A medical hand tool physical interaction evaluation approach for prototype testing using patient care simulators

TouchMark: Partial Tactile Feedback Design for Upper Limb Rehabilitation in Virtual Reality

The use of Virtual Reality (VR) technology, especially in medical rehabilitation, has expanded to include tactile cues along with visual stimuli. For patients with upper limb hemiplegia, tangible handles with haptic stimuli could improve their ability to perform daily activities. Traditional VR controllers are unsuitable for patient rehabilitation in VR, necessitating the design of specialized tangible handles with integrated tracking devices. Besides, matching tactile stimulation with corresponding virtual visuals could strengthen users' embodiment (i.e., owning and controlling virtual bodies) in VR, which is crucial for patients' training with virtual hands. Haptic stimuli have been shown to amplify the embodiment in VR, whereas the effect of partial tactile stimulation from tangible handles on embodiment remains to be clarified. This research, including three experiments, aims to investigate how partial tactile feedback of tangible handles impacts users' embodiment, and we proposed a design concept called TouchMark for partial tactile stimuli that could help users quickly connect the physical and virtual worlds. To evaluate users' tactile and comfort perceptions when grasping tangible handles in a non-VR setting, various handles with three partial tactile factors were manipulated in Study 1. In Study 2, we explored the effects of partial feedback using three forms of TouchMark on the embodiment of healthy users in VR, with various tangible handles, while Study 3 focused on similar investigations with patients. These handles were utilized to complete virtual food preparation tasks. The tactile and comfort perceptions of tangible handles and users' embodiment were evaluated in this research using questionnaires and interviews. The results indicate that TouchMark with haptic line and ring forms over no stimulation would significantly enhance users' embodiment, especially for patients. The low-cost and innovative TouchMark approach may assist users, particularly those with limited VR experience, in achieving the embodiment and enhancing their virtual interactive experience.

Methods for Gastrointestinal Endoscopy Quantification: A Focus on Hands and Fingers Kinematics

Gastrointestinal endoscopy is a complex procedure requiring the mastery of several competencies and skills. This procedure is in increasing demand, but there exist important management and ethical issues regarding the training of new endoscopists. Nowadays, this requires the direct involvement of real patients and a high chance of the endoscopists themselves suffering from musculoskeletal conditions. Colonoscopy quantification can be useful for improving these two issues. This paper reviews the literature regarding efforts to quantify gastrointestinal procedures and focuses on the capture of hand and finger kinematics. Current technologies to support the capture of data from hand and finger movements are analyzed and tested, considering smart gloves and vision-based solutions. Manus VR Prime II and Stretch Sense MoCap reveal the main problems with smart gloves related to the adaptation of the gloves to different hand sizes and comfortability. Regarding vision-based solutions, Vero Vicon cameras show the main problem in gastrointestinal procedure scenarios: occlusion. In both cases, calibration and data interoperability are also key issues that limit possible applications. In conclusion, new advances are needed to quantify hand and finger kinematics in an appropriate way to support further developments.

Biomechanical risk factors associated with distal upper extremity musculoskeletal disorders in endoscopists performing colonoscopy

BACKGROUND AND AIMS

Endoscopists experience upper extremity musculoskeletal injuries. The primary aim of this study was to compare distal upper extremity biomechanical risk factors during colonoscopy with established risk thresholds. Secondary aims were to determine which subtasks during colonoscopy are associated with the greatest risk and to evaluate an intervention to reduce risks.

METHODS

Twelve endoscopists performed 2 to 4 colonoscopies while thumb pinch force and forearm muscle loads of extensor carpi radialis (ECR) and flexor digitorum superficialis (FDS) muscles were collected. Peak exertion values were analyzed using amplitude probability distribution functions. An endoscope support device was evaluated during simulated colonoscopy (n = 8).

RESULTS

Mean endoscopist age was 42.3 years; 67% were men. Peak thumb pinch force exceeded risk thresholds for pinch force (10 N) and percent of time spent in forceful pinch for all colonoscopy subtasks. Peak ECR and FDS muscle activity exceeded the action limit (10% maximum voluntary contraction [MVC]) in both forearms. Peak left FDS, left ECR, and right ECR activity exceeded the threshold limit value (>30% MVC). Peak left FDS and ECR activity were significantly greater during insertion than during withdrawal (P < .05). Peak right FDS and ECR activity were significantly greater during right colon insertion compared with withdrawal (P < .05). The endoscope support device reduced left ECR muscle activity (P = .02).

