Assistive Technology

The Official Journal of RESNA

ISSN: 1040-0435 (Print) 1949-3614 (Online) Journal homepage: http://www.tandfonline.com/loi/uaty20

Advanced patient transfer assist device with

intuitive interaction control

Heather C Humphreys, Young Mi Choi & Wayne J Book

To cite this article: Heather C Humphreys, Young Mi Choi & Wayne J Book (2017): Advanced
patient transfer assist device with intuitive interaction control, Assistive Technology, DOI:
10.1080/10400435.2017.1396564

To link to this article: http://dx.doi.org/10.1080/10400435.2017.1396564

Accepted author version posted online: 24

Oct 2017.

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Download by: [UNIVERSITY OF ADELAIDE LIBRARIES] Date: 25 October 2017, At: 07:16
 Advanced Patient Transfer Assist Device with Intuitive Interaction
Control
Heather C. Humphreys1, Young Mi Choi2, Wayne J. Book1

1. Georgia Institute of Technology, School of Mechanical Engineering

2. Georgia Institute of Technology, School of Industrial Design

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Corresponding author:
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Young Mi Choi, christina.choi@gatech.edu

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Abstract

This research aims to improve patient transfers by developing a new type of advanced robotic
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assist device. It has multiple actuated degrees of freedom and a powered steerable base, to

maximize maneuverability around obstacles. An intuitive interface and control strategy allows
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the caregiver to simply push on the machine in the direction of desired patient motion. The

control integrates measurements of both force and proximity to mitigate any potential large
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collision forces and provides operators information about obstacles with a form of haptic

feedback. Electro-hydraulic pump controlled actuation provides high force density for the
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actuation.
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Nineteen participants performed tests to compare transfer operations (transferring a 250 lb.
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mannequin between a wheelchair, chair, bed and floor) and interaction control of a prototype

device with a commercially available patient lift. The testing included a time study of the transfer

operations and subjective rating of device performance. The results show that operators perform

transfer tasks significantly faster and rate performance higher using the prototype patient transfer

assist device than with a current market patient lift. With further development, features of the

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 new patient lift can help facilitate patient transfers that are safer, easier, and more efficient for

caregivers.

Introduction

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The goal of this paper is to present data on the effectiveness and efficiency of a newly designed patient

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transfer assist device (PTAD) to improve patient transfer tasks (Humphreys, 2016). A new, cost

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effective, hydraulically actuated prototype patient transfer assist device has been developed and

fabricated; hydraulic actuation has advantages in terms of force density over electrical actuators that are

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typically used at this power scale. The PTAD has multiple actuated degrees of freedom, which can

improve maneuverability and reduce forces required from caregivers. Improved methods for control of
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machines that work collaboratively with humans, sharing a task and a workspace, were developed in this

work. It also aims to overcome some of the control challenges with these actuation systems in this type of
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application, such as non-ideal characteristics of the low cost actuation systems and management of a

machine with large force capability operating in a home or clinical environment with humans in its
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workspace.
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Background
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This research is motivated out of the growing concern over caregiver injuries related to patient transfers in

the healthcare industry. According to a recent series on National Public Radio titled "Injured Nurses",
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nurses suffer over 35,000 back and other orthopedic injuries that require missed work each year

(Zwerdling 2015). Studies have shown that even the best manual techniques result in unsafe lower back

loads when performing a variety of manual and machine assisted patient transfers (Marras, Davis et al.

1999; Zhuang, Stobbe et al. 1999). Healthcare workers in hospitals, nursing homes, emergency services,

critical care, operating rooms, orthopedic units and home healthcare environments are all potentially

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 exposed to risks associated with patient lifting (Waters, Collins et al. 2006). There is already a need to

find solutions to the current problem, which is likely to increase in the future. For example, as the US

population of adults aged 65 and over grows from 40 million in 2010 to an estimated 55 million in 2020

(Humphreys and Book 2014).

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Patient Transfer Barriers

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Because of a high incidence of orthopedic injuries to caregivers resulting from manual transfer

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operations, many organizations are implementing safe patient handling (SPH) procedures. This includes

organizations such as the Veterans Health Administration (Petzel 2010) as well as guidelines from the

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Occupational Health and Safety Administration (Chao and Henshaw 2009). Many guidelines restrict

patient lifting without the use of a lift device to reduce the risk of musculoskeletal injuries.
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Implementation of SPH policies in healthcare settings often leads to significant improvements in
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musculoskeletal comfort levels as well as reductions in musculoskeletal injuries (Fadul, Brown et al.

