PRE2019 3 Group13

Parkinson Spoon for Hand Tremors

Group members

Student name	Student ID	Study	E-mail
Yara Daamen	1337157	Pyschology & Technology	y.f.daamen@student.tue.nl
Heather Hanegraaf	1330454	Biomedische Technologie	h.e.h.hanegraaf@student.tue.nl
Mayke Scheffer	1234784	Electrical Engineering	m.scheffer1@student.tue.nl
Wouter Haneveer	1300334	Computer Science	w.haneveer@student.tue.nl
Gijs van Bakel	1239471	Applied Physics	g.v.bakel@student.tue.nl

Problem Statement

Simple tasks like eating are not as obvious for everyone. For instance: people with a tremor, or who are suffering from Parkinson’s disease, have trouble with something as simple as bringing a spoon to their mouth. Their meals take a lot longer and they often have to be assisted while eating. There are several products available on the market, like self-stabilizing spoons and forks but the disadvantage of these products is that they are quite expensive and big. This means people are able to eat independently again, but they should always take their own cutlery with them.

Objectives

Independent use The user should be able to utilize this product independently to assist them while eating. This means that the device should be easy to turn on and be natural to use. This way, the user can do daily life tasks without needing help from caregivers, making them more independent.

Cost efficient - As people with Parkinson's disease often already have enough costs to care for their disability, it is important that the device has a affordable price (less than €100, - ). This way, it can be available for way more users in need. Another point to keep in mind is safety. If this device is too expensive the user will be at risk of being robbed, which has to be considered as people with Parkinson's disease can be more vulnerable and a easy target to rob.

Comfortable in use - The device should be comfortable in use for the target group. It should have a shape that is comfortable for the duration of a three-course meal. Using the device should not cause any pain or harm and users should have no negative feelings against using it. These criteria will be verified through user tests. The user should be fully comfortable to use the device within two weeks of getting used to it.

Recognize nature of movement - The device should recognize unwanted vibrations that are, for instance, caused by a tremor or Parkinson’s disease. The unwanted vibrations should be distinguished from wanted movement of the cutlery within one period of movement. The error in recognizing the nature of the movement should be less than 10%.

Act on unwanted movement - When an unwanted movement is recognized, this should be compensated by keeping the piece of cutlery stable. The stabilizing should not take more than two periods of the unwanted vibrations. The piece of cutlery should only be allowed to move in the direction of the wanted movements.

Modular - The device should be compatible with at least 90% of the cutlery that is used in restaurants. Therefore the part of the device that is connected to the cutlery must be adjustable in size and it should be able to attach and use the device within one minute. This means that the user can feel more comfortable when using the device, as the device can be attachted to the cutlery other people are using for example. The device should be able to work for at least three hours without intermediate charging. This is for the comfort of the user, as they might want to use the spoon during the whole day without having to charge it.

Approach, Milestones Deliverables and Planning

Approach

The aim of this project is to help people with nerve diseases such as tremor to become more independent. We are going to do this by making special cutlery, which makes it possible to eat independently for this target group. We want to achieve this goal by delivering a prototype and model on how the cutlery can be implemented. The approach to reach those two goals contains multiple steps.

1. Research

Firstly, we will be going through research papers and other sources which describe the state of art of such cutlery and its respective components. This allows our group to get a grasp of the current technology of such a system and introduce us to the new developments in this field. This also helps to create a foundation for the project, which we can develop into. The state of art also gives valuable insight into possible solutions we can think and whether their implementation is feasible given the knowledge we possess and the limited time. The Research has to be done with the use of literature, survey(s), personal interview(s), recent reports from research institutes and the media and analyzing patents which are strongly connected to our project.

2. USE aspects

Furthermore, we will continue to analyze the problem from a USE – user, society, enterprise – perspective. An important source of this analysis is the state of art research, where the results of these cutlery systems in different stakeholders are discussed. The USE aspects will be of utmost importance for our project as every engineer should strive to develop new technologies for helping not only the users but also the society as a whole and to avoid the possible consequence of the system they develop. This analysis will finally lead to a list of requirements for our design.

3. Product shaping

Finally, we hope to develop a prototype in which the product will be conceptualized and programmed. In this process the RPC's are used to choose the program, hardware and the approach of the programming language itself.

4. Documentation

The wiki has to be updated and look like a report at the end of the project. To accomplish this someone will be assigned to check and edit the page every week. Besides the wiki, a presentation has to be made in anticipation of the last few weeks. Together with the prototype, the wiki page and the presentation are our final deliverables for the project.

Below the summary of the main steps in our approach of the project.

• Doing research on our chosen project using SotA literature analysis
• Analyzing the USE aspects and determining the requirements of our system
• Choose the Hardware and Software for the prototype
• Work on the prototype
• Create a demo of the tracking functionality
• Evaluate the prototype

Milestones

Here the major milestones can be found for every week. :

• Week 1: The subject is chosen and also the Plan for the project has been made.
• Week 2: It is clear who the users are, the research is finished and also the requirements are decided.
• Week 3: Research into design prototype and costs + Survey.
• Week 4: Research into software prototype and a list of parts and estimation of costs is made + Survey.
• Week 5: Building prototype + information from enquete to improve the prototype.
• Week 6: The prototype has been made.
• Week 7: The tracker demo will be finished in order to be at the presentations.
• Week 8: The wiki page is finished and updated with the results that were found from testing the prototype. Also, future developments are looked into and added to the wiki page.

Deliverables

Within this project there are four final deliverables.

