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 easy 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. With these existing solutions people are able to eat independently again, but they always have to 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, and thus 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 is affordable (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 an 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 to hold 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 when using it. These criteria will be verified through user tests. The user should be fully comfortable using 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 deliberate 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 unwanted vibrations. The piece of cutlery should only be allowed to move in the direction of the deliberate 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 attached 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 that cause tremors to become more independent. We are going to do this by making a device that can be attached to any cutlery, which makes it possible to eat independently for the target group. We want to achieve this goal by delivering a prototype and information about this prototype on the wiki page. 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 the 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 to solve our problem statement. 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 analysing patents that are strongly connected to our project.

2. USE aspects

Furthermore, we will continue to analyse the problem from a USE – user, society, enterprise – perspective. An important source of this analysis is the state of the 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 consider the possible consequences of the system they develop. This analysis will lead to a list of requirements for our design. We also set up a survey to find out any unknown requirements. This makes that the requirements are based on the USE analysis and the survey.

3. Product shaping

When we finish these two steps, we will 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

To finish, the wiki has to be updated and should 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 and a demo to show how the prototype works, the wiki page and the presentation are our final deliverables for the project.

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

• Doing research on our chosen project using SotA literature analysis
• Analysing the USE aspects and set up the survey to determine the requirements of our device
• 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 (SotA) is finished and also the requirements are determined.
• Week 3: Research into design prototype and costs + set up survey.
• Week 4: Research into software prototype and a list of parts and estimation of costs is made.
• Week 5: Building prototype + information from survey to improve the prototype.
• Week 6: The prototype has been made.
• Week 7: The demo will be finished and ready to be presented.
• 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 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 + Survey	Software Design + Survey	Prototype	Proof Reading	Demo	Conclusions + Future Developments
Heather Hanegraaf	Write approach, milestones and deliverables	Requirements	Wiki Page check	USE Analysis	USE Analysis	Presentation script	Start making presentation	Wiki Page check
	Brainstorm subject ideas	Requirements justification	Survey	Survey	Send Survey	Survey ideas	Finish presentation	Finish presentation + audio
	Make the planning	Adjust Planning	Finish Requirements			Efficiency of performance method	Clean the wiki page	Clean the wiki page
Yara Daamen	Research 13 papers	USE Analysis	Survey	Wiki Page check	Foam grapper system	Foam grapper system	Finish Presentation	Wiki Page check
	Add the research papers to the wiki page			Adjust objectives			Finish chapter "holding spoon"	Finish presentation + audio
				Survey
Mayke Scheffer	Write problem statement and objectives	Research Prototype	Explain start prototype	Improve Prototype	Wiki Page check	Make final prototype	Finish prototype	Wiki Page check
			Improve Prototype		Order Components	Prototype Justification		Finish prototype
					Meeting Prototype Building		Edit BoM	Start testing prototype
Wouter Haneveer	Research 5 papers		3D printing	3D printing report on wiki page	make 3D printing	Wiki Page check	Finish 3D printing	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		Edit BoM
							Edit Wiki page	Clean wiki page
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			Write future improvements	Finish future improvements
Group Work	Brainstorm about the subject during meeting	Meeting Planning + prepare feedback session	Group meeting	Group meeting	Group meeting	Skype Meeting online	Skype Meeting 1	Skype Meeting 1
	Online meeting (WhatsApp) about subject						Skype Meeting 2	Skype Meeting 2
								Skype meeting 3

State of the Art

Several papers have been collected on the topic of self-stabilizing technologies, which are shown at the 'Literature study week 1' section near the end of the report, 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 have 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 to 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 tremors but can also generate its needed electrical energy . In this system, two clamped guided piezoelectric beams are used to hold the spoon and a clamped piezoelectric beam 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 the desired setpoint (SP) and a measured 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 this 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 the 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 be seen by adding weight.

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

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 the movement is 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 research 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 the distance to an object 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 a dynamic environment and to pick up food, we need to go towards the food and this way would work against what we want to accomplish.