2014). There are a number of factors that can create barriers and influence healthcare workers’ motivation
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to use lifting devices during patient transfer activities. These include knowledge about existing workplace

guidelines, availability of adequate lifting devices (in both functionality and quantity), adequate facilities
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that do not pose barriers (such as too little maneuvering space) to device use, as well as guidance on the
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use of a lifting device in an individual patient’s care protocol (Koppelaar, Knibbe et al. 2013).
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A study by (Krill, Staffileno et al. 2012) found similar barriers. They also highlighted the most physically

demanding tasks and environmental limitations expressed by registered nurse staff in their study. The

most demanding tasks included transferring patients from chair to bed, transferring from cart to bed and

handling obese patients in general. The most cited environmental limitations were the size of rooms,

carpeted areas and lack of help. Having mechanical lifts was also cited as an item that would make their

jobs easier.

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 The provision and availability of lift equipment is clearly an important component in reducing caregiver

injuries. It also requires ergonomic assessment and modification of spaces where transfers take place.

Use of floor lifts requires sufficient space around beds and furniture (Collins et al., 2010; Hignett, 2003;

Fray and Hignett, 2013; Koppelaar et al., 2013; Schoenfisch et al., 2011). Factors such as proper lighting

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must be taken into account (Hingett, Edmonds, etc). The equipment itself must be adequate to the task

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and allow caregivers to execute safe patient transfer tasks while keeping physical loads on themselves

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within safe levels (Hignett 2003; Collins, Wolf et al. 2004; Kurowski, Gore et al. 2012). Depending on

the task involved, equipment may include ceiling lifts (hoists), floor lifts (and the associated lift slings),

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standing lifts, slide sheets, electric beds, transfer boards and handling belts.
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With equipment, environment and policies in place, the reliability of the equipment is important in

reducing injuries in both caregivers and patients. Unreliable equipment will lead operators to lose faith in
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equipment and stop using them (Elnitsky, Lind et al. 2014). Caregivers may become unwilling to use

battery operated equipment if battery charge runs out in the middle of a lift leaving them without the
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ability to complete the task. This can be a problem with ceiling lifts and cause staff to revert to executing

manual lifts. Lack of safety features on equipment can lead to similar issues or injuries to staff or
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patients. Equipment that lacks self-locking features can move and lead to falls if the patient moves during
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a transfer. A caregiver can more easily be injured when trying to help in these situations.
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New Types of Patient Transfer Assist Devices

Current lifts do not address some needs and do not take advantage of newer developments in robotics

technology. While considerable research has investigated ergonomics of patient transfer operations,

only a few published studies involve development of actual patient transfer assist devices. The original

patent by Hoyer describes a lift device very similar to those on the market today, consisting of a U-shaped

base with casters, a vertical post, and a lifting boom actuated by a hydraulic cylinder (Hildemann and

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 Hoyer 1958). In (Jeannis, Grindle et al. 2013) and (Tsai, Jeannis et al. 2014), a new type of patient lift

called the Strong Arm is developed, which mounts to the base of a power wheelchair. It is also controlled

from an operator input force and uses a sling. The device is powered by electric motors and travels with

the patient on the power chair. However, difficulties with this design include significant lifting power

limitations and tipping stability. In (Mukai, Hirano et al. 2010), design of a humanoid-style nursing

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assistant robot is developed, which is intended to perform patient lifting and moving tasks. The robot is

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led by the caregiver through tactile guidance. Patient comfort is an issue with this design. The National

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Institute for Standards and Technology also developed a new type of patient transfer device, which is also

intended for rehabilitation by allowing the patient to walk with part of the body weight supported;

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however, while this device has a wide range of functionality, it is not a convenient transfer aid

(Bostelman, Albus et al. 2007).

