Portfolio Miriam Zisook

2 College St. #2261 I Providence, RI 02903 (847) 828-6710 I mzisook@g.risd.edu

As an intern at the University of Pittsburgh Department of Rehabilitation Science and Technology and VA Pittsburgh Medical System I designed a splint for PIP Contracture, a common and difficult to treat hand problem. The VA has filed a patent for this splint, for which I am co-inventor. The project was a collaboration between the Human Engineering Research Lab and the Department of Veterans Affairs Competitive Pilot Project Fund.

Introduction PIP Splint

Distal Phalanx Middle Phalanx Proximal Phalanx
Dorsal Side

Contractures are usually treated by surgery followed by splinting. Splinting is rarely effective because the splints available have major functional problems.

Ventral Side

Healthy PIP Joint

Contracted PIP

My job was to explore the shortcomings of current treatments and design a splint that would improve the outcomes for patients by: 1. 2. 3. 4. 5. 6. The Proximal Interphalangeal (PIP) Joint is the second knuckle on each digit. Shortening of the flexor tendons can be caused by many conditions and eventually lead to contracture. Contractures can cause pain, functional limitation and problems with hygeine. researching current methods developing design criteria based on research generating concepts presenting in design reviews with surgeon and therapists creating prototypes developing procedure for fabrication

2009

Research Methods PIP Splint
Method Results Literature search I read scholarly research papers and books on surgery and splinting. Scholarly work primarily concerned with straightening the finger, not usability or patient comfort. Emphasize problems with patient adherence. Available splints are high profile, have few options for fit and are not easily customizable.Outdated use of materials. No flexible plastics or fabrics presented.

Market review

Gutter Splint Dificult to fit, rolls, puts pressure on specific points Patient Interview

Oval 8 Splint low profile, but puts high pressure on small areas

Bunnell Splint Does not apply enough force

R. Knuckle Bender so bulky it causes functional limitations

I had many conversations and interviews with patients in the occupational therapy and surgery clinics.

Patients admit to not wearing their splints, complaining of improper fit, pain and discomfort, difficulty donning, and embarrassment.

Observation of clinic/ Experiential Research

Clinicians admit do not straighten well because of material limitations, improper fit, and lack of patient adherence. I found making custom splints challenging and time consuming and available splints uncomfortable.

Design Criteria PIP Splint
Problems discovered in research 1. Flexible Material combined w/ effective extension moment Straightening 2. Low profile, not interfere with activities of daily living Adherence 3. Comfortable, held in place by circumferential tension Adherence, Comfort 4. Form fitting for variety of finger sizes and still easy to don Adherence, Fit 5. Pressure diffused over the whole finger Adherence,Comfort 6. Permit visual monitoring of skin health and circulation Adherence, Comfort

Adherence If the splint is uncomfortable or difficult to put on then it will not be worn

Comfort/ Health Splints cause pain and discomfort because pressure is uneven

Fit Custom splints are difficult to fabricate and off the shelf splints are difficult to fit

Straightening Splint needs to apply enough corrective force to straighten the contracture

Based on the design criteria I developed a series of sketches and models to test the concepts. The flexible material was used to secure the splint and distribute the force of the rigid stay. I considered different ways to put the stay on and adjust the size and straightening force.

Initial Exploration PIP Splint

Adjust width by placing the stay in different pockets.

Use tensioned bands instead of stay to relieve pressure

Concept Development PIP Splint
Using a series of models and sketches I explored possible arrangements of the stays and explored different materials and ways of making the prototypes. Biradial stays allow flexing between them and permit the material to hammock. Multiple radial cavities worked very well but made the device difficult to put on. Using 4 radial cavities was very effective at stabilizing the joint. At the discretion of the doctor the stays can be adjusted and customized and reinserted into the cavities after the sleeve is donned.

Cast urethane rubber was the chosen material. In order to go through iterations quickly and accurately I used SolidWorks to create molds to pour the rubber into.