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 research . However, this system is designed for cars and is therefore too 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 but 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 too heavy since we should add multiple masses to be able 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 are our findings of how to measure tremors.

One could measure tremors by using advanced mathematical methods of time series analysis as seen in this research . 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 four accelerometers and is capable to measure tremors, movement and accidental falls . This device also has the possibility to connect via Bluetooth, Wi-Fi 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 embedded 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 being carried out. The requirements will then be formed from this USE analysis after which we will us to develop 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 where tremors occur, since people with those disorders are potential users of our product. It was interesting to conduct further research into the disorders 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 our 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 for 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, for 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. Besides these symptom, tremor, lack of coordination or unsteady gait can also be experienced. Even severe symptoms could disappear completely and the person could regain lost functions. However, in the worst cases, people can have partial or complete paralysis.

Parkinson's disease

Parkinson's disease 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 behavioural 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 hands — especially when doing simple tasks, such as drinking from a glass or tying shoelaces. Essential tremor is usually not a dangerous condition, but it typically gets worse over time and can be severe for 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 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 of 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 have 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 are 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' independence and feeling of self-worth. This is also a benefit to society, as people may feel 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.

Flexible 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 disease. 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 size 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, which is 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.

Figure 1: Other solutions for the same problem, Stakeholder Enterprise

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 several Parkinson associations. The first association we chose to message was called 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 those associations are best accessible and the quickest response to our survey. The e-mail 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. They responded by telling us the Parkinson Vereniging wasn't really meant for that. They did however link two other options to continue our research. The first link they sent was of parkinsonzorgzoeker.nl . However, this site is mostly meant for approaching individuals, whereas we needed to contact as much people as possible. We thus decided that this site was not useful for us. The next link they sent was also from Parkinson Vereniging, but this time meant especially for research requests . We also sent them a mail. However, they reacted saying that they were for research centred around the people who have Parkinson's disease, not the caretakers. We then chose to go for different associations. We found Brabantzorg , but they told us they were too busy because of corona. This is also the case for an association called Careyn . They also informed us that they were too busy with corona. The last association we messaged was 24uurszorgsevice . They haven't responded yet.

In view of circumstances (the COVID-19 virus) we still send the survey to the caregivers, but bearing in mind that there was probably no response to this, because the caregivers have their hands full. Hoping that there would be a reaction, it was the intention that a thematic analysis was carried out on the results. This allowed us to make our product even better for the users, but given that we unfortunately did not have any responses to the survey, the requirements that follow in the next section are only based on the USE analysis and thus on literature study.

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.

Requirement ID	Technical requirement description
R1	The device must cancel out at least 60% -70% of a sudden movement caused by a tremor
R2	The device must be able to withstand heat flux
R3	The device 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 device 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 device must not be higher than 100 euro
R10	The device should have constructive elegance
R11	The device must work for 3 hours 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 resolve 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 that occurs at rest, is often asymmetricaland 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 cancelled. The product must also be able to withstand heat flux and liquid. This is because it is used when eating 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. Another functional requirement is that the service life of the spoon should last approximately 3 hours. 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 separately attached 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 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 will move around a lot and we do not want it to get stuck to anything.

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. 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.

Gripper

One of these systems is a gripper for small parts. These grippers are made to accommodate 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 originally made for more delicate parts. You can see such a gripper in Figure 2.

Vacuum Gripper with Fingers

Another one of these system is a vacuum gripper which you can see in Figure 3. These grippers are very useful for gripping any kind of workpieces regardless of size, material and surface. It is also very lightweight and would be ideal for our device. However, this product seems to be very expensive. As we want to develop a cheap solution we can not use this system.

Vacuum Gripper wrapped around

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 demonstrated in Figure 4. This material can meld 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 reliable and cheap.

Figure 2: Gripper system for small parts

Figure 4: Material that wrapped around the object

Figure 3: Vacuum gripper system

This research was important to realise what systems exist right now. However, we also found out that these systems are not applicable for our product. These systems are indeed very accurate and useful for our product, but as we stated before, we want a affordable product. This means that we cannot use these systems. The attachment system we ended up using is very simple and described in the 3D printing section.