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Interaction Safety with Proposed Robotic PTAD
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Improving safety in physical human-machine interaction has been receiving increasing attention. Safety

and management of external interaction forces are critical considerations with the proposed design. The
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proposed PTAD takes advantage of robotics technology, using coordinated feedback control of powerful

hydraulically actuated joints, which in turn necessitates management of external interaction forces.
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Considerable research has also been done to determine safety criteria for robots in operation with human
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operators, though no consensus has been reached on suitable standards. Collision forces required to cause

pain or injury vary widely depending on a number of factors, including where the impact occurs on the
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body, the time of impact, and whether or not the body is pinned or free. ISO standards list a maximum

threshold force of 150 N (ISO 2011), but other researchers claim that this threshold is too high (Haddadin,

Albu-Schäffer et al. 2010). In the comprehensive Robotics Handbook (Siciliano and Khatib 2008), a

chapter is devoted to research on safety in physical human-robot interaction, and it includes a function to

rate severity of injury based on impact duration. One of the most common measures of human safety in

robot interaction, the Head Injury Criterion (HIC) (Haddadin, Albu-Schäffer et al. 2010), which is based

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 on acceleration and time of impact. Based on this Park cites a lower maximum collision force target of 50

N. All of the recognized metrics for safety in human robot interaction are noted in literature to have

significant limitations, and there is no consensus on a maximum acceptable collision force.

As for interactions between the machine and the environment, the concept of robot control design for

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environmental interaction and motion, rather than pure motion control, has been an active area of research

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for over three decades, resulting in a substantial volume of publications. Applications of interaction

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include human interactions, walking, machining, excavation and teleoperation with haptic feedback. A

considerable amount of research in the 1980's involved hybrid force/position control, or a switching

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control between position control in free space and force control in contact, e.g. (Raibert and Craig 1981).

A sentinel set of papers was published by Hogan in the late 1980's (Hogan 1985; Hogan 1989), who
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developed and analyzed an impedance control; in this scheme, rather than controlling force or position,

the controller aims to attain a desired output impedance transfer function Z(s) = F(s)/V (s) , or force divided
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by velocity. In this case of examining the impedance of a point of mechanical interaction between two

bodies, the machine and the interacting body in the environment, F(s) corresponds to an external
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interaction force, and V(s) corresponds to the motion of the interaction point, or how it differs from the

machine speed if there was no interaction force. If there is no external interaction force, then the
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controller drives the machine to the reference trajectory.

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Device Requirements
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For this project, the goal was to develop a new patient transfer assist device (PTAD) that is able perform

all typical transfers in a home or clinical environment, work within space constraints of a typical home or

clinical environment, and have adequate lift capacity (at least 500 lb). It also had to be compact and

feature a simple, intuitive control strategy with smooth, stable motion that can allow a single caregiver to

simultaneously maneuver both the device and the patient. A focus group consisting of spinal cord injury

patients, as well as their home caregivers and physical therapists was convened to explore requirements

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 for the new device. The focus group consisted of ten participants, including four spinal cord injury

patients, three home caregivers and three physical therapists. Individual interviews were less structured,

but all included discussion of their experiences with current market patient lifts, limitations of those

devices, and desirable features for new lifts. Individual interviews included home caregivers for a

bariatric paraplegic patient, a hospital nurse, clinicians in a spinal cord injury rehabilitation center,

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clinicians in a nursing home, sales personnel for a patient lift distributor, and an experienced engineer in

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the patient lift industry. The operator testing of the current market patient lift was also performed early in

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the development phase. Information from the focus group, individual interviews, and operator testing was

combined to include a broad range of lift users and other stakeholders for the compilation of device

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requirements. Many of the requirements were also found in existing literature, reinforcing their

importance.
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Must-Have Machine Features
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• Capability to perform most typical transfers within a home or institution (e.g. between a

wheelchair, floor, toilet, bed, chair or car seat)

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• Provide lift capacity equivalent to current market electrically actuated lifts (500 lb.) in any

useable kinematic configuration

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• Run all day on a single battery charge, typically 8 - 12 transfers

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• Have sufficient range of motion for performing typical patient transfers

• Fit comfortably through 32 in. door (maximum base width 29 in.)

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• Lift patient above bed in a semi-supine position (beam height 72 in.)

• Comfortably reach floor height (beam height 22 in.)

• Reach middle of a double bed (beam length 33 in. + 6 in. clearance = 39 in.)

