschappen van de orthese. De resultaten tonen aan dat deze manier van werken niet alleen de pasvorm, maar ook het comfort, de bewegingsweerstand en zelfs de esthetiek beter laat aansluiten bij de noden van de patiënt.
Maar daarmee stopt het niet. Deze orthese is niet alleen anders in vorm, ze vraagt ook om een andere manier van werken. In samenwerking met orthopedisch experten onderzocht ik hoe zo’n modulair systeem intuïtief kan worden ingepast in het bestaande zorgproces. Hoe een orthopedisch instrumentenmaker ermee aan de slag kan. Hoe het ontwerp afgestemd kan worden op de gebruiker. En hoe het blijft passen, ook als alles verandert.
De volgende stappen
Deze orthese is maar een begin. De mogelijkheden reiken verder dan het ontwerp alleen. Hoe kunnen orthopedisch instrumentenmakers vlot met dit systeem aan de slag? Hoe brengen we de juiste afstemming tussen vorm, stijfheid en comfort in kaart? En hoe maken we ook het uiterlijk van het hulpmiddel iets waar mensen zich goed in voelen?
Net zoals schoenen meegroeien met je voeten en stijl, moet een orthese kunnen meebewegen met je lichaam en leven. Geen vaste vorm als beperking, maar een flexibel systeem om een dynamisch leven te ondersteunen. Dat is de toekomst van mobiliteit.
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