 So, my name is Vanessa Martin-Weigern and today I'm going to be talking to you all about the project that I've been working on over the last seven weeks in which I created a device to help those with hand tremors or limited fine motor skills insert a catheter more independently in their own home. I worked with Devin as my mentor so again this was an individual project. The title of my device is catheter insertion aid. So a quick overview of what I'm going to talk about today first I'm going to go into some background of both tremors and urinary catheters and explain how these two topics inspired this project. From there I'm going to move into my concept of design and talk about a demonstration that I built and I'm going to discuss different tremor suppression techniques that were considered for this design and finally talk about future work. So a tremor is defined as an unintentional rhythmic muscle movement that commonly affects the hands, arms, face, voice, trunk and legs. It is a neurological disorder and the brain does not have the ability to send the correct signals to the muscles to keep them from shaking. Those who suffer from tremors include people who have multiple sclerosis, have suffered a stroke or traumatic brain injury, have a neurodegenerative disease that destroys parts of the brainstem or cerebellum or aging people. There are treatments for tremors but no cures and these treatments include drug therapy, surgery or physical therapy and each of these options either offer a potential risk to the user or are not 100% effective. With drug therapy just like any drugs there are side effects that could be detrimental to the patient's health. With surgery you run the risk of hemorrhaging or having psychiatric issues after and though physical therapy is helpful in alleviating the tremor it does not completely suppress the tremor. In fact 25% of people who are treated for tremors with one of these three options still say that they cannot control their tremor efficiently and have to deal with them in day-to-day life. Essential tremor is the most common type of tremor and affects up to 10 million people in the U.S. alone affecting men and women equally. It most commonly targets the hands and is an action tremor which means it's going to be present when the person is completing an action or if their limb is outstretched from their body. The severity of the tremor varies from person to person but can increase depending on the amount of stress the activity causes the individual or on the activity itself. A urinary catheter is defined as a thin flexible rubber tube that is inserted into your body to drain your bladder. It is inserted into your body through the urethra and drains the urine either into a toilet or into a bag. And somebody who needs to use a urinary catheter will end up using it up to six times a day. Those who may need to use one include people who are bed confined and too weak to get up to use the restroom which is most commonly seen in aging people. But also people who have spina bithra, cerebro palsy or multiple sclerosis do not have the ability to contract their bladder muscles to hold their urine so they must use a urinary catheter. As you can see there is some overlap between those who may need to use a catheter and those who have tremors, especially those who are elderly or have multiple sclerosis. Currently there is no proposed technology to help make the catheter insertion process more comfortable for these people. And because there was this overlap I thought it was an interesting project topic to look into. So for my concept of design I took inspiration for how the product should work from a senior design group from Virginia Commonwealth University. They built a mechanical design to help men with spinal cord injuries insert a catheter. This was a purely mechanical device and may be difficult for somebody with limited fine motor skills or tremors to use. And also it only targeted men and I wanted to create a device that helped both men and women. So the first step was to automate their system to make it accessible to people who had limited fine motor skills. And I did that by controlling a motor using an Arduino and a flip switch. And the flip switch has three modes, forwards, backwards, and off. So the person can not only insert the catheter using the aid but also remove it as well. From there, a gear train reduced the speed from the motor to what I thought was an acceptable feed speed for the catheter. And the catheter was pulled forward and backward using two rollers that moved at the same speed but in opposite directions. There's also a lubrication system included in the device because a catheter needs to be lubricated to go into the body comfortably. And I showed that in the demonstration using a rack and pinion system and a syringe. So as the rack is pushed forward by the pinion, the plunger of the syringe is pushed forward expelling lubrication onto the device or onto the catheter, making it ready for insertion as it comes out of the device. I also created a brief sketch of what the final product might look like. This is by no means a final product but highlights a few important features that need to be considered for the final design. On the backside, we see the catheter input into the device. And this is going to be a funnel-like shape. Somebody with tremors is going to have a very hard time inserting the catheter into a small opening. So this funnel provides a guide so that involuntary motion can still happen but the catheter moves into the device easily and smoothly. The hole for lubrication on top of the device is also built in this funnel-like design for the same purpose. On the front side, we see the catheter output and the flip switch to control the device. And the shape of the catheter output can be better seen on the side view. It's tapered down almost like the end of a funnel. And this would allow the individual to line up the device with the urethra to allow a smooth transition from the device into the body. There's also an emergency stop switch on the device. And this is because different blockages may be hit when somebody