Prototype Process PIP Splint

Make positive model of splint in CAD

Create mold cavities and add air holes, reference pins, and a funnel for the liquid

Build the molds in the Stereolighography (SLA) rapid prototyper

Several Iterations to establish the best ways to design the mold features

Pour rubber

Prototypes of sleeves

Final Design Review PIP Splint

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Future Work

It may be possible to replace the stays with a thicker/ stiffer band of material over the dorsal side of the joint. It would be much easier to put the splint on if it were lined with a material that did not stick such as fabric.

Introduction Inclusion Chair
Problem A special education school district provided a grant to design a chair for Garrett, an eight-year-old with a physical and cognitive disability. The seat enables him to sit at the cafeteria lunch table with his peers. I worked with Garrett’s therapy and education team to develop the chair and test prototypes with the goal that it be universal enough to work for many children with diverse needs.

Garrett Enjoys being with his friends but has physical needs that require special seating

Cafeteria tables Nowhere for Garrett to sit in his wheelchair

Before Garrett currently uses these chairs for diffferent tasks but none have the correct amount of support for his body or can be used at the cafeteria table

After Garrett can sit independently in the cafeteria at lunchtime and in the community

2009

Research Methods Inclusion Chair
The overarching research problems were: 1. How can I ask Garrett what he wants, when Garrett does not use words to say what he wants? 2. How can research challenge existing perceptions of what is right? To learn how to tell if Garrett was comfortable I explored Garrett’s behavior in other settings, and I interviewed his family, therapists, teachers and peers.

To change his therapists perspectives on his sensory needs I researched methods for therapy in other areas, especially sensory integration disorders

To open my mind to new approaches and aesthetic styles I looked for inspiration in seemingly disparate areas of design

From video of Garrett using many different available alternatives I learned that his body is rarely calm enough for him to sit safely without his feet, lap and upper body secure. Initially, it was very important to his therapists not to secure his upper body. Opening their minds took creative approaches to research..

I also did a morphological ordering of existing products, observed other students, interviewed people with less experience with special needs about their prejudices, and researched children’s products and trends.

This chart explains how I developed design criteria based on research results. It was used as an organizational tool by the whole teamProblem I Tous to move forward his peers at lunchtime so he can work towards speech, social and occupational goals in an included setting Summary I Garrett’s Chair Overall and enabled include Garret with through disagreements with a unified set of goals. Overall Solution I Supplemental seating which helps Garrett meet his goals at the cafeteria table with his peers Miriam Zisook

Overview Chart Inclusion Chair
Usability Transporting Chair I Make it lightweight with a handle
Trial 1 I weight is a barrier I aid will have hands full

Safety

Social

Feeding & Communication

Postural/ Sensory

Universality& Growth

Independence I Use enough physical/ sensory support to protect Garrett’s independence and social space
Observation I Lunch is an indepenObservation I When Garrett is more secure/ supported he is given dent time for Garrett’s peers I A rare opportunity for Garrett to have more space/ independence space from adults

Size I Adjustable booster & supports, padding inserts
Morph. ord. I Garrett will grow over time I kids are all different sizes and proportions

