nfralick
Tue, 08/06/2024 - 15:55
Edited Text
ThreeDimensional
Printing
& Medical Art Therapy in Oncology
Ashley M. Engler
Art Therapy Graduate Student
Summer, 2024
Overview
Contents
01
Purpose and Justification
02
Introduction: Context and Terms
03
Literature Review
04
Methods: Program Guide
05
Limitations and Future Research
06
Conclusion: Final Thoughts
The purpose of this project is
to identify existing use of
digital media in art therapy,
best practices for medical art
therapy in oncology, and to
inform a proposal for 3D
printing in art therapy with
cancer patients.
Terms
Related to This Project
• Active Treatment - the period of time in which a patient is receiving medical
intervention for their disease.
• CAD - Computer-Aided Design software.
• Digital Art Therapy - Technology-based art therapy methods and materials.
• Remission - the period of time in which a cancer is controlled.
• Survivor/Survivorship - anyone who has been diagnosed with cancer.
Introduction
Understanding the Cancer Experience
• Cancer is the second-leading cause of death in the United
States (Siegel, 2024).
• Cancer doesn’t discriminate!
• There are a variety of disease types, with a host of
comorbidities and complications.
• Can be extremely disruptive.
• Psychological impact is shaped by:
⚬ Disruptions in normative milestones
⚬ Medical environment & traumas
⚬ Financial burdens
⚬ Threat of infection & isolation
⚬ Existentialism
Medical Art Therapy
Roles, Responsibilities, and Resources
Definition
• A type of art therapy practice based
in medical settings.
• Provides people with medical illness
opportunities for:
⚬ self-expression
⚬ processing experiences
⚬ aid in grief/bereavement
⚬ family support
⚬ reduction of physical symptoms
related to medical illness.
Expanding Roles
• Niche focus in oncology.
⚬ Focus on trauma-informed
interventions.
• Working with an interdisciplinary
team.
• Coordinating patient care.
• Ensuring patient safety.
• Innovating delivery methods.
What is 3D
Printing?
An additive manufacturing process whereby a threedimensional (3D) object is created from a digital 3D model
produced using Computer-Aided Design (CAD) software.
3D Printing
Benefits in the Literature
In Medicine & Oncology
• Uses:
⚬ Personalized pre-operative
treatment planning.
⚬ Patient education.
⚬ Synthetic organs.
⚬ Prostheses/adaptive tools.
• Limitations:
⚬ Bio-compatibility.
⚬ Infection control.
In Mental Health
• Not used much!
• Adaptive tools most widely used.
• Benefits:
⚬ Greater patient
understanding.
⚬ Higher trust in care team.
⚬ Minimal decision-making
conflict.
Transitional Objects
• Describes an object that is external to oneself but embodies a symbolic
connection to someone or something else of importance.
⚬ What is “me” and what is “not me.”
⚬ Winnicott (1971)
• Important across the lifespan.
• Externalization.
• Use bereavement care:
⚬ memory-making.
⚬ encapsulation of experiences.
⚬ bonding.
• Arthern & Madill (1999) suggest a four-level model for use in therapy.
“By holding the TO the client is
able to touch what cannot be
touched; to gain through sensory
contact a holistic and powerful
awareness...In this way a
presence is made of absence”
Arthern & Madill (1999)
Program Guide
Treatment Framework
Theoretical Perspective
• The underlying theoretical stance for this resource guide builds
upon Winnicott's (1953) theory of transitional objects.
• Uses a dual approach:
⚬ Dialectical Theory suggests that two seemingly conflicting
things can be true simultaneously, and intervention
strategies rest on the dialect of acceptance and change.
⚬ Narrative Therapy is rooted in the assumption that narrative
is a basic human means of bearing experiences of time,
events, change, thoughts, and feelings.
