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					Human Factors Evaluation of I-BiT™ Prototype Development

The early research prototype of the I-BiT™ system needed development to produce a
manufactured prototype suitable for commercialisation. Carleton Ltd recruited
I4innovation to help. The research and development process involved collaboration
between the designers, developers, researchers, clinicians and patients to ensure a
practical, comfortable and easy to use end product. Members of the I-BiT research
team worked with colleagues from the Institute for Occupational Ergonomics at the
University of Nottingham to conduct human factors evaluation of the prototypes.
Clinicians and Consultants from the Orthoptic Department, QMC, Nottingham
reviewed each prototype and provided feedback on aspects relating to use with
patients in clinic. The pictures below illustrate this phase of the development process
and show how the final prototype has been ergonomically designed to suit the needs
of different types of patient users.

Research prototype
The research prototype was built to test feasibility and proof of concept of the
research idea. Very little funding was available at this stage and so the prototype
consisted of a PC screen and viewer hood mounted inside a wooden box (Figure 1).
The patient was required to look into the viewer hood to view the game. A height
adjustable chair was used so that the patient could be presented at the correct height.
They were also required to keep their head still to view the display correctly. This
seated position was not comfortable beyond many minutes and patients found it
difficult to keep still. This could mean that they were not viewing the display with
both eyes and so would not be receiving appropriate treatment.

                               Figure 1: Research prototype

Manufactured prototype version 1
The I-BiT system needed to be suitable for use by adults and children. It was
important therefore to include a facility for height adjustment. A purpose built viewer
box was constructed allowing the patient to view the display by looking straight ahead
into the box (Figure 2). A chin/forehead rest was mounted on to the table to support
head position. Published anthropometrics data were used to determine the range of
adjustment needed to accommodate adults and children (Figure 3). The patient sat on
a height adjustable chair and the height adjustable table was positioned so that the
chin/forehead rest supported the head in a comfortable neutral position (avoiding neck
strain). A monitor screen was built into the side of the viewer box to allow the
clinician to set up treatment parameters and view patient interaction with the game.

                             Figure 2: Purpose built prototype

                    Figure 3: Table adjustments for adults and children.
Human Factors evaluation of this prototype identified a number of further
modifications required to ensure patient and clinician comfort. The height adjustable
table allowed presentation of the viewer at the correct height for adults and children
but created different postural concerns. Adults could not position the seat close
enough to the table to allow them make use of the chair back support and needed to
place their feet on either side of the height adjustment column. Trying to get close
enough to the viewer also meant that the table was sometimes pressed against the
upper part of the chest. Children needed to perch on the edge of the seat to get close
enough to the viewer and the table was sometimes pressed against the abdomen.
There was also not enough room for them to hold the interaction controller on their
laps as the adults could, and so they had to place the controller on the table and then
reach up to hold and control it. Fixing the viewer on the height adjustable table also
caused some problems for clinicians. When the system was set at the lowest height
for children, they would have to crouch over the keyboard to control the interface
(Figure 4).

                      Figure 4: Uncomfortable position for clinicians.
Feedback from the clinicians was generally positive, as the system now looked liked
an impressive piece of ophthalmic kit. However, they raised the issue of discomfort
for clinicians and also concerns that children may not be able to sit at the viewer for
sufficient viewing time (30 minutes). Clinicians also considered it very important for
the system to be more portable and take up less space.

Manufactured prototype version 2
The Manufacturing developers took on board comments from the Human Factors
team and clinicians regarding design of version 1 and this lead to the development of
the second manufactured prototype.

                                Figure 5: Second prototype
This second prototype was completely different in appearance to the first (Figure 5).
The viewer was mounted on an extending arm, which was remote controlled. The
extending arm meant that the patient could sit comfortably in the chair, using the back
support, with the display viewer presented to them at a comfortable position. The chin
rest was no longer needed and there was plenty of room beneath the box allowing the
patient to sit comfortable in the chair holding the interaction device on their lap The
flexibility of position control for the viewer control meant that any height or angle
presentation could be produced (Figure 6). If required the patient could be fully
reclined or if in a wheelchair this would not present a problem. The tilted computer
screen also meant that the clinician had an option of either standing or sitting whilst
the patient was being treated (Figure 7).

                           Figure 6: Flexible position of viewer.

                       Figure 7: Comfortable position for clinicians.
Feedback from the clinicians, both in-house and those viewing the system at the
Royal College of Ophthalmologists’ Annual Congress (Birmingham 2005) was much
more positive. They liked the smaller design, ability to present the viewer at different
angles to the patient, the workspace provided for the clinician including virtual
keypad and tilting monitor screen. However, it was noted that clinicians who work
within small units have very limited treatment space and so an even smaller version
would be desirable. The manufacturers have taken this on board and are now working
towards producing a more compact version.

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