Emese Elkind

@conference{Elkind2025e,

title = {Customizable 3D-Printed Above-Elbow Prosthetics for Refugees with Limb Loss: A Low-Cost Solution for Global Rehabilitation Needs },

author = {Emese Elkind and Alina Gammage and Lauren Windover and Cole McCauley and Noah Learned and Max Wolkoff and Kyla Wisener and Xian Wang and Gabor Fichtinger and Kanchana Thornton},

year  = {2025},

date = {2025-05-15},

booktitle = {Rehabilitation Engineering and Assistive Technology Society of North America (RESNA)},

note = {1st Place in the 2025 Student Design Challenge},

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pubstate = {published},

tppubtype = {conference}

}

@conference{Elkind2025d,

title = {Creating Customizable Above-Elbow 3D-Printed Low-Cost Prosthetics for Refugees of the Civil War in Myanmar},

author = {Emese Elkind and Alina Gammage and Lauren Windover and Cole McCauley and Noah Learned and Max Wolkoff and Kyla Wisener and Xian Wang and Gabor Fichtinger and Kanchana Thornton

},

url = {https://labs.cs.queensu.ca/perklab/qbit-rice-2025-poster/},

year  = {2025},

date = {2025-04-11},

urldate = {2025-04-11},

booktitle = {Rice360 Global Health Technologies Design Competition},

journal = {Rice360 Global Health Technologies Design Competition},

publisher = {Rice University},

note = {2nd Place and Public Invention - Incremental Improvement Award},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{Elkind2025b,

title = {Developing low-cost 3D-printed prosthetics with a functional wrist for patients along the Thai-Myanmar border},

author = {Emese Elkind and Aung Tin Tun and Olivia Radcliffe and Laura Connolly and Colleen Davison and Eva Purkey and Parvin Mousavi and Gabor Fichtinger and Kanchana Thornton 

},

url = {https://labs.cs.queensu.ca/perklab/eelkind_imno2025_poster_wrist/},

year  = {2025},

date = {2025-03-05},

urldate = {2025-03-05},

publisher = {INOVAIT Image-Guided Therapy (IGT) x Imaging Network Ontario (ImNO)},

abstract = {INTRODUCTION: Inadequacies in the Burmese healthcare system, heightened by the 2021 military coup and related civil war in Myanmar and the COVID-19 pandemic, have contributed to an influx of refugees to Thailand to seek medical aid. An estimated 1.5 million Myanmar nationals entered Thailand since January 2023 [5]. Without immigration status, these refugees are unable to receive healthcare. Burma Children Medical Fund (BCMF) is a nonprofit based in Mae Sot, Tak, Thailand that focuses on funding underserved Burmese communities’ medical treatment and providing support services, including accessible prosthetics for refugees who have experienced limb loss [1]. Prosthetics in lower-income countries are usually passive, meaning they lack mechanisms to restore critical limb functions such as gripping, rotation, or complex hand movements. Therefore, patients cannot fully perform their daily functions, impacting their abilities to work and affecting family caretakers. BCMF aims to make prosthetics that work best in low-resource settings using open-source designs, which only allow for fixed hand positions. The usage of prosthetic arms depends heavily on their functionality and comfort. Patients are more likely to consistently use prosthetics if it aids them in returning to normalcy. In this study, we present a design for an interchangeable and functional prosthetic wrist that enables critical hand motions such as rotation.

METHODS: BCMF currently provides custom-fitted, low-cost, 3D-printed prostheses that are found on Thingiverse, a public library of 3D designs.  One such design is the Kwawu Arm 2.0 [2], which can be adjusted with OpenSCAD [4], a software for modifying 3D CAD models to fit the recipient's measurements. To maintain BCMF’s workflow, the interchangeable wrist model was created using the 3D design software, Autodesk Fusion 360, and designs from open sourced Quick-Connect Wrist designs found on Thingiverse [3]. The wrist was merged onto the Kwawu Arm, printed, assembled, and tested for durability and comfort both with and without patients. This is an iterative process where patient feedback ensures the prosthetics cater to the diverse needs of the recipients. 

