Project

1. DEVELOPMENT OF A SIT-TO-STAND
TRANSFER AID FOR STROKE
HEMIPLEGIC PATIENTS
Joyce Lim Qing Rou H21101125
Ng Nan H21101124
H’ng Wan Theng H21101118
Thum Lee Wen H21101120

2. ABSTRACT
• Transfer in post-stroke patients starting from the early stage is essential to improve their activities of daily
living.
• Sit-to-stand (STS) movement is an important functional task of activities of daily living that is biomechanically
demanding. It is a prerequisite for mobility like transfers, walking and stairs climbing (Lomaglio & Eng,
2005).
• However, stroke patients tend to have a high possibility of fall because of the pathological problems which may
affect their balance, muscle strength, muscle tone, proprioception, coordination, and sensation.
• This results in reliance of the patient on the caregiver/physiotherapist in performing these movement. Improper
transfer technique and/or overexertion by the caregiver/physiotherapist may result in acute injury or chronic
musculoskeletal conditions and may also result in fall of the patient.
• These necessitate the need for a sit-to-stand and transfer device that emphasizes on the safety of both the patient
and the caregiver, its affordability, and its effectiveness and efficiency. The objective of this research is to
design and develop an innovative sit to stand transfer aid that offers assistance for both the patient and the
caregiver during the manoeuvre.
• A cross sectional study will be conducted, and this aid will be tested on 8 stroke hemiplegic patients.

3. 1.1 BACKGROUND
• Hemiplegia is a common consequence of stroke which can be associated with paralysis, spasticity, or
paresis of one side of the body.
• Integrated coordination of bilateral sides of the body is required in sit to stand transfer. However, this
postural control mechanism might be impeded by hemiparesis in stroke patients (Li et al., 2019).
• Incidence of fall is high during sit to stand transfer when compared to sitting or standing alone in stroke
patients with postural control mechanism dysfunction (De Nunzio et al., 2014).
• The greater the involvement of the caregiver in the activities of daily living of the patient and the more time
spent with providing care, the more that a caregiver will experience burden and strain (Bugge et al., 1999).
• Some risk factors have been identified which may contribute to work-related musculoskeletal disorder in
allied health professionals or caregivers during manual handling in sit to stand transfer. These include
restricted space, overexertion of caregivers, awkward and improper posture, distance, behaviours of various
patients. Utilising assisted transfer equipment has been suggested as one of an effective intervention to
reduce WRMD in handling overweight and obese patients (Choi and Brings, 2016).
CHAPTER 1: INTRODUCTION

4. 1.2 OBJECTIVE
• To design and develop an innovative sit to stand transfer aid that offers assistance for both the patient
and the caregiver during the manoeuvre.
1.3 SCOPE OF IDEAS
• Manual approaches to sit to stand transfer are incapable of offering risk-free assistance to both the
patient and the caregiver/physiotherapy.
• Over the years, various types of transfer aids have emerged in the market.
• According to (Lin et al., 2023), although transfer equipment has shown to help the patient to transfer
themselves independently, some of this equipment are not extensively developed and are not fully
efficient in safety during transfer.
• These increase the need to create an assistive device that allows safe transfer under the independence of
the patient, taking into consideration the safety of both the patients and the caregivers, and the product’s
effectiveness and efficiency in transferring.
• In this research, a low-cost, high-stability, and portable aid for transfer assistance will be developed.
This sit-to-stand transfer aid functions as a stable support to assist the patient’s propulsion and balance
when rising to reduce the patient’s dependence on caregivers. The aid is also movable which assists the
caregiver/physiotherapist to mobilise the patient from one place to another.

5. 1.4 DIVISION OF WORK
Joyce Lim Qing Rou Ng Nan Thum Lee Wen H’ng Wan Theng
Preparing project proposal X X X X
Background study X X
Product layout preparation X X X
Purchase of materials X X
Gantt chart X X
Progress Report X X X X
Final Report X X X X
Presentation and Demo X X X X
Table 1: Division of Tasks

6. CHAPTER 2: REVIEW OF LITERATURE
• (Riccoboni et al., 2021) has studied and compared the biomechanical constraints of using a
motorless stand-and-turn device versus manual patient handling.
• Nine caregivers were involved in motion capture and ground reaction forces measurement sessions
for three handling scenarios: manual handling with one caregiver, manual handling with two
caregivers, and motorless device-assisted handling.
• Forces and torques at the L5/S1 joint were computed using Inverse Dynamics.
• The result of the study shown that motorless device-assisted handling resulted in the lowest loads
on the lumbar area, while manual handling with one caregiver imposed the highest loads,
sometimes twice as large as those in the former case.
• Based on these findings, it was recommended that caregivers use stand-and-turn devices whenever
possible during sit-to-stand and stand-to-sit transfers to minimize the physical strain on their backs.

