REACHER A Helping Hand

Chapter 2: Literature Review

2.1 Disability - Definition:
Disability is an umbrella term, covering impairments, activity limitations, and participation restrictions. Impairment is a problem in body function or structure; an activity limitation is a difficulty encountered by an individual in executing a task or action; while a participation restriction is a problem experienced by an individual in involvement in life situations. Thus disability is a complex phenomenon, reflecting an interaction between features of a persons body and features of the society in which he or she lives. - World Health Organization.

2.2 Disability Statistics In Pakistan:

According to the 1998 census of Pakistan, approximately 2.49 percent of the population has some form of disability. Translated in absolute numbers, nearly 3.2 million people in Pakistan are disabled out of which 1.37 million are females and 1.99 million males, while 37.2% fall in 0-14 age group. This is significantly lower than the World Health Organization (WHO) estimate of approximately 10 percent, which is because of a different definition as WHO included persons with mild and moderate disabilities also. Rough estimates project that 28 percent of persons with disabilities are literate, only 14 percent of persons with disabilities are employed, 70 percent are reliant on family members for financial support whereas the majority, almost 66 percent, persons with disabilities live in rural areas where awareness levels are extremely low (World Bank, 2005).

2.3 Problem Reduced Mobility:

Mobility is defined as the ability to move freely and easily or the ability to move spontaneously and independently. Mobility is how an individual moves from one place to the other. Impaired mobility can affect all aspects of daily living such as bathing, eating, dressing, and household activities. When mobility is impaired, there is an accompanying loss of independence in which can result in depression, decline in multiple organ systems, and an increase in risk of heart disease, stroke, diabetes, colon cancer. Mobility can be impaired due to weakness, stiffness, and pain. In addition, age, falls and fractures, prolonged inactivity, illnesses and medications can reduce mobility.

2.3.1 Old Age:

The changes that occur with aging can lead to problems with mobility (ability to move around), such as unsteadiness while walking, difficulty getting in and out of a chair, or falls. Muscle weakness, joint problems, pain, disease, and neurological (brain and nervous system) difficulties-common conditions in older people-can all contribute to mobility problems. Sometimes several mild problems occur at one time and combine to seriously affect mobility. Another mobility problem that older people experience is falls. Falls result in broken bones, bruises, and fear of falling. Older bones break more easily than younger bones and they heal less quickly and not as completely. If a hip is fractured, canes, walkers, or wheelchairs might be needed permanently. 2.3.1.1 Why The Aged? More than one billion people in the world live with some form of disability, of whom nearly 200 million experience considerable difficulties in functioning. In the years ahead, disability will be an even greater concern because its prevalence is on the rise. This Page 1

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is due to ageing populations and the higher risk of disability in older people.................... The majority of people with disabilities are elderly. As the proportion of older people grows, so will the number of people with disabilities. Disability is part of the human condition. Almost everyone will be temporarily or permanently impaired at some point in life, and those who survive to old age will experience increasing difficulties in functioning. Everyone, one way or the other experiences disability at old age therefore disability with age is a major concern. As an effort to make living conditions easier I have decided to introduce an assistive device that will contribute to comfortable and independent living for the older people. 2.3.1.2 Human Factors To Be Kept In Mind While Designing For Old People: MOBILITY BALANCE MUSCLE STRENGTH DEXTERITY VISION HEARING COGNITION Brief information follows on the broad categories of impairment that should be taken into account. MOBILITY Difficulty in walking can be caused by foot, leg, hip or back problems. Many people can walk only a short distance and many rely on a walking aid such as a stick. Speed of movement is also affected. Bending over or down to reach or pick up something will be difficult, so the height of any task will be important. Adjustable heights are helpful to people with walking difficulties. They are likely to choose to sit at a task which others will carry out standing. The height of any object or task will be particularly important to people who cannot walk at all and use a wheelchair. Reaching low will be difficult and can unbalance their position. Items above a certain height will be unreachable. Some wheelchair users have other disabilities, for example in their upper body which will further restrict their reach. Whether people are unable to walk or walk with difficulty, they are likely to have problems bending, reaching, lifting and turning. BALANCE Difficulty in maintaining equilibrium can have a physical cause e.g. lack of strength in the lower body, and a sensory cause e.g. difficulty in processing visual information. Older people are more likely to experience dizziness. Firm and safe supports should be provided where hands will easily find them, and the need for stretching should be avoided. In designing products and layouts, attention should be paid to preventing trip hazards. DEXTERITY Arthritis is a common cause of poor dexterity, creating pain in the joints and limited movement and weakness in the arms and hands. In handling products people cannot get a firm grip, have limited strength to pull or push and they find precise finger movements impossible or painful. Actions that require force or a tight hold put pressure on the fingers and strain on the joints. The discomfort and pain are prolonged if continued force is needed. Double actions, such as push and twist, are particularly difficult for people with poor dexterity. The use of one hand and arm can be more restricted than the other, so people may use just their stronger hand to carry out tasks. Those with paralysis on one side will do everything one handed. VISION Page 2

