Our project begins with literature review to establish baseline weighted decision matrices and preliminary c-sketches to validate with our user. Designs were then screened against requirements and affirmed by iHPs before extending it to the greater MSK community.
DBTL #1
Using our literature review, we determined what are likely to be our user’s needs.
We built the WDM by determining design requirements, and choosing weights associated to the literature statements based on what needs were found most often.
We had our WDM evaluated by our co-PI.
We learnt from our co-PI that the next decision framework most go further into detail regarding quantitative testable requirements. We also finally met with our stakeholder, which taught us her specific needs for the design.
Decision Framework #1
At this point in the project, as we did not have a user to work with, we decided to first understand the gaps in pipette design with respect to the biomechanical basis of WMSDs and have a baseline set of C-sketches. To do this, we made a mock weighted decision matrix (WDM) and made the symptoms associated with WMSDs into immediate needs of a potential user, and the necessary qualities needed for the pipette to fulfill these needs was attributed to User Requirements. Weights were given to each requirement based on the frequency in which each term appeared in the literature and ranked in the same way (Table 1). Based on the literature and user requirements, multiple c-sketches were drafted and ranked according to the weighted decision matrix.
Table 1: Nested Weighted Decision Matrix of Functionality
(Literature-based) User Statement
Associate User Need
Associated Requirements
Weight
Repetitive tasks stimulate pain and strain in my wrist/hand/arm.
Avoid undergoing prolonged repetitive motions with the pipette
Engaging different muscles to dispense/draw solutions
28%
Prolonged wrist/forearm extension
Reduction in wrist extension for dispensing solutions
Holding neutral wrist position
24%
“Forceful tasks stimulate pain in my hand/wrist/forearm”
Reducing the pressure needed to handle the pipette
Reducing the pressure required to turn the pipette knob or press down
20%
“Strong gripping intensifies my hand/wrist pain.”
Reducing the need for extensive gripping
Increasing the surface area of pipette body, to reduce amount of grip tension needed
16%
“Mechanical stress on the palm”
Reduce pressure on the palm and associated areas.
Consider ergonomics in our design to better fit hand shape
8%
“Forward bending of the wrist (carpal tunnel syndrome) causes pain in my wrist”
Reducing the need to rotate the hand in case solutions need to be dispensed/drawn up from different angles.
A rotating pipette tip
4%
Co-PI Feedback
After having a discussion with Dr. Usprech, we realized our initial weighted decision matrix was lacking quantifiable requirements and did not include justifications for the weights associated with the criteria, so we knew we needed to explore the specific values of how to precisely test for the user requirements in the WDM.
Dr. Jenna Usprech
Co-Principal Investigator, PhD, PEng, Associate Professor of Teaching, SBME, UBC
User conversation
After a long process of searching for a user, we finally found one and had our first meeting with her. Based on the designs and literature search and the first interview with our user was conducted. Her consent was granted prior to the commencement of the interview, and interview questions amalgamated based on the literature were asked of her. The full profile and experience of the interview is as follows:
Our user is an undergraduate student occupied in wet lab work. She had experienced temporary paralysis in her wrist from the repetitive tasks of writing and baking, which highlights that an injury can happen to anyone. After resting for a period of time, her wrist healed; however, painful, numbing and tingly sensations still recur when she performs certain straining tasks, especially while performing work in the lab. Her story is invaluable in showing that musculoskeletal disorders can arise in anyone, and we need to be prepared to support the professional and personal goals of individuals occupied in wet lab who face these physical barriers.
User
User Interview #1
We wanted to first understand the physiological profile of wrist paralysis, so we asked the sensations she experienced in light of her MSK: she described tingly, numb, painful sensations that goes up from her hand to her forearm. Based on the literature, we had understood that a lack of sufficient rest time is a pertinent issue within the workspace, so we wanted to understand whether this stretched to the wet lab in our user’s case.
She said that she required using lighter pipettes or she would get pain around her wrist. Our perspective was magnified to capture a bigger idea that in the absence of proper ergonomics and equipment adaptations to meet the needs of paralyzed individuals, painful symptoms can return and interfere with that individuals work and mental health.
She explained that her wrist strain is always in the back of her mind. We then wanted to further understand what tool in the lab caused discomfort to her the most and in what way; thus, we proceeded to discuss how micropipettes can worsen symptoms. She described that the repetitive nature of ELISA work at her lab and the heavy weight of multichannel pipettes stimulated pain and discomfort in her wrist, so she would either wear a wrist brace every time such work had to be completed to immobilize it or use lighter pipettes if available. She also touched on the awkward posture she rests her wrist in, and recognizes that a more neutral posture, such as a straight wrist, would likely relieve some of her strain. To minimize wrist rotation, she highlighted the rotating tip of multichannel pipettes to be helpful for her. This helped us understand what modifications need to be made to our current knowledge from the literature and gave us a more tangible comprehension of social implications associated with MSKDs. After our first user interview, we decided to change our user needs and requirements to fit her specific needs and modified what we had learned from the literature. We combined the previous WDM we had made from the literature review with our user’s statements to produce a WDM that specifies her needs (Table 2).