• Legs fit around typical toilets, chairs, recliners (up to 37 in. wide), and bariatric wheelchairs (up

to 35 in. wide)

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 • Compact design to work within the space constraints of a typical home or clinical environment

• Navigate through typical bathroom, from wheelchair to toilet

• Compact design to fit and maneuver inside a home garage

• Steerable, powered base

• Speeds up to 9 in/s

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• Transfer operations should be completed in less time than with a typical Hoyer lift
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Nice-to-Have Machine Features

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• Capability to perform less common transfers within a home (e.g. if a patient falls in an difficult to

access space, for example, between a toilet and a tub)

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• Provide lift capacity equivalent to current market electrically actuated bariatric lifts (1000lb) in

any useable kinematic configuration

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• Lightweight, stowable, transportable design (to fit inside an SUV or hatchback, e.g. BMW 335

coupe: 38 in. x 37 in. x17 in.)

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• Powered, steerable, omni-directional base

• Assisted patient seat angle adjustment

•
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Moveable base/outriggers to go around common seating locations, such as chair legs

• Capability to extend base or outriggers under low couches or beds

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• Horizontal motion with respect to the base in two axes, within tipping stability limits

• Ability to change patient posture on-the-fly

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Must-Have Control Design & Interface Requirements

• Safe under all conditions, particularly direct contact with humans

• Easily operable by a single caregiver

• Ability to control machine with one hand while simultaneously fine-tuning and orienting the

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 patient with the other hand

• Capability to lift, orient and achieve appropriate posture of patient, via caregiver/machine team

• Smooth, stable control in all operating conditions

• Sufficient dynamic response for a range of patient weights

• Require minimal force applied by operator

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Nice-to-Have Control Design & Interface Features

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• Minimal swing and oscillation

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• Smooth, stable control in all operating conditions

• Controller capability to prevent motion which could cause tipping, to allow for an extended the
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range of motion

• Same desirable dynamic response for a wide range of patient weights

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As for the time required for a patient transfer operation, this depends heavily on a number of factors, such

as the starting and ending positions/poses, the distance between locations, and the capabilities/limitations

of the patient, and as a result, there is no industry-defined standard. A comparison of time required,
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divided into subtasks, between the new design patient transfer assist device and a current market lift, is

discussed later with the results of this study.

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PTAD Mechanical Design

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Based on these requirements, a fully functional first generation device was fabricated for testing (Figure

1). It has four actuated degrees of freedom, each powered by its own electro-hydraulic-actuator (EHA).
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All batteries, hydraulic power, actuators, electronics, amplifiers, sensing and controllers are onboard. The

patient rests in a sling that is attached to a hanger bar at the end of the boom; this is the current industry

standard. A force sensing handle is mounted near the patient at the end of the boom to provide all operator

control input. The horizontal boom extension is driven by a belt drive mechanism and moves on a set of

high load capacity linear bearings, and it is powered by a small low speed high torque (LSHT) geroler

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 hydraulic motor. The vertical lifting consists of a scissor mechanism and actuated by a hydraulic cylinder.

The wheels are actuated by larger LSHT hydraulic motors. The design includes obstacle detecting sensors

designed to stop the motion of the lift in the event that an obstacle is encountered.

While this first prototype is considerably bulkier than desired, that extra size was needed for modularity

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and in order to use currently available mechanical components, in particular the scissor lift mechanism.

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Most of the design could easily be optimized to fit in a much more compact package; for example, using

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four scissor levels rather than two would considerably decrease the outer dimensions of the scissor

mechanism.

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The prototype PTAD meets all of the must-have design requirements except for the compact design. The

mechanical design was not optimized for size in this first prototype, and that presented a limitation in
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testing. The prototype does meet all of the necessary machine design requirements related to power,

speed, lifting capacity, forces required from the operator, battery power, range of motion, and capabilities.
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It also meets the functional requirements, such as providing smooth, stable, coordinated control of

multiple degrees of freedom and providing the capability for a single operator to control the machine with
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one hand, while simultaneously orienting the patient with the other. Some nice-to-have features were not

included in this prototype. Some proposed features that were not implemented in this prototype include:
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(1) actuated rotation of the patient between seated and supine posture, (2) compensation for patient
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swinging/oscillation, (3) a lightweight, stowable, easily transportable design, (4) payload capacity up to