EARLY STAGE
Program
Structure
A Four-Stage Program
Inspired by the work of Athern & Madill
(1999), this program uses a four-phase
model. It is designed in stages to offer
flexibility and can be started at any point
in one’s cancer journey. One of the
overarching goals of this integrative
approach is to provide clients with
opportunities to reframe life events and
give them profound meanings.
Physical stage of TO embodiment. This stage focuses on
exploring materials, media, and methods.
MIDDLE STAGE
Process stage of TO embodiment. This stage emphasizes
the client’s ability to attribute meaning to material and
engaging in externalization.
LATE STAGE
Context stage of TO embodiment. This stage deepens
meaning and draws connection between present moment
and wider therapeutic context.
CONCLUDING STAGE
Concept stage of TO embodiment. This stage is about
integrating the artwork into the client’s own life.
Materials
• Laptop/Computer
⚬ Must have good memory and strong graphics capabilities to run CAD software.
⚬ Portability is key!
• CAD Software
⚬ Many 3D printers have accompanying CAD software that can be downloaded
from the company’s website.
• USB External Storage
⚬ Some are wireless or bluetooth.
⚬ It may be safer to use a “hard” transfer like a USB flash drive.
• 3D Printer
⚬ So many choices!
⚬ Consider space, user-friendliness, cleanliness, and need for ventilation.
• Filament
⚬ Each unique project will require consideration of filament type.
⚬ The complexity of design, intended purpose, color, size, and durability are all
factors that will influence this decision.
Program in Action
A PROVIDER’S PERSPECTIVE
Early Stage
• Ideating - Recreating the
caduceus using art supplies and
other meaningful symbols.
• Develop concept sketch.
• Used TinkerCad online software
to re-create the idea using prebuilt shapes.
Middle Stage
• Preparing to print and problemsolving any printing challenges.
• Choose filament type and color.
• Used a MakerBot Extruder+
• Make the first print!
⚬ Sometimes, it’s trash.
Middle Stage
• Problem-solving printing
challenges.
• Complete first print!
• Embodiment - attributing
meaning to physical material.
Late Stage
• Finding resolutions - altering,
destroying, or preserving pieces.
⚬ Might integrate other media.
• Used acrylic paint, a 3D Doodler pen.
glitter glue, and super glue.
• Encouraging future-oriented thinking,
identifying rituals, deepen
personification, reconfigure narrative.
Concluding Stage
• Integration of artwork into one’s own
life by finding artistic resolution.
• Give it a “home”:
⚬ Chose to put in a shadow box for
preservation.
• Identify key take-aways:
⚬ Process reflected my work.
⚬ Symbolic imagery.
⚬ Encapsulation.
Limitations
Limitations
• Not enough research!
• Technology media can be very expensive:
⚬ Computers, printers, and filaments.
⚬ Storage devices.
⚬ Subscriptions/membership fees.
⚬ Maintenance and updates.
• Storage of PHI and safe use of digital media.
• Niche context and totally theoretical.
Material Alternatives
• 3D Doodler– Handheld additive device that uses filament
(similar to the 3D printer) fed through a pen-shaped stylus.
⚬ Often require a power source, such as a wall outlet.
⚬ The heating element, located near the nozzle tip, poses
a risk of burn or other heat-related injury.
• Virtual Sculpting Apps– Allows creators to digitally sculpt
unique designs.
⚬ Most will export files in the necessary formats that 3D
printers accept.
⚬ Users should be aware of costs associated with downloading
and using these apps, including membership fees.
Questions?
Citations
Arthern, Jenny, & Madill, A. (1999). How do transitional objects work?: The therapist’s view. British Journal of Medical Psychology, 72(1), 1–21. https://doi.org/10.1348/000711299159754
Aimar, A., Palermo, A., & Innocenti, B. (2019). The role of 3D printing in medical applications: A state of the art. Journal of Healthcare Engineering, 2019, 1–10.
https://doi.org/10.1155/2019/5340616
American Cancer Society. (2024). Cancer glossary: Definitions & phonetic pronunciations. Cancer Glossary | Definitions & Phonetic Pronunciations | American Cancer Society.
https://www.cancer.org/cancer/understanding-cancer/glossary.html
Cahalan, L., Smith, A., Sandoval, M., Parks, G., & Gresham, Z. (2021). Collaborative legacy building to alleviate emotional pain and suffering in pediatric cancer patients: A case study.