• This wiki page, which contains all of our research and findings
• A presentation, which is a summary of what was done and what our most important results are
• A prototype
• A video of the tracker demo

Planning

Name	Week #1	Week #2	Week #3	Week #4	Week #5	Week #6	Week #7	Week #8
	Research	RPC's and USE Analysis + start prototype research	Hardware Design + Enquete	Software Design + Enquete	Prototype	Proof Reading	Future Developments	Conclusions
Heather Hanegraaf	Write approach, milestones and deliverables	Requirements	Wiki Page check	USE Analysis	USE Analysis	Presentation script		Wiki Page check
	Brainstrom subject ideas	Requirements justification	Survey	Survey	Send Survey	Survey ideas
	Make the planning	Adjust Planning	Finish Requirements			Efficiency of performance method
Yara Daamen	Research 13 papers	USE Analysis	Survey	Wiki Page check	Foam grapper system	Foam grapper system		Wiki Page check
	Add the research papers to the wiki page			Adjust objectives
				Survey
Mayke Scheffer	Write problem statement and objectives	Research Prototype	Explain start prototype	Improve Prototype	Wiki Page check	Make final prototype		Wiki Page check
			Improve Prototype		Order Components	Prototype Justification
					Meeting Prototype Building
Wouter Haneveer	Research 5 papers		3D printing	3D printing report on wiki page	make 3D printing	Wiki Page check		Wiki Page check
	Add the research papers to the wiki page	Summary State of the art sources 7-25		3D printing improve		Final 3D model printing
Gijs van Bakel	Write User part	Research Prototype	Mechanical solutions research	Literature Study check	Meeting Prototype Building	Prototype Justification	Wiki Page check	Wiki Page check
	Research 7 papers	Summary state of the art sources 1-6		Arduino code on wiki page
Group Work	Brainstorm about the subject during meeting	Meeting Planning + prepare feedback session	Group meeting	Group meeting	Group meeting	Skype Meeting online
	Online meeting (Whatsapp) about subject

State of the Art

Several papers have been collected on the topic of self-stabilizing wearables, which are shown at the 'Literature study week 1' section, together with a short summary in one or two sentences. They are sorted into distinctive categories for clarity. The following section summarizes the most important findings of the collected literature for our project, together with additional research on other topics that has been done at a later time, such as the section on mechanical stabilization.

Similar products

Active cancellation hardware is currently used in noise-canceling headphones. This method uses two DC motors connected with mechanical yokes that couple vertical and horizontal motion of the spoon. The sensor/controller system uses a tri-axial accelerometer embedded in the spoon base to sense the direction of tremor in the x and y directions and directs the spoon the move in the opposite direction. A bandpass filter is used to filter out noise, and acceleration data as a function of time is resolved into the frequency domain using Fourier transformation.

Vibration isolation and a dynamic vibration absorber can be used to reduce the hand tremor with a semi-active device, which can not only reduce hand tremor but also generate its needed electrical energy. In this system, two clamped guided piezoelectric beams (B1 and P1) are used to hold the spoon and a clamped piezoelectric beam (B2 and P2) is used as a dynamic vibration absorber.

A PID controller can be used to actively control the system. This type of controller continuously calculates an error value e(t) as the difference between a desired setpoint (SP) and a measure process variable (PV) and applies a correction based on proportional, integral, and derivative terms (denoted P, I and D respectively), hence the name (from Wikipedia) In the study “Design of a noninvasive and smart hand tremor attenuation system with active control: a simulation study” two motors are used that can rotate in perpendicular directions, which allow the mechanism tip to move horizontally and vertically.

Another method uses Inertial measurement unit (IMU) sensors and actuators for stabilizing a cup while under severe hand vibration. It is like the Active force method in the sense that a microcontroller processes the feedback from the IMU, upon which it rotates the two motors in the opposite direction of hand movement in order to achieve proper stabilization. PI and PID controllers are also used for the self-stabilizing cup.

Note on the frequency of tremors: Based on previous studies, it is concluded that the frequency of the hand tremor is different from the frequency of the voluntary movement. Accordingly, the frequency of the hand tremor in Parkinson’s disease is in range of 3–6 Hz and it is between 5 and 12 Hz in essential tremor disease Therefore, a low-pass filter, with a cut-off frequency of 3 Hz, can be used to distinguish the voluntary motion from tremor movement.

Solutions to reduce tremors

Next to self-stabilizing wearables we also did research on ways to reduce tremors, here the most important findings to reduce tremors.

One could think about adding weight to the patient's wrist or use a heavier spoon, since then an equal amount of force would mean less movement since the mass is bigger , however contradictory to , states that no significant changes can been seen by adding weight.

Another thing that could be done to the spoon is to make the handle smaller. As shows a smaller handle makes people with the Parkinson's disease move faster and smoother, possibly since they have more control over the spoon due to the shorter distance to is.

An exoskeleton can also be used to suppress tremors . Here an exoskeleton uses an electromyogram (EMG) signal, which is a biosignal which affects the activation of muscles, to measure whether movement in voluntary or not, if the movement is voluntary the exoskeleton moves with the body else it will not move and suppress the movement. However, exoskeletons can be used in other parts of the arm as well, like seen in much more complicated exoskeletons can be made, this one uses Active Force Control (AFC) based on piezoelectric actuators to reduce tremors in the wrist.

Tremors could also be reduced by measuring distance to something and keeping this distance the same with the help of motors . However, for our project this is not relevant since we want our tool to be useable in dynamic environment and to pick up food, we need to go towards the food and this way would work against what we want.

With the use of accelerometers, actuators and position sensors, tremors could be seen and reduced by countering the force of the tremor with an equally big force into the opposite direction, according to . However, this system is designed for cars and is therefore to big and expensive to use for a spoon. If a way smaller and cheaper version could be made it might be a good way to reduce tremors in a spoon, the problem is that it might be difficult to see whether a movement is from a tremor or a voluntary movement from the user itself.

By rotating an unbalanced mass, one could counter and thus reduce a tremor . However, added on a spoon this would make the spoon heavy since we should add multiple masses to be albe to create a counter force in every direction, thus making it not usable for cutlery.

Using a coin type vibration motor and a micro controller, it is possible to create random vibration patters to distract the user from the bio-mechanical feedback loop with the hand and reduces the hand tremor and improving the ability to grip or hold an object .

Lastly, we found that muscle co-contraction could be used to stabilize joints . When a tremor is measured, the muscles are electronically contracted to stabilize the joint, this reduces the tremors since your muscles are contracted and thus unable to create a tremor.

Measuring tremors

We also did research on ways to measure tremors, here our findings of how to measure tremors.

One could measure tremors by using advanced mathematical methods of time series analysis as seen in . Here an easy to use Microsoft windows application is built to investigate forms of tremors using advanced mathematical methods of time series analysis.

We also found a device using 4 accelerometers and is capable to measure tremors, movement and accidental falls . This device also has the possibility to connect through Bluetooth, WIFI and GSM to a remote supervisor.

Another way to measure tremors is by combining accelerometers with gyroscopic transducers, a device is made using three-axis accelerometer and three axis gyroscopic transducers embed in one device called shimmer . This device can measure the acceleration, velocity and displacement of a tremor.