RESULTS: Since the launch of the prosthetics project in 2019, BCMF has provided 3D-printed prosthetics to 76 patients. The interchangeable hand provides a solution to many patients' everyday activities and can rotate the hand 360 degrees (Fig.2) and has been tested on and used by one patient thus far (Fig.1). 

CONCLUSIONS: The BCMF prosthetics project provides a low-cost solution to healthcare challenges in the context of poly-crisis experienced in Myanmar, enhancing the resilience and adaptability of affected refugee communities. The collaboration between BCMF and Queen’s University demonstrates the potential for future partnerships between educational institutions and NGOs to address health care access disparities. Future work includes continuing to fill the gap between open-sourced models and patient-specific needs to refine the 3D-printing workflow by continuing to create customizable, generalized designs. We also plan to test the interchangeable wrist with more patients and develop body-powered prosthetic designs to support more critical movements.

REFERENCES: [1]Burma Children Medical Fund - Mae Sot, Thailand. BCMF | Burma Children Medical Fund - Mae Sot, Thailand - Operating to give people a future. (n.d.). https://burmachildren.com/ [2]Buchanan, J. (2018, March 27). Kwawu Arm 2.0 - Prosthetic - socket version. Thingiverse. https://www.thingiverse.com/thing:2841281 [3]NIOP. (2022, February 9). NIOP Q-C V1 quick-connect wrist. Thingiverse. http://www.thingiverse.com/thing:5238794 [4]OpenSCAD. The Programmers Solid 3D CAD Modeller. (n.d.). https://openscad.org/ [5]UN. Overview of Myanmar nationals in Thailand. IOM UN migration. https://thailand.iom.int/sites/g/files/tmzbdl1371/files/documents/2024-10/overview-of-myanmar-nationals-in-thailand-october-24.pdf 

},

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@conference{Elkind2025c,

title = {Bridging the Gap with Customizable Above-Elbow Prosthetic Designs to Balance Open-Source Models and Patient-Specific Needs},

author = {Emese Elkind and Aung Tin Tun and Noah Learned and Cole Mccauley and Lauren Windover and Alina Gammage and Kyla Wisener and Max Wolkoff and Colleen Davison and Eva Purkey and Gabor Fichtinger and Kanchana Thornton},

url = {https://labs.cs.queensu.ca/perklab/eelkind_imno2025_poster_latebreaking_arm/},

year  = {2025},

date = {2025-03-05},

urldate = {2025-03-05},

publisher = {INOVAIT Image-Guided Therapy (IGT) x Imaging Network Ontario (ImNO)},

abstract = {INTRODUCTION: Myanmar’s healthcare system, strained further by the 2021 military coup and civil war, has led millions of refugees to Thailand seeking medical aid [1]. Burma Children Medical Fund (BCMF), based in Mae Sot, Tak, Thailand funds these Burmese communities’, who are unable to receive medical treatment by providing support services, including prosthetics for refugees [2]. BCMF makes prosthetics for low-resource settings using open-source designs. The usage of prosthetic arms depends heavily on their functionality and comfort, as patients are more likely to use prosthetics if it restores normalcy. The staff at BCMF have limited Computer Aided Design (CAD) experience so Queen’s Biomedical Innovation Team (QBiT) at Queen’s University has started a prosthetic project to support them. The student-led biomedical engineering design team modifies open-sourced designs to tailor them to patient needs. Specifically, we aim to add an above-elbow prosthetic to the existing below-elbow prosthetics currently used by BCMF to produce an affordable and functional prosthetic. 

METHODS: BCMF currently adapts Thingiverse designs, such as the below elbow Kwawu Arm 2.0 [3], which can be adjusted with OpenSCAD [4], a software for modifying models to fit the recipient. QBiT has modified the Kwawu arm and designed a shoulder piece and harness system to extend the below elbow prosthetic to fit above elbow amputees (fig.1). A polyester strap forms a harness and is secured with snap buttons so the patient can control the prosthetic by adjusting their shoulder to move the elbow joint and to operate the hand attachment (fig.2). The arm is undergoing an iterative testing process for durability and comfort with constant communication between the BCMF and QBiT. Patient feedback ensures the prosthetics cater to the needs of each recipient. QBiT has developed a comprehensive manual, complete with detailed images, outlining the steps for setting up the harness to fit the patient's measurements. 