Children (8). https://doi.org./10.3390/xxxxx
Devine, K. A., Viola, A. S., Coups, E. J., & Wu, Y. P. (2018). Digital Health Interventions for adolescent and Young Adult Cancer Survivors. JCO Clinical Cancer Informatics, (2), 1–15.
https://doi.org/10.1200/cci.17.00138
Medicine, M. (2016, May 3). 10-yr-old boy bashes 3D printed tumor “Boris.” YouTube. https://www.youtube.com/watch?v=LAqtuO9LIAo&t=90s
Michigan Medicine - University of Michigan. (2016). Bash “Boris”: 10-year-old boy smashes his 3-D printed tumor. Newswise. https://www.newswise.com/articles/bash-boris-10-yearold-boy-smashes-his-3-d-printed-tumor
Nainis, N., (2008). Approaches to Art Therapy for Cancer Inpatients: Research and Practice Considerations, Art Therapy, 25:3, 115-121, DOI: 10.1080/07421656.2008.10129597
Potash, J. (2018). Special Issue on Medical Art Therapy, Art Therapy, 35:2, 58-59, DOI: 10.1080/07421656.2018.1490615
Wake, N., Rosenkrantz, A. B., Huang, R., Park, K. U., Wysock, J. S., Taneja, S. S., Huang, W. C., Sodickson, D. K., & Chandarana, H. (2019). Patient-specific 3D printed and augmented reality
kidney and prostate cancer models: Impact on patient education. 3D Printing in Medicine, 5(1). https://doi.org/10.1186/s41205-019-0041-3
Winnicott, D. W. (1971). Playing and reality. London: Tavistock.
Printing
& Medical Art Therapy in Oncology
Ashley M. Engler
Art Therapy Graduate Student
Summer, 2024
Overview
Contents
01
Purpose and Justification
02
Introduction: Context and Terms
03
Literature Review
04
Methods: Program Guide
05
Limitations and Future Research
06
Conclusion: Final Thoughts
The purpose of this project is
to identify existing use of
digital media in art therapy,
best practices for medical art
therapy in oncology, and to
inform a proposal for 3D
printing in art therapy with
cancer patients.
Terms
Related to This Project
• Active Treatment - the period of time in which a patient is receiving medical
intervention for their disease.
• CAD - Computer-Aided Design software.
• Digital Art Therapy - Technology-based art therapy methods and materials.
• Remission - the period of time in which a cancer is controlled.
• Survivor/Survivorship - anyone who has been diagnosed with cancer.
Introduction
Understanding the Cancer Experience
• Cancer is the second-leading cause of death in the United
States (Siegel, 2024).
• Cancer doesn’t discriminate!
• There are a variety of disease types, with a host of
comorbidities and complications.
• Can be extremely disruptive.
• Psychological impact is shaped by:
⚬ Disruptions in normative milestones
⚬ Medical environment & traumas
⚬ Financial burdens
⚬ Threat of infection & isolation
⚬ Existentialism
Medical Art Therapy
Roles, Responsibilities, and Resources
Definition
• A type of art therapy practice based
in medical settings.
• Provides people with medical illness
opportunities for:
⚬ self-expression
⚬ processing experiences
⚬ aid in grief/bereavement
⚬ family support
⚬ reduction of physical symptoms
related to medical illness.
Expanding Roles
• Niche focus in oncology.
⚬ Focus on trauma-informed
interventions.
• Working with an interdisciplinary
team.
• Coordinating patient care.
• Ensuring patient safety.
• Innovating delivery methods.
What is 3D
Printing?
