Contents
- Eric Sabelman describes new technologies being applied to the problem of
falls in the elderly and to a new traction system for hand therapy.
- Mike van der Loos gives an update on DeVAR, the
desktop vocational assistant robot, as it moves into commercialization and VA
sponsored field evaluation.
- Maurice le Blanc has been looking at the tech transfer
process at the RR&D Center and reports on a methodology we have
developed for evaluating the tech transfer potential of ongoing projects.
- In an article reprinted from the San Francisco
Chronicle, Teresa Moore writes about the potential of new technologies for
people with disabilities.
- Tech Transfer Briefs
Detecting and preventing falls in the
elderly
Eric E. Sabelman
Hearing aids and eyeglasses are perhaps the best-known examples of wearable
instruments for augmenting aging-diminished sensory function. However, hearing
and vision are not the only senses that decline with age. Another is balance
due to combined losses in other senses. These losses result in impaired
mobility and increased risk of injurious falls.
Every year one-third of the elderly living at home will fall - and about 1
in 40 of these will be hospitalized. The ability to perform activities of daily
living without danger or fear of falling can make the difference between living
independently and needing caretakers.
Wearable balance sensors
We are developing a wearable instrument that can identify patterns of movement
accompanying loss of balance before a fall actually occurs. It will then be
able to warn of pre-fall behavior, and if necessary, signal that a fall has
occurred.
To sense falling and loss of balance, this instrument relies on measurement
of accelerations of the head relative to the upper body. This approach permits
us to identify other factors such as visual distraction, and it emphasizes
those body segments, the head and trunk, that contribute most to postural
instability.
As part of our development process we are testing elderly (64 to 85 years)
and young (24 to 29 years), subjects with simple balance assessment tasks. They
are also given tasks such as climbing steps and sitting and rising from chairs,
which represent activities of daily living.
Accelerometric sensors are mounted on an eyeglass frame and on a belt pack.
Signals from these sensors are analyzed, and from these the pitch (front to
back) and sway (side to side) movements are derived.
One interesting preliminary result shows that while climbing down stairs,
older subjects experience sharper and more extreme head movements than the
young subjects. These sharp head movements then affect the stability of the
visual field, and this comes at a time when the older person is relying more on
visual cues for balance as other balance senses are diminishing.
Clinical applications
We anticipate clinical use of accelerometric instrumentation to come in three
stages. First, it could be used as a diagnostic tool to quantify heretofore
qualitative measures of balance. Second, it could serve as a biofeedback device
for use during therapy of individuals learning to compensate for balance
deficits. Third, the technology could be developed as a fall-prevention aid for
continuous use by institutionalized and community-living fall-prone elderly
individuals.
Subjects go through balance assessment
tasks while wearing the accelerometry instrument.
This project is in early stages and promises to yield valuable knowledge
leading to the design of assistive devices for fall prevention. The project is
the collaborative work of Eric Sabelman, PhD, Deborah Kenney, OTR, James Gadd,
MS, and Carol H. Winograd, MD.
First steps in the commercialization of
DeVAR
Machiel Van der Loos
The Desktop Vocational Assistant Robot (DeVAR) is the outgrowth of twelve
years of collaborative research and development between the Palo Alto VA
Rehabilitation R&D Center and the Department of Mechanical Engineering of
Stanford University. DeVAR has evolved through two major revisions to reach its
present form - a voice-controlled industrial robotic arm suspended on a
motorized track over a workstation. This design configuration enables the robot
to perform useful manipulation tasks in a structured vocational setting.
The most recent VA-sponsored evaluation culminated in a two-year off-site
placement of DeVAR in the office of a computer programmer in a major San
Francisco utility company. The user is quadriplegic, with a C4-level spinal
cord injury. This user customarily has an attendant to perform all daily
manipulation tasks. Once installed, DeVAR was able to perform all needed
manipulation functions for two 5-hour periods per day. The attendant performed
setup1 lunch-time, and evening tasks for the programmer and the robot, but was
not needed at other times during the day. DeVAR was then commanded by the user
to tear printouts, turn pages, serve beverages and do other tasks.
VA purchases evaluation units
This evaluation demonstrated the value of DeVAR in a real-life setting. In
order to undertake a wider evaluation, the Palo Alto VA Robotics team submitted
a Request for Evaluation to the VA Rehabilitation Unit (REU) in Baltimore,
Maryland. In response, the VA committed funds to purchase several additional
DeVARs so that the system could be evaluated in other VA Spinal Cord Injury
Centers. The VA contracted for two units with Tolfa Corporation (Palo Alto,
California), a local manufacturer. To date, one DeVAR has been delivered to the
REU center and another to the VA hospital in Richmond, Virginia.