1000 lb., (5) actuated side-to-side motion, and (6) moveable/spreadable base or outriggers
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Operator Interface & Control Features

A simple, intuitive caregiver interface has been implemented, which provides coordinated rate control

using a force sensing handle mounted near the patient for the operator input. The caregiver interacts

directly with the patient, while simultaneously controlling the lift device. With a powerful machine

working in a relatively delicate environment, it is necessary for the controller to manage any external

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 interaction forces, to keep them in a safe range, in addition to smoothly controlling motion. The operator

control concept is shown in Figure 2.

An interaction control framework was used to control both the motion of the patient and manage any

external interaction forces, using measurements of force from load cells and proximity from ultrasonic

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sensors. A significant challenge lies in implementation of interaction control with these electro-hydraulic

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pump controlled actuators, which are intrinsically stiff, have slow dynamics, and have many nonlinear or

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non-ideal features; the control aspect of the research is discussed in detail in (Humphreys, Book et al.

2013; Humphreys and Book 2014; Humphreys, Book et al. 2014; Humphreys and Book 2016). An

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impedance control framework has been formulated and implemented, using redundant sensing of

obstacles. In addition to the direct sensing of external force using load cells, an additional feedback term
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was added to the control using ultrasonic sensors to measure proximity to obstacles. This combination of

proximity and force feedback provides needed redundancy in sensing of obstacles, and the proximity
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sensing gives the controller some advance notice in order to reduce collision forces by slowing its motion

toward them before they occur. This form of interaction control was initially tested on one degree of
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freedom of the machine, as a part of the operator testing. More information on the interaction control,

development and testing can be found in (Humphreys 2016). The addition of robust, reliable interaction
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control enables the use of coordinated feedback motion control and an intuitive, easy to use caretaker
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interface, and it is expected to help reduce the caretaker’s mental workload.

Method
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Operator testing of the prototype PTAD was performed and compared against a current market lift: a

Hoyer-style Invacare model 9805 lift. There were two main goals of the operator testing. The first was to

evaluate the performance of the prototype PTAD in patient transfer tasks, focusing on demonstrating the

concept of a multiple degree of freedom force-assist machine. The second was to evaluate the ability of

the controller to manage undesirable external interaction forces. This discussion will focus on the first

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 segment of the operator testing; more information about the interaction control operator testing can be

found in (Humphreys 2016).

A total of 19 volunteers participated in the testing of the new PTAD. Each participant independently

performed both the transfer testing and interaction control testing tasks. Once completed, each participant

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completed a survey designed to capture their opinion of various aspects of the lift such as ability to

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complete a transfer alone, controllability of the device and accuracy of the controls. All questions on the

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survey were Likert-type items on a 6 point scale, ranging from 1 (very poor) to 6 (excellent). A similar set

of operator experiments was performed using a current market patient lift to transfer the same mannequin,

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including both the transfer operations and survey, with a different set of 12 participants. Whenever

possible, results are compared between the new PTAD and the current market lift.
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Participants were recruited through posted flyers on campus and social media, so they were primarily

graduate students at Georgia Tech. No previous experience with patient lifts was required, because such
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experience could slightly bias the reviews and performance results. Three of the participants did have

minimal prior experience using patient lifts. The experiments with the current market patient lift were
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completed earlier, prior to the fabrication of the prototype PTAD, since the results of that study were

intended to not only provide a comparison of the two devices, but to also inform the design of the
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prototype PTAD. Just prior to both experiments, participants were given instructions on how to operate
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the machines, and they were instructed to perform each type of transfer sub-task (e.g. lift from chair,

lower onto bed, etc.) one time prior to performing the time study.
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Full Mannequin Transfer Testing

All transfer related tests involved moving a 250 lb. mannequin between various locations. These included

transferring the mannequin from the following locations, as shown in Figure 3:

1. A wheelchair to a bed

2. A bed to a chair

3. A chair to the floor

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 4. From the floor back to a chair.