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There is a continuum of visual impairment. Short- and long-sightedness are very common and both usually corrected by spectacles. There are a number of more severe impairments which prevent people seeing images clearly and fully. They include a reduced field of vision, including tunnel vision, difficulty in perceiving depth, in distinguishing similar colours from each other, difficulty focusing and seeing an interrupted image, such as spots before the eyes. At the extreme is blindness. Some blind people can distinguish light and shape, others have no awareness of light. People who are blind depend on tactile information on products. Few use Braille but all will use raised markings and shapes to feel their way round an item. The ability to discriminate detail and to discriminate differences between levels of contrast both decline with age. Older people need more light to distinguish objects than younger people. Difficulty reading small print is common after the age of around 50. People, who use visual information, whatever their level of impairment, are helped by large print and good colour contrast, and matt paper or surfaces: avoid reflecting surfaces and dazzle. In handling products people with poor sight have difficulty with visual displays, seeing markings and labelling and any assembly that involves small parts. Printed instructions are a problem. Information should be as short and simple as possible, the layout straightforward, and as well as large print and strong colour contrast, sans-serif typefaces are generally easier to see. HEARING People of any age can be hearing impaired but loss of hearing is part of the natural ageing process. The high frequencies or tones are usually lost first. People with a moderate hearing impairment, have difficulty hearing conversation and specific auditory information, particularly against background noise. People with severe impairment, deaf people, cannot use hearing for communication. COGNITION Cognitive impairment affects the ability to take in information and attend to it, to learn new things, to make decisions and to solve problems. The ability to concentrate declines in older age, so older people have difficulty keeping their attention focused on a task. The increased use of medication can cause drowsiness. People with cognitive impairment are helped by simple displays and the use of obvious sequences and patterns. Information is more difficult to remember if it has no clear structure. Printed text should be kept to a minimum, with steps and choices clearly illustrated graphically. People should not be expected to remember complex operations.

2.3.2 Damaged Vertebral Column:

The spinal cord is a long, thin, tubular bundle of nervous tissue and support cells that extends from the brain where as the vertebral column is a bony structure that extends from the skull (which it supports) to the pelvis. The vertebral column serves two main purposes. The vertebrae are support for the body's frame, keeping it standing upright. It connects the head to the rest of the body and it serves as protection for the spinal cord. The bony rings surround the sensitive spinal canal, which transmits the body's electrical transmissions from the brain to the rest of the body. Vertebral fractures are different than a broken arm or leg. A fracture or dislocation of a vertebra can cause bone fragments to pinch and damage the spinal nerves or spinal cord. Most spinal fractures occur from car accidents, falls, gunshot, or sports. Injuries can range from relatively mild ligament and muscle strains, to fractures and dislocations of the bony vertebrae, to debilitating spinal cord damage. Depending on how severe your injury is, you may experience pain, difficulty walking, or be unable to move your arms or legs (paralysis). Many fractures heal with conservative treatment; however severe fractures may require surgery to realign the bones.