The two systems will be pilot-tested at these sites for two months. This
will allow the technical and clinical staff to become acquainted with the
system, and it will permit initial evaluation procedures to be finalized. The
DeVARs will subsequently undergo extensive testing, during 6 to 12 month
installations at a number of VA Spinal Cord Injury Centers. Test subjects will
be veterans who are high-level quadriplegics.
Determining prescribability
The goal of the REU evaluation is to determine whether the VA should consider
this system to be prescribable by health care professionals as an assistive
device for high-level quadriplegic veterans. This evaluation has national
significance since other health-care providers and agencies such as insurance
companies are likely to use the VA evaluation as a basis for considering this
'new' technology a viable product. The formal VA evaluation is expected to take
one year starting in March 1992. A decision on DeVAR prescribability will
follow, possibly by the summer of 1993.
A constant-force traction unit for hand
therapy
Eric E. Sabelman
A special constant-force spring device has been designed, developed and
successfully tested at the RR&D Center. This device was originally
developed as part of a spinal stabilization system for the transport of
cervical spinal cord injury patients. Now it has been redesigned for use in
hand and wrist exercise therapy. This new application will benefit both
patients and clinicians and should increase the commercial technology transfer
potential of the traction unit.
The constant-force spring device was initially developed to provide traction
for cervical spinal cord injury patients during inter- and intra-hospital
transport. Prototype units continue to be used at several locations. Two were
adopted by the Stanford Life-Flight helicopters and one is used in-hospital at
the Santa Clara Valley Medical Center. Additional testing is also underway at a
Santa Rosa, California medical center.
An appearance model, showing one
potential design configuration for a commercial hand therapy unit
Widening commercial potential
The hand therapy application represents the third stage in the movement of this
technology toward commercialization. The first was the initial design stage
which demonstrated the feasibility of the technology. In the second stage, the
technology was directed to a product with a specific purpose. In the third
phase the product is being refined and redesigned for a completely different
application. This redirection comes in response to feedback from the commercial
sector.
Manufacturing contacts carefully considered the commercialization of this
device, and they had reservations about its limited market size. Even though
field tests had demonstrated the device's value, their market analysis
suggested that spinal cord injury use alone could not support a commercial
product. In response, we looked for other applications of the technology that
would support wider commercialization. Hand therapy is seen as one area of
rehabilitation where this technology could provide an improvement over the
state of the art and which has a wider market potential.
Benefits to hand therapy
Constant-force-spring traction units offer an alternative to the standard
hanging-weight and rubber-band force generating mechanisms currently used in
hand therapy. One of the few products now available is the J.A. Preston Hand
Table, which operates with five weights suspended from pulleys under the
tabletop. This device and others may be effective in restoring hand and finger
function, but they are large and bulky, and there is little potential for
quantifying motion improvement or strength output.
The constant-force spring device uses a simple hook-and-summing-bar system
to adjust the total force output from 0.67 to 2.5 pounds, using up to nine
springs. The springs are easily adjusted for different levels of therapy, and
they provide for quantifiable exercise forces which are adjustable in known
increments. The device is lighter than existing systems and provides for
reduced friction as well as improved control over the direction and magnitude
of forces applied in each therapy procedure.
The constant-force traction unit is now being tested in a clinical setting.
We are also working with industrial designer Neil Goldberg to develop
'appearance models' to explore the shape which a commercial product might take.
These offer a way of communicating to manufacturers the product potential of
this device.
This project is the work of biomedical engineer Eric E. Sabelman, PhD, hand
therapist Yuriko Wong, OTR, and expert machinist James Anderson, JEM.
High tech help for the
disabled
Teresa Moore
Chronicle Staff Writer
(c) 1992 San Francisco Chronicle
Reprinted by permission
The following article appeared in San Francisco Chronicle, January 14, 1992.
We reprint it here for the benefit of our readers outside the San Francisco
area because of its timeliness and its relevance to tech transfer in
rehabilitation.
Donna Yeager was born without arms. But that hasn't stopped her from leading
a successful career.