is inserting a catheter. And when these blockages are hit, it's important to adjust the catheter as necessary to prevent internal bleeding or internal damages from occurring. So this switch just provides a quick and easy way for the user to quickly shut off the device, ensure it stays off while they're adjusting the catheter, and then a reset switch would be hit to resume the coughing process. So moving into tremor suppression, as I kind of touched on before, somebody with tremors has limited fine motor skills, which makes it difficult for them to hold small objects but also put objects into small openings. With regards to coughing, this is going to mean somebody's going to have a very hard time putting a catheter into the small opening of the urethra, making the coughing process difficult and potentially painful. So when considering how I should build this device, I needed to find a way to either suppress or compensate for the tremor motion to make it easier and more comfortable for the catheter to be inserted. I looked into four different options that I will discuss further in the following slides, but these options include sensors and actuators, weight, mask ring damper systems, and using an uncoupled device from the user. So with sensors and actuators, this is known as an active tremor suppression system, and what that means is that the sensors are collecting real-time data and sending a response to the actuators to create and to create an equal and opposite motion of the tremor, thus suppressing the tremor. What I liked about this option is it could easily be adapted to each individual because the sensors are collecting real-time data. However, this idea is still being researched, and as a result, there's still quite a few bugs that need to be worked out. One of the major bugs is that the sensors have a hard time deciphering between the voluntary motion of moving the limb and the involuntary motion of the tremor, and that causes the sensors to send an incorrect response to the actuator, which then does not successfully suppress the tremor. Also, the algorithms used to control the system can become very complicated and difficult to master, and overall, I thought a simpler solution was better implemented into this design. Next, I thought about using weight. Weight is currently used on in-marketable technology for tremor suppression. There's a line of weighted eating utensils to help somebody eat more comfortably in their own home, and doctors or physical therapists may recommend that a patient wear wrist weights to help reduce the shaking motion of the tremor. I liked this because it was a simple solution because either the person could be advised to wear wrist weights, or adding weight to a device is relatively cheap compared to other alternatives. However, even with the weights, some shaking still occurs in the patient, and depending how severe the shaking is, could make the capping process still very difficult for them. In addition, I was initially thinking of creating a device that would look similar to a squirt gun or a glue gun, and if you added weight to the system, it could make it top heavy and prone to tipping, or depending on how heavy the device needed to be to help reduce the tremor, could just make it too difficult to hold in the user's hands while the entire capping process was taking place. Finally, if somebody was suggested to wear wrist weights while using the catheter insertion aid, this would just cause additional hassle to the user because they would need to put on the wrist weights, set up the aid, cap themselves, wait for their bladder to drain, remove the catheter, remove the wrist weights, and then wash everything. Not only is the cloth-like material of the wrist weight going to be difficult to clean and sanitize, and if it's not cleaned correctly, bacteria could spread and infection could happen in the individual, but just the extra hassle of having to put on these weights and wear them while the capping is taking place could discourage the individual from using this device. So then I looked into mass spring damper systems. I liked that a basic mathematical model already exists for mass spring damper systems, making it very easy to implement into the design because the coefficients of the springs and damping would just need to be adjusted in the experimentation. It's also a very simple solution. Mass spring damper systems, though not necessarily used in tremor suppression technology, are used in technologies today, and they pretty much effectively help reduce the vibratory motion in these components. However, this is a passive system, and what that means is that mechanical damping is used to help reduce the effect of the tremor, and with that damping, mechanical resistance can occur. And what that means is the person's just going to feel resistance when completing the voluntary motion of moving the device. And depending on how strong this damping is, it could be a hassle for the user to use this particular device. In addition, each damping, or the damping would need to be adjusted in each individual product for the user-specific tremor. Tremor tremors range between three and eight hertz, and though this seems like a relatively small range of frequency, you cannot encompass this range of frequency with one damping coefficient. And I read two different papers in which studies were done, and the researchers attempted to create a damping coefficient to encompass this range, and they were both unsuccessful. So each device would need to be manufactured in some way that it could be adjusted as necessary. And finally, currently, mass spring damper systems have been proven to be ineffective in suppressing a tremor. There was one group that created a makeup applicator device for individuals with tremors, and one of their initial prototypes implemented a design similar to what I was considering implementing into my design. And they connected two cups using springs and dampers, and when they tested this prototype among a focus group of women with tremors, they recorded that it was completely ineffective in reducing the shaking motion so that the woman