A Scalable Solution for Pediatric Neuromuscular Care and Its Strategic Integration as a CIRAS Member
- project name : Orthese Brasil
- project number: CIR_2506xxxxx
- project start: april 2025
- project manager: Tom Emus
Abstract
The Orthese Brasil initiative, developed by OrthoAlemao, addresses a critical public health gap in Brazil: access to affordable, high-quality AFO (ankle-foot orthoses) for children with neurological and neuromuscular disorders. With over 43 million children under 15 in Brazil and tens of thousands affected by conditions like cerebral palsy and muscular dystrophy, the need for scalable orthotic solutions is acute. This paper explores the integration of OrthoAlemao as a CIRAS Health & Infrastructure Center partner. It outlines the technological, economic, and social dimensions of the project, identifies transdisciplinary research opportunities, and formulates a strategy for global scale-up and scientific evaluation within the CIRAS framework.
1. Introduction
1.1 Problem Statement
In Brazil, many children requiring AFO orthoses remain untreated due to:
- High costs (~2,000 BRL = $380 USD per orthosis vs. minimum wage of 1,518 BRL),
- Manual, slow production methods, and
- Unequal access in rural areas.
Each child typically requires 2–3 orthoses per year. Untreated cases lead to long-term disability, educational exclusion, and socioeconomic marginalization.
1.2 The Solution: A Digital Manufacturing Model
OrthoAlemao proposes a digitally managed, decentralized production system using 3D scanning and SLS printing. The process includes:
- Distributed 3D scanner deployment to orthopedists,
- Centralized CAD processing and design, and
- High-precision SLS printing in regional hubs.
Projected benefits:
- Cost reduction to ~$76 USD (400 BRL) per orthosis,
- Production scaling from urban to rural regions,
- Export potential across Latin America.
2. CIRAS Membership Analysis
2.1 Alignment with CIRAS Centers
| CIRAS Center | Project Impact |
|---|---|
| Health | Improved pediatric care for neuromuscular diseases |
| Infrastructure | Distributed 3D printing systems for medical supply chains |
| Governance | Policy engagement for public health subsidies |
| Justice | Addressing medical inequality in underserved populations |
| Science | Applied biomechanics, additive manufacturing, pediatric neurology |
| Education | Orthotic technician training & clinical simulation modules |
3. Research Goals (2025–2028)
3.1 Biomedical Engineering Research
- Analyze biomechanical effectiveness of SLS-printed orthoses.
- Evaluate material performance and durability in tropical environments.
- Publish comparative studies vs. traditional orthotic solutions.
3.2 Health Outcomes Research
- Longitudinal tracking of mobility metrics, school participation, and mental health in children using OrthoAlemao orthoses.
- Integration of WHO Functional Independence Measures (FIM) for impact assessment.
3.3 Social Equity Impact
- Map socioeconomic outcomes for families receiving subsidized care.
- Explore correlations with educational access and family income resilience.
3.4 Production Systems Optimization
- Simulate logistics flows from scan to delivery.
- Integrate AI-driven error correction in digital orthosis design.
4. Mutual Benefits: CIRAS ↔ OrthoAlemao Partnership
| OrthoAlemao Gains | CIRAS Gains |
|---|---|
| Access to global health research network | Real-world case study in digital medical infrastructure |
| Certification support, evaluation tools | Platform for transdisciplinary publication & policy impact |
| Connection to CIRAS Education Centers | Evidence for scalable models in child health equity |
| Expansion through CIRAS Latin American nodes | Testing ground for regional manufacturing ethics, ecology |
5. Implementation Opportunities
5.1 Establish a CIRAS–OrthoAlemao Pilot Clinic
- In São Paulo or Recife, with joint supervision by CIRAS Health, Education, and Infrastructure Centers.
- Include remote diagnostics via CIRAS telehealth tools.
5.2 CIRAS Clinical Training Program
- Develop training for technicians, pediatricians, and rehab specialists.
- Focus on 3D scanning, digital workflow, and patient fitting protocols.
5.3 Research Hub Integration
- Launch CIRAS working group to:
- Co-publish outcomes in journals like BMC Pediatrics, Nature Digital Medicine.
- Develop open datasets for AFO usage and long-term outcomes.
6. Future Scale-up and Regional Impact
| Country | Rationale for Expansion |
|---|---|
| Peru | High rural pediatric disability rate |
| Colombia | Existing CIRAS partnerships with health universities |
| Mozambique | Portuguese-speaking country with orthotic supply deficits |
| India | High demand and early 3D printing adoption in medical sector |
Each expansion can replicate the Brazilian digital-to-print pipeline, adjusted for national health frameworks and CIRAS institutional presence.
7. Investment and Sustainability Evaluation
- Capital Need: $150,000,000 (equipment, software, infrastructure).
- ROI Model: 5-year annuitized repayment (5% p.a.), break-even at 12,000 orthoses/year.
- Impact Metrics: >50,000 children served in first 5 years; >70% reduction in unit cost.
8. Conclusion
The Orthese Brasil project is a compelling example of precision public health innovation, addressing pediatric disability through scalable, digitally driven orthotic care. Its CIRAS membership not only validates its scientific and ethical framework but enables regional replication, academic study, and public health impact at scale.
As CIRAS continues to support systems that link science, justice, and health equity, partnerships like OrthoAlemao will become foundational pillars in achieving measurable transformation for underserved children globally.