Yeager, 34, manages mainframe computers for Hewlett Packard. She wears a
headset to talk to her customers by phone. Her computer keyboard, identical to
those used by nondisabled workers, sits on a desk mounted a little lower than
the height of her seat so that she can type with her feet. And something as
simple as a tracker ball, a device similar to a computer mouse, enables her to
use her toes to access 15 different computer systems.
During the course of her lifetime, advances in technology have emancipated
Yeager.
"Before the technology was available, I had a little teeny table that I
put my books and papers and typewriter on,'' she said. "In high school, I
was probably typing about 30 words per minute, and now I'm typing 55 to 60
words per minute because the computer is so much easier to access.
Technology has revolutionized Yeager's everyday life, enabling her to
advance in her career and produce a weekly cable television show on disabled
issues. But Yeager was one of the lucky ones: She was able to find a product
that met her needs.
Making the match between the disabled consumer and a liberating innovation
has proved an elusive goal for both inventors and those who would benefit from
their work. Most inventors have trouble finding venture capital, but those with
ideas aimed primarily at the disabled have an especially hard time getting
support.
People who design and market products for those with sensory and mobility
impairments say that aside from adaptations of military research and
applications developed by major computer companies, most innovations are the
work of cottage industries financed by scarce government grants or out of the
developer's own pocket.
"In general, they feel like our market is too narrow and too
small," said Rick Plescia, vice president of HumanWare, a firm in Loomis
(Placer County) that develops and manufactures products for people with visual
and learning disabilities. "Venture capitalists are looking for ways to
maximize profits, and this is not the way to do it."
Plenty of ideas, no money
There are lots of ideas that could enhance the independence and employability
of disabled Americans - if only the capital could be found to launch the
product. A recent design competition at the Exploratorium in San Francisco
showcased a number of imaginative computer applications to extend the range of
freedom for disabled people:
- The TongueTouch Keypad, a dental retainer fitted with nine sensors that
puts a range of computer programs at the tip of a paraplegic's tongue.
- The Unicorn Smart Keyboard, a computer keyboard that has a membrane
touchpad like the control on a microwave oven, instead of raised key. The size
of the touchpad units is flexible to suit people who type with their chins or
fists or head-pointers.
- Multiactive, a portable visual aid that magnifies, clarifies and brightens
standard-sized text for visually impaired readers.
Despite the usefulness of these products, designers say they are
hard-pressed to find the resources needed to reach a wide market.
"Business people shy away from me," said Gordon Fuller, who
modified military cockpit technology to create Multiactive. "When they see
my product and hear the word 'disabled,' they think 'charity.' "
Third world wheelchairs
That story is a familiar one for engineer Ralf Hotchkiss, who began looking for
money to develop wheelchairs for Third World countries 20 years ago. The
investors he approached were cordial but cool to his ideas.
Things have not changed much today, even though Hotchkiss' contributions
have been recognized by the prestigious MacArthur Foundation. In 1989, the
foundation awarded him a $260,000 "genius" fellowship for a program
he runs at San Francisco State University that trains engineers to product
inexpensive, sturdy wheelchairs from materials readily found in poor countries.
"There's more interest, but still not enough action,'' Hotchkiss said,
noting that most of this work has been financed by foreign nonprofit
corporations.
Part of the problem with marketing products for the disabled is that no one
knows for sure how big the market is.
Even the people who collect the data admit that they are not always sure
what degree of impairment constitutes a disability. Some counts of the disabled
include people with learning disabilities, alcoholics and the mentally ill.
Others define disability based on job-related injuries.
Defining the disabled
According to the most comprehensive data available - a 1989 survey by the
National Center for Health Statistics - 34,218,000 people identified themselves
as having "a degree of activity limitation" because of injury or
chronic illness. But that does not include people who are institutionalized for
physical or mental disability.
One problem is that mainstream companies do not know how to approach
disabled consumers, said Deborah Kaplan, director of technology policy for the
World Institute on Disability, based in Oakland. She conducted a workshop for
Pacific Bell on marketing telecommunications accommodations for people with
hearing and speech impairments.
"The burning question was, 'Is it OK to market to disabled
people?'" she said. "They wanted to know, 'Maybe people would
perceive that as being tacky - is that exploitative?'"
Kaplan and others say industries are missing a huge opportunity for profits.
"This is an invisible market," she said. "A lot of people don't
regard the disabled as people who have money to spend."
Putting teeth in the law
That may change when a new federal law, the Americans with Disabilities Act,
takes effect in July.
