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"A team of physicians, engineers, and physiotherapists, attempted to devise and build a leg flexion device for a young man with paraplegia. This seemingly simple task proved to be a challenging, learning and rewarding experience."
HackaHealth Zurich 2021 was a roller-coaster and an amazing experience at the same time.
So far, I have been in a number of high-level hackathons, where participants were expected to pitch a versatile idea tackling a regional/global problem (eg restricted access to healthcare facilities due to COVID-19, digital health il-literacy, climate change). In this context, one or few ideas would win a position under the entrepreneurial sun on the grounds of their novelty, sustainability, and marketing strengths. Such a competition favored those who had innovative ideas in their field and were willing to put them under a multidisciplinary approach and assess their marketing strengths.
HackaHealth was different. Instead of a collective problem, we met a person with a particular disability and a request for a specific solution. In our case, a young man experiencing paraplegia and blindness associated with congenital spina bifida sought a solution enabling him to flex his lower extremities without the assistance of a physical therapist or caregiver. We, a group of physicians, engineers, and physiotherapists, who previously did not know each other, spent two and a half days in the Student Project House Workshop of the Swiss Federal Institute of Technology in Zurich working directly with the patient and constructing a personalized solution from the ground up.
The solution was nothing more and nothing less than a box. The man’s trunk and head would lie on a semi-rigid mattress, while his hand would be able to control and lock a lever connected to a cylinder pushing his femurs upwards. In less than 2 days, after deciding to focus on this idea, we had to collect the materials and tools required in order to construct the device. The construction process posed a number of challenges and helped us – or at least the author – to become more pragmatic in their expectations. Fancy ideas about sustainable biomaterials with embedded turmaline jades for simultaneous photodynamic physiotherapy or temperature sensors for the early diagnosis of pressure ulcers and soft tissue infections were postponed or abandoned for the sake of functionality.
The particular meaning of functionality was adjusted to a prototype that the young man could carry with him back home on the very next day. It also pertained to the fact that the prototype “costs” approximately 200 dollars and can be repaired or even completely replaced at a relatively low cost. Restoration or improvement does not require a high level of expertise, a basic understanding of mechanics and basic crafting skills suffice. Finally, yet importantly, the device did not rely on electrical components. The range and the duration of motion are completely up to the user.
Although there is always room for improvement, the device was deemed effective and safe at the end of the event, and it, hopefully, remains helpful to the user. The conceptualization and construction would not be possible without a great team of students and young professionals whose backgrounds ranged from medicine and physiotherapy to different branches of engineering.
At a personal level, I can keep – and recommend – the following takeaways;
  •  While (triumphantly) writing or talking about personalization, one can usually forget that this is about discussing with the patient(s) and co-deciding the solution of their problem based on their self-perceived needs and the available resources and expertise.
  • Before proposing sophisticated treatments or devices, one should have a good grasp of their construction process and logistics. Even though we are not supposed to build up the devices we use or implant as physicians, understanding their structure and their inherent advantages and disadvantages can make our choices more realistic.
  • Being challenged in presumably simple tasks, such as designing and setting up a  box and a lever, serves as a reminder that we always rely on the expertise and the efforts of numerous unnamed people playing distinct roles in the supply chain. One missing part can disturb the whole chain.
Overall, challenges like this can improve our understanding of personalized medicine, provide us with practical constructing and problem-solving skills, and even serves as lessons of humility.

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Christos Tsagkaris, MD

Christos is a Medical Doctor from Greece, currently working as a Research Fellow in Orthopedics in Zurich, Switzerland

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