could put on makeup, which means it would be ineffective in suppressing the tremor motion in the capping process. So finally, I looked at creating an uncoupled device, and what that would entail is creating a stand for the catheter insertionate to sit on top of, and then the person would just kind of flip it on, and the capping would be done almost automatically for them. What I liked about this system is that it's simple, once again, because a stand would just need to be created, but also it could be adjusted to accommodate everybody. I'm hoping that the stand would be raised and lowered and adjusted to different angles so it could accommodate both men and women, but people of different body shapes and sizes. Eventually down the line, the system could be automated, so if somebody with extremely limited fine motor skills or reduced use of their arms and hands could cap themselves independently using this device. And also it frees the use of both hands, and this is important in the capping process because when somebody's inserting a catheter, it's important to hold your genitals in a way that they are as still as possible, but at the correct angle so the catheter enters the body correctly. And if somebody has tremors and shaking hands, this is going to be very difficult for them to accomplish. However, if they can use both hands, then they can position themselves in a way that they can reduce the shaking in their hands to the best of their ability, hold their genitals as still as possible, and allow the catheter to be inserted more comfortably. Some downfalls to this idea though is that the designing of the stand could become complicated, and I will talk about that in the next slide. And also the emergency stop switch is not going to be directly in the user's hands, which means that they're going to have to reach out to hit this button, which could be a problem or it could not be a problem, and further research and testing would need to be done to see if adaptations needed to be made to the design to make this emergency stop switch more accessible to the user. So for future work, prototyping would need to begin on both the catheter insertion aid and on the stand. And as I said, that the stand could become kind of complicated in designing and a lot of different features would need to be taken into consideration. First, looking at the base, two different options were being considered, either a tripod stand or a flat base, as seen in the picture. I decided to go with the flat base because I thought a tripod would just be prone to tipping, but it would be important that the weighted base is heavy enough to keep the stand from tipping over, but light enough that the user could still pick up the base and take it with them, so capping is not restricted to the home. Next, the joints of the system would need to be considered. I thought a ball and socket joint might be too difficult for somebody with tremors to maneuver properly, so I'm currently looking at using two hinge joints to limit the amount of motion. This would still allow the user to move the device left and right and forward and backward, but just refine the amount of movement that they were able to move the device in. Also, the system should be compactable. Similar to a portable camera tripod, it should be able to fold down, once again, allowing the user to take the device with them, so capping is not restricted to the home, but this also allows them to store the device in a bathroom cabinet, so it doesn't have to be out all the time. And finally, a clamping system would need to be designed for the top of the device to hold the aid in place. I'm thinking about using a system where you would set the aid on top of the device, use both hands to clamp it into place, and once capping was done, a push button could be hit to release the clamps, allowing the person to pick up the device and clean it as necessary. This is just a brief idea of what the final system could look like, and as designing proceeded, the overall look of the system is probably going to change. Once prototyping was done, testing could begin, and the initial steps of testing would be using a catheter insertion dummy that they use in hospitals to teach nurses how to insert catheters into patients. And during these tests, it would be important to see how well catheter transition from the aid into the body and begin making fixes from there. So I'd like to give a special thanks to Devin Berg, my crop, and Dwayne Bunce. Devin Berg was my mentor over the last seven weeks and really helped me get this project to where it is today. My crop runs the Fab Lab on campus and allowed me to use the laser cutter to help me print the gears for my demonstration, and Dwayne Bunce runs the shop downstairs, and not only did he allow me to use the shop space, but my gears were initially slipping on the wooden dowels I used, and he provided me with some insight and some help to keep those gears in place. So without these three men, I wouldn't have finished my project to where it is today, and I'd like to extend my thanks to them. Here's a short bibliography of the work I used. Do I have any questions? So you said that sanitation is something of importance. So if I say this, how would it be cleaned? Do you take it apart, or is it completely just waterproof, and you just wash it in a bowl? Once again, that would go more into the prototyping, but for my thoughts right now, I'd like it for it to be just waterproof. So you could just submerge it in water or run soap and water through it, and the person doesn't have to try and disassemble it, because if they have tremors, that could be very difficult for them to take apart and put back together. So just something that they could just bleach or just rinse right away would be the best solution. Rebecca, is your concept to learn? That could vary depending on the prototyping. Like I said, squirking on glue gun was being considered for the hand model, and even if this was set on top of a device, I think I would want to keep it about the same, just so it's small and compact and easy to take with the person. Any other questions? Thank you.