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Spinal injuries can range from relatively mild ligament and muscle strains (such as whiplash), to fractures and dislocations of the bony vertebrae, to debilitating spinal cord injuries. Spinal fractures and dislocations can pinch, compress, and even tear the spinal cord. Whiplash is a common injury to the neck caused by hyperextension or rapid back and forth motion of the head - most often in a car accident. The jerking motion strains the muscles and ligaments of the neck and may cause the discs to bulge. Whiplash can lead to headaches, stiff muscles, or neck pain. Whiplash is different than a spinal fracture or spinal cord injury and the symptoms usually improve with conservative treatment. Spinal instability is the excessive motion between vertebrae caused by stretched or torn ligaments and broken bone. Abnormal slipping and rubbing motions can cause pain and damage the spinal nerves or spinal cord. Stable fractures can usually be treated with bracing and rest. Unstable fractures usually require surgery to realign the bones and prevent spinal cord or nerve injury. Fractures occur when more pressure is put on a bone than it can stand, it will break. The most common type of spine fracture is a vertebral body compression fracture. Sudden downward force shatters and collapses the body of the vertebrae. If the force is great enough, it may send bone fragments into the spinal canal, called a burst fracture. People affected by osteoporosis, tumours, and certain forms of cancer that weaken bone are prone to vertebral compression fractures (VCF). The fracture appears as a wedge-shaped collapse of the vertebra. Multiple VCFs can cause a forward hunch of the spine called kyphosis. Dislocations occur when the ligaments and/or discs connecting two vertebrae together are stretched or torn, the bones may come out of alignment. For example, when the rapid forward motion of the upper body against a seat belt pulls apart the vertebra and stretches the ligaments. A dislocated vertebra can cause instability and spinal cord compression. They usually require stabilization surgery or a brace. Fracture-dislocations occur when bone is broken and the ligaments are torn. These fractures are usually unstable, tend to be very debilitating, and are often surgically repaired. 2.3.2.1 Designing For People With Damaged Vertebral Column: People with damaged vertebral columns are faced by reduced mobility. Even if the damaged vertebral column heals, some effect stay that limit the persons movements. It is essential to cater of the mobility needs of such people otherwise they become dependent on other people.

2.4 Solution - Assistive Devices:

An assistive technology device can be defined as any item, piece of equipment, or product, whether it is acquired commercially, modified, or customized, that is used to increase, maintain, or improve the functional capabilities of individuals with disabilities Assistive devices and technologies such as wheelchairs, prostheses, mobility aides, hearing aids, visual aids, and specialized computer software and hardware increase mobility, hearing, vision and communication capacities. With the aid of these technologies, people with a loss in functioning are able to enhance their abilities, and are hence better able to live independently and participate in their societies. These Assistive Devices endorse the human rights of disabled persons, enabling their social and economic integration in the society for a more productive growth and development of the country. People with disabilities experience greater challenges in attaining and maintaining maximum independence and health. Lack of services creates a barrier to full inclusion and participation in all aspects of life. It is our responsibility as designers and humans to liberate these disables from the challenges they experience by providing them with products that assist their problems and contribute to their normal and healthy living.

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REACHER A Helping Hand 2.5 Assistive Devices - Design Specifications:

CONTROLS
Easy to reach: without the need to bend or stretch. Large enough to grip easily: small fiddly controls put strain on the joints used in bending

fingers and hands.