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 draw shapes with precise lengths. Solidwork also allows for easy fixes since if you change the length of one part Solidwork changes the other parts to fit this change.

Holding the spoon

Figure 5: Screw key to make turning easier

The first step in designing the case is finding a way to hold most spoons without damaging it. Since we want our design to work for many different spoons, and every spoon has a different handle design, we needed to find a cheap way in which we could attach all spoons to our design. We decided to make a tube to put the spoon in, and then jam the spoon with a screw. To prevent damage to the spoon a piece of rubber can be added to the screw, however even without the rubber we did not damage the spoon by jamming it. To make it easier to turn the screw we could also add an attachment to the screw which you can easily turn, which would look like the one on Figure 5. Another problem was that it could be difficult to get the spoon in the center of the holder. To make this easy we made a V, Figure 7, shape in the back of the holder which moves the back of the spoon to the center of the holder.

Figure 6: 3D drawing of holder

Figure 7: v shape inside holder to center the spoon

Place servo's

Figure 8: connection piece

The second step in our design was to find a place for the servo's. We could not just attach both servo's to the handle and to the holder, since then the holder would have two attachment points with the handle and would not be able to turn. We thus needed to either first correct the pitch or the roll axis relative to the handle. If we tried to correct the pitch axis before the roll axis, we would need to attach the pitch servo to the handle, then attach the roll servo to the pitch servo, and lastly attach the holder to the roll servo. This would however not be possible since rotating the handle around the roll axis would change the axis the pitch servo would correct in. Thus we first needed to correct the roll axis and then correct the pitch axis. We needed to attach a handle to the roll servo, attach the roll servo to the pitch servo and lastly connect the pitch servo to the holder. The roll servo needs to be behind the spoon in order to turn around the spoons roll axis, the pitch servo needs to be to the side of the spoon. Thus to be able to attach the roll servo to the pitch servo we need to make a connection piece. This connection piece needs to move from the side of the holder to the back of the holder while giving the holder enough space to turn along the pitch axis. The pitch servo needs to be attached to the connection on the body itself, while the roll servo needs to be connected to the connection with the feet of the servo.

The handle

Lastly we need to design a handle to hold the device with. This handle needs to be attached to the body of the roll servo, and have enough room inside it for the rest of the electronics. Because all the electronics need to be in the handle we also needed a way to open and close the handle. We decided to make the handle in two pieces, which we can attach together with screws. This also allows us to easily open the handle to replace batteries or remove broken electronics. Since one of the servo's is outside the handle we needed a way for the cable to get inside the handle. For this we made a little cut in the side of one of the parts of the handle. With all the electronics that need to fit in the handle, the handle is bigger than we would have liked. This could be solved by using electronics particularly developed for this product, such that the shapes of the electronics allow for a more compact design.

Figure 9: part 1 of the handle with servo hole

Figure 11: Placement of the parts without electronics

Figure 10: part 2 of the handle with cable hole

The results

Below the printed results can be seen. The idea was to use the 3D printed case in the prototype, however because of the COVID-19 outbreak, we were unable to put the electronics together with the 3D printed component. This means that all these pictures are without most of the electronics. Since the servo's used in the pictures are borrowed, we were unable to connect them to the parts thus in Figure 12 a notebook was put under the spoon in order to get the spoon on the correct height such that it looked like the product is fully attached.

Figure 12: Prototype without electronics

Figure 14: Inside of the handle

Figure 13: Connection piece with servo's

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]). A picture showing the a graphical representation of the pitch, roll and yaw axes can be seen in Figure 16 in the section Design Choices, further on in the wiki. The movement of the spoon will be measured by an MPU6500 accelerometer. The servos and sensor will be attached to a Digispark Attiny85 microcontroller. 4 AAA batteries will be used to power the circuit. The prototype works with a PID controller 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 15: Circuit for Prototype

Arduino code

Active force method

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

Arduino code 1

Prototype with PID controller

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

Arduino code 2

Design Choices

Stabilizing two or three axes?