Mechanical Stabilization research

So far all the sources that are found use electrical stabilization, either with the active force method, a PID controller or some other electronic device. However we know that mechanical stabilizing is used currently is the field of stabilizing cameras and we want to see whether this could be applied to our problem statement. So to this goal more literature research into mechanical stabilization has been done, with the results of this presented below.

No sources have been found that directly use mechanical stabilization for stabilizing cutlery, so some literature of self-stabilizing cameras has been found to see if we can draw any parallels. Some literature by Rodriguez-Padilla, I. et al mentions how image stabilization is actually not do actively, but “edited in”. A template matching method is used that consists of selecting small high-contrast regions of an image and these are matched with a reference image to compute their displacement, which is then corrected.

Another source of literature mentions a similar approach to the ones that have been found for stabilizing cutlery, using a PID controller with an inertial measurement unit (IMU). The same method is used for cameras on UAVs (unmanned aerial vehicles)

MEMS (micro-electromechanical system)-based gyroscopes and accelerometers are also used in order to stabilize cameras. These units are however specifically made for this purpose and would be too big to use in the area of self-stabilizing cutlery.

USE Analysis

It is good to first know who the users of the product are. Society and enterprise must also be taken into account before we start making the prototype. That is why a USE analysis is now being carried out. The requirements will then be formed from this USE analysis after which we will start developing the prototype.

User

First, we take a look at the user aspect of our product. At the start of this project it was only clear that there would be a product for people with a tremor, or a disorder in the nerves. First of all, research was done into which disorders tremors occur, since people with those disorders are potential users of our product. The conditions that it was interesting to investigate further are MS, Parkinson's and essential tremors. Now a short analysis will follow about these diseases and then a choice will be made for which patients a device will be developed.

MS

More than 2.3 million people are affected by MS worldwide. Most people living with MS are diagnosed between the ages of 20 and 50, with more than twice as many women as men being diagnosed with the disease. MS is an abbreviation fo multiple sclerosis. It is an unpredictable, often disabling disease of the central nervous system, caused by the immune system which attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of your body. Eventually, the disease can cause permanent damage or deterioration of the nerves. Symptoms range from numbness and tingling to blindness and paralysis. The disease varies greatly from person to person, and from time to time, in the same person. For instance, one person might experience abnormal fatigue, another might have severe vision problems, and another could develop attention and memory issues, also tremor, lack of coordination or unsteady gait is one of the symptoms. Even severe symptoms could disappear completely and the person could regain lost functions. In the worst cases, however, people can have partial or complete paralysis.

Parkinson

Parkinson's is the second most common progressive brain disease with 7 million patients worldwide. Parkinson's disease is a brain disorder that leads to shaking, stiffness, and difficulty with walking, balance, and coordination. Parkinson's symptoms usually begin gradually and get worse over time. As the disease progresses, people may have difficulty walking and talking. They may also have mental and behavioral changes, sleep problems, depression, memory difficulties, and fatigue. One clear risk factor for Parkinson's is age, most people with Parkinson’s develop the disease at about age 60. Parkinson's disease signs and symptoms can be different for everyone. Early signs may be mild and go unnoticed. Symptoms often begin on one side of your body and usually remain worse on that side, even after symptoms begin to affect both sides. Parkinson's disease has four main symptoms: tremor (trembling) in hands, arms, legs, jaw, or head, stiffness of the limbs and trunk, slowness of movement and impaired balance and coordination, sometimes leading to falls. Another symptom is chewing and swallowing difficulties can occur, especially during the later stages of the disease. These can be due to changes in function either in the autonomic nervous system or the muscles in the throat, known as the pharyngeal muscles.

Essential tremors

Essential tremor is a nervous system (neurological) disorder that causes involuntary and rhythmic shaking. It can affect almost any part of your body, but the trembling occurs most often in your hands — especially when you do simple tasks, such as drinking from a glass or tying shoelaces. Essential tremor is usually not a dangerous condition, but it typically worsens over time and can be severe in some people. Other conditions don't cause essential tremor, although essential tremor is sometimes confused with Parkinson's disease. Essential tremor can occur at any age but is most common in people age 40 and older. The tremor signs and symptoms are: begin gradually, usually more prominently on one side of the body, worsen with movement, usually occur in the hands first, affecting one hand or both hands, it can include a "yes-yes" or "no-no" motion of the head and it may be aggravated by emotional stress, fatigue, caffeine or temperature extremes.

Our chosen users are people suffering from hand and arm tremors which are caused by the Parkinson’s disease but also people suffering from essential tremors. We have chosen both conditions as users, as this increases the number of people who are potential users. Furthermore, essential tremors and the tremors in Parkinson's disease are very similar, therefore the spoon can be used by both patients.

To really focus on perfecting a product fitted to our user, it is necessary to chose a specific topic. Therefore, we mainly focus on Parkinson's patients, as this is a much better known problem that needs to be addressed. These users, people with Parkinson’s disease, are in almost all cases elderly around or above 60. These people are often in need of a lot of care and can’t perform a variety independent tasks on their own. Especially eating is a very frequent activity that has to be assisted minimally 3 times a day. For patients who are still mentally healthy it can be a very degrading feeling to bave to be fed. A device that could help these patients could greatly improve their independence and feeling of self-worth. Although we focus on Parkinson, the spoon can thus still be used by both parties.

Society

For the society, this device can make a small, but needed, change to the healthcare. As the population of elderly grows bigger and bigger so will the amount of patients with Parkinson’s disease. This will have a big impact on the society as they’re in high need of caring. By using this device, the working load for the caretakers could be decreased, allowing them to have more time for other activities. Furthermore, it can greatly improve patients their independence and feeling of self-worth. This is also a benefit to society, as people get happier overall.

Enterprise

For the Enterprise stakeholder it is of course about companies that have the same kind of idea to tackle this problem. It is clear that there is already a big market for these products. We will now discuss some of those similar products.

Flexibel TPE and Lepel Torso Grip

Our solution is aimed at robots and works through the use of electricity, but there are also companies that have come up with a much simpler solution. For example, a flexible silicone edge around the edge of the spoon. In this way the food stays on the spoon better. This can indeed be a good solution for the problem, but the success rate of an electric spoon is higher than with this solution.

