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An assistive device that can reliably help frail patients transfer from bed to wheelchair and back.

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Elderly patients often struggle to recover from unexpected hospitalizations, leaving them permanently bedbound and at a higher risk of complications and even dying. We're creating an assistive device that can help these frail patients transfer from their beds to a wheelchair, which will dramatically increase their independence and quality of life.

BACKGROUND

By 2030,  a quarter of the population will be over the age of 65. Though life expectancy has increased significantly over the last century, complications from chronic diseases such as diabetes, heart disease, osteoporosis, and cancer often cause catastrophic events in the elderly - leading to functional decline, loss of independence, and even death. 


Our team had the opportunity to shadow and work with the geriatric population the last two months in the Miami Veteran Affairs Hospital as well in the Miami Jewish Health System, a private healthcare facility for the elderly. We learned that the holistic treatment of the geriatric population addresses four domains: medical, psychological, socioeconomic, and functional. The last domain, functional, describes the ability of an individual to live independently. 

To assess independence, doctors evaluate a patient's ability to perform Activities of Daily Living (ADLs) and Instrumental Activities of Daily Livings (IADLs). These tasks - eating, dressing ourselves, bathing, making phone calls - we perform every day without a second thought. However, to patients recovering from catastrophic events, these tasks may seem insurmountable. 


Patients who cannot perform any of the ADLs or IADLs cannot live independently in the community and depend on nurses, aides, and social workers. These individuals often have to move from their homes to assisted living and long term care facilities, at times against their will (for their safety). 

After identifying and screening many potential healthcare needs of this population, we discovered that inability to transfer independently was one of the largest contributing factor to loss of independence among the elderly. Recovering from a heart attack or a bout of pneumonia, these patients are often decompensated and at a very high risk of fall. Consequently, they remain bedbound, leading to further decompensation and further loss of functionality. These patients have higher rates of mortality due to increased risk of pressure sores and infections. After witnessing this happen to many of our patients, we decided to take action.

IDENTIFYING THE PROBLEM

Rehabilitation medicine plays an essential role in helping individuals recover from acute illnesses. Physical therapists and physical medicine doctors work tirelessly to help patients become more functional and more mobile. One of the most important milestones a patient learns is the ability to transfer from the bed to the wheelchair. This is a key milestone in recovery for bed-bound patients. The ability to travel in a wheelchair exponentially increases a patient's functionality. They can now eat in the kitchen, bathe in the restroom, and better interact with their loved ones.  

Use of a Hoyer Lift (image courtesy of Free Foundation)

Patients unable to transfer into a wheelchair require expensive hoyer lifts (essentially cranes operated by an assistant) or use a transfer board (essentially a wooden board that an assistant slides the patient on). It is important to note that some patients can use these independently, however this requires immense arm and wrist strength that many do not have. 



Use of Transfer Board (Image courtesy of Fairview Health Services)

We decided to create a better assistive device that patients can use to reliably transfer from bed to wheelchair and back. Our device is geared toward patients with limited upper and lower extremity strength. 

OUR SOLUTION 

To create our device, we observed our patients, interviewed physical therapists, and actually performed hundreds of transfers on our own using the existing transfer board and various prototypes. We discovered the simplest movement for a chair bed transfer was not a lateral slide (such as the one the transfer board uses) but rather a pivot of the body. This movement is captured with our first prototype which we created with a pair of crutches. 

USE: ...

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  • 8/31/2017: Design

    Riya Fukui09/01/2017 at 17:45 0 comments

    Today we met with all the team members and decided on a practical design. Considering:

    - Fall risk

    - Ease of use

    - Simple mechanics

    - Cost efficiency

    This is our final design:

  • 8/26/2017: First Prototype

    Riya Fukui08/31/2017 at 22:40 0 comments

    This is our first prototype:

    (You can see our legoman sitting on it!)

    This is a leaning pivot system where people can lean in to the device, transfer their weight, pivot, then sit down. Here is a video on how it works:

  • 8/22/2017: Design Brainstorming and Concept

    Riya Fukui08/26/2017 at 18:32 0 comments

      Winner concept: A transfer board that allows one side to be elevated while the person is seated.