How many axes the spoon should stabilize is a question that quickly came up. We use the pitch, roll and yaw axes that are usually used in planes. These axes are also frequently mentioned in literature and they are perfect for the stabilization of the spoon. Figure 16 below shows these axes for clarity. It is obvious that the pitch and roll axes are necessary to stabilize, to make sure that food doesn’t fall off the spoon. However, the question arose whether the yaw axis is necessary, helpful, or completely useless. Below some of the arguments for and against using 3 axes instead of 2 are outlined.

Figure 16: The roll, pitch and yaw axes, displayed from the viewpoint of an aircraft

The main argument for only stabilizing two axes is that the yaw axis simply doesn’t have to be stabilized. The movement in the same plane as the spoon (the yaw axis) would not contribute to many difficulties with eating. If this axis were to be stabilized, you even run the risk of stabilizing voluntary motions. Another argument for not using 3 motors is that it would make our design bulkier. It is critical that the stabilizing mechanism is as small and light as possible for ease of use, shown and discussed in our requirements of the product.

Type of controller

The type of controller that the self-stabilizing spoon will use has also been a big decision point. A few of the popular control mechanisms have been described in the State of the Art, for example using the Active Force Method or a PID controller. Ultimately we settled on using a PID controller with the stabilizing mechanism consisting of two motors that supply a force against the tremor direction, thus keeping the spoon level.

We already had a preference for a PID controller after we saw that many studies in the literature were also using them for prototypes and initial designs for self-stabilizing devices. A few of us already have experience with PID controller so it would take less time to set up. We do realize that PID controllers are outdated in the sense that the technology is pretty old, but for the sake of building an initial prototype in the limited timeframe that we had in this course (8 weeks) we think this is a good stepping stone for the prototype, which could be improved further with state of the art technology if this product is further worked out.

Choice of components

The individual physical components for the first prototype have been chosen with the following things in mind. First is the compatibility. The component must do what it is expected to do (shown in the circuit and description above) and have enough strength to fulfil the tasks (e.g. the servos). Second is the size of the component. As mentioned in the requirements, the total device should be as small and light as possible, in order to make it as comfortable and easy to use. The last important property of the component that was looked at is the price. Again the requirements mention the price should be as low as possible because many comparable but way more expensive products are already on the market.

The First Prototype: Proof of Concept

The initial prototype has been made in week 3. The goal of this test is to see whether our ideas about stabilizing the spoons actually work. Figure 17 below shows this initial prototype. The initial prototype consists of the Inertial Measurement unit, one servo motor and a spoon, all connected to the Arduino. The code that is used is the first one shown in the section Arduino code. Even though this code is written for two motors, it still works for any set-up with one motor as well. So now we have only one sensor present, but we see that when the sensor and motor with spoon attached are rotated in the pitch direction, the spoon keeps stays level. From this we conclude that the proof of concept is a success and from here we integrated the other components into the final prototype.

Figure 17: First Prototype: only pitch axis stabilized

The Process

After typing a few keywords in Google it seemed like making the prototype wouldn’t be a particularly hard task. There are lots of examples of people who made something like we are attempting . The first approach was to write our own PID controller based on the codes used in these projects and the help from the examples in the Arduino PID library . After that the idea was to improve the controller in order to get the desired stabilization. Although, in the end, this first approach is more or less what we did to achieve the final controller, there have been a few bumps in the road. The coronavirus had a big impact on the process, this impact was direct as well as indirect.

Lack of testing equipment

For the first prototype we borrowed the needed materials from the department Electrical Engineering, some friends and we used some of our own. While researching the components, we focused on everything that would actually be in the final product. This included the Digispark Attiny85 microcontroller, which does not have serial communication. In the Arduino code, this means that every Serial.print() statement does not do anything and therefore it is hard to detect bugs in the code. We knew this beforehand and planned on borrowing the Arduino Uno again, but this was not possible due to the coronavirus. Therefore, we had to revise what we needed and ordered an Arduino Uno, a breadboard and extra wires.