7. • According to (Das et al., 2022), they designed and developed a sit-to-stand assisted device for
elderly and disabled persons. Sit to stand trajectory was done in sagittal plane for synthesis of four
bar mechanism.
• They have found that the time for STS motion with the assistive device is approximately 27s which
is longer compared to without the device.
• The load placed on feet gradually increased to approximately 500N at 17s. And 200N of load was
taken by STS assisted device and it can support 28% of load during STS.
• There are still some limitations as the weight of their device, which is around 10 kg, can be
modified by using lighter materials. Another shortcoming of the device is the inability to adjust the
height according to different patients due to the geometry and fixed joining method.
• A saddle assistive STS device which was designed by (Hojjati Najafabadi et al., 2021) had some
modifications as compared to the conventional assistive devices such as saddle design for weight
support, power equipment installed on the device body, lack of wearing and removing equipment,
and simple setting in the device.
• All these modifications provide convenience, maintain strength of lower extremities, and reduce
the force and torque produced during STS.
• Although the patient is unable to utilise this device independently, the number of caregivers can be
reduced to one person which is not possible in manual assisted STS.

8. • (Asker and Assal, 2019) developed a multifunction robotic STS assisted device to assist STS and
ambulation in elderly population.
• It consisted of several modes which are best effort STS mode, lift and transfer assisted mode, stand
in the upright position mode, and walking mode.
• It was stated that these robotic devices have more capabilities when compared to a traditional STS
assistive device because of the sensing and control system and these were able to assist in STS,
standing, transfer as well as walking.
• However, the limitations of the device were mentioned which are the rigidity and the high payload
capability due to the parallel designed structure.
• (Ha et al., 2022) had designed a sit to stand transfer assistive device and its feasibility was tested
on 10 healthy participants.
• Overall participants were satisfied about the function and level of assistance by the device during
sit to stand transfer.
• However, some limitations such as a nonadjustable knee protective plate, lack of locking device to
prevent sliding, too large size of the device, and difficulty to operate as the inclination of the
support stand is low were pointed out.

9. CHAPTER 3: LIMITATIONS OF THE PRODUCT
1. The overall height of our product cannot be adjusted. In order to compensate for it, the knee
supports and the hand grip parts were designed to be adjustable in order to suit the patient.
2. It is a rechargeable product. After using it, the user needs to charge the electric motor
regularly by using a battery charger so that it can function well.
3. There might be a whirring sound when the electric motor is running. Thus, it may make the
patient or user feel annoyed.
4. The user needs to lock all four of the wheel brakes manually; it might be a little time-
consuming to lock each brake separately.

10. 3.1 BASIC FEATURE OF THE PRODUCT
• A gas trolley will be modified to use as the main body of the product. To enhance the stability of
the base, extensions will be added to the front and back of the base respectively.
• Two lockable wheels are added to the end of the base for ambulation purposes, allowing the
caregiver/physiotherapist to move and control the direction of the transfer aid easily. Each wheel
has a brake control for easy and safe manoeuvring.
• A low centre of gravity and a broad underlying support surface with wheels at all corners can
eliminate the risk of tipping.
• Two knee cushion supports added at the bottom part of the transfer aid which heights can be
adjusted vertically, allowing it to adapt the settings according to the patient's height for their
comfort and for efficient sit-to-stand propulsion.
• To prevent the feet from sliding backward, a raised block will be added on the base plate on the
end of the area designated for the foot placement.
• Two adjustable cushioned hand grips for each hand are added at the upper part of the transfer aids,
providing support for the patient to propel himself up during sit-to-stand. A hand strap will be
prepared for the hemiplegic patients to comfortably secure the hemiplegic hand to the aid.

11. • A lumbar belt which is connected to an electric motor system can be worn over the patient's lumbar
region and under the patient’s Glutes.
• The purpose of the lumbar belt is to compensate for the weak lower extremity and provide extra
support for the trunk. This belt can be adjusted automatically depending on the patient's body size
by using the electric motor which can be controlled remotely with a small device instead of using
human force.
• A car battery is placed in front of the body for charging purposes which weight can be served to
counteract the weight of the patient, making the transfer process even safer and more stable.

