A Piezoelectric Haptic Device to Simulate Human Radial Pulse

Matthew Dennis

School of Engineering, Department of Electronic, Electrical and Systems Engineer ing,

University of Birmingham, B15 2TT, UK
mxd589@bham.ac.uk

Abstract: The Mixed Reality (MxR) Medical Emergency Response Team (MERT) trainer is a
virtual environment that allows MERTs to train in a high fidelity battlefield environment. However,
whilst the trainer possesses a strong visual and auditory capabilities, many users’ have called for
tactile feedback; enabling MERTs to record the pulse of the casualty during training simulations.
This study proposes the application of a piezoelectric haptic device to simulate the human radial
pulse. Piezoelectric tactile displays are low-cost, satisfactory fidelity and controlled using a micro-
controller and signal amplification circuitry. A Bluetooth Low Energy module controls the BPM of
the device and allow MERT trainers to simulate the change in heart rate of casualties in range of
post traumatic conditions. The system performed satisfactorily where user feedback was positive.
The next step will be to integrate the simulator into the MERT trainer and conduct further user
trials.

standard of training is of exceptionally high quality

1 Introduction to prepare teams for the demands that could be
A Medical Emergency Response Team
presented on the battlefield. There have been two
(MERT) is a group of medical personnel trained in
training delivery methods used to prime militar y
providing first response emergency care to combat
medical staff pre-deployment or refresh existing
casualties. The members who make up the teams
MERT personnel which have either proven to be
comprise doctors, trauma consultants, paramedics
“problematic” and/or “limited” in nature [2]. The
and nurses. MERTs treat casualties on board the
first method involved delivering training exercises in
dedicated platform, the Chinook helicopter, used to
live operational aircraft i.e. a Chinook. However, this
transport them to and from the evacuation site and
form of training was unsustainable as it was
military camp to improve the chances of surviva l
“impossible to synchronise” the schedules and
before administering further treatment. In 2010,
timelines of the Deployed Hospital Care and
MERTs handled 1,225 evacuations in Afghanis ta n,
participation of the aircraft [2]. The second method,
with 30 medics on call and on standby for 24 hours
which is currently used, is a ground-based facsimile
[1].
of a Chinook, which has limitations of fidelity
In the height of the military conflict, MERTs compared to that of an operational Chinook and high
provide a specialist service that plays a vital role in overall start-up and maintenance costs of the raw
the welfare of soldiers in the British Armed forces materials used to construct the simulator.
and its allies. It is therefore important that the

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 Stone et al., (2017), highlighted the importance where it is considerably harder to record pulse
of alternative forms of training MERTs, proposing a onboard an operational Chinook. During the flight of
digital simulation solution. Medical teams would use the operational aircraft, the rear cabin exerts extreme
mixed reality (MxR) technology to train in an vibration and the natural movements of the
immersive experience that could maintain the helicopter can disrupt medics recording the pulse of
standard of high-quality training. The solutio n the patient. The radial pulse is of importance to
provides clear economic benefits: where the emergency responders, where circulation and
environment is simulated, the set-up cost will be haemorrhage control is a key component of the
significantly cheaper than the raw materials required Primary Survey to manage trauma on active sites [3].
to create the facsimile. The MxR solution provides a In addition, a pulsating radial pulse implies that the
better logistical approach to training: the system is systolic blood pressure is at least 90 mmHg [4],
not in one fixed location or in operation from allowing first responders to gain critical insights into
competing demands. Upon construction of the the casualties’ condition with minimal equipme nt
simulation concept, user feedback gained from initia l and time. Stakeholders in the initial feedback,
tests was positive [2] as testers praised the system therefore, have called for the ability of the medical
highly for its high-fidelity audio and visual feedback. team to check the radial pulse of the casualty through
The concept included a scaled Chinook VR Model a tactile pulse simulated within the system. A small,
and allowed a range of training exercises to be remote controlled device designed to impleme nt
successfully completed in conditions like that of an high fidelity tactile feedback could potentially be
operational aircraft [2]. integrated into the SimMan, simulating the human
pulse. This would allow MERTs to exercise the
Whilst the MERT MxR training simulator has
correct method of recording pulse during training
received positive user assessment of its capabilities,
and observe the effect of external factors commonly
one criticism of the system is the fidelity of tactile
experienced on the battlefield e.g. shock or blood
feedback in certain areas. The system simula tes
loss.
tactile feedback when the user interacts with a
casualty digitally mapped to a training manikin 2 Literature Review
(SimMan), medical equipment and other members of The following section of the report discusses
the team. However, the only method through which the research completed that contain relevance to the
the medical responders can check the pulse of a deliverable of this project. The first area of research
casualty is through an in-simulation monitor that completed was the application of Human Factors
displays vital life-signs. This is a potential issue methods, user-centred design and their importance to
regarding the fidelity of the training experience the project to create a user focused device. This is
followed with review on Haptic Interfaces and the

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potential hardware required. Computer haptic complete redesign [5] if humans cannot use the final
rendering techniques complement tactile devices product.
where the software libraries used model and deploy
2.1.2 Human-Centred Design
a tactile interface are evaluated. To recreate a high-
Human-centred design is an approach which
fidelity pulse, it is paramount to complete research
aims to make systems usable by focusing on the
into the biological field of blood flow, palpitatio n
user’s needs and requirements through the
and its response to a haemorrhagic shock that could
application of human factors, usability knowledge
occur in the battlefield in addition to previous studies
and techniques [7]. The design approach is
that have simulated pulse through artificial methods.
standardised by the British Standard BS EN ISO

2.1 Human Factors and Human- 9241-210:2010 where the benefits of its applicatio n
Centred Design to systems are listed below:

2.1.1 Human Factors  Improved user experience

Unanticipated human behaviour in systems  Reduced discomfort and stress
can create problems that can render them less  Ease of understanding and use, thus
capable than planned. The end deliverable is reducing training and support costs
primarily intended for human use, where human  Increased productivity of users
factors must be considered. This is because varied
problems can manifest and remain undiscovered Following the standard throughout the design
during the design and review phases [5] of a system process of the project will increase the likelihood
when the physical and cognitive limits of the human that the device will be able to integrate seamlessly
are not anticipated. These issues in design are known with the work environment (MERT trainer) of the
as Human Factors problems. Human Factors or end-user.
Ergonomics is a science based discipline that Figure 2 illustrates that the BSI standard
combines physiology, psychology, engineering and proposes four linked human-centred design activities
statistics [6]. Human factors methods are used as that are non-linear, iterative and interdepende nt
tools throughout the design process to mitigate the when developing a system. The first human centred
problems that a user potentially may create and design activity requires the design authority to
ensure the design is user focused. Methods include understand and specify the context of use i.e.
interviews, questionnaires, task analysis and more to defining the system environment, stakeholders and
gather data from the end-user and integrate into the their characteristics, goals and tasks. This is followed
project. Considerable time, effort and expense can be by the second design activity to specify the user
saved where these methods are implemented earlier requirements. This enables the design authority to
into the design stages, rather than having to face a

3
evaluate future design solutions against the needs of  What are the benefits of using a haptic
the user. The activities are repeated iteratively where interface?
appropriate until a designed solution meets the user  What type of haptic interface is
requirements. required; Kinaesthetic or Tactile?
 How will the interface be designed
mechanically?
The benefits including a haptic interface to
improve the existing MERT training simulation has
been described previously in this report. A “pulse”
that medical emergency response trainers can utilise
whilst training will vastly improve the fidelity of the
training experience in the MxR system. Therefore, as

Figure 2 – Interdependence of human-centred the training experience becomes more realistic, the
design activities - [7] chance of the trainees transferring their skills to the

In the context of the project, the first design real-world will increase [8].

activity has been completed, where the environme nt

2.2.1 Tactile and Kinaesthetic interfaces
and stakeholders have been determined by Stone et Haptic interfaces display forces to a user
al., (2017). However, the user requirements and through the use of motors or actuators and therefore
design solution remain outstanding activities to be simulate the feel of physical objects [9]. “Haptic” is
finished. Multiple iterations of the design process a general term that includes both tactile and
will not be made during the project, however, the kinaesthetic displays. A kinaesthetic haptic interface
first iteration of the haptic device will be evaluated is defined as a device that allows the user to perceive
against the original user requirements to propose force internally, within the muscles and tendons,
future solutions and implementation. allowing the user to assume “presence” in the virtua l
environment [8]. A tactile haptic interface stimula tes
2.2 Haptic Interfaces
the tactile sensors in human skin to allow the brain
The radial pulse provides information through
to perceive vibration, pressure and touch [8].
the sensation of touch about the heart rate, blood
Therefore, the haptic interface that will be selected
pressure and haemorrhagic shock to MERTs. The
to develop from throughout the project will be tactile.
pulse simulator, therefore, requires a haptic interface.
Kinaesthetic devices require greater aptitude in
To create a haptic interface Kotrum, 2008
mechanical design to create and operate than tactile,
recommends the designer must answer the following
and their implementation would be excessive to
questions to implement the approach:
represent a pulse. Furthermore, existing kinaesthetic

4
systems are made from probe/joysticks devices or Furthermore, control of pneumatic actuators without
exoskeletons and are “grounded” and “non-portable ” the use of bulky and expensive control values can be
[8]. This has the potential to create diffic ulty difficult [11]. The pulse simulator will be required to
integrating the interfaces into the existing MxR be used throughout the MERT training schedule
system. Tactile interfaces are generally smaller, hence it is essential the device must be robust and
cheaper and less invasive than their kinaesthetic suitable for long periods of time. Therefore, the
counterparts. In addition, Kotrum (2008) bladder actuator is unlikely to be an appropriate
recommends that tactile devices are more suited to option to create the simulator.
simulating simple cues, including a radial pulse. Vibrator actuators can be controlled with
greater accuracy and are more reliable than bladder
2.2.2 Mechanical components
actuators [10]. The actuators can also be used to
The components used in the mechanical design
create pressure and thus hold the potential to
must be of high quality to ensure the fidelity of the
simulate a pulse. The actuators are also smaller,
pulse is realistic to the trainees. Kotrum (2008)
cheaper and more commercially available than
recommends the actuators used in the simulator must
bladder actuators. This makes them more likely to fit
be of a high power to weight ratio, high torque force
within the budget available for the project.
output and have a large frequency range in which
A very common tactile display is the pin array
forces can be created (bandwidth). The pulse
[8] due to the response time of the actuator, degree
simulator requires an actuator with a high power to
of control and fidelity. However, this device is not
weight ratio because a smaller device creates a less
available from any electronics distributors or
intrusive interface in the MxR trainer. The
commercial outlet at the time of writing. Many pin
bandwidth of the actuator must also be high, where
array devices have been proposed in academic
it will be required to represent a range of frequenc ies
research [12-15], where they have been custom-
when the pulse rises and falls depending on the
made for their respective investigations. Therefore,
condition of the causality. A wide range of actuators
whilst this device remains an option to create a haptic
are available to create tactile displays includ ing
actuator, it is very likely it will be the most expensive,
bladder, vibrator and pin actuators.
time consuming and academically demanding
Bladder actuators use pneumatic or hydraulic
technical choice to construct.
compression to control the flow of a fluid (gas or
liquid) in a pocket that creates a sensation of force
2.3 Haptics in M edical training
[10]. However, Sherman & Craig (2002), describe simulators
that bladder actuators are hard to maintain over long Medical simulators are widely used to

periods of time, have unfavourable response time by enhance the training experience of paramedics,

design and difficult to tailor for multiple users. doctors and nurses. Therefore, the fidelity of the

5
haptics must be of a high standard [16] to ensure the Medicine to diagnose various diseases. The
transfer of skills from the training simulator to the components of the simulator were enclosed in a
real-world. Varied attempts aimed at creating haptic silicon artificial wrist model, where a pressure sensor
pulse simulators have been researched, where their placed on the outside determined the force output of
conclusions are important to consider. the solenoids as shown in figure 3. A similar device
One investigation demonstrated a haptic pulse would not be suitable for use in the MxR trainer,
simulation of virtual palpitation for the use in where modifications to the existing SimMan would
medical training [17]. The trainer allows the user to have to be made to integrate the device due its larger
interact with a virtual human body through a virtua l size. Therefore, this research has shown that a
proxy [18]. A collision detection algorithm creates a solenoid or DC actuator component cannot be used
haptic response when the user is within range of the in future design solutions.
areas of the body that pulse can be recorded (radial, The final investigation discussed in this paper
brachial, femoral etc.). However, whilst the product explored the use of three different (piezoelectr ic,
of the research is similar this project, it does not micro-speaker and pin array) tactile interfaces to
consider how blood flow and haemorrhagic shock simulate the femoral pulse [20]. A pin array
would affect the heart rate of the causality. developed by Salford University [15] was able to
Furthermore, the haptic device used to create the precisely manipulate the position of the pins at high
pulse feedback was kinaesthetic and grounded and is frequency, force and displacement. Although the
not suitable to integrate into the existing MxR trainer device received very positive feedback a
for factors discussed previously in section 2.2.1. disadvantage of using this device is that it is very
expensive to produce. Micro-speakers were tested,
however, it was found that they do not produce
enough force to warrant a palpable pulsing sensation
to the user. The final tactile interface used was a
piezoelectric pad that produced pulsing sensations
that proved to be “compelling”. The major
advantages to this tactile interface is that they are

Figure 3 – Schematic diagram of the pulse low-cost, very small (therefore able to easily
simulator - [19] integrate with the MERT trainer) and can be driven

Another investigation simulated radial pulse by microcontrollers with amplification circuitry. At

through the use of microprocessor controlled the time of writing, multiple piezoelectric technica l
options are available through online electronics
solenoids [19]. The device allowed users to learn the
patterns of pulse referred to in traditional Chinese distributors at low-cost. Due to its lack of

6
disadvantages and research showing that the material
can produce a satisfactory level of fidelity, the
project will be based around the use of a
piezoelectric tactile device.

3 Solution
- Piezo
o TDK
- Amplification
o Op-Amp
- DAC
o R2L ladder
- Microcontroller
o Arduino
- BLE
o Bluetooth module

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Conclusion
http://userlab.usask.ca/papers/EuroHap06.pdf
[You could use ISO standards in future??]

Acknowledgements

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 [10] W. R. Sherman and A. B. Craig, Understanding
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