Ordering late

Before ordering the components, we had to contact Lambèr Royakkers, who sent us to the Mechanical Engineering workshop to ask if they already had the things that we needed in their possession. The workshop was closed due to the coronavirus and we had to order them ourselves. Together with having to reorder, this process costed us a week of our valuable time.

MPU6500

Figure 18: Arduino circuit realisation

The sensor that we wanted to use, the MPU6050, was sold out when we ordered our components. However, a seemingly similar one was available, the MPU6500. Time pressure and inexperience made us decide to go for this sensor. Not knowing that it meant that it was not possible to use the example projects mentioned above. These Arduino codes use so called ‘libraries’, which are sets of functions written by experienced programmers. The MPU6050 is widely used and there are lot of different libraries available. The Arduino examples above don’t even use the same ones. The MPU6500 is less popular and there were no examples within the scope of our project available. There was a library available that made it possible to read the values of the sensor. Having values and getting the right values out of a PID controller turned out to be two completely different things and after spending a day working on this without result, we tried another approach. Until this moment a combination of three existing projects was used instead of recreating one of the three. The new plan was to use the MPU6500 with the Gyro stabilizer from instructables. This ended up in deep research into Arduino communication, I2C protocols and sensor addresses, where it felt like every answer raised two new questions. Although this research was very interesting and it gave useful insights in how Arduino’s work, this level of programming was not going to bring us closer to a self-stabilizing spoon. It would need an advanced Arduino user or a lot more time adjust libraries in a way that would work for us. In the meantime the MPU6050 sensor was available again so we decided to order it so we could test the existing Arduino codes and finalize our own PID controller.

The final week

The MPU6050 surely made everything a lot easier. The ‘instructables’ code worked somewhat, but a lot less stable than in the corresponding video. The spoon tended to start vibrating instead of stabilizing after fast movements and after about 30 seconds it stopped working until the reset button was pressed. After this it was time to test and tune our own PID controller.

Indirect impact

Due to the coronavirus only one of us was working on the electronics part alone. Indirect this is also a reason that everything took a lot longer than expected. If we could meet it would have been a lot easier to work together on programming and assembling everythingeven if it is with group members that have no experience at all. Another advantage of working at the university would be the possibility to ask help from other students and helpdesks/workshops. Having someone taking a fresh look at a project can sometimes save a lot of time debugging, especially when there is just a wire connected wrongly.

The Final Prototype

The prototype consists of two parts, the internal electronics and the 3D-printed design. Due to the coronacrisis it was not possible to meet in order to put everything together. In an ideal situation the electronics would have been soldered on a protoboard that fits into the grip of the 3D-printed case. Unfortunately this was not possible because the needed soldering equipment for soldering such precision is only available on the university. Since there is no fitting case, the electronics are taped together, which makes the system much less stable. The sensor is taped to the ‘roll’ sensor; therefore this movement is much more accurate than the ‘pitch’ sensor. With the 3D-printed case this won’t be this way.

Figure 19: 3D case prototype

Figure 20: Final prototype (without 3D case)

Bill of Materials

Product	Costs	Link
Attiny85 Microcontroller	€5.00	https://www.tinytronics.nl/shop/nl/arduino/main-boards/digispark-attiny85-met-micro-usb
2x Sg90 Servo	€8.00	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	€0.80	https://www.tinytronics.nl/shop/nl/prototyping/printplaten/experimenteer-printplaat-5cm*7cm-dubbelzijdig
Behuizing (3D print)	~€2	-
2x AAA battery holders	€1.60	https://www.tinytronics.nl/shop/nl/batterij-en-accu/batterijhouders/2x-cr2032-lir2032-batterij-houder-met-losse-draden
4x AAA chargeable batteries	€7.00	https://www.tinytronics.nl/shop/nl/batterij-en-accu/aaa/eneloop-oplaadbare-batterij-4x-aaa-750mah
Wires	€4.00	https://www.tinytronics.nl/shop/nl/kabels/prototype-draden/breadboard-draden-140-stuks-verschillende-maten-in-doosje
Total Cost	€33.40	-
UNO R3	€11.50	https://www.tinytronics.nl/shop/nl/arduino/main-boards/uno-r3-met-usb-kabel
Desoldering braids	€1.50	https://www.tinytronics.nl/shop/nl/prototyping/solderen/desoldeerlint-1mm-1.5m
Breadboard	€4.00	https://www.tinytronics.nl/shop/nl/prototyping/breadboards/breadboard-830-points
MPU6500 accelerometer	€5.00	https://www.tinytronics.nl/shop/nl/sensoren/accelerometer-gyro/mpu-6500-accelerometer-gyroscope-6dof-module-3.3v-5v
Shipping cost	€7.50	-

