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1 Table of Contents T Letters to Parkinson s Society of Canada... 1 Reference design... 4 Considered Ideas... 5 Jointed Pen... 5 Pressurized Ink Cartridges Decision Making Process... 8 Key Features Dimensions Inkless Metal Pen Tip Finger Piece Material Selection Body material selection: Finger piece Finger Friction Padding Photographs Future Improvements Simulating Tremors Corrective Pen Design... 20

2 Letters to Parkinson s Society of Canada 1 Letters to Parkinson s Society of Canada Northern_Ontario. htm Hello, we are engineering science students from University of Toronto, St. George campus doing a design project on the handwriting needs of Parkinson s patients. To address the need, we need to better understand the factors that go into the problem, so I have a few questions I was hoping you would answer, and if you are not the department to contact for this inquiry, please forward this to the correct department. What are the major motor related symptoms that make it difficult for Parkinson's patients to effectively handwrite? Please provide a description of how it contributes to the difficulty as well as the degree to which it contributes to the difficulty. Tremor/shaking is one of the major symptoms of PD; although with medication, this can be controlled. Another symptom is micrographia which is small handwriting. Micrographia is small handwriting. As Parkinson's disease progresses, handwritten words become smaller in size for some sufferers. How effectively does the current solutions, such as the Pen Again address the situation? Are there any improvements that you would suggest for the current solutions? Some people learn to practice mindfulness where they think BIG in terms of making their movements larger so their handwriting isn t as small/illegible. See research abstract at the top. Thanks, Jack Xue Good morning, Jack; The Communications (Media) department of the national office forwarded your message to me: our office serves the Toronto area, and I m part of the client services team here. Thank you so much for your , and interest in PD, and I hope I can answer some of your questions. 1. Handwriting can be an issue for people living with Parkinson s disease. There are four cardinal motor signs of PD, which make up the word TRAP: T tremor. Parkinson s tremor is first known as a tremor at rest, meaning when someone moves their hand, the tremor disappears. Later on in the disease it may be more present, and more difficult to write. R rigidity, or stiffness. The stiffness of muscles make it difficult to coordinate movement. This results in a particular handwriting symptom known as micrographia (small handwriting).

3 Letters to Parkinson s Society of Canada 2 A akinesia (without movement) or bradykinesia (slowness of movement). This may impact someone s ability as well, as it can be very fatiguing to finish movement. P postural instability (problems with balance) wouldn t impact writing. 2. The first recourse is medication: levodopa (which becomes artificial dopamine) and other anti- Parkinson's medications work the best on slowness and stiffness, especially in the earlier years. They do continue to work; however, the disease progresses over the years and a person produces less dopamine, and the specialist can only compensate so far with levodopa before side-effects can develop. a) Y shaped pens may be of help to some people, depending on their particular symptoms. As people living with PD have different symptoms, they may have different needs. b) Some Y shaped pens, and regular pens also have a stickier surface, which assists with grip. c) Some people find a fatter pen easier to hold d) Some people may find a weighted pen off-sets tremor 3. There may not be a single PD solution, as symptoms can differ in terms of what people may be able to manage. It must be able to flow smoothly, so it does not take a large amount of effort; easy to hold; and easy to grip. I hope this helps. Best regards, Robert TerSteege Robert TerSteege, CIRS-CAN Information & Referral Associate Parkinson Society Central & Northern Ontario 4211 Yonge Street, Suite 321 Toronto, Ontario M2P 2A9 Office: ext Fax: robert.tersteege@parkinson.ca Dear whomever it may concern, I am a first year student in the University of Toronto Engineering Science program. My team and I are currently developing a writing device that is used to aid Parkinson s patients with writing legibly. We have chosen a few prototypes of the product that we would like firsthand experience and feedback on. Is there any possibility that we can spend some time with a patient that is willing test the prototypes? If not, could you kindly direct us to someone who may help us with this request? Thank you for your time. Sincerely, - Bill (Wen Tao) Zhao

4 3 Hello, Bill; Thank you for your . Would you be working with a Jack on this project? I had a similar question about writing aids from another U of T student. For any kind of research involving clients, we would need a flyer listing what the project is about, whom to contact, etc., as well as confirmation that it has been reviewed by any necessary ethics committee(s). We would then forward on. Due to privacy concerns, we simply can t give you names. Should you have any further questions or concerns, please do not hesitate in contacting me. Best regards, Robert TerSteege Robert TerSteege, CIRS-CAN Information & Referral Associate Parkinson Society Central & Northern Ontario 4211 Yonge Street, Suite 321 Toronto, Ontario M2P 2A9 Office: ext Fax: robert.tersteege@parkinson.ca

Reference design 4 Reference design http://www.penagain.com/ http://penagain.