An additive manufacturing process whereby a threedimensional (3D) object is created from a digital 3D model
produced using Computer-Aided Design (CAD) software.
3D Printing
Benefits in the Literature
In Medicine & Oncology
• Uses:
⚬ Personalized pre-operative
treatment planning.
⚬ Patient education.
⚬ Synthetic organs.
⚬ Prostheses/adaptive tools.
• Limitations:
⚬ Bio-compatibility.
⚬ Infection control.
In Mental Health
• Not used much!
• Adaptive tools most widely used.
• Benefits:
⚬ Greater patient
understanding.
⚬ Higher trust in care team.
⚬ Minimal decision-making
conflict.
Transitional Objects
• Describes an object that is external to oneself but embodies a symbolic
connection to someone or something else of importance.
⚬ What is “me” and what is “not me.”
⚬ Winnicott (1971)
• Important across the lifespan.
• Externalization.
• Use bereavement care:
⚬ memory-making.
⚬ encapsulation of experiences.
⚬ bonding.
• Arthern & Madill (1999) suggest a four-level model for use in therapy.
“By holding the TO the client is
able to touch what cannot be
touched; to gain through sensory
contact a holistic and powerful
awareness...In this way a
presence is made of absence”
Arthern & Madill (1999)
Program Guide
Treatment Framework
Theoretical Perspective
• The underlying theoretical stance for this resource guide builds
upon Winnicott's (1953) theory of transitional objects.
• Uses a dual approach:
⚬ Dialectical Theory suggests that two seemingly conflicting
things can be true simultaneously, and intervention
strategies rest on the dialect of acceptance and change.
⚬ Narrative Therapy is rooted in the assumption that narrative
is a basic human means of bearing experiences of time,
events, change, thoughts, and feelings.
EARLY STAGE
Program
Structure
A Four-Stage Program
Inspired by the work of Athern & Madill
(1999), this program uses a four-phase
model. It is designed in stages to offer
flexibility and can be started at any point
in one’s cancer journey. One of the
overarching goals of this integrative
approach is to provide clients with
opportunities to reframe life events and
give them profound meanings.
Physical stage of TO embodiment. This stage focuses on
exploring materials, media, and methods.
MIDDLE STAGE
Process stage of TO embodiment. This stage emphasizes
the client’s ability to attribute meaning to material and
engaging in externalization.
LATE STAGE
Context stage of TO embodiment. This stage deepens
meaning and draws connection between present moment
and wider therapeutic context.
CONCLUDING STAGE
Concept stage of TO embodiment. This stage is about
integrating the artwork into the client’s own life.
Materials
• Laptop/Computer
⚬ Must have good memory and strong graphics capabilities to run CAD software.
⚬ Portability is key!
• CAD Software
⚬ Many 3D printers have accompanying CAD software that can be downloaded
from the company’s website.
• USB External Storage
⚬ Some are wireless or bluetooth.
⚬ It may be safer to use a “hard” transfer like a USB flash drive.
• 3D Printer
⚬ So many choices!
⚬ Consider space, user-friendliness, cleanliness, and need for ventilation.
• Filament
⚬ Each unique project will require consideration of filament type.
⚬ The complexity of design, intended purpose, color, size, and durability are all
factors that will influence this decision.
Program in Action
A PROVIDER’S PERSPECTIVE
Early Stage
• Ideating - Recreating the
caduceus using art supplies and
other meaningful symbols.
• Develop concept sketch.
• Used TinkerCad online software
to re-create the idea using prebuilt shapes.
Middle Stage
• Preparing to print and problemsolving any printing challenges.
• Choose filament type and color.
• Used a MakerBot Extruder+
• Make the first print!
⚬ Sometimes, it’s trash.
Middle Stage
• Problem-solving printing
challenges.
• Complete first print!
• Embodiment - attributing
meaning to physical material.
Late Stage
• Finding resolutions - altering,
destroying, or preserving pieces.