Another simple solution is to make a better grip on the spoon. This way the spoon is easier to hold for people with Parkinson's. The handle of the spoon itself then becomes larger, which research shows that this has no positive effect on the use of the spoon. This research was conducted by Clinical Rehabilitation and their findings were as follows: "The movement of the participants with Parkinson's disease was faster (shorter movement time) and smoother (fewer movement units) when they used spoons with a small or medium-sized handle than when using a spoon With a large-sized handle In contrast, the healthy controls showed no significant differences in movement kinematics between handle sizes. Moreover, the participants with Parkinson's disease had a significantly smaller hand aperture and used more fingers to hold the spoons than the controls did. " This shows that the handle should not be too large, but it should be big enough since patients with Parkinson's hold the spoon with more fingers. So in our design we want a combination of good grip, big enough for holding the spoon, but not too big because this would have a negative effect on the time to move and the smoothness to do so.

Foodrobot

A robotic arm is another solution to the problem. ZorgvanNu explains how it works: "Obi has two control buttons: one to choose which bowl to scoop from, and one to control the scooping movement. An arm with a spoon on it scoops up the food and brings it to the mouth. If you are going to use Obi, first set the correct position of the arm in relation to your mouth. You can always set it (or have it adjusted) in a different way, so that you do not always have to sit in the same way. " This is a very good solution if the tremors become so bad that the patient can no longer hold the spoon. However, we have opted for a different solution, precisely to be more mobile and not to have to carry a large device if the patient goes out for diner, for example. Another disadvantage of this solution is that the contact between human and robot must be very consciously taken into account. Because if the patient suffocates? The robot simply continues, which would not be user-friendly. It is a good solution, if people come in the next stage of Parkinson's and they have no other option left. However, our solution is for people who can still use a spoon themselves.

Liftware, Gyenno and "Smart"-spoon

There are also products that are very similar to what we want to produce. This is namely a spoon that measures the tremors and then tries to counteract it by making the opposite movement. Liftware, Gyenno and "Smart" spoon are examples of this. Although there are already working products on the market, we are convinced that we can improve the product. Those products are namely still very pricy and has a limited use. Our goal is to produce a simple and cheap working device that can be attached to any spoon to create a natural eating experience.

Requirements

The requirements follow from the user analysis. This is because the users are going to use the product and therefore the device must meet their requirements. The requirements that are still unclear after the user analysis has been carried out are clarified with a survey. In this survey, questions are asked about the specifications to our target group. Under the heading "Survey" there is more to read about how this happened.

Requirement ID	Technical requirement description
R1	The spoon must cancel out at least 60% -70% of a sudden movement caused by a tremor, that is
R2	The robot must be able to withstand heat flux
R3	The spoon must be able to withstand water or other liquid
R4	Energy consumption should be as low as possible
R5	It must be a device that can be mounted on a spoon. So a separate device.
	Functional requirement description
R6	The spoon must ensure that a person with a disability in the nervous system can eat independently
R7	The size of the cutlery must not be larger than a normal spoon
R8	The weight of the spoon must not be more than that from a normal spoon
R9	The cost of the robot must not be higher than 100 euro
R10	The device should have constructive elegance
R11	The device must work for 1 hour without the need for replenishing batteries.
R12	The device must be natural and simple to use
R13	The device must be durable and able to withstand longer use
R14	The device must be able to fit on any spoon and hold it securely
R15	The device must be compact and streamlined

Technical Requirement Justification

It must be measurable whether the device works or not, which is why it has been stated in the requirements that the spoon must be able to remedy 60% to 70% of all tremor movements. In this way it is testable whether the spoon is indeed functioning properly. The percentages come from literature studies, from similar products. This study demonstrated a 71% to 76% reduction in tremor with the ACT device on. Moreover, the classical Parkinson's tremor at rest occurs, is often asymmetrical, has a distal maximum and a typical frequency of 4–6 Hz. So to meet the requirement of 60 to 70%, 2.6 - 3.9 Hz would have to be canceled. The product must also be able to withstand heat flux and liquid. This is because it is used when eating any hot meals. For example, think of soup, which is both liquid and hot. Another standard but important requirement is the lowest possible energy consumption. This requirement requires no explanation. The last technical requirement is very important. As you can read in the USE Analysis section, there are similar products that also help people with tremors to eat independently. However, their product is a spoon, fork or knife that eliminates tremors. We want to make a product that can be attached separately to a spoon, fork or knife. In this way you only have to take the small device with you and not all the adjusted cutlery.

Functional Requirement Justification

The most important requirement is of course that the spoon must help the user to eat independently. Furthermore, there are also requirements for the weight and size of the device. This is because people with Parkinson's already have trouble eating, and therefore the size and weight must be kept as small and as light as possible, so as not to add any more obstacles. The price of the spoon is also important, since comparable but very expensive products are already on the market. We want to develop a product that is affordable for everyone, so a requirement has been set for the price of the product. Furthermore, the device must have a constructive elegance, this requirement speaks for itself. It must look representative, otherwise nobody would want to use it. The final functional requirement is that the service life of the spoon should last approximately 1 hour. This is because the device must at least accompany a meal, since people do not want to replace the batteries in the middle of the meal.

The device should be natural to use because a lot of elderly (especially those who are not mentally healthy anymore) struggle to use new technologies. If the device is not natural and simple to use, the eating experience might only be more stressful than before. The device should be durable because it will be used multiple times per day and will be cleaned and moved all the time. Furthermore, people with tremors can accidentally drop this device on the ground and bump it around, so it should be sturdy enough to withstand all of that. As already stated before, the device must be be separatly attachted to cutlery, but it is important that it is able to grab onto (almost) all cutlery and keep it secure. This makes our product stand out as it can be applied to the already provided cutlery. The last last requirement, that the device must be compact and streamlines is also important. If there are loose parts or parts sticking out, they can get stuck to the environment which stop the user from eating. Especially due to the tremors the device wil move around a lot and we dont want it to get stuck to anything.

Survey

A survey has been set up to find out how the prototype can be better shaped and which requirements have to be met. This survey was sent to the Parkinson Vereniging. We chose to send it here, as it is the largest institution of Parkinson's disease in the Netherlands. It was decided to conduct a survey in the Netherlands, as these are best accessible and the quickest response to our survey. The address we sent it to is: info@parkinson-vereniging.nl. The survey is addressed to the caregivers of patients with Parkinson's. Here's what the survey looks like. Link Survey

In view of circumstances (the COVID-19 virus) we still send the survey to the caregivers, but bearing in mind that there is probably no response to this, because the caregivers have their hands full. Hoping that there will be a reaction, it is the intention that a thematic analysis is carried out on the results. This allows us to make our product even better for the users.

Systems for holding spoon

From the USE analysis, the requirement emerged that our product must be a device that can be attached to the spoon (or other cutlery) and that it should be a separate device. This is because it then becomes much more portable to take it elsewhere. In this way you only have to take the small device with you and not all the adjusted cutlery. However, this requires a system that ensures that the device can be attached to any spoon (or other cutlery), regardless of its size. Research has been done into this, which system would work best for this. In this section you can read the results of the research.

There are several ways to hold the spoon in place within the tool. It should be able to tightly hold on to almost any type of spoon and should thus be able to get a grip on different kinds of handles. Some of these systems offer a part of the solution or more.

One of these systems is a gripper for small parts. These grippers are made to accomdate to different kinds of weights and shapes of small objects. . However, these grippers are mostly designed for small and delicate parts notes Costas Charalambous :“Grippers and vacuum cups always need a light tough to properly grab small parts because they’re delicate,”. Nonetheless, these grippers could be applied to our product even if they're orginally made for more delicate parts. You can see such a gripper in Figure 4.

Another one of these system is a vacuum gripper which you can see in Figure 5. These grippers are very usefull for gripping any kind of workpieces regardless of size, meterial and surface. It is also very lightweight and would be ideal for our robot. However, this product seems to be very expensive. As we want to develop a cheap solution we can not use this system.

The third system is similar to the vacuum system, but replaces the "fingers" with a material that wrappes around the object and holds it. It is demonstraded This material can mold to any shape upon contact with the object . . This system reduces the amount of parts that have to be controlled and can thus be more reliabale and cheap.

Figure 4: Gripper system for small parts

Figure 5: Vacuum gripper system

Figure 6: Material that wrapped around the object

3D printing

To make the case for all the electronics, we decided to use 3D printing to our advantage. However before we can print something, we first need to draw the case. For this we decided to use Solidwork. With this program we are able to accurately draw a case, Since Solidwork makes it very easy to decide the length of each part of the case. However before we are able to draw the case in Solidwork, we first need to finalize the electronics and how we are putting everything together.

Prototype

Circuit

To get an idea of how such a spoon would work we started with a very simple prototype in week 3. This prototype works with the active force method. The prototype will first be focused on spoons, since not all cutlery (spoons, forks and knives) have to be stabilized in the same way. Two servos will be used to compensate movements on the pitch and roll axis of rotation ([1]). The movement of the spoon will be measured by an MPU6050 accelerometer. The servos and sensors will be attached to a Digispark Attiny85 microcontroller. A 7.2 volt lipo battery will be used to power the servo's and a 3V coin cell battery will power the microcontroller. The prototype works simply by inducing a force opposite of the measured acceleration, which then aims to bring the spoon to the reference position.The connection of these components can be seen in the following figure:

Figure 1: Circuit for Prototype

A PID controller will be used to stabilize the spoon.

Bill of Materials

Product	Costs	Link
Attiny85 Microcontroller	€5.00	https://www.tinytronics.nl/shop/nl/arduino/main-boards/digispark-attiny85-met-micro-usb
Sg90 Servo	2x €4.00	https://www.tinytronics.nl/shop/nl/robotica/motoren/motor/sg90-mini-servo
MPU6050 accelerometer	€5.00	https://www.tinytronics.nl/shop/nl/sensoren/accelerometer-gyro/mpu-6050-accelerometer-en-gyroscope-3-axis-module-3.3v-5v
Printplaat	€0.60	https://www.tinytronics.nl/shop/nl/prototyping/printplaten/experimenteer-printplaat-5cm*7cm-dubbelzijdig
Behuizing (3D print)	~€2	-
Knoopcelbatterij houder	€1.00	https://www.tinytronics.nl/shop/nl/batterij-en-accu/batterijhouders/2x-cr2032-lir2032-batterij-houder-met-losse-draden
Knoopcelbatterij CR2032	2x €1.00	-

Arduino code

Active force method

The Arduino code for the very first prototype without PID controller is shown below.

#include <Wire.h>
#include <MPU6050.h>
#include <Servo.h>

Servo sg90_x;
Servo sg90_y;

int servo_x = 2;
int servo_y = 10;
MPU6050 sensor ;
int16_t ax, ay, az ;
int16_t gx, gy, gz ;

double Setpoint;

void setup ( )
{
  Setpoint = 90;
  sg90_x.attach (servo_x);
  sg90_y.attach (servo_y);
  sg90_x.write(Setpoint);
  sg90_y.write(Setpoint);
  Wire.begin( );
  Serial.begin  (9600);

//  Serial.println  ( "Initializing the sensor" );
  sensor.initialize ( );
  Serial.println (sensor.testConnection ( ) ? "Successfully Connected" : "Connection failed");
  delay (100);
}

void loop ( )

{
  sensor.getMotion6 (&ax, &ay, &az, &gx, &gy, &gz);
  servo_x = map (ax, -17000, 17000, 0, 255) ;
  servo_y = map(ay, -17000, 17000, 0, 255);


sg90_x.write(x_out);
sg90_y.write(y_out);

Prototype with PID controller

The Arduino code for the prototype with the PID controller can be seen below. Some comments have been added for clarity.

#include <Wire.h>
#include <MPU6050.h>
#include <Servo.h>
#include <PID_v1.h> /* Include libraries */

Servo sg90_x;
Servo sg90_y; /* Define the two servos */

int servo_x = 2;
int servo_y = 10;
MPU6050 sensor ; /* Define the variables that the sensor reads out, namely the accelerometer and gyroscope values */
int16_t ax, ay, az ;
int16_t gx, gy, gz ;

double Setpoint;
double x_in, x_out, y_in, y_out;
//PID parameters
double Kp = 0, Ki = 10, Kd = 0; /* Define the PID parameters */

PID xaxisPID(&x_in, &x_out, &Setpoint, Kp, Ki, Kd, DIRECT); 
PID yaxisPID(&y_in, &y_out, &Setpoint, Kp, Ki, Kd, DIRECT);

void setup ( )
{
  Setpoint = 90; /* Define initial (reference) position */
  sg90_x.attach (servo_x);
  sg90_y.attach (servo_y);
  sg90_x.write(Setpoint);
  sg90_y.write(Setpoint);
  Wire.begin( );
  Serial.begin  (9600);

spoonPID.SetMode(AUTOMATIC);
spoonPID.SetTunings(Kp, Ki, Kd);
  
//  Serial.println  ( "Initializing the sensor" );
  sensor.initialize ( );
  Serial.println (sensor.testConnection ( ) ? "Successfully Connected" : "Connection failed");
  delay (100);
}

void loop ( )

{
  sensor.getMotion6 (&ax, &ay, &az, &gx, &gy, &gz);
  x_in = map (ax, -17000, 17000, 0, 255) ; 
  y_in = map(ay, -17000, 17000, 0, 255);

myPID.Compute();

sg90_x.write(x_out);
sg90_y.write(y_out);

Design Choises

analyse waarom 2 of 3 assen op de wiki

zeggen waarom we bepaalde componenten gebruiken en niet andere keuze hebben gemaakt

etc

OOK HOE WE VAN EERSTE PROTOTYPE NAAR LAATSTE FINAL PROTOTYPE ZIJN GEGAAN (DUS MET DE 3D PRINT CASE EROMHEEN)

Figure 2: First Attempt Prototype

How it works

Efficiency of Performance from Prototype

Test methods must be developed to test whether the prototype meets the requirements and to see whether it works well enough. Two methods have been devised to measure the efficiency of the performance of the prototype. The first test is practical and therefore technical and the second method is based on theory.

Technical

Method 1. In the requirements it has been explained that a typical tremor has a frequency of 4–6 Hz. We have also made the requirement that 60 to 70 percent of the tremor must be compensated. This resulted in that 2.6 - 3.9 Hz would have to be canceled. And so that when the spoon is working, there is only a frequency of 1.4 - 2.1 Hz. If this is indeed the case, then it can be concluded that the spoon works well enough in this respect.

Test results 1.

Method 2. In another study, they also tested a Parkinson's spoon. There they took advantage of the decrease in amplitude. If the amplitude of the movements decreased significant when the spoon was on as compared to off, the test was successful and it was concluded that the function of the spoon was meaningful. This is also a method on which we will test the efficiency of the spoon.

Test results 2.

Method 3. The purpose of the spoon is that as much food as possible remains on the spoon and is therefore not fallen of during a tremor. So what matters in the end is what percentage of the food remains on the spoon when the spoon is on as compared to when the spoon is off. If this is significantly more, it can be concluded that the purpose of the spoon has been achieved and so a conclusion can be drawn about the efficiency of the spoon.

Test results 3.

Theoretical

Then there is also a method to test the Parkinson Spoon theoretically. This is done through a follow-up survey to the first survey. In this survey it is first explained what our product exactly is and then questions are asked whether the caregivers think that this product can work. The form of the survey is not yet clear. It can be a survey for many caregivers or an interview is conducted with one of the caregivers. The questions we want to ask in the survey / interview can be read in this link: Survey 2.

Conclusion Efficiency of Performance

___________ Als alle tests gedaan zijn, moeten we hier de resultaten samenvatten en daarna een conclusie trekken over de efficiency van het product _________

Literature Study week 1

At least 25 pieces of literature have been found in the field of the problem statement in week 1. They have been collected, sorted into categories and a short summary per article has been written.

Similar products

[1] Thilmany, J. (2013). Stable spoon. Mechanical Engineering; New York, 135(5).

Spoon that cancels human tremors. Same technique as in noise cancelling headphones: active cancelation software. Digital cameras also cancels motion. LiftWare tremor-cancelling spoon from company Lift Labs.

[2] Pathak, A., Redmond, J. A., Allen, M., & Chou, K. L. (2013). A noninvasive handheld assistive device to accommodate essential tremor: A pilot study. Movement Disorders, 29(6), 838–842. https://doi.org/10.1002/mds.25796

Research on how active cancellation of tremor (ACT) can stabilize motion of spoon. Results show that the device helps reduce tremor amplitude and severity. Same company Lift Labs.

[3] Abbasi, M., & Afsharfard, A. (2018). Modeling and experimental study of a hand tremor suppression system. Mechanism and Machine Theory, 126, 189–200. https://doi.org/10.1016/j.mechmachtheory.2018.04.009

Very useful for our project. Research on application of the system. By experiments they obtain and validate electromechanical equations.

[4] Abbasi, M., Afsharfard, A., Arasteh, R., & Safaie, J. (2018). Design of a noninvasive and smart hand tremor attenuation system with active control: a simulation study. Medical & Biological Engineering & Computing, 56(7), 1315–1324. https://doi.org/10.1007/s11517-017-1769-9

Same researchers. Simulated study on how the device will work.

[5] Vishnu, V., Prabaharan, P., Sujadevi, V.G., Meher, M.D.IMU sensor based self-stabilizing cup for elderly and parkinsonism (2017) 2017 International Conference on Advances in Computing, Communications and Informatics, ICACCI 2017, 2017-January, pp. 2264-2269.

A proposal for a wearable auto stabilizing cup holder that helps in routine performance tasks such as drinking water. The system uses IMU sensors and actuators for stabilizing the cup when under severe hand vibration.

[6] Turgeon, P., Laliberte, T., Routhier, F., Campeau-Lecours, A. Preliminary design of an active stabilization assistive eating device for people living with movement disorders(2019) IEEE International Conference on Rehabilitation Robotics, 2019-June, art. no. 8779388, pp. 217-223. https://doi.org/10.1109/ICORR.2019.8779388

A preliminary design for a stabilizing eating device. It includes mechanical design, damping arrangement, electronic design and control algorithms.

Solutions to reduce tremors

[7] McGruder, J., Cors, D., Tiernan, A. M., & Tomlin, G. (2003). Weighted Wrist Cuffs for Tremor Reduction During Eating in Adults With Static Brain Lesions. American Journal of Occupational Therapy, 57(5), 507–516. https://doi.org/10.5014/ajot.57.5.507

Research on the usage of weights on the forearm. Research shows that making the wrist heavier resulted in fewer tremors while self-feeding for some individuals.