RESULTS: Since 2019, BCMF has provided 76 3D-printed prosthetics. The new above elbow design eliminates electronic components, reducing complexity and cost while improving durability for Burmese climates and living conditions during the war, making it more accessible for a wider range of users. The prosthetic incorporates interchangeable end-effectors to adapt to the patients’ daily activities. The control wires connecting the harness to the dynamic prosthetic are routed internally, minimizing the risk of snagging. The final design will restore partial range of motion to the patient through the use of the prosthetic.   

CONCLUSIONS: The BCMF prosthetics project provides a low-cost solution to healthcare challenges in the context of the poly-crisis experienced in Myanmar, enhancing the resilience and adaptability of affected refugee communities. This collaboration demonstrates the potential for future partnerships between educational institutions and NGOs to address health care access disparities and empowers BCMF to expand their reach and improve access to low-cost, body-powered prosthetic solutions for a growing number of patients in need. Future work includes continuing to fill the gap between open-sourced models and patient-specific needs to refine the 3D-printing workflow by creating customizable, generalized designs.

REFERENCES: [1] UN. Overview of Myanmar nationals in Thailand. IOM UN migration. https://thailand.iom.int/resources/overview-myanmar-nationals-thailand-april-2024[2] Burma Children Medical Fund - Mae Sot, Thailand. BCMF | Burma Children Medical Fund - Mae Sot, Thailand - Operating to give people a future. (n.d.). https://burmachildren.com/ [3] Buchanan, J. (2018, March 27). Kwawu Arm 2.0 - Prosthetic - socket version. Thingiverse. https://www.thingiverse.com/thing:2841281 [4] OpenSCAD. The Programmers Solid 3D CAD Modeller. (n.d.). https://openscad.org/},

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pubstate = {published},

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@conference{Elkind2025,

title = {Strengthening Low-cost Prosthetic Solutions in Thailand/Myanmar Through Academic Institution-NGO Collaboration },

author = {Emese Elkind and Olivia Radcliffe and Aung Tin Tun and Laura Connolly and Colleen Davison and Eva Purkey and Gabor Fichtinger and Kanchana Thornton

},

year  = {2025},

date = {2025-02-22},

urldate = {2025-02-22},

booktitle = {Health & Human Rights Conference},

publisher = {School of Medicine},

organization = {Queen's University},

abstract = {The ongoing civil war in Myanmar, along with the related coup in 2021, have displaced millions of refugees to Thailand, where many lack immigration status and cannot access medical care. The Burma Children Medical Fund (BCMF) [1] addresses these challenges by providing funding and support for medical treatment, including a 3D-printed prosthetics program initiated in 2019 for individuals with limb loss. Due to limited Computer-Aided Design (CAD) experience, BCMF staff have turned to open-source prosthetic designs. We aim to establish an academia-NGO partnership to strengthen BCMF’s efforts, provide technical support, and broaden outreach to underserved communities needing low-cost, body-powered prosthetic devices. Our collaboration includes Queen’s University volunteers traveling to BCMF’s workshop for on-ground support and continuing remote assistance. As BCMF utilizes open-source prosthetic designs from platforms such as Thingiverse [2], we wanted to maintain the 3D printing workflow while addressing gaps in open-source prosthetic offerings. We identified three critical needs: devices for short-below-elbow amputees, above-elbow amputees, and a detachable, rotatable wrist. In response, we modified BCMF’s most used prosthetic design to customize the model for these specific needs. We conducted iterative testing for durability and comfort, ensuring constant communication between staff and recipients, allowing patient feedback to guide our designs. Over the past two years, Queen’s University has sent two volunteers to BCMF, with another planned for this year. So far, five recipients use our short-below-elbow prosthetic design, and one has received a quick connect wrist. In addition, we are currently collaborating remotely on a new prosthetic design for above-elbow amputees. This partnership between Queen’s University and BCMF improves access to low-cost prosthetic solutions, expands BCMF’s recipient pool, and demonstrates the potential for future partnerships between educational institutions and NGOs to address disparities in healthcare access. 