Movement I Use sensory reinforcers for correct posture (neoprene wrap, tactile surfaces, limits he can feel without moving) to minimize movement & encourage Garrett to control his own posture with the addition of rigid supports/ belts for safety
Feet I Observation, Research I Sensory reward for placement I Task persistence increases when footrest present Trunk front to back I Observation, Trial 2 I secure limits I sensory Position at Table I Use adjustable booster and bench attachment to keep Garrett in the mid- input helps reduce body movement dle of his peers at the appropriate height and distance from table for self feeding and create body awareness Trial I proximity to aid means Gar- Observation I Garrett should be in Observation, Research, Trial 1,2, Trunk side to side I Observation, morph. ord. I establish height and research, Trial 1,2,Morph. ord. I rett must be secure enough for aid middle of action distance from table approproate to be across table I protect peers’ secure limits I sensory input helps for feeding I aid will be across the reduce body movement and create personal space table body awareness Head I Observation, Morph ord.I Aesthetic I Use kid friendly bangs head I padding I sensory form, color and materials reward for posture Connection to bench I Use HipsI Observation, Morph ord.I Image boardsI Kid specific form strong clamp crotch strap, secure sides, pitch language uses bright colors, curves Trial 1I strength, security prioriback seat to stop sliding forward or simple geometric shapes, limtiesI users feel more secure with ited exposed hardware, characters metal clamp than less conventional and animals, abstractions of famil- Focus on Goals I chair should Posture I Adjustable support for feet, head, hips & trunk approaches I safe at different iar forms I Stay away from medical, optimize lunchtime goals Feet I Observation, Research, benches industrial, military references Observation, Trial 2 I Garrett is better able to focus on tasks one Morph. ord. I feet should be square, centered, secure at a time I giving postural support increasesfocus on cognitive, Trunk front to back I Research, Cleanliness I Removable, speech and motor skills I sensory Morph. ord. I contoured back or washable cover integration aids increase Garrett’s lat. grid supports promote midline Observation I Garrett is a messy focus I Primary goals at lunch are alignment eater I spills, smell will alienate Head I Research, Morph ord.I social skills and self- feeding peers contoured headrests common Hips I Research, Morph ord.I square, flat, secure Observation, Trial 1 I Garrett may tip bench if he has a large range of forward to back trunk motion I Movement increases risk of injury with utensils Observation, Research I Garrett’s movement may invade peers’ personal space I movement may alienate peers Observation, Trial 1, Research I Garrett uses body movement to communicate I Needs some movement to self feed

Transferring I Sides flexible to get G in & out easier
Trial 1, 2, observation I bench fixed unless Garrett is first in last out, unlikely to happen regularly I have to transfer him from the side or back I with rigid sides it is difficult to get him in or out from the side

Support I Modular feet, head, hips & trunk support
Research, Morph. ord. I Garret’s needs change daily& over time I different kids will need different amounts and types of support I no continuum exists from more support to less, always different combinations

Connection to bench I Quick threads w/ groove to slide
Oservation, Trial 1I table & hardware are barriers I has to be easy to place and secure

Cleanliness I Removable, washable cover
Observation I Easy cleaning is necessary

Initial Thoughts Inclusion Chair

Because Garrett’s needs for support varied widely from trial to trial, it was necessary for all elements to adjustable and modular. The prototypes themselves became tools to research Garrett’s needs further.

Studies Inclusion Chair
Small scale sketch models helped find ways to simplify the mechanisms. I chose to unify the booster for height with a mechanism for sliding forward because we observed that Garrett couldn’t reach the table.

Here the chair would consist of panels with slots that could be put together like a puzzle to fit each child. It would be collapsible for transportation

During research I observed that Garrett moves his body less when he has sensory stimulation around his trunk. I experimented with a flexible wrap instead of rigid sides to offer him sensory input and calm his body movement. In this concept the seat, trunk support and foot rest would slide up and down along a frame while the trunk support and armrest rotate to tighten and to allow access from the side

Initial Prototype Inclusion Chair
Concept Based on my research and studies I built the chair with a flexible chest support and hip support which would give Garrett sensory input and reassurance of his boundaries without using the traditional hard supports found in other products.

Trial When Garrett tested the chair he did not extend and throw himself forward as much as in his current chair and he was able to feed himself.

Final Prototype Inclusion Chair

Functions Inclusion Chair
Seat Position Seat moves up and down along frame when buckle is tightened to adjust booster height | Chair slides forward and back to bring child closer to table

Trunk Support There are two sets of chest supports that can be adjusted for width and height. One is rigid and stuck at 90 degrees to maintain posture. The other is flexible and is secured with a velcro wrap for better upper body security and sensory input. Both can be adjusted for height and width.