Transfers to and from the floor were not conducted with the current market lift because it was unable to

reach floor level. The mannequin remained situated in the sling for all operations as the focus was on

investigating the aspects of efficiency and control of the lift while moving the mannequin. The time to

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complete each component of the transfer task was recorded. For this discussion, two categories of

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subtasks are defined. The “transport” subtasks refer to transporting the mannequin from one location to

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another, primarily using the base motion; in these stages, the mannequin is free from any physical

interaction with the starting/ending locations (e.g. bed, chair, floor). The “lifting/lowering” subtasks refer

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to all other subtasks, where the mannequin is in very close proximity to the starting/ending locations.

The experiments were not designed to be identical in all subtasks for both devices, because the devices
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have somewhat different capabilities to be tested. Some subtasks performed in the experiments (e.g. lift

mannequin from chair, lower mannequin onto bed) were the same for both experiments, and the times can
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be compared for those. For the transporting stage of the process, it is important for the device to be able to

maneuver the patient through tight spaces with many obstructions. Overall compactness and optimization
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of the mechanical design is necessary for that stage, and while that is an important requirement for a

PTAD design, it was not feasible to make the first prototype modular at the same time as optimizing the
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size and maneuverability. Therefore, the experiments were designed to avoid any comparison in the
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‘transporting’ subtasks. The full transfer operations that were tested are broken down into sets of

subtasks, and only the subtasks that are in boxes in Figures 2-3 can be compared between the two devices.
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The full time study results are valuable for evaluation of the prototype PTAD, with or without the

comparison to the current market device. Images from the testing are shown in Figure 4.

Interaction Control Testing

A second set of experiments were performed to evaluate the interaction control, with the same set of

participants as the full transfer experiments with the new PTAD. The experiments focused on the ability

of the controller to manage external interaction forces to remain within safe levels during unexpected

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 collisions and to inform the operator of the collision through a form of haptic feedback. Participants

performed a set of short transfers of the mannequin between two chairs. In some cases, an obstacle was

placed such that it was not visible to the operator, and the collision forces were measured; this was tested

with the interaction control active and inactive. This comparison of the collision forces and motion

tracking performance between the cases of active and inactive interaction control provided an evaluation

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of the controller’s ability to reduce the interaction forces and inform the caretaker of the obstacle.

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Each participant completed a total of eight transfers. They completed two transfers for practice, one with

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the obstacle and one with no obstacle. Then they completed six transfers, each with different

combinations of three control algorithm variations and two obstacle variations (with or without the

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obstacle). Half of the tests included the obstacle. The interaction control was tested using only the

horizontal and vertical motions of the machine; these results can be easily extended to the wheel motion.
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It is preferable to test the interaction control on the horizontal motion, to avoid complications from

gravitational forces and complex kinematics. The test obstacle consisted of a small steel plate (3 in. x 6
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in.) and a stiff spring, which were mounted on the device, and it was hidden from the view of the

operator. The details of the interaction control design and subsequent experimental evaluation are a
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separate thrust of this research and beyond the scope of this publication. Further information on the

interaction control can be found in (Humphreys 2016; Humphreys and Book 2016).
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Results and Discussion

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The time taken to perform the subtasks of the transfer operations with the market lift and the new PTAD

are shown in Figures 5 and 6. These are all standard box plots, with the whiskers representing the
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minimum to maximum values, the lower box representing the first quartile, the upper box representing the

third quartile, and the line between the boxes representing the median. The time study gives some insight

into which operations require the most time, and subsequently how design efforts should be focused to

reduce the time required to perform transfers.

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 It is promising to note that most transfer subtasks require considerably less time with the new PTAD..

And surprisingly the data show that the “transport" subtasks are generally not slower for a motions of

similar distance, even with this oversized prototype. With the current market lift, most lifting and

lowering operations are typically performed in about 40-50 seconds, while with the PTAD, those same

subtasks are typically performed in about 15-20 seconds. With some improvements to optimize the

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mechanical design to make the gross motions around the room more efficient, a PTAD can be expected to

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reduce the personnel time required for patient transfers.

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Unpaired t-tests were used to compare the times required for participants to perform the subtasks that

could be directly compared between the experiments using the current market patient lift and the new

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PTAD. All data were checked to ensure that all assumptions were met for the test (independence, normal

distribution and equality of variances for ANOVA). All passed with the exception of the case of 'fine
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position over bed' as described below:

• Lift above wheelchair: There was a significant difference in the time required, with the new
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PTAD (M=52.62, SD=17.86) requiring an average of 36.15 seconds less than the current market

lift (M=16.47, SD=5.34); t(28)=8.3, p<<0.001.