DBTL #2
We created C-sketches of different possible designs that targeted the needs we learnt about from the literature review and from our user discussion,.
We created a combined weighted decision matrix (WDM) by using the advice from our co-PI, Dr. Jenna Usprech, and incorporating our users needs alongside the literature review.
We tested the C-sketches by evaluating them against the WDM we had built. All our designs failed so we had to then perform another screening of new C-sketches.
We learnt what aspects of the designs work and don’t work, which will inform our next cycle of C-sketches. As well, we had 3 iHP conversations to help inform the following steps to of design.
C-Sketches Round #1
Based on the responses of the interviewed user, the first round of designs with regards to the literature review was amended to meet their specific needs of the user. Preliminary screening was performed and all designs failed with the addition of factors such as weight of the pipette, with further emphasis on repetition.
Table 2: Round 1 Design Descriptions
Design
Description
A
Hook that goes around the hand for better support so the user can loosen their grip.
B
Lever (with opening so you can see pipette type) to reduce extension of thumb, and a longer lever reduces force.
C
Ergonomic hand mold to loosen gripping and alleviate force in palm.
D
Hand rest to reduce strain.
E
Using magnetic strips to keep pipette attached to hand under a glove to reduce grip and provide better support.
F
Wrist brace with extension for pipette to sit in to help stabilize wrist and keep in neutral position, and alleviate weight of pipette.
G
Lever to provide somewhat more support and guidance to how the pipette is held.
H
Provide a platform to guide the hand and further secure it to prevent wrist bending.
I
A soft fabric with an increasing width that results in reduced grip as the hand wraps around the pipette. Has, along the pointer finger, guiding ridges to provide more support. Reduces tension on the hand and cushions the palm to reduce pain.
J
An add-on to Design I to reduce the bending of wrist as the pipette is gripped onto. The platform will force the user’s hand into a streamline path as inspired by wrist-immobilizing CTS casts and they will use their shoulder to get the pipette back up again; they simultaneously are using different muscles and avoid repetition and also experience reduced gripping due to both the platform and the pipette cast.
Combination of pipette and add on must remain as close to the lightest multichannel pipette as possible
28%
2
”Strong gripping intensifies my hand/wrist pain.” (R)
Reducing the need for extensive gripping
Increasing the surface area of pipette body, to reduce amount of grip tension needed
Decreased grip strength needed compared to regular pipette.
24%
3
Repetitive tasks stimulate pain and strain in my wrist/hand/arm. (R)
Avoid undergoing prolonged repetitive motions with the pipette
Engaging different muscles to dispense/draw solutions
Option to use 2 different muscles groups/positions
20%
4
Prolonged wrist/forearm extension and “Forward bending of the wrist (carpal tunnel syndrome) causes pain in my wrist” (R)
Reduction in wrist extension for dispensing solutions and Reducing the need to rotate the hand in case solutions need to be dispensed/drawn up from different angles.
Holding neutral wrist position or a supportive platform
Wrist shouldn’t overexert from the angle of 180 +- 20 degrees
16%
5
”Mechanical stress on the palm” (N)
Reduce pressure on the palm and associated areas.
Use soft material
Material must be more compressible then the pipette plastic
8%
6
”Forceful pushing of pipette knob stimulate pain in my hand/wrist/forearm” (N)
Reducing the pressure needed to handle the pipette knob
Reducing the pressure required to turn the pipette knob or press down
Decreased force used when pressing pipette knob compared to regular pipette
4%
(R) = Requirement
(N) = Nice to have
Screening #1
Almost all of our designs failed after screening based on our user’s needs, and we decided to focus on the following elements for round 2 of our c-sketching based on what we had learned from our user: repetition, rotating add-ons, lightness in weight.