Functions Inclusion Chair
Additional Adjustments The seatbelt is passed through a clip on the side of the seat to squeeze the seat snug around the hips | Pelvic Support from a crotch strap | footrest height adjustable | Seat depth can be adjusted by adding padding | Washable cover is removable

In the community Garrett will be able to enjoy more experiences with his friends and family in a chair that is colorful, friendly and playful in appearance

Garrett Inclusion Chair

Since Garrett began using this chair he has grown socially. Through the research and trials Garrett’s therapy program has been reinvented to include sensory considerations. Another child has also begun to use the chair.

Process I observed the use of a watering can and identified difficulties with weight bearing and pouring from the wrist and balance I developed and tested sketch models and prototypes. These sketches are examples from my exploration of how a watericang can could be reinvented to alleviate these problems for universal use.

Initial Concepts Watering Can
1. Watering sling. Carry weight with whole body. Use nozzle to pour. Difficult to don and doff. 2. Reverse spout allows user raise whole arm to pour instead of bending wrist.

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3. Alleviate problems of weight bearing by placing on the ground on wheels. No need to bend down or bend wrist to pour. 4. Angle nozzle to the side to create a second handle to distribute weight and help with balance.

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2008

Balance Exploration Watering Can
Concept By making the watering can shallower and broader it would require less tilt in the wrist to pour from it which would alleviate the increased strain of bearing weight with a bent wrist.

Observations Water splashed around easily and it was awkward to carry. It was also difficult to maintain balance because weight bearing was on one side of the body.

Unfolding Exploration Watering Can
Concept Separate the weight bearing and pouring demands by either pivoting the basin or lowering the spout without changing the position of the weight bearing hand.

Result It was very comfortable to use but required a mechanism to prevent the spout from “deploying” accidentally. Not the most simple or elegant solution. Also posed a risk that that mechanism could be difficult to use, especially for someone with limited dexterity.

Selected Concept, Basin Watering Can

Concept Inspired by a statue of a goddess pouring a basin of water, the watering basin is evocative of an offering. It helps the user connect with their garden, and enables the user to center the weight at their core.

Nightlight This light for a child’s room can be manufactured with one die and sold in a flat envelope to consumers for creative assembly. It fits a “Grundton” table lamp from IKEA. The user can control the brightness for day or night by peeling away layers to release more light.

Paper Lampshade Nursery Nightlight

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2008

Problem Hand Sanitizer For Hospital Use
Every year 2 million patients get preventable antibiotic resistant infections in the hospital and 90 thousand die as a result.

“Doctors and nurses wash their hands one-third to one-half as often as they are supposed to. Even if you get the whole process down to a minute per patient, that’s still a third of staff time spent just washing hands. With alcohol finally in wide use the compliance rates for proper hand hygeine improved substantially, from 40% to 70%. But the hospital infection rates did not drop one iota. Our 70% compliance just wasn’t good enough.” -Dr. Atul Gawande Author of Better: A Surgeon’s Notes on Performance

Dr. Gawande’s Barriers I Design Opportunities Convenience I Device must be portable, wearable, fast, used with one hand

Memory I Device must be bold, prominent, not hidden in pocket

Aesthetic I Device must be patient-friendly, fit into hospital setting

Accountability I How much gel the doctor has used must be visible

2007

Concepts Hand Sanitizer For Hospital Use

Form study and idea generating based on 4 design criteria. Focused on forcing the user to wear the device in a certain way to create a standard and encourage mindfulness. Each features a way to view how full it is and can be used with one hand. From left: Wristband, clip to pager, wear on stethoscope, armband.

After conducting interviews with design and medical students determined flexibility is use would be better for compliance. Additional ideas to develop aesthetic, mechanism of use and ease of use.

Product Hand Sanitizer For Hospital Use
Final Design Hand sanitizer can clip to clothing, charts, stethoscope, etc. but is not easy to use from a pocket, keeping it always in sight. It has a playful shape the user won’t mind showing. It can be used easily with one hand by cupping hand over object and squeezing the gel into the palm. Additionally, the dispenser is clear so the user is accountable for how much hand sanitizer they have used. A full gel packet at the end of a day means sick patients.

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