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• Fine position over bed: There was a significant difference in the time required, with the new

PTAD (M=15.58, SD=4.77) requiring an average of 38.76 seconds less than the current market
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lift (M=54.34, SD=40.52); t(28)=4.17, p<<0.001.

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There was a single outlier in the market lift data (a duration more than 4 times the average of all

other) making the distribution non-normal. Removing this point satisfies the normality
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requirement and the difference is still significant [the PTAD requiring an average of 27.82

seconds less than the current market lift (M=43.4, SD=18.85); t(27)=6.2, p<<0.001.]

• Lower onto bed: There was a significant difference in the time required, with the new PTAD

(M=17.63, SD=3.1) requiring an average of 23.63 seconds less than the current market lift

(M=41.26, SD=17.33); t(28)=5.86, p<<0.001.

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 • Lift above bed: There was a significant difference in the time required, with the new PTAD

(M=20.05, SD=6.43) requiring an average of 32.05 seconds less than the current market lift

(M=52.10, SD=23.20); t(28)=5.72, p<<0.001.

• Lower onto chair: There was a significant difference in the time required, with the new PTAD

(M=13.79, SD=5.79) requiring an average of 39.26 seconds less than the current market lift (M=53.05,

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SD=21.66); t(28)=7.53, p<<0.001.

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For the interaction control experiments, descriptive statistics were calculated across all trials, as well as a

two-way ANOVA to compare the difference in means of the external interaction forces between cases

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with the interaction control active and inactive. The results show that the difference in means is highly

significant (p << 0.001), has a medium effect size (0.525), and a mean reduction in collision force of
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53%. Furthermore, in all cases with interaction control active, collision forces were maintained below 140

N, which is below the ISO standard maximum acceptable collision force of 150 N. Considerable analysis
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of the control design and details on the interaction control experiments can be found in (Humphreys

2016). These interaction control results indicate that it should be feasible to design a hydraulically
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actuated patient transfer assist device that has control capability to manage any unintentional collision

forces to be safe for humans in the workspace.

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The survey results (Figures 7-9) showed that overall, participants rated the PTAD higher than the current

market lift in almost every metric, though the differences were small in some cases. In the overall ratings,
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the average ratings for important metrics such as the ability to transfer alone, ease of obstacle avoidance,

ability to transfer quickly, and overall maneuverability, all were improved over the current market lift, in

spite of the bulky prototype design. For the PTAD controller ratings, all of the metrics including overall

controllability, accuracy, response speed and smoothness of the lifting arm, accuracy and response speed

of the base, all had average ratings of good to excellent. The only exception was the smoothness of the

base motion, which was rated as fair. Average ratings for all metrics were higher than those for current

16
 market lift except the speed of response of the lifting arm.

Operators found the smoothness of the base control to be particularly lacking; it is difficult to attain

smooth motion control performance with these low cost power units, but it could likely be improved with

better compensation for the non-ideal effects. Operators also found the speed of response of the lifting to

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be lower than desired, which is partially a result of integrating the operator input to obtain a position

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control reference, as well as the need for considerable damping in the control to obtain fairly smooth

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motion from these power units. This effect could likely be improved to some degree with better tuning.

Several operators also noted that the machine dynamic response was not what they initially hoped for, but

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they felt that they could “get used to the machine dynamics" quickly. Ratings were divided into “lifting

and lowering" stage and a “transfer stage", where the transfer stage refers to the motions involved in
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transporting the mannequin from one place to another, when it is free from any contact with the starting

and ending locations.

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The ratings for the transfer stage are primarily focused on the wheel control and base design, both of
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which are not yet optimized in this prototype. Still, the ratings showed improvement over the current

market device in all metrics, and all metrics received average ratings between good and excellent, except
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for “ease of changing directions", which is primarily a result of the casters. A number of operators
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mentioned the known limitations, such as the difficult to turn casters and large overall size. But they also

noted that the powered wheels are a significant improvement over the unpowered casters of the current
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market lift. Smooth control of fine motions is difficult with these hydraulic power units, as a result of the

check valve circuit designed to hold the load against gravity without power. The check valves are pilot

operated and remain closed until the pump reaches sufficient pressure to open them; that combined with

stiction makes it difficult to obtain smooth control at low flow.

