Prototype A Features:  Suction cup attachment that was placed on wall  Wet wipes fastened on back with Velcro Advantages:  Wet wipes easily pulled off and disposed of  Easy push on, pull off setup  Compact design Disadvantages: Figure 2: Prototype A.  Awkward wiping motion  High risk of suction cup failure with high downward force  Attached far away from toilet  Must be preloaded by someone other than the client  Coarse wiping surface Prototype B Features:  Attached to front lip of toilet  Made almost entirely from soft plastic (polyethylene)  Foam base for wiping contact  Finger holes for securing wet wipes in place  Foam coating to prevent scratching Advantages:  Wipes are self-loaded and easy to pull off Figure 3a: Side view of Prototype B.  Convenient mounting location  Client can easily attach and detach device  Closed-cell foam used to prevent bacterial growth  All materials are easily cleanable Disadvantages:  Somewhat bulky  Arm of device flexes too much  Does not fit every toilet  Finger tabs are too stiff for the client Figure 3b: Top view of Prototype B. Prototype C Features:  Rubber finger tabs  Smaller, sleeker design Advantages:  Portability  Shaped to fit almost any toilet Disadvantages:  Lacks a polished look Figure 4: Prototype C.  Still flexes a little too much at the arm  Crevices and gaps between separate components allow for dirt and bacteria buildup Final Product Features:  Plastic part of device composed of one solid piece  Thickness of plastic varied throughout device Advantages:  Easier to clean  Sleek look  Very stiff arm to minimize bending  Will have foam coating around clamping part for a tighter fit Figure 5: Final product. Disadvantages:  Can work for almost any toilet, but does not always have an ideal fit  Cost: $822 (for plastic base) Rehabilitation Engineering: Autonomous Toileting Assistive Device BME 273: Andrew W. Carroll, Nina M. Connell, Kristin P. Duncan, Jennifer M. Young Department of Biomedical Engineering, Vanderbilt University, Nashville TN USA Our client is an eight year-old male with severe upper arm deformities including fixed flexion contractures at both elbows of over 130 degrees. His right hand has one finger with no grasping capabilities while his left hand has two fingers with minimal grasping abilities. Figure 1: Client’s anatomical deformities. Client currently requires an assistant to help him wipe after bowel movements. In order to help the client become more independent, we have designed and built an assistive device which aids in sanitation after bowel movement. Goals The purpose of this project is to design an effective wiping device which allows our client to be fully independent in his everyday life. Through an iterative technology approach to design, we have resolved to create a safe, portable, and pragmatic solution for our client’s needs. Meet client’s specifications including: Portable Compact Independent set-up and loading Sanitary and easily cleaned Natural wiping technique Durable After following an iterative design process, we have developed a final prototype that meets the goals and specifications provided by the client. The device allows the client to wipe and sanitize himself following a bowel movement in a natural way without the assistance of anyone else. We believe this device will further add independence to our client's life, thus providing greater quality of life. Dr. King and Vanderbilt University Department of Biomedical Engineering Mark Richter of Max Mobility Aaron Fitzsimmons, CP, OT Tina Fitzsimmons, OT with Nashville Metro School District Assistive Technology In the United States, there are 1,285,000 people living with limb loss in The birth prevalence of congenital limb deficiency in 1996 was per 100,000 live births. Previous work has been conducted by Vanderbilt ES 101 students and by a private assistive technology company. Little progress was made in forming a solution. Current solutions for similar patients include portable bidets and private assistants. Neither coincides with the capabilities and desired independence of our client. Bidets are too difficult for the client to carry and setup due to his minimal grasping capabilities. We have presented additional suggestions on assisting the client, such as getting on a bowel schedule. This would allow the client to minimize restroom usage during school hours. An iterative approach was used in making several prototypes. Each prototype was built and then evaluated by the client, the advisor, and the research group. Through continuous communication with the client and through hands-on research, a final prototype was developed. An initial meeting was held with the client, his family, a prosthetist, our advisor, and an occupational therapist in order to obtain clear specifications on the client’s needs and wishes. Prototype A was constructed using household materials such as Velcro, tape, a sponge scrubber, and a suction cup. Upon completion of the prototype, a meeting with the client and the advisor helped with design modifications. Prototype B and Prototype C were both constructed in a prosthetic workshop and molded to a toilet in order to ensure a custom fit. A mold of the client’s toilet was made to insure that the device would work properly for the client while at home. The prototype was then given to the client for approximately 10 days; he tested the device and gave us feedback and tips. IntroductionPrototypesMethods Background Prototypes bases were first formed of 3/16" copolymer plastic, but a decision was made to switch to 1/8" polypropylene, which is much stiffer but also exhibits a small amount of elastic deformation (for improved clamping and holding capabilities). 1/8” ethyl vinyl acetate (EVA) foam will be used for the lining around the toilet clamp. This foam is easy to clean and thus provides superior hygiene. The wiping wedge of the device was formed from layers of bacteria-resistant closed cell P-cell plastazote. The final product is manufactured of ABS plastic and made using Fused Deposition Modeling (FDM). Materials should be cleaned using ½ water and ½ alcohol so as to not degrade the foam. This will reduce bacterial contamination and ensure the longevity of the device as a whole. Materials Discussion The final prototype is a successful device which our client is able to install, load, use, and remove independently. It mimics the natural wiping technique used by most people and is compact enough to be discretely carried in public and at school, thus minimizing the social issues surrounding our client's condition. The client and the client's family are pleased with the solution we have developed. The sanitary concerns have been reduced as much as possible by the materials chosen for the device as well as the type of wipe loaded and used with the device. Risk Reduction There are several safety issues that cannot be completely eliminated due the nature of what the device is used for. Like any device that is used in toileting, the inability to keep the device sterile is an ongoing challenge. We chose to make the device out of plastics that could be easily cleaned with disinfectants daily, except for removable pieces which can be thrown out and replaced if they become contaminated or after several uses. As a portable device which is placed on the toilet and is not permanently attached to the toilet, there are safety issues concerning movement of the device while in use as well as mechanical failure. As the client or user places force on the device, there is a possibility that this force and torque can dislodge the device or even cause it to break. We have taken these safety issues into consideration in our design to the best of our ability. Implications for Others and Future Direction While few individuals possess the exact deformities as our client, there are a significant number of individuals who have the same limited range of motion, strength, and thus dependence. This assistive toileting device could serve as an option for someone with not enough motion or angle range to wipe themselves following a bowel movement but enough strength, grasping ability, flexibility and range of motion to 'install' the device before each use, as well as load with the wipes. Individuals missing upper extremities entirely or without any digits would most likely be unable to use this device. Future work on this design would include a better solution for fitting the device to different size and shape toilets. Also, further inspection of options for materials to construct different portions of the device might allow for a more sanitary design and practical use. Additional work on the design might include a version with an easy open and close hinge to make the device more compact. We chose not to try this due to our clients limited strength, especially his decreased grasping abilities. We would like to identify other groups of users to which we can market our device. Conclusion Acknowledgements