⚬ Might integrate other media.
• Used acrylic paint, a 3D Doodler pen.
glitter glue, and super glue.
• Encouraging future-oriented thinking,
identifying rituals, deepen
personification, reconfigure narrative.
Concluding Stage
• Integration of artwork into one’s own
life by finding artistic resolution.
• Give it a “home”:
⚬ Chose to put in a shadow box for
preservation.
• Identify key take-aways:
⚬ Process reflected my work.
⚬ Symbolic imagery.
⚬ Encapsulation.
Limitations
Limitations
• Not enough research!
• Technology media can be very expensive:
⚬ Computers, printers, and filaments.
⚬ Storage devices.
⚬ Subscriptions/membership fees.
⚬ Maintenance and updates.
• Storage of PHI and safe use of digital media.
• Niche context and totally theoretical.
Material Alternatives
• 3D Doodler– Handheld additive device that uses filament
(similar to the 3D printer) fed through a pen-shaped stylus.
⚬ Often require a power source, such as a wall outlet.
⚬ The heating element, located near the nozzle tip, poses
a risk of burn or other heat-related injury.
• Virtual Sculpting Apps– Allows creators to digitally sculpt
unique designs.
⚬ Most will export files in the necessary formats that 3D
printers accept.
⚬ Users should be aware of costs associated with downloading
and using these apps, including membership fees.
Questions?
Citations
Arthern, Jenny, & Madill, A. (1999). How do transitional objects work?: The therapist’s view. British Journal of Medical Psychology, 72(1), 1–21. https://doi.org/10.1348/000711299159754
Aimar, A., Palermo, A., & Innocenti, B. (2019). The role of 3D printing in medical applications: A state of the art. Journal of Healthcare Engineering, 2019, 1–10.
https://doi.org/10.1155/2019/5340616
American Cancer Society. (2024). Cancer glossary: Definitions & phonetic pronunciations. Cancer Glossary | Definitions & Phonetic Pronunciations | American Cancer Society.
https://www.cancer.org/cancer/understanding-cancer/glossary.html
Cahalan, L., Smith, A., Sandoval, M., Parks, G., & Gresham, Z. (2021). Collaborative legacy building to alleviate emotional pain and suffering in pediatric cancer patients: A case study.
Children (8). https://doi.org./10.3390/xxxxx
Devine, K. A., Viola, A. S., Coups, E. J., & Wu, Y. P. (2018). Digital Health Interventions for adolescent and Young Adult Cancer Survivors. JCO Clinical Cancer Informatics, (2), 1–15.
https://doi.org/10.1200/cci.17.00138
Medicine, M. (2016, May 3). 10-yr-old boy bashes 3D printed tumor “Boris.” YouTube. https://www.youtube.com/watch?v=LAqtuO9LIAo&t=90s
Michigan Medicine - University of Michigan. (2016). Bash “Boris”: 10-year-old boy smashes his 3-D printed tumor. Newswise. https://www.newswise.com/articles/bash-boris-10-yearold-boy-smashes-his-3-d-printed-tumor
Nainis, N., (2008). Approaches to Art Therapy for Cancer Inpatients: Research and Practice Considerations, Art Therapy, 25:3, 115-121, DOI: 10.1080/07421656.2008.10129597
Potash, J. (2018). Special Issue on Medical Art Therapy, Art Therapy, 35:2, 58-59, DOI: 10.1080/07421656.2018.1490615
Wake, N., Rosenkrantz, A. B., Huang, R., Park, K. U., Wysock, J. S., Taneja, S. S., Huang, W. C., Sodickson, D. K., & Chandarana, H. (2019). Patient-specific 3D printed and augmented reality
kidney and prostate cancer models: Impact on patient education. 3D Printing in Medicine, 5(1). https://doi.org/10.1186/s41205-019-0041-3
Winnicott, D. W. (1971). Playing and reality. London: Tavistock.