All materials used in our product are listed above the double line, while under the double lines we listed all the materials we had to use in order to create our product

Efficiency of Performance / Testing the 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 cancelled. 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.

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.

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.

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

Due to the lack of time, explained in The Process, it was not possible to actually test the performance of the device.

So unfortunately, we were no longer able to test our prototype. To still evaluate if the prototype is usable we looked at how many requirements the prototype meets. Here you can see the set requirements again. The following requirements have been achieved:

Requirement ID	Technical requirement description
R1	The device must cancel out at least 60% -70% of a sudden movement caused by a tremor
R2	The device must be able to withstand heat flux
R3	The device 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 device 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 device must not be higher than 100 euro
R10	The device should have constructive elegance
R11	The device must work for 3 hours 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

The requirements which are met, are colored green above. 10 out of the 15 requirements are met as you can see. Some of the requirements that were not met, were not met because we did not do the tests and therefore cannot conclude whether they have been met. These could therefore be checked off later, if the tests on the prototype are done in the future. So a very large part of the requirements have been met and we therefore say that the prototype is successful.

Future Improvements/Research/Developments

This section deals with the improvements that could be made after this project is done. The reasons for not including these in the main project are the limited timeframe of this project and the coronavirus, limiting our USE implementation. Below the areas in which either the USE aspects can be implemented and the technical design can be improved are highlighted.

USE survey

It has already been described that the survey that has been made for this project has not been able to be used, due to the coronavirus. Understandably caregivers and institutions did not have time to answer our questions in order to improve the USE aspects of our design and product. Carrying out another survey now that a prototype has been made could even be more beneficial, as you can give the caregivers a better idea of our product, giving us better answers to implement these design changes and improving the design for the end-user. A themed analysis would be carried out to analyse the data that is received from the survey, which in turn we can use to improve the design.

User testing

In this project, we have regrettably not done a user testing session with an actual Parkinson's patient. However, this is certainly something that we would consider if we had more time. A type of session where we simply tell a patient to use our device and observe what some of the difficulties (and good parts!) of our design can make us aware of issues that we didn't even think about before, simply because we don't deal with the problems ourselves. There are different ways to go about this. You could just observe like just described and use your knowledge about the subject together with the user's experience. Including a survey or some type of review session with the user can give more insight into specific problems that are not visible to an observer.

Hardware improvements

One of the areas in which the prototype can be improved a lot is the hardware that is used. Currently, it uses cheap commonplace components that are not ideal for example considering the size of the components, as we want the product to be the least bulky it can be. The servo motors take up quite a lot of space. The current servo that is used twice is the SG90 mini servo (link in the Bill of Materials) which has dimensions of 23x12.2x29 mm. The smallest component that is sold normally is the Power HD Sub-Micro Servo HD-1440A servo , with dimensions 20.2x20.2x8.5 mm, which is less than half of the volume than the ones we used. This means that two of these servos would still be smaller (in volume) then 1 SG90 servo. This servo does cost a little more but this is not very significant (5.43 vs 4.00 euros) Similar to this arguably better components can be found for the other parts as well. Another example of this is the microcontroller. A microcontroller developed by InvenSense has dimensions 3x3x0.9 mm which is extremely small compared to the one that we used.