CONCLUSIONS

Thumb pinch forces and time spent in forceful pinch indicate high-risk exposures during colonoscopy. Left wrist extensor muscle activity exceeded established thresholds with the greatest risk occurring during insertion. An endoscope support device reduced loads to the left wrist extensors.

Hand-Product Contact Point Detection on Surgical Instruments – A User Evaluation

The interaction of hand tools with the user is crucial and a key factor for his or her performance. In specific medical devices like surgical instruments, it is also important to ensure patient safety, namely, to avoid the risk of a surgical instrument’s being left inside a body.

This article investigates the patterns of hand-to-product contact areas by identifying the potential locations to couple an external add-on tracing device on surgical instruments. A user evaluation study was conducted to determine the contact areas between the surgeons’ hands and different surgical instruments. The methodology, the results, and a discussion are described below.

Research on Key Indicators in Modern Surgical Practice Assessment: Ergonomic Approach

It is undeniable that fundamental requirements in surgery refer to the adequate use of medical knowledge (eg, clinical knowledge and technical skills). However, this knowledge and skills of surgeons should be supplemented with synergetic research of capabilities of surgeons, operating rooms (ORs), and nontechnical skills. In this article, by using expert research, we presented 15 key indicators in surgical practice assessment. Communication efficiency in the OR has been ranked as the first and most important among indicators using the fuzzy analytic hierarchy process method. Within the analysis of this indicator, we have shown a new method that provided us with the results describing the extent of communication, the correlation in the communication system, surgeon workload uniformity, and isolation of individual surgeons in the OR. The goal of this research is aimed at the increase of operator efficiency in the OR. It is necessary that results of this kind of research find their practical use and become an obligatory element in the construction of new ORs as well as reconstruction of old ORs.

Qualitative ergonomics/human factors research in health care: Current state and future directions

The objective of this systematic review was to understand the current state of Ergonomics/Human Factors (E/HF) qualitative research in health care and to draw implications for future efforts. This systematic review identified 98 qualitative research papers published between January 2005 and August 2015 in the seven journals endorsed by the International Ergonomics Association with an impact factor over 1.0. The majority of the studies were conducted in hospitals and outpatient clinics, were focused on the work of formal health care professionals, and were classified as cognitive or organizational ergonomics. Interviews, focus groups, and observations were the most prevalent forms of data collection. Triangulation and data archiving were the dominant approaches to ensuring rigor. Few studies employed a formal approach to qualitative inquiry. Significant opportunities remain to enhance the use of qualitative research to advance systems thinking within health care.

Characterization of right wrist posture during simulated colonoscopy: an application of kinematic analysis to the study of endoscopic maneuvers

BACKGROUND

Endoscopic maneuvers are associated with a high incidence of musculoskeletal injuries.

OBJECTIVE

To quantify wrist motion patterns during simulated endoscopic procedures to identify potential causes of endoscopy-related overuse injury.

DESIGN

Twelve endoscopists with different levels of experience were tested on 2 simulated endoscopic procedures that differed in their level of difficulty.

SETTING

Right wrist movement patterns were recorded during simulated colonoscopies by using a magnetic motion-tracking device. Analysis focused on 3 wrist degrees of freedom: abduction/adduction, flexion/extension, and pronation/supination.

INTERVENTIONS

Subjects were tested on 2 GI lower endoscopies (colonoscopies) on a simulator.

MAIN OUTCOME MEASUREMENTS

Time spent within ranges of the entire wrist range of motion for 3 wrist degrees of freedom.

RESULTS

Endoscopists spent up to 30% of the duration of the procedures at the extremes of the wrist joint range of motion. Endoscopic experience did not affect the time spent at the extremes of the wrist joint of motion. The time spent within each range of motion differed depending on the wrist degrees of freedom and difficulty of procedure.

LIMITATIONS

This study examined only 1 upper limb joint in a limited number of subjects and did not measure interaction forces with endoscopic tools.

CONCLUSIONS

We identified wrist movement patterns that can potentially contribute to the occurrence of musculoskeletal injury in endoscopists. This study lays the foundation for future work on establishing links between upper limb movement patterns and the occurrence of overuse injury caused by repetitive performance of endoscopic procedures.