References

[1] Burma Children Medical Fund - Mae Sot, Thailand. BCMF | Burma Children Medical Fund - Mae Sot, Thailand - Operating to give people a future. https://burmachildren.com/ 

[2] Buchanan, J. (2018, March 27). Kwawu Arm 2.0 - Prosthetic - socket version. Thingiverse. https://www.thingiverse.com/thing:2841281 },

note = {3rd place},

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pubstate = {published},

tppubtype = {conference}

}

@conference{Elkind2024b,

title = {Enhancing healthcare access by developing low-cost 3D printed prosthetics along the Thai-Myanmar border},

author = {Emese Elkind and Aung Tin Tun and Olivia Radcliffe and Laura Connolly and Colleen Davison and Eva Purkey and Parvin Mousavi and Gabor Fichtinger and Kanchana Thornton 

},

url = {https://labs.cs.queensu.ca/perklab/wp-content/uploads/sites/3/2024/10/EElkind_CCGH2024.pdf},

year  = {2024},

date = {2024-10-25},

urldate = {2024-10-25},

publisher = {Canadian Association for Global Health},

abstract = {Background/Objective

Inadequacies in the Burmese healthcare system, heightened by the 2021 military coup of the civil war in Myanmar and the COVID-19 pandemic, have driven thousands of refugees to Thailand seeking medical aid. Without immigration status, these refugees, especially those who have experienced limb loss, are challenged by the inability to receive healthcare. Burma Children Medical Fund (BCMF, www.burmachildren.com) based in Mae Sot, Tak, Thailand focuses on funding underserved Burmese communities’ medical treatment and providing support services.  

Prosthetics in lower-income countries are usually passive, therefore, patients cannot fully perform their daily functions, impacting their abilities to work and affecting family caretakers. BCMF aims to make body-powered prosthetics that work best in low-resource settings using open-source designs, which only allow for fixed hand positions. The usage of prosthetic arms depends heavily on their functionality and comfort. Patients are more likely to consistently use prosthetics if it aids them in returning to normalcy and reducing family burdens. My objective is to design an interchangeable hand to enable critical rotational movements.

Methodology

The BCMF prosthetics project makes custom-fitted, low-cost, 3D-printed prostheses. BCMF uses open-source prosthetic models such as the Kwawu Arm 2.0, which provides an OpenSCAD (openscad.org) file for adjusting the model to the recipient's measurements. To maintain BCMF’s workflow, the interchangeable wrist model was created using the 3D design software, Autodesk Fusion 360, and designs from NIOP Q-C v1 and v2 Quick-Connect Wrist. The wrist was merged onto the Kwawu Arm, printed, assembled, and tested. This is an iterative process where patient feedback ensures the prosthetics cater to the diverse needs of the recipients. 

Results

Since the launch of the prosthetics project in 2019, BCMF has provided 3D-printed prosthetics to 76 patients. The interchangeable hand provides a solution to many patients' everyday activities and can rotate the hand 360 degrees.

Conclusions

This project provides a low-cost solution to healthcare challenges in the context of poly-crisis experienced in Myanmar, enhancing the resilience and adaptability of affected refugee communities.