17
 The most positive ratings and review comments were given for the lifting and lowering

stages (Figure 10), with average ratings for all metrics falling between very good and excellent, and

improvement in average ratings over the current market lift for all four metrics.

Conclusion
A prototype PTAD is developed in this research, and it demonstrates the concepts of multiple electro-

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hydraulically actuated degrees of freedom with coordinated control, as well as interaction control, applied
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to the patient transfer application. Some issues with patient lifts are directly improved with this prototype:

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• Lower forces required from the operator

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• Powered base motion

• Capability to perform transfers faster

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• Larger range of motion (including the ability to reach the floor).
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Key design concepts are proven through the testing, which are expected to lead to more significant

performance improvements. First, the addition of multiple hydraulically actuated degrees of freedom with
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intuitive coordinated control can be expected to lead to the following, in later stages, after an optimized

mechanical design is achieved:

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• Improved maneuverability around obstacles and through tight spaces.

• Improved ability to lift patients from difficult-to-reach places.

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Second, the addition of intuitive coordinated control, where the operator simply pushes on the machine in
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the desired direction of patient motion, can be expected to lead to reduced operator mental workload.

Third, the addition of interaction control can be expected to result in the following improvements, once it

is applied to all degrees of freedom:

• Improved safety for patients and others in the workspace.

• Reduced operator mental workload.

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 • Fewer incidences of damage to objects in the workspace.

• Faster transfer operations.

Addition of more actuated degrees of freedom with coordinated, feedback controlled motion has

considerable advantages in this application. But without the addition of interaction control, the fly-by-

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wire, feedback controlled system would have potential to increase the possibility of injuries or damage

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resulting from collisions. In the current market lift, the actuated joint is controlled by an operator in open

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loop from a manual hydraulic input lever; in such systems, the operator can feel any significant increases

in the force applied by the actuator. Adding feedback motion control can improve the machine dynamic

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response and enable coordinated control, but it reduces the operator's feel for the environment. Under

pure position or velocity feedback, when the machine encounters an obstacle, the feedback control
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increases the actuator command in an attempt to achieve the desired motion; therefore, as compared with

open loop manual hydraulic control, the operator is less aware of the increase in forces applied to the
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environment. Furthermore, the addition of more actuated degrees of freedom can result in higher collision

force capabilities from some joints (e.g. the wheels, which are not actuated in the current market patient
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lift). The addition of various forms of interaction control typically provide the operator with even better

haptic information about interaction forces than open loop control, and it allows for the controller to
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reduce the interaction forces. Additionally, like driving a car with ultrasonic backup sensors, if the
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machine can be trusted to warn the caregiver of any impending external interactions, and to minimize

interaction forces, then the caregiver will be able to spend less time checking around the machine to avoid
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collisions while moving through the workspace, thereby reducing the caregiver's mental workload and

improving the speed of operations.

19
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Figuure 1: Four deegree of freeddom prototyppe patient traansfer assist ddevice.

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Figure 2.. Operator innput force maapping to patiient motion

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Figure 3. Trannsfer locationns; Left: Currrent market lift, Right: Paatient Transfe
F fer Assist Devvice

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an Figuure 4. Photos from transfeer operations testing

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Figure 5. Time sttudy results for the PTA
AD transfer tasks. Boxees indicate subtasks
s thaat can be
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directly compared bbetween the current marrket lift andd the prototyype PTAD.
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Figure 66. Time studyy results for tthe market lifft transfer tassks. Boxes inndicate subtasks that can bbe directly

coompared betw
ween the currrent market llift and the pprototype PTA
AD.
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Figure 7. O
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an Overall lift raatings. Left: PTAD, Righht: market lifft

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Figure 8. Liift controllerr ratings. Left

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ft: PTAD, Rigght: market liift

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Figure 9. Lift transfer stagge ratings. Leeft: PTAD, Right: markett lift

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Fiigure 10. Ratings for thee lifting and lowering stagge. Left: PTA
AD, Right: cuurrent markeet lift
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