0mm) Y shaped pens may be of help to some people, depending on their particular

5 Reference design 4 Reference design Price: ~$4.00 Refillable: Each pen comes with 2 extra ink refills worth 1 mile of ink each. Available in blue, red or silver. Black ink is standard, medium point (1.0mm) Y shaped pens may be of help to some people, depending on their particular symptoms. As people living with PD have different symptoms, they may have different needs. Robert TerSteege, Department of communication, Parkinson Society of Canada

6 Considered Ideas 5 Considered Ideas Jointed Pen Preliminary concept model

7 Considered Ideas 6 Detailed concept sketch

7 Pressurized Ink Cartridges http://history.nasa.gov/spacepen.

8 7 Pressurized Ink Cartridges Ink cartridge is built into the base and pressurized to compensate for the lack of gravity pulling the ink down. Similar design to the space pen.

9 8 Decision Making Process Weighted decision matrix Matrix scale, 1 (worst) - 5 (best) Cost of manufacture (5%) Amount of material and manufacturing needed 1: most expensive 5: cheapest Similarity to current pen (5%) How similar the writing style is compared to the conventional pen 1: least similar 5: most similar Maintenance (10%) How easy it is to maintain the product (i.e. refilling the ink) 1: most difficult/troublesome to maintain 5: least difficult/troublesome

10 9 Durability (10%) How long the product can last without running out of ink and/or breaking 1: lasts the longest 5: lasts the shortest Manufacturability (15%) how easy it is to manufacture the product (easier if less materials/moving parts) 1: hardest to manufacture 5: easiest to manufacture Convenience & portability (25%) Ease and convenience of carrying product around 1: least portable 5: can be carried around to most places and used anytime Functionality (30%) How well the design targets/addressed the problem 1: solves the least number of problems 5: solves the most problems

10 Key Features Dimensions http://physicaltherapy.rehabedge.com/tm.aspx?m=61197&mpage=1&key=%ee%bc%8d http://www.dimensionsinfo.com/wallet-size/ Chosen dimensions: 12cm long, 7cm wide, 3.

11 10 Key Features Dimensions Chosen dimensions: 12cm long, 7cm wide, 3.5cm tall Mouse shaped body Computer mouse universally designed to work with all hand sizes Current generation and future generations of Parkinson s patients are only going to become more familiar with computer mice Smooth Surface Allow easy movement of the design Smooth enough to glide over paper Inkless Metal Pen Tip Material: metal alloy tip partially composed of lead that sheds tiny deposits of metal when written with Lasts a lifetime (uses tiny amounts of the metal alloy) Durable (lasts a lifetime) Maintainable (does not use ink, sharpened with sandpaper if needed) Helps portability (smudge-free, does not make marks on skin) No need for an ink cartridge (portability, manufacturability) Valid on legal documents as it is permanent and clearly visible on photocopies Julio Iglesias, Branch Manager

12 11 Finger Piece 1. Stiff The stiffer it is, the more control user will have Dampens the hand tremors Overly stiff finger piece may cause trouble due to muscle rigidity as a symptom of Parkinson s 2. Retractable Helps portability Adjusts to all possible sizes 3. Bendable Lowers the cost and difficulty of manufacture Increases risk of mechanical failure 4. Positioned in the middle Allows both left-handed and right-handed users to use the product distal arm tremors typically oscillate about 4Hz to 12Hz with magnitudes of the lower frequencies approaching 20mm

13 12 Material Selection Body material selection: Narrowed down to plastics, for easier injection shell molding: First applied limits on glass temp > (80 Celsius, above all realistic temperatures for operation and storage): Picked highest impact resistant plastic and lowest glass temperature for ease of molding: PVC rigid high impact, molding and extrusion

13 Finger piece http://ergobag.se/download/mouse%20input%20devices%20and%20work- Related%20Upper%20Limb%20Disorders.

14 13 Finger piece Related%20Upper%20Limb%20Disorders.pdf Since this part will come in contact with the skin, applied non toxic, non hazardous, and food contact filter, also included fresh water resistance since most promising candidates were steel. After zooming into the top left:

15 14 Young s modulus not considered since the cross section of the part is flexible, using calculations with the value of young s modulus: mm thick, 1 cm wide, 8cm long Finger Friction Padding Graphed elastomers against hardness (as a measure for friction) and price with hardness as the primary criterion:

16 15 Quick search confirms that VMQ silicone has a high coefficient of friction:

17 16 Photographs Concept design and metrics

18 17

19 18

20 19 Design process

21 Future Improvements 20 Future Improvements Simulating Tremors The transcutaneous electrical nerve stimulation (TENS) device can be used to selectively stimulate certain muscles responsible for the tremors in affected patients. Various strength tremors may be emulated by changing the pulse width, duty cycle, current, or the electrically-conductive area through which the targeted muscles are stimulated Corrective Pen Design A team at the Northeastern University attempted to solve the same problem. Their approach involves suspending a pen in a magnetic viscous fluid, increasing resistance with respect to velocity.

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