12. 3.2 BUDGET ESTIMATIONS
Item Quantity Unit price (RM) Total price (RM)
1 Gas trolley 1 RM 179 RM 179
2 Electric motor with remote control 1 RM 290 RM 290
3 Car battery (12 V) 1 RM 100 RM 100
4 Lumbar belt 1 RM 50 RM 50
5 Hand strap 2 RM 8 RM 16
6 Knee cushion support 2 RM 12.50 RM 25
7 Wheel with brake 4 RM 6.25 RM 25
8 Battery charger 1 RM 40 RM 40
9 Welding workmanship - NIL -
10 Engineering fee - RM 200 RM 200
Total RM 925
Table 2: Budget and Material List

13. 3.3 BIOSKETCHES
Figure 1: Front view of transfer aid. Figure 2: Top view of transfer aid. Figure 3: Side view of transfer aid.

14. CHAPTER 4 : METHODOLOGY
INCLUSION CRITERIA
1. Post-stroke hemiplegic patients
2. Inability to perform sit-to-stand and transfer
independently
3. Age of 50 – 70
4. Ability to comprehend and to follow
instructions;
5. Brunnstrom recovery stage beyond 3 for
lower extremities
6. Muscle power grade 3 or above for the non-
affected lower extremity according to Medical
Research Council (MRC) Scale
7. Intact trunk control to remain upright in
sitting/standing position
8. Good sitting balance
EXCLUSION CRITERIA
1. Acute medical comorbidities, such as recent
myocardial infarction
2. Recent fractures in the extremities
3. Spasticity level 3 and above according to the
Modified Ashworth Scale of lower extremities
4. Contractures of lower extremities.
4.2 DATA COLLECTION METHOD
A single session for the subjects to perform sit-to-stand and transfer
manoeuvre will be carried out.
Outcome measures:
• TSQ-WT (Tele-healthcare Satisfaction Questionnaire – Wearable
Technology) to evaluate the user’s satisfaction with this device
• A self-developed questionnaire for the operator
(caregiver/physiotherapist).
4.1 STUDY CRITERIA
Table 3: Inclusion and Exclusion Criteria

15. 4.3 PROCEDURE
1. The subject will be positioned in a sitting position on a standard wheelchair and the STS transfer aid is
placed in front of the patient.
2. The wheels will be locked, the height of knee paddings and the handheld handles will be adjusted to
suit the subject by the caregiver/physiotherapist.
3. Their feet will be placed according to the markings for foot placement on the base plate and their
knees against the paddings for leg support.
4. A belt will be worn over the patient’s lumbar region and below the Glutes, the length of which can be
elongated from the motor system using a remote controller. (Caregiver/physiotherapist may help the
patient in wearing the belt and/or adjust the length of the belt)
5. Hand strap can be used to secure the hemiparetic arm on the handle for proper grip.
6. Caregiver/physiotherapist will be standing in front of the patient and the transfer aid, holding the top
of the aid and stepping on the front of the base plate.
7. Remote control can be used to shorten the length of the belt which will help the patient to propel to
standing by exerting forces over the patient’s waist and upper thighs.
8. Once the patient has safely come to a standing position, equipment can then be unlocked and allow the
caregiver/physiotherapist to transport the patient with the portable transfer aid.
9. The same procedure may be reversed for helping the patient to sit down.
10.Once the patient has sat down completely and safely, the caregiver/physiotherapist can proceed to
remove the hand strap and the belt off the patient.

16. REFERENCES
• Lomaglio, M. J., & Eng, J. J. (2005). Muscle strength and weight-bearing symmetry relate to sit-to-stand
performance in individuals with stroke. Gait & Posture, 22(2), 126–131.
https://doi.org/10.1016/j.gaitpost.2004.08.002
• O’sullivan, S. B., Schmitz, T. J., & Fulk, G. D. (2019). Physical Rehabilitation, 7e. Mcgraw-Hill Education
Llc., C.
• Li, J., Zhong, D., Ye, J., He, M., Liu, X., Zheng, H., ... & Zhang, S. L. (2019). Rehabilitation for balance
impairment in patients after stroke: a protocol of a systematic review and network meta-analysis. BMJ open,
9(7), e026844.
• De Nunzio, A. M., Zucchella, C., Spicciato, F., Tortola, P., Vecchione, C., Pierelli, F., & Bartolo, M. (2014).
Biofeedback rehabilitation of posture and weight-bearing distribution in stroke: a center of foot pressure
analysis. Functional neurology, 29(2), 127.
• Nyberg, L., & Gustafson, Y. (1995). Patient falls in stroke rehabilitation: a challenge to rehabilitation
strategies. Stroke, 26(5), 838-842.
• Bugge, C., Alexander, H., & Hagen, S. (1999). Stroke patients’ informal caregivers. Stroke, 30(8), 1517–
1523. https://doi.org/10.1161/01.str.30.8.1517
• Hayes, J., Chapman, P., Young, L. J., & Rittman, M. (2009). The prevalence of injury for stroke caregivers
and associated risk factors. Topics in Stroke Rehabilitation, 16(4), 300–307. https://doi.org/10.1310/tsr1604-
300
• Choi, S. D., & Brings, K. (2016). Work-related musculoskeletal risks associated with nurses and nursing
assistants handling overweight and obese patients: A literature review. Work, 53(2), 439-448.