[8] Meshack, R. P., & Norman, K. E. (2002). A randomized controlled trial of the effects of weights on amplitude and frequency of postural hand tremors in people with Parkinson’s disease. Clinical Rehabilitation, 16(5), 481–492. https://doi.org/10.1191/0269215502cr521oa

Again research on weighted utensils for patient suffering from Parkinson’s Disease. This time no support for a significant effect on reduction of the tremor.

[9] Matsumoto, Y., Seki, M., Ando, T., Kobayashi, Y., Nakashima, Y., Iijima, H., … Fujie, M. G. (2013). Development of an Exoskeleton to Support Eating Movements in Patients with Essential Tremor. Journal of Robotics and Mechatronics, 25(6), 949–958. https://doi.org/10.20965/jrm.2013.p0949

Usage of exoskeleton to suppress tremors and support voluntary movement. The research shows that the exoskeleton works to a certain extent.

[10] Song, C., Gehlbach, P. L., & Kang, J. U. (2012). Active tremor cancellation by a “Smart” handheld vitreoretinal microsurgical tool using swept-source optical coherence tomography. Optics Express, 20(21), 23414. https://doi.org/10.1364/oe.20.023414

In the medical world are tremors also an obstacle, especially for microsurgeons. The device helps steady the surgeon tool by canceling the tremors. This could also be applied to our subject.

[11] Ma, H.-I., Hwang, W.-J., Chen-Sea, M.-J., & Sheu, C.-F. (2008). Handle size as a task constraint in spoon-use movement in patients with Parkinson’s disease. Clinical Rehabilitation, 22(6), 520–528. https://doi.org/10.1177/0269215507086181

Research on the effect of the size of a spoon handle on the amount of tremors that a Parkinson’s Disease patient is experiencing. The results show that a smaller to medium sized spoon handle caused a faster and smoother movement compared to a big handle.

[12] Hamdy, A. (1999). Active damping of vibrations in elevator cars. Journal of Structural Control, 6(1), 53–100. https://doi.org/10.1002/stc.4300060105

Usage of active damping system for cars. It doesn’t apply perfectly to the spoon but shows how a system can actively reduce the extremes.

[13] Chuanasa, J., & Songschon, S. (2014). Essential tremor suppression by a novel self-balancing device. Prosthetics and Orthotics International, 39(3), 219–225. https://doi.org/10.1177/0309364614525185

Self-balancing device that can be used for tremor suppression. Algorithm controls mass actuator.

[14] Rovini, E., & Merammani, C., & Cavallo, F. (2017) How wearable sensors can support parkinson’s disease diagnosis and treatment: A systematic view. Frontiers in Neuroscience, 11 (OCT), art. no. 555. DOI: 10.3389/fnins.2017.00555.

Review of 136 papers that shows a wide overview of wearable devices for the management of Parkinson’s disease. Objectives: This review focuses on wearable devices for PD applications and identifies five main fields: early diagnosis, tremor, body motion analysis, motor fluctuations (ON-OFF phases), and home and long-term monitoring.

[15] Hosseini, S.M., Al-Jumaily, A., Kalhori, H.Tremor suppression in wrist joint using active force control method(2017) 9th Australasian Congress on Applied Mechanics, ACAM 2017, 2017-November.

The paper proposes a new AFC (active force control) method for tremor attentuation, using a three-degree-of-freedom musculoskeletal model. Matlab is used to analyze the model. Conclusion: AFC-based system with a piezoelectric actuator and a PD controller is very effective is suppressing the human hand tremor.

[16] Vidya, V., Poornachandran, P., Sujadevi, V.G., Dharmana, M.M.Suppressing Parkinson's diseases induced involuntary movements using wearables(2018) Proceedings of 2017 IEEE International Conference on Technological Advancements in Power and Energy: Exploring Energy Solutions for an Intelligent Power Grid, TAP Energy 2017, pp. 1-4. https://doi.org/10.1109/TAPENERGY.2017.8397267

This paper proposes and implements a low-cost wearable assistive device for Parkinson’s disease patients. A coin vibrator motor a micro controller are used. The induced vibration on the wrist distracts the patient’s brain from the bio-mechanical feedback loop with the hand and reduces the tremor and improving the ability to grip or hold an object.

[17] Gallego, J.A., Rocon, E., Belda-Lois, J.M., Pons, J.L. A neuroprosthesis for tremor management through the control of muscle co-contraction (2013) Journal of NeuroEngineering and Rehabilitation, 10 (1), art. no. 36. https://doi.org/10.1186/1743-0003-10-36

This study uses a neuroprosthesis in order to reduce effects of tremors. The treatment relies on muscle co-contraction for tremor management. Results: The neuroprosthesis attained significant attenuation of tremor (p<0.001), and reduced its amplitude up to a 52.33±25.48%.

Reading tremors

[18] Lauk, M., Timmer, J., Lücking, C. H., Honerkamp, J., & Deuschl, G. (1999). A software for recording and analysis of human tremor. Computer Methods and Programs in Biomedicine, 60(1), 65–77. https://doi.org/10.1016/s0169-2607(99)00012-7

Research on monitoring the different types of tremors by analyzing the recording and applying mathematical methods.

[19] Marino, S., Cartella, E., Donato, N., Muscarà, N., Sorbera, C., Cimino, V., … Di Lorenzo, G. (2019). Quantitative assessment of Parkinsonian tremor by using biosensor device. Medicine, 98(51), e17897. https://doi.org/10.1097/md.0000000000017897

Home-made and low-cost device that can read tremors.

[20] Serrano, J.I., Lambrecht, S., del Castillo, M.D., Romero, J.P., Benito-León, J., Rocon, E.Identification of activities of daily living in tremorous patients using inertial sensors(2017) Expert Systems with Applications, 83, pp. 40-48. https://doi.org/10.1016/j.eswa.2017.04.032

Instead of measuring tremors, the paper instead focuses on contextualizing the symptoms of diseases like Parkinson’s. The study describes the development of a comprehensive methodology based on machine learning techniques to segment and detect activities of daily living in people with tremor using inertial sensors, which aims at facilitating detailed interpretation of tremor movements by neurologists.

[21] Mehmet Engin (2006). A recording and analysis system for human tremor. Measurement, 40(3), 288-293. https://doi.org/10.1016/j.measurement.2006.05.015

Tremor analysis based on frequency and amplitude to diagnose people’s condition.

