Low-Profile Dynamic Wrist Orthosis Device for Pediatric Patients with Wrist Motor Impairment; An Actor-Network Approach for Reducing Abandonment of Prescribed Assistive Technology

Despite the growing achievements in the field of medicine the global population still suffers from disabilities, which can arise from congenital or acquired conditions, or can simply develop during aging. The technical research aimed to improve an existing low-profile and dynamic wrist orthosis, a product of a previous capstone, created for pediatric patients with motor impairments. If not for creators revisiting existing designs, patients run the risk of receiving and potentially discarding inappropriate assistive devices. Alongside poor device functioning, many other reasons exist that cause patients to choose to abandon prescribed technology. The Science, Technology, and Society (STS) research proposes elements suitable for insertion into the provision system created between a healthcare provider and a patient for reducing the rate of prescribed assistive technology abandonment. The technical report and research paper are loosely connected; the technical project is based strictly on design of an assistive technology, whereas the research considered the process of prescribed devices getting to and remaining in the hands of the user.

As a beginning to the crucial process of device monitoring and design iteration, the technical work required experts and designers to first identify shortcomings of the existing prototype. Next, design criteria were developed following clinical observations and meetings with occupational therapists. To approach improving upon the existing design, the team followed three different prototyping design paths by incorporating springs, rods, or semi-rigid materials. The final thermoplastic prototype underwent mechanical testing to produce quantitative results vital to the identified problem. Additionally, participants without motor impairments wore and rated the physical prototypes and occupational therapists in the University of Virginia Health System were asked to rank each design with respect to the aforementioned criteria.

Though the process of brazing coil springs failed, progress was made with piano wire and thermoplastics, which represent the rod and semi-rigid designs, respectively. The thermoplastic prototype mechanically failed with forces representative of the weight of a 14-year-old’s hand. Further, users believed that the piano wire and thermoplastic prototypes fared better than the existing design. Occupational therapists rated the thermoplastic model the highest in comparison to the existing and created designs. The final Pugh chart scores indicated a need in the field of assistive technology for an improved device for these patients and that the team made progress in approaching that ideal. Future steps beneficial to this work would include organizing a clinical trial to incorporate patient feedback for design iterations.

The STS research aimed to find solutions for reducing the abandonment of prescribed assistive technology and the associated negative consequences. Seven individual aspects from a global call for assistive technology provision standards were implemented into the patient-device system to address the problem of device disuse: reduced production costs, device programs, product monitoring systems, updated information systems, existing provision models, the physician and provider network, and flexible roles. The basic patient-device network was developed using the Actor Network Theory and reasons for abandonment stemmed from varied surveys. Possible solutions were identified from a World Health Organization position paper arising from a 2017 Global Research, Innovation, and Education in Assistive Technology Summit. Each item was assessed for introduction into the established network and, if it could be proven to benefit the system, was added into the network, which was simplified using Pacey’s Triangle.

The topic of device satisfaction is heavily concerned with the idea that patient-device matching is critical. Though the original position paper was specifically created to address global device accessibility many of the principles held promise for the context of abandonment by improving the patient-device matching process and its outcomes. Together, the proposed solutions provide a viable option for increasing device retainment by continuously assuring the patient receives a suitable product. Elements believed to be most promising include device programs, lowered manufacturing costs, and professionals’ flexible roles.

The approach for any assistive product design process should be focused on meeting the direct needs of intended patients. With future users in mind, it is much more possible to increase the chances that such patients will want to use the device to reap its benefits. It is therefore the responsibility of all researchers, designers, manufacturers, and health professionals involved to play a substantial role in delivering the best possible assistive device.

School of Engineering and Applied Science

Bachelor of Science in Biomedical Engineering

Technical Advisor: William Guilford

STS Advisor: Catherine Baritaud

Technical Team Members: Sophia Martinese, Madisan Yates