Of course, the parts that we used for the prototype, as well as the parts that are researched parts, are freely available for purchase for any non-specific use. This means that if parts were to be constructed by ourselves if we had the knowledge to do so, they would be specifically made with the product specifications and preferences in mind. This means that the size, power, weight, etc. can be optimized, which would make a big difference if this product would be produced and put for sale for consumers worldwide.

Software Improvements

Currently, the prototype uses a PID controller. It is evident that the PID controller is not state of the art anymore as it is quite old. One literature source talks about how PID controllers are simple compared to other solutions and can be integrated into almost any system together with the robustness properties that ensure stability and high performance under changes of the parameters. There are other alternatives such as the Field Programmable Gate Array (FPGA) and more predictive instead of reactive control systems. Because the PID controller is purely reactive it could be interesting to look into more predictive methods of stabilization in possible future research.

Conclusion

Millions of people worldwide are suffering from tremor diseases like MS, Parkinson or essential tremors and need help with some basic things in life, like eating. To reduce the amount of help these people need and reduce the work load of people in the healthcare, we decided to make a self-stabilizing spoon. There are already some devices on the marktet to tackle this product, but our goal was to make a device which you could click onto the spoon and you could bring it anywhere you want without feeling restricted. Futhermore, the products that already exist are expensive, so we wanted to make an affordable product.

To accomplish this, we first did some research about how we could hold the spoon, regardless of the size. Since a spoon can have many different forms and sizes, making something to click the spoon into was not an option. The attachment ways we did find that would be useful for our project were way too expensive and didn’t satisfy our need to keep the cost low. Because of this, we eventually ended up securing the spoon with a screw as can been seen in the 3D printing section. To make our spoon self-stabilizing we also needed to find a way to measure and reduce the tremors. We found that the cheapest, fastest way that was still accurate is to use a gyroscope accelerometer combination. This means that we are able to measure the speed and angle of the movement of the spoon. By countering the movement with servo motors, we are able to stabilize the spoon enough for food to stay on the spoon. To still be able to move the spoon and to keep our design small, we also took a look into the axis of rotation that we really needed to compensate. This research showed us that the most important axis to stabilize while eating are the roll and the pitch axis. We could also stabilize the pitch axis but while doing this we would increase product size, and we would be unable to turn the spoon towards our mouth meaning that eating would become more difficult.

In order for us to say how much time we could save in the healthcare section we decided to make a survey to sent to people caring for people with Parkinson. Unfortunately, we did not receive any response due to the COVID-19 outbreak. The COVID-19 outbreak also made it impossible for us to test our device and to assemble the electronics and the 3D printed parts together, as explaned in the Section "The Process". To still "test" our prototype we verified our requirements by just looking at our product. In conclusion we made a great starting point for a product that later can be used to solve this problem.

VERSIE Heather

The problem addressed during this project is the fact that people with a nervous disorder, specifically Parkinson's disease and essential tremors, have much more trouble with daily tasks than healthy people. We have focussed on the need for help of this target group during meals, because they have trouble with something as simple as bringing a spoon to their mouth. This means that their meals take a lot longer and they often have to be assisted while eating.

To give these people more freedom, self-esteem and independence, we have developed a device that can stabilize a spoon or other cutlery while eating with a tremor. Research has shown that there are already similar products on the market, but these prove to be large, expensive and inconvenient to transport when eating out. That is why we were convinced that we could improve the current products on the market by making an affordable and small device that can be mounted on a regular spoon.

In the past seven weeks we have been busy realizing the prototype described above. In the wiki page, the process and the choices made, can be read. Unfortunately, the final prototype has not been tested, as can be read in the results section, due to the COVID-19 conditions which caused that only one of the group members could work on the prototype hardware and software. It is therefore impossible to draw a real conclusion on whether our product is the solution for the problem mentioned.