Relevance to Sub-Theme

This presentation aligns with sub-theme 2 by developing and testing methods to improve healthcare access and quality in areas affected by war, migration, poverty, and racial disparities.},

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@conference{Elkind2024,

title = {Modifying Radix Lenses to Survive Low-Cost Sterilization: An Exploratory Study},

author = {Emese Elkind and Keiran Barr and Colton Barr and Kristof Moga and Tivadar Garamvolgy and Tamas Haidegger and Tamas Ungi and Gabor Fichtinger},

url = {https://labs.cs.queensu.ca/perklab/wp-content/uploads/sites/3/2024/10/EmeseElkindImNO2024-2.docx},

year  = {2024},

date = {2024-03-19},

urldate = {2024-03-19},

publisher = {Imaging Network of Ontario (ImNO) Symposium},

abstract = {INTRODUCTION: A major challenge with deploying infrared camera-tracked surgical navigation solutions, such as NousNav [1], in low-resource settings is the high cost and unavailability of disposable retroreflective infrared markers. Developing an accessible method to reuse and sterilize retroreflective markers could lead to significant increase in the uptake of this technology. As none of the known infrared markers can endure standard autoclaving and most places do not have access to gas sterilization, attention is focused on cold liquid sterilisation methods commonly used in laparoscopy and other optical tools that cannot be sterilized in a conventional autoclave.

METHODS: We propose to modify NDI Radix™ Lens [1], single-use retroreflective spherical marker manufactured by Northern Digital, Waterloo, Canada. Radix lenses are uniquely promising candidates for liquid sterilization given their smooth, spherical surface. This quality also makes them easier to clean perioperatively compared to other retroreflective infrared marker designs. Initial experiments show that liquid sterilization agents degrade the marker’s retroreflective gold coating (Fig. 1). Hence the objective of this project is to develop a method to protect the Radix Lenses with a layer of coating material that does not allow the sanitizing agent to degrade the coating to enable the lens to survive multiple sanitation cycles while retaining sufficient tracking accuracy. We employed two cold liquid sterilisation agents, household bleach which is a common ingredient of liquid sterilisation solutions and Sekusept™ Aktiv (Ecolab, Saint Paul, MN, USA), which is widely known for sterilizing laparoscopy instruments. Store-bought nail polish and Zink-Alu Spray were used to coat the lenses. Data were obtained by recording five tests each with five rounds of sterilization, each tested with six trials, for a total of 150 recordings. The five tests were as follows: 1) Radix lens coated with nail polish and bleached, 2) uncoated and bleached, 3) coated with nail polish and sanitised, 4) uncoated and sanitised, and 5) coated with Zink-Alu Spray and sanitised. To assess the impact of the sterilization on the lens’s fiducial localization error, two metal marker frames equipped with four sockets designed for the Radix lenses were used. The reference marker frame was secured to a flat table while the other marker frame moved along a fixed path on the table. The position and orientation of the marker clusters were streamed into 3D Slicer using the Public Library for Ultrasound Toolkit (PLUS). A plane was then fit to the recorded marker poses in 3D Slicer using Iterative Closest Point and the marker registration error was computed. Distance from the camera, angle of view, and distance from the edges of the field of view were held constant.

RESULTS: With each round of sterilization, the error of coated lenses was lower than the unprotected lenses, and the error showed a slightly increasing trend (Fig. 2). The lenses appeared fainter in the tracking software the lenses appeared fainter while all lenses remained trackable and visible despite the significant removal of reflective coating.

When reflective coating was fully rubbed off the lenses, the tracking software could still localize the markers; however, the lenses did appear much fainter in the tracking software.  We observed that the reflective coating rubs off the lens in routine handling, and recoating with Zink-Alu spray can partially restore marker visibility. Using protective nail polish coating prevented the reflective coating from rubbing off altogether. 

CONCLUSIONS: This exploratory study represents a promising step toward achieving low-cost sterilization of retroreflective infrared markers. Studies with the NousNav system need to be undertaken to measure the extent of degradation in tracking accuracy is tolerable as a side effect of marker sterilization. Before using coated Radix lenses on human subjects, it must be verified that the protective coating (common nail polish in our study) is fully biocompatible and remains undamaged by the cold sterilization agent (Sekusept™ Aktiv in our study.) 

REFERENCES: [1] NousNav: A low-cost neuronavigation system for deployment in lower-resource settings, International Journal of Computer Assisted Radiology and Surgery, 2022 Sep;17(9):1745-1750. [2] NDI Radix™ Lens (https://www.ndigital.com/optical-measurement-technology/radix-lens/)  },

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