"The Americans with Disabilities Act has real teeth," said Carl
Brown, director of the California Community College system's High Tech Training
Center, which teaches disabled students to use technology that helps them in
regular classes.
Brown pointed out that the law, which bans discrimination on the basis of
disability, will require businesses to provide work stations that can be used
by disabled workers. If a business with 50 or more workers employs any disabled
people, it must provide a phone, computer or other office equipment that will
enable them to work.
Brown said some computer companies already provide features in standard
software to accommodate disabled users, such as large-print screens .
Options like the large-print screen, which is used by millions of office
workers who would hardly consider themselves disabled, are seen as a key to
offering disabled technology to wider markets. The speaker phone, for example -
a device in homes and offices everywhere - was originally developed for the
disabled.
Everybody loves curb cuts
His approach is called "curb cut philosophy," after the spaces cut in
curbs for wheelchairs. "Everybody loves a curb cut," said Arjan
Khalsa, whose company designed the Unicorn keyboard, which has applications for
general use as well. "The mom with a stroller, the UPS man with a
handcart, the kid on a skateboard."
Yeager thinks that technology can have a profound effect. "There are a
lot of disabled people collecting public assistance who could be employable
with a few technical modifications, " she said.
Evaluating products for technology
transfer potential
Maurice le Blanc
Gayle Curtis
The process leading to commercialization of a device can require a
substantial commitment of manpower and resources. Contacts with potential
manufacturers must be developed and maintained; advanced prototypes and
enhancements of the project are needed for demonstration; supporting documents
and promotional materials must be developed and produced; and patentability
must be investigated.
As the number of device design and development projects at the R&D
Center continues to grow, they come in competition with each other for the
resources needed to support their technology transfer. In response we are
exploring ways to evaluate the potential of various projects for successful
commercialization or dissemination.
Developing an assessment process
In 1991 Elizabeth Batson, a technology transfer advisor, was consulted to
review our assessment process and develop a systematic way to evaluate
projects. The result is a worksheet that examines factors in each project which
would affect its commercial feasibility.
The worksheet poses questions about the value of the product in the
following areas:
- Value to licensee
- potential market size
- risks involved
- competitive advantage offered.
- Value to user or purchaser
- importance of need
- satisfaction of need
- alternatives to the product
- Value to the funding agency (VA)
- concurrence with mission
- champion inside the Center
- champion outside the Center
One person completes the worksheets for a given set of potential products by
interviewing each investigator and conducting preliminary market research as
needed. This evaluator then meets with the Tech Transfer group to review the
assessments. The team can then set its priorities and allocate resources to
support the transfer of the project according to the project's perceived
potential.
First responses show value of the process
Worksheets on six current projects have just been completed. This first round
of assessments has provided valuable feedback about the evaluation process, as
well as giving a common reference for discussion about specific projects.
Factors of the project which scored low in the assessment process can now be
seen as targets for improvement.
For example, the value to licensee might be rated low because of small
potential market size. This can provide impetus to the investigator to find
wider applications for an inventive technology. (See the article on the
constant-force traction unit in this edition of OnCenter for an example of this
market widening strategy.)
In the next issue of OnCenter we will report in more detail on our
experience with this evaluation process.
Tech Transfer Briefs
RR&D at Technology 2001
On December 3-5, 1991, the RR&D Center presented an exhibit at the
Technology 2001 Conference and Exposition at the San Jose Convention Center.
The event promoted products, processes, and technology that are available for
license or sale by the various exhibitors. Approximately 3300 people attended,
visiting the 240 exhibits of government R&D centers, universities, and
high-tech firms. The Center demonstrated Dexter II (the fingerspelling hand)
and SIMM (software for interactive musculoskeletal modeling) and highlighted
other Center projects on videotape. These projects are considered strong
candidates for commercialization.
Fingerspelling hands for Gallaudet University
Gallaudet University in Washington DC, has contracted to have two
fingerspelling hands built and delivered for testing. With funding from NIDRR
(National Institute of Disability and Rehabilitation Research), RR&D Center
staff will fabricate two enhanced mechanical fingerspelling hands. These
devices provide receptive communication for people who are deaf and blind, as
reported in the June 1989 Issue of OnCenter. Researchers at A.I. duPont in
Wilmington, Delaware will contribute hand motion data, and a team of
investigators at Gallaudet University will put the resultant devices through a
series of user evaluations.
For more information on any of these articles contact the author or Al Sacks
at 650/493-5000 ext 6-4475.
Issue No. 4 - June, 1992