17. • Lin, C.-Y., Masroor, S., Bahrudin, & Bulut, H. (2023). The Design and User Evaluation of Body-Transfer
System via Sliding Transfer Approach for Assisting Functionally Impaired People. Machines, 11(5), 555.
MDPI AG. Retrieved from http://dx.doi.org/10.3390/machines11050555
• Joey, N. C., & Ho Marc, W. K. (2020). Does self-initiated sit-to-stand training with an assistive device regain
the independence of sit-to-stand in stroke patient? A single-blinded randomized controlled trial. Journal of
Rehabilitation and Assistive Technologies Engineering, 7, 205566831986605.
https://doi.org/10.1177/2055668319866053
• Riccoboni, J.-B., Monnet, T., Eon, A., Lacouture, P., Gazeau, J.-P., & Campone, M. (2021). Biomechanical
comparison between manual and Motorless Device Assisted patient handling: Sitting to and from standing
position. Applied Ergonomics, 90, 103284. https://doi.org/10.1016/j.apergo.2020.103284
• Das, S., Halder, S., Sahu, S. K., Srinivasan, S., & Rakshit, S. (2022). Design and Development of a Sit-to-
Stand Assistive Device. In Machines, Mechanism and Robotics: Proceedings of iNaCoMM 2019 (pp. 249-
256). Springer Singapore.
• Purwar, A., Galeotafiore, T., Miles, J., & Renert, J. (2013). U.S. Patent No. 8,468,622. Washington, DC: U.S.
Patent and Trademark Office.
• Jun, H. G., Chang, Y. Y., Dan, B. J., Jo, B. R., Min, B. H., Yang, H., ... & Kim, J. (2011, June). Walking and
sit-to-stand support system for elderly and disabled. In 2011 IEEE International Conference on Rehabilitation
Robotics (pp. 1-5). IEEE.v
• Hojjati Najafabadi, A., Amini, S., & Farahmand, F. (2021). Improving sit-to-stand transition by the saddle-
assistive device in the spinal cord injury: A case study. Proceedings of the Institution of Mechanical
Engineers, Part H: Journal of Engineering in Medicine, 235(7), 735-742.
• Asker, A., & Assal, S. F. (2019). A Systematic approach for designing a multi-function sit-to-stand mobility
assistive device based on performance optimization. Advanced Robotics, 33(2), 90-105.
• Ha, S. H., Jeong, S. Y., Hong, S. K., Choi, W. J., Lee, K. K., Park, D. H., ... & Lee, G. C. (2022).
Development and feasibility test of sit-to-stand transfer assistive device. Journal of Korean Academy of
Physical Therapy Science, 29(1), 41-46.

18. APPENDICES – appendix 1
TSQ-WT (Tele-healthcare Satisfaction Questionnaire – Wearable Technology)

19. APPENDICES – appendix 2
Operator Feedback Form
Item Statement Strongly disagree Disagree Neutral Agree Strongly agree
1 I often have to assist patient in sit-to-stand transfer.
2 I had good initial impression of the product.
3 The product was easy to use.
4 The product was safe to use.
5 The product was able to reduce my workload.
6 I am satisfied with the quality of the product.
7 I am satisfied with the appearance of the product.
8 The features of the product were able to meet my demands.
9 I would like to use this product at home/in the clinical settings.
10 I would like to recommend this product to others.
11 I would like to purchase this product.
12 I believe that this product will improve the quality of my life.
How could we improve our product to better meet your needs?

20. APPENDICES – appendix 3
MAY 2023 JUNE 2023 JULY 2023 AUG 2023 SEPT 2023 OCT 2023 NOV 2023 DEC 2023 JAN 2024
Selection of topic
Thesis proposal development
Proposal draft submission
Obtain university ethical clearance
certificate
Literature survey
Purchase of materials
Design and development of the sit-to-
stand transfer aid
Submission of progress report 1
Submission of progress report 2
Completion of final prototype
Testing of the product among subjects
Submission of progress report 3
Data analysis and result
interpretations
Submission of progress report 4
Work Plan (Gantt Chart)

21. THANK YOU