To be able to say something about the quality of the solution to the problem, we looked at how many requirements were met in the final prototype. This turned out to be at least 10/15, of which some of the unfulfilled requirements were not met because they simply have not been tested. So, in conclusion, at least 10 and maybe after tests have been done in the future more than 10, of the 15 requirements have been met. With the future improvements in mind, it can be concluded that the prototype is a great starting point for a product that later can be used to solve this problem.

versie 2

Millions of people worldwide are suffering from tremor diseases like MS, Parkinson or essential tremors and need help with some basic things in life, like eating. To reduce the amount of help these people need and reduce the work load of people in the healthcare, we decided to make a self-stabilizing spoon. Our objectives with this spoon where to allow for independence use, such that patience would need less care and make them more independent. Next we wanted to make our product cost efficient. We found that there were already some products like this on the market, however these products are expensive, thus to make such products more accessible to patients we wanted to make an affordable product. Of course if we want people to use our product we also needed to make it comfortable, else people will not use it and we will not reduce work load of people in the healthcare and we will not increase the independence of the patient. Furthermore we need our product to recognize and act on unwanted movements, Since the product must still allow the user to eat, we need to make sure that wanted movement is still possible to bring the food to your mouth. Lastly since we noticed that all likewise products are only usable with special cutlery for that product, we wanted to make our product modular. We want to be able to put almost all cutlery in our device to make patients feel more comfortable to use the product outside of there own home.

To accomplish our objective to make our device modular, we first did some research about how we could hold the spoon, regardless of the size. Since a spoon can have many different forms and sizes, making something to click the spoon into was not an option. The attachment ways we did find that would be useful for our project were way too expensive and didn’t satisfy our need to keep the cost low. Because of this, we eventually ended up securing the spoon with a screw as can been seen in the 3D printing section. This solution allowed for all spoons with a width less then 22 mm and a height less then 8 mm to fit into our device, which fits all spoons we have ever seen.

Our objective to make patients be able to independently use our product, we needed to allow for cutlery to be easily attached to our device. For this we carved a V shape in the back of the holder to reduce the need to keep the spoon centered while securing the cutlery. Next to that we can put something on the screw to make turning easier as can be seen in the 3D printing section.

To make our product measure and act on unwanted movement. We did some research about how to measure and reduce tremors. We found that the cheapest, fastest way that was still accurate is to use a gyroscope accelerometer combination. This means that we are able to measure the speed and angle of the movement of the spoon. By countering the movement with servo motors, we are able to stabilize the spoon enough for food to stay on the spoon. To still be able to move the spoon and to keep our design small, we also took a look into the axis of rotation that we really needed to compensate. This research showed us that the most important axis to stabilize while eating are the roll and the pitch axis. We could also stabilize the pitch axis but while doing this we would increase product size, and we would be unable to turn the spoon towards our mouth meaning that eating would become more difficult.

We tried to make our product as small as possible, such that it would be comfortable to use it. By using small electronics and only correcting 2 axis, we made our product pretty small if you look at what goes into the product, however still we would have liked the product to be smaller, in order for it to be more comfortable, next to size we made our handle oval shaped, this allows for a more comfortable and natural grip then a circular or squared product.

In order for our product to be affordable, we used cheap electronics, meaning that performance may be a little less then if we used the best possible electronics. Luckily for us by decreasing the size and thus only correcting 2 axis we also made the product cheaper. As can be seen in the bill of materials the product costs less then €35 euro's to make. This is a lot less then the maximum price of €100 we started with.

In order for us to say how much time we could save in the healthcare section we decided to make a survey to sent to people caring for people with Parkinson. Unfortunately, we did not receive any response due to the COVID-19 outbreak. The COVID-19 outbreak also made it impossible for us to test our device and to assemble the electronics and the 3D printed parts together, as explained in the Section "The Process". To still "test" our prototype we verified our requirements by just looking at our product. This allowed us to say that we fulfilled at least 10 out of the 15 requirements. Looking at the objectives we feel like we have succeeded in all of them except the comfortable in use one, We however did get close to succeeding in it, since it does not feel awkward to hold but it is also not comfortable to hold. Maybe patients would have found it comfortable enough to use this product, but we feel like it is a little to big to be really comfortable. In conclusion we made a great starting point for a product that later can be used to solve this problem.

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. Logbook Group 13