Non-slippery surface: the greater the friction of the surface, the less force is needed to retain

the grip.
Protruding or raised rather than recessed: easier to locate by touch, and open space around a

protruding control allows it to be operated by swollen and inflexible fingers, or the side of a very weak or painful hand; recessed controls provide limited space for fingers only, requiring a specific grip. Requiring light pressure to operate: this decreases the pressure required from the user's fingers. Avoid controls requiring dual action, such as push and twist: they require continued pressure and twisting at the wrist, painful or impossible for some people. Well spaced rather than cramped or close together: provide enough space around each control for swollen fingers or a hand with tremor. Use some different shapes and sizes: so different controls can be identified by touch. Large clear labelling: use strong colours that contrast against the background colour. Tactile markings: need to be easy to locate and feel, to guide partially sighted and blind people. Provide essential information in different modes: pictorial, tactile, lights and sounds.

STABILITY
Must not tip over easily. Effective anti-slip bases: particularly helpful for one-handed use.

ACCESSORIES

Easy action to connect and disconnect: without the need for precision or strength. Avoid fiddly parts: awkward to set up. Separate storage as an alternative: to reduce the weight of a portable product. Cleaning. Avoid unnecessary markings: they trap dust and debris and make cleaning difficult. Avoid sharp edges: uncomfortable or even painful to touch or grip.

PORTABILITY
No heavier than necessary to lift. Good holding places or carrying handle: well placed, comfortable, space for two hands. Good balance and shape: so that it does not strain joints, nor swing into the person carrying it.

INSTRUCTIONS
Clear, straightforward layout. Clear, straightforward type face. Large type size: 14 point where possible, not below 10 point, and good space between the

lines.
Strong colour print on a light background. Matt paper or with a slight sheen: glossy paper reflects light and is more to difficult to read

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Offer alternative formats: large print (14 point minimum), Braille and audio tape.

2.6 Evaluation And Selection Criteria Of Assistive Devices:

Four key evaluation and selection criteria for long-term users of assistive devices are:
Effectiveness: The extent to which the function of the device improves one's living situation,

functional capability, or independence.

Affordability: The extent to which the purchase, maintenance, or repair of the device causes

financial difficulty.
Operability: The extent to which the device is easy to operate and adequately responds to

demands.
Dependability: The extent to which the device operates with repeatable and predictable levels

of accuracy under conditions of reasonable use.

2.7 Types Of Assistive Devices:

Assistive devices for independence are available to aid in mobility (ambulatory aids), activities of daily living (ADLs), as well as for voice, hearing, vision, and safety. Ambulatory aids (e.g., canes, crutches, walkers) are used to provide an extension of the upper extremities to help transmit body weight and provide support for the patient. Assistive devices for ADLs, as well as for self-care and leisure activities, range from simple objects for daily use (e.g., plate guards, spoons with built-up handles, elastic shoelaces, doorknobs with rubber levers) to complex electronic devices, such as voice-activated environmental control systems. Assistive devices to improve independence can be classified as follows:
Assistive devices for mobility/ambulation Assistive devices for activities of daily living (ADLs) and self-care Assistive devices for voice, hearing, vision, and safety

Impairments and the associated assistive devices that aid in ambulation and mobility include the following:

Mildly impaired balance/stability: Single-point cane. Unilateral lower limb pain/mild weakness: Single-point cane; hold with unaffected side. Moderate impaired balance/stability: Quad cane (narrow or wide base). Moderate to severe unilateral weakness/hemiplegic: Walk cane/hemi-walker. Bilateral lower extremity weakness/paralysis: Bilateral crutches or walker (pickup or frontwheeled). Severely impaired stability: Walker (pickup or front-wheeled). Impaired wrist or hand function: Platform forearm walker. Difficulty climbing stairs: Stair-climbing walker. Impaired bed mobility: Bed rails (half or full); hospital bed (manual or electrically controlled). Difficulty with transfer: Transfer (sliding) board. Difficulty getting up from chair: Seat-lift chair or uplift seat assist.