Table 4: Screening Table - Round 1
Design
Pass/Fail
Reasoning
Benefits
A/G**
Fail
wouldn’t help with repetition; wouldn’t affect wrist rotation; lightweight
Helps with stronger gripping
B
Fail
wouldn’t help with repetition; could invoke awkward bending of the hand
can help with repetitive tasks; Reduces extension of the thumb; could help with wrist rotation; lightweight
C
Fail
won’t actually alleviate any strain/weight on hand; wouldn’t help with repetition; heavier
Reduces awkward bending of the wrist; less gripping needed; wrist is in more neutral position would help with pain from wrist rotation
D
Fail
won’t actually alleviate any strain/weight on hand; wouldn’t help with repetition; wouldn’t reduce any pressure on palm; would be heavier
wrist is in more neutral position would help wrist rotation; kind of alleviates strong gripping; reduces awkward bending of the wrist
E
Fail
won’t actually alleviate any strain/weight on hand since extensive pressure stays the same; uncomfortable having magnetic strips; wouldn’t help with repetition; wouldn’t help with wrist rotation; wouldn’t help with wrist bending; could be heavier/lighter based on materials/dimensions we choose
Reduces gripping (additional force between hand and pipette) would cause less pressure on your muscles to keep pipette in your hand
F
Fail
doesn’t alleviate force; maybe if it was more of a brace and went further up arm
alleviates repetition (put it down less); could reduce gripping; could reduce wrist roation (brace-like?) and neutral position; would alleviate weight (if you’re using other muscles)
H
Fail
Repetition; doesn’t aid in stronger grip; excessive pressure
rotation of hand is in a better place; aids in preventing awkward bending; lighter design
I
Fail
repetition; foam material on it’s own can’t be sterilized; rotation of hand is in a better place; doesn’t aid in stronger grip; excessive pressure; aids in preventing awkward bending; lighter design
Rotation of hand is in a better place; doesn’t aid in stronger grip; excessive pressure; aids in preventing awkward bending; lighter design
J
Fail*
Foam can’t be sterilized
Engaging different muscles can reduce repetition; rotation of hand is in a better place; somewhat aids in stronger grip; excessive pressure; aids in preventing awkward bending; lighter design
**Due to their similarities, design A and G were combined
iHP conversation
To broaden the scope of our pipette, we conversed with Dr. Backman about how arthritis pain and discomfort can be alleviated through ergonomics. Dr. Catherine Backman is an occupational therapist and has served as the President of the Association of Rheumatology Health Professionals. She has worked with arthritic patients for many years, bridging her experiences with respect to these patients to occupational interventions; something we hope to do through our inclusive lab design project. We hoped to gain insight into the medicine behind arthritis which, in return, enables us to consciously design our pipette add-on such that it addresses a larger demographic of musculoskeletal disorders. But it was also important for us to understand the psychosocial aspect of arthritis and address our gaps in knowledge after having done some preliminary research.
Dr. Catherine Backman
PhD; Professor Emeritus, Occupational Science & Occupational Therapy, UBC and Senior Scientist Emeritus, Arthritis Research Canada
We first asked Dr. Backman about what arthritis encompasses and what kinds of struggles each subtype of arthritis brings. She described that there are many, but more prominently, osteoarthritis and upper-extremity rheumatory arthritis have the following profile, respectively: weakness in the base of the thumb (stability issues), and distal/NCP/wrist joints wearing off result in rheumatory arthritic people being unable to make a complete fist. However, she added that all of these vary based on the individual; for example, different people have varying losses of range in motion and varying degrees of fingers, hands, and joints can be affected. We then went back and forth in describing our designs and asking her for more concrete examples of tasks that would ignite pain for arthritic patients. She first underlined that repetitition cause discomfort and worsened symptoms; once we shared with her that we hope to address this by using shoulder muscles to dispense instead of the wrist (Design J, Round 1), she supported the idea by saying that “they actually recommend shoulder bags instead of hand bags!” In other words, using different muscles/fingers/posture/tasks would reduce repetition, confirming our notion in one of our primary designs, it is about energy conservation while using a larger muscle to use less force for the same task. As for gripping, she described that some patients experience numbing of hands and weakness in the thumb with rheumatory arthritis which makes them unable to sufficiently grip onto objects. As we brainstormed with her, she suggested a squeezable material and larger surface area to be helpful as well as a rougher, textured surface, she had seen arthritic individuals liking wearing gloves because it reduces skidding, as their neuropathy or parestesia causes numbing in the hand. She finally added that our approach is good, given the broad set of arthritic symptoms, in thinking beyond one person and think how to maximize the tasks that can be done.
These were incredibly helpful for us design-wise, but we also wanted to better understand arthritic patients within a larger society. So we asked Dr. Backman about the social dynamic of people with arthritis. She highlighted that our society is dismissive of the day-to-day struggles arthritic individuals experience; it is seen as a disease that only affects the joints, whereas it can be systemic and affect many different bodily functions such as the immune (inflammation), respiratory and nervous system. Medications often take a toll on people’s mental health and with the society’s existing ignorance, arthritic people have to juggle their work while shielding their pain so they are not seen as an inconvenience which can be exhausting. We need to think of arthritis as something that can happen to anyone, and employees need to cultivate an environment that is inclusive of everyone who is at risk of or already has arthritis. It is not a one-off thing.
We decided to focus on incorporating the suggestions Dr. Backman gave into our designs: maintaining the idea of increased surface area (Design J, Round 1), but also adding a textured surface to reduce skidding, using a squeezable, light-weight material and leveraging the idea of wrist extensions that drive the user (subconsciously) to using their shoulder muscles instead of their wrist to use less force and experience less repetition. But now we also understand a broader perspective of arthritic patients experiences within the society, and checking our potential biases despite having done a literature review was incredibly valuable. These qualities were used in our next screening with a second round of designs to leverage a design over another given that they address arthritic patients’ needs.