      Other ideas:

      1. Hoyer
        1. Pump-able
        2. Automatic
        3. Pushes a button and automatically transfers
      2. Board with wheels
        1. Start sliding once you’re on
        2. A conveyor belt
      3. Platform for chair to become higher than the bed
      4. Something to lower the bed
      5. Air inflator in seat that deflates on one end so the patient slides
        1. Like a wedge
      6. A wheelchair that flattens to the height of bed
        1. The patient does a roll
      7. Wheelchair is part of the bed
      8. Hoyer lift with magnet
      9. A vest that assists with lifting oneself
        1. Like the pull up machine with weights
      10. Using the momentum to fall on top of the bed
      11. Using mini-steps to go backwards on to the bed
      12. A wheelchair where you can take off the back so that you can go backwards
        1. Go backwards
      13. Escalator to the bed
        1. A conveyor belt that will let you slide into your chair
      14. Monkey bar to move yourself into the bed
      15. Something hanging that they can grab on to
        1. Maybe there’s a counter weight
      16. Make the bed into a jungle gym
      17. Put a little bit of C4 under the butt and poof
        1. Similar to spring loaded trampolines
      18. Electromagnet maglev to slide the patient
        1. Or air pressure
      19. Use long stick
      20. The wheelchair seat that attaches to a pole and the seat moves
        1. Cushion that elevates from the chair
        2. An arm to turn onto the chair
      21. Back to the bed and chair pushes up
        1. Air mattress cushion that will lift them
      22. A wench that will pulls you up to the bed
        1. Like a zip line that will lift them up
      23. A slide in the seat that slides in and out like Chinese table

  • 8/19/2017: Need statement

    Riya Fukui08/26/2017 at 18:24 0 comments

    Need statement:

    - There is a need for a way to confidently transfer from bed to wheelchair and back without assistance.

    Evidence: We met with many patients in a hospital and they all needed assistance in transferring

    Wheelchair:


    Bed:


    And back:


    And so on...

  • 8/19/2017: Need assessment

    Riya Fukui08/26/2017 at 18:20 0 comments

    Problem statements:

    -Urinary incontinence
    --Elderly patients suffer from urinary incontinence limiting their functional and social independence

    -Recovering from hip fracture
    --One of the leading cause of catastrophic events in elderly
    --Point of entry for severe decline

    -Humidifier for oxygen tank
    --Patients with oxygen without humidifier suffer from drying of mucous membranes leading to discomfort

    -Bed mobility
    --Weak truncal strength limits bed mobility which leads to pressure ulcers
    --What do bed-bound patients do for bowel and bladder?

    -Diabetes
    --Finger sticks are invasive and uncomfortable
    --Difficulty with self-administration of insulin
    ---Independent insulin management is challenging without proper finger sticks and insulin dose calculation

    -Hydration status
    --Elderly patients are not sensitive to thirst (don't remember to drink), limited access to water, difficulty swallowing

    -Serious falls in the elderly

    -IADLs
    --Difficulty with use of smart phones due to impaired speech, dexterity, visual acuity
    --Managing finances
    --Transportation
    --Preparing meals
    --How to get elderly set up with different services as there are many out there
    --Elderly patients are unable to manage medications and doctor's appointments

    -Social isolation
    --Skype? There are services that connect people who want to learn a language
    --Nutritional status. Elderly patients eat less when they are eating alone.

    -Eye drops
    --Elderly patients have decrease manual dexterity leading to difficulties applying eye drops and managing Glaucoma

    Preliminary finalists:
    1. Social Isolation - informal support system to support each other, to get others to remind elderly about meds/eating... etc
      Why does the problem occur:
        -decreased mobility, functional capacity, inability to drive, fear of fall, incontinence
        -institutionalization
        -memory problems
      Medical implication
        -depression, decreased nutrition, cognitive impairment, increased mortality
      Women, older age, less education, lower wealth, marital status (single, widowed)
      Evidence:
        -60% have mobility impairment
        -Change or loss in social network, social role, physical or mental health and resources
      Effective intervention
        Group activities: discussion, self-help, bereavement
        Specific population: women, widow, mild cog problems
        More than one method
        Allows participants some level of control
        Process of evaluation throughout the intervention
      Aim of intervention
        Reducing loneliness and or depression
        Increasing the social network size
        Improving the quality of supports
        Increasing the frequency of social contact
        
      Questions to ask:
        -Age, marital status, family members, member of organization in community, previous occupation, level of education, sources of income, spiritual/religious, exercise, nutrition
        -Ask about IADLs
        -Who in your life do you interact with the most?
        -How often do you get to see your family?
        -Do you use your telephone to talk to them? Is it video?
        -Number of new relationships, in past year?
        
        (When did you start feeling like you losing social interactions?)
        Social isolation questionnaire:
          First, how often do you feel that you lack companionship: Hardly ever, some of the time, or often?    1    2    3    
          How often do you feel left out: Hardly ever, some of the time, or often?    1    2    3    
          How often do you feel isolated from others? (Is it...

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  • 8/4/2017: Need searching

    Riya Fukui08/26/2017 at 18:19 0 comments

    Problem Statement: Because of either physical, cognitive or sensory deficits, elderly individuals require assistance to perform instrumental activities of daily living, which include cleaning, cooking, finances, using a telephone, taking their medications, or traveling, making them less independent.

    Plan:
    - Make a questionnaire about the use of smart phones and what troubles they have.
    - We want to find out the most common IADL that the targeted population is having trouble -> convert to need statement
    - Research online what is the most common deficits that occur in the elderly population.

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