Impairments and the associated assistive devices that aid in activities of daily living include the following:
Eating: Built-up utensils, universal cuff with utensil hold. Dressing: Button hook, zipper hook, Velcro closure, sock aid, long shoe horn, elastic shoe

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Bathing: Wash mitts, long-handled sponge. Grooming: Built-up combs or brushes, electric toothbrush, electric razor with custom handle. Loss in 1 hand of eating-related functions: Plate guard, rocker knife. Impaired coordination, tremor: Weighted utensils. Impaired range of motion (ROM) of shoulder, proximal weakness: Reacher (reaching device). Impaired mobility for toileting: Bedside or rolling commode, raised toilet seat, grab bars around toilet. Impaired mobility for bathing: Tub transfer bench, hand-held shower, grab bars on tub or shower; shower chair. Impairments and associated assistive devices to aid in communication include the following:

Difficulty holding pen to write: Built-up pen or pencil. Difficulty typing: Typing stick. Reading difficulty caused by impaired vision: Magnifying glasses, talking clock or watch. Difficulty dialing and using phone: Push-button dialing or 1-touch dialing with speaker phone; voice-activated phone. Difficulty calling for help: Simple buzzers or other signaling devices operated by switches that require minimal pressure; medical alert system, such as Life Alert.

2.8 Assistive Devices - Materials:

The material is the first thing you need to keep in mind because this can guarantee you its life span. The stronger the material is the more will the products last. There are many different types of materials that have been used such as metal, plastic, acrylics, glass, wood etc. Choosing the material is important as it plays a very vital role in making the product look attractive and also assures its safety.

2.9 Introduction To My Product Reacher:

Many of our loved ones are handicapped or disabled. They struggle to maintain their independence and to attend to the activities of daily living, despite limitations. Reaching aids may lower the possibility of this unfortunate scenario reach, lose balance, fall, and break hip. They allow our loved ones to reach high and bend low without assistance. The popular term for these devices is reachers and grabbers. There is a wide array of reaching aids: Reaching devices with rotating claws and magnetic heads Reachers with optional wrist support Reachers that hook onto walkers and canes Folding reachers Toilet aid reachers Long-handed reachers

Reachers are useful if you have difficulty reaching clothes that are placed too high, too low or too far from you. Reachers are also useful for individuals who use a wheelchair, as they can help you take clothes off the closet or pick up objects that are on the floor. Reachers can especially be used by old people as it is difficult for them stretch to reach high and bend to reach low.

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It may also be used by people with damaged vertebral column or people with diseases such as Cervical Spondolysis, Osteoporosis or Osteoarthritis. People with such diseases have limited mobility and cannot stretch or bend or even move like normal humans.

2.10 Assistive Devices - Case Study:

Figure 1.10.1 The Raptor Reacher is a low cost, durable, lightweight, all plastic reacher with a contemporary design unlike other reachers. The jaw opens a full 2 1/2" (6.3 cm) and provides a tight grip on even the smallest items such as coins or bulky items like newspapers, clothing and cans. Raptor Reacher Features:
Durable. Lightweight. Plastic.

Raptor Reacher Specifications:

Jaw opens: 2 1/2 in. Length: 24 in. Weight: 6 oz.

Figure 2.10.2 The 26 inch EZ Reachers with round silicone tips provide a powerful and secure grip with delicate sensitivity. Constructed of lightweight aluminum with a stainless steel spring mechanism for heavyduty use. The handle is comfortable to hold and has an easy-to-operate pistol grip full finger trigger. Page 8

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EZ Reachers will handle objects of different shapes and sizes up to 5 lbs. The jaws open to 4.5 inches wide. 26 inch model weighs 10 oz. 26 inch EZ Reacher Features: Round silicone tips provide a powerful and secure grip. Constructed of lightweight aluminum. Stainless steel spring mechanism for heavy-duty use. 26 inch EZ Reacher Specifications: Lift objects up to 5 lbs. Jaws open to 4.5 inches wide. 26 inch model weighs 10 oz.

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