[22] Gugliandolo G, Capra PP, Bramanti A, Di Lorenzo G, Campobello G, Donato N, Marino S (2019). A Movement-Tremors Recorder for Patients of Neurodegenerative Diseases. IEEE Transactions on Instrumentation and Measurement, 68(5), 1451-1457. https://doi.org/10.1109/TIM.2019.2900141

Tremor recorder for people affected by neurodegenerative diseases.

[23] Reem Musab, Azizan As’arry, Khairil Anas Md Rezali, Nawal Aswan Abdul Jalil, Raja Mohd Kamil Raja Ahmad, Mohd Zarhamdy Md Zain (2019). Tremor Quantification and its Measurements Using Shimmer. Journal of Physics: Conference Series, 1262. https://dx.doi.org/10.1088/1742-6596/1262/1/012024

Different sensors to measure tremors and comparison between them.Different sensors to measure tremors and comparison between them.

Possible users

[24] Deuschl, G., Petersen, I., Lorenz, D., & Christensen, K. (2015). Tremor in the elderly: Essential and aging-related tremor. Movement Disorders : Official Journal of the Movement Disorder Society, 30(10), 1327-34. https://doi.org/10.1002/mds.26265

Tremor research on elderly, seen is that people get tremors as they get older.

[25] Balestrino, R., & Schapira, A. (2020). Parkinson disease. European Journal of Neurology, 27(1), 27-42. https://doi.org/10.1111/ene.14108

General research on Parkinson's disease.

References

Logbook

This section contains tables with the amounts of time spent on each subject by each member, per week.

Week 1

Name	Time (h)	Breakdown
Yara	8.5	Lecture + forming groups [2], whatsapp meeting [3], state of the art [3.5]
Wouter	8	Lecture + forming groups [2], whatsapp meeting [3], state of the art [3]
Gijs	7	Lecture + forming groups [2], whatsapp meeting [3], orientation subject literature research [2]
Heather	10.5	Brainstorming possible subject [ 3 ], Whatsapp meeting [ 3 ], Lecture + forming groups [ 2 ], Write approach [ 1 ], Write Milestones and deliverables [ 0.5 ], Make Planning [ 1 ]
Mayke	8	Lecture + forming groups [2], Whatsapp meeting + research [3], write problem statement + objectives [3]

Week 2

Name	Time (h)	Breakdown
Yara	1.5	Group meeting [1], feedback session [0.5]
Wouter	1.5	Group meeting [1], feedback session [0.5]
Gijs	4	State of the art [1.5], Group meeting [1], feedback session [0.5], Editing wiki (adding written parts and fixing errors) [1]
Heather	6	Group meeting [1], feedback session [0.5], Editing planning [0.5], Write Requirements [1.5], Write Requirement Justification [2.5]
Mayke	0

Week 3

Name	Time (h)	Breakdown
Yara	4.5	Meeting [1], feedback session [0.5], write USE analysis [2], set up survey[1]
Wouter	5.5	Summarize sources [4], meeting [1], feedback session [0.5]
Gijs	6.5	Summarize sources 1-6 [1.5], Brainstorm meeting for prototype [0.5], meeting [1], feedback session [0.5], Working on initial prototype [3]
Heather	7.5	Meeting [1], feedback session [0.5], Tech / Functional requirements Research [2.5], Finished Requirement justification [2.5], check wiki page [1]
Mayke	14	Brainstorm meeting prototype [0.5], research and components gathering [1], Making first prototype [3], team meeting + feedback session [1.5], designing circuit [8]

Week 4

Name	Time (h)	Breakdown
Yara	8	Finish USE analysis [1], editing wiki[0.5], finish survey [1], finish RPC's [1.5], finish justification[1], meeting[1], presentations[2]
Wouter	5	Finish summary of sources [2] , meeting[1], presentations[2]
Gijs	5.5	Mechanical stabilization research [1], adding logbook into wiki + correcting mistakes [0.5], Meeting [1], Presentations [2], preparation presentation [1]
Heather	9.25	Survey [2], Mail Survey [0.5], Research where to send the survey [1.5], Final version Survey [2], Presentations [2], Meeting [1], editing wiki [0.25]
Mayke	9	Research batteries [3], adjusting circuit and updating wiki [1], making bill of materials [1], writing code for arduino PID controller [4]

Week 5

Name	Time (h)	Breakdown
Yara	0	Research S.M.A.R.T. Objectives [0.5], edit objectives [1], check and edit wiki page [1], meeting [2]
Wouter	0	Learning Solidworks [4], 3D print on wiki [0.25], Meeting [1], feedback session [0.5]
Gijs	4.5	Reformatting literature research and fixing references [2], Adding Arduino code [0.5], Fixing errors in wiki [0.5], Meeting [1], feedback session [0.5]
Heather	8	Meeting [1], feedback session [0.5], Research Enterprise Stakeholder [2.5], Write USE Analysis Enterprise [1.5], Research User Stakeholder [2.5]
Mayke	0	Adjusting code [1], MPU6050 research[2]

Week 6

Name	Time (h)	Breakdown
Yara	0	Research unions for parkinson [0.5], contact unions, send survey and mail [1]
Wouter	0	Skype Meeting [1], Feedback Session [0.5]
Gijs	0	Skype Meeting [1], Feedback Session [0.5]
Heather	10	Finished USE Analysis [5], Start Wiki Page Survey [1.5], Skype Meeting [1], Feedback Session [0.5], Research where to send Survey now [2]
Mayke	9.5	Ordering and testing components [4], debugging code[4], Skype Meeting [1], Feedback Session [0.5], soldering[1]

Week 7

Name	Time (h)	Breakdown
Yara	0	Research on gripper system and editing wiki [3], writing new mails[0.5]
Wouter	0
Gijs	0
Heather	0	Edit wiki page (pictures, headings, order etc) [2.5], Presentation script [2.5], Efficiency of performance method research [1.5], Efficiency of performance Tech. [1], Efficiency of performance Theory [2], Edit wiki page (so that the steps taken are in logical order) [1.5]
Mayke	19	researching new sensor MPU6500 [3], testing trying researching [16]

Week 8

Name	Time (h)	Breakdown
Yara	0
Wouter	0
Gijs	0
Heather	0
Mayke	0