Following up on the Human Gait

In our last post, we were testing some new techniques and looking closely at ways to make the typical Nursing Unit more efficient. Our first step involved something we are exploring across the board, in many of our current projects: DECONSTRUCTING THE  NURSE STATION.

In other words, we have asked ourselves (and our clients) "Why do nurses sit at desks? Is this still a relevant concept or are we simply replicating past necessity with outdated approaches?".

We have concluded that Nurse Stations are not a necessary element in all Nursing Units, anymore. There are plenty of new/mobile tools that make charting and patient documentation much more efficient, freeing up space and saving cost on traditional millwork expenses.

Now that we identified the opportunity to save space and money, the next challenge is how to intelligently use all this extra space.

In this project our focus has been on the patient first and the visitor second...don't worry the staff are also seeing great improvements in how they utilize space and work within the unit. But in this project we have focused heavily on the amenities that make the visitor's wait and stay more comfortable while they provide the companionship necessary to all patients during recovery. 

Shaping Space, The Human Gait, Technology and Planning for the Future Deconstructing the Nurse Station

PDS was recently faced with an exciting challenge: Convert a 30-year-old nursing unit into an efficient / felxible space, prepared to adapt to the next 30 years of healthcare advancement.  Looking back and looking forward, we find ourselves in a unique place in time.  Behind we see nursing units structured around large bulky stations, crafted to address the needs of the paper chart world.  The present, we find ourselves surrounded by constant advances in the delivery of data.  Data is everywhere.  We access it on our watches, phones, tablets, laptops and occasionally a desk top computer.  The future, we anticipate will further the human mobility of navigating in a world of data; It will be everywhere.  The Cloud will be an ether in which we live, we will be surrounded by data and we believe devices will eventually become integrated into everything we do, who we are, what we are, our spaces, our environments, our clothing, our accessories.  All to facilitate access to our data.

So how do we create a nursing unit that will address the current needs of large mobile computing carts and residual paper as our society transitions to the ether?  How do we create a flexible environment that will embrace the movement to a mobile society that is fluid in its access to data?  How do we understand mobility, stations, visual fields, and layering of space to create flexible environments?

We have begun our study by breaking down the unit through a cohesive study of the human gate and how the users of the space might actually occupy it.  How do we move through space, how do we embrace the fluid needs of mobile access to data? How do we create space where there is none?  We see deconstruction of the past as a solution to creating space for the future.  Removing barriers that are impediments to our being able to embrace mobility and access to data, each other and the patient.  Removing barriers to find space where there was none, to accommodate family members in calming, collective space that supports their needs.

Below you will find our early studies that focus on natural circulation and usage of the residual "negative space" that occurs through deconstruction.  Woven through this space are the path of patients, visitors, nurses and physicians.  Within the deconstruction, we aim to find the solution to the future, mobility and access to data.  Ultimately, we believe this will free us to finally realize the true benefits of technology which will allow nursing to function in a fluid space facilitating patient care and interaction with all involved in the healing process.

 
 

Study Normal Human Walking Behavior

FIG. 1.Stick diagram shows typical body movements during curved walking. Point at the intersection of the dotted lines joining the hip and greater trochanter of left and right body sides in the first stick on the left is the&nbsp…

FIG. 1.

Stick diagram shows typical body movements during curved walking. Point at the intersection of the dotted lines joining the hip and greater trochanter of left and right body sides in the first stick on the left is the body midpoint. Vector represented at the level of the body midpoint indicates the instantaneous heading. Sagittal plane: vertical plane passing through the heading vector; the plane follows the vector's orientation during walking. Frontal plane: vertical plane perpendicular to the sagittal plane.

Grégoire Courtine and Marco Schieppati tested the hypothesis that common principles govern the production of the locomotor patterns for both straight-ahead and curved walking. Whole body movement recordings showed that continuous curved walking implies substantial, limb-specific changes in numerous gait descriptors. Principal component analysis (PCA) was used to uncover the spatiotemporal structure of coordination among lower limb segments. PCA revealed that the same kinematic law accounted for the coordination among lower limb segments during both straight-ahead and curved walking, in both the frontal and sagittal planes: turn-related changes in the complex behavior of the inner and outer limbs were captured in limb-specific adaptive tuning of coordination patterns. PCA was also performed on a data set including all elevation angles of limb segments and trunk, thus encompassing 13 degrees of freedom. The results showed that both straight-ahead and curved walking were low dimensional, given that 3 principal components accounted for more than 90% of data variance. Furthermore, the time course of the principal components was unchanged by curved walking, thereby indicating invariant coordination patterns among all body segments during straight-ahead and curved walking. Nevertheless, limb- and turn-dependent tuning of the coordination patterns encoded the adaptations of the limb kinematics to the actual direction of the walking body. Absence of vision had no significant effect on the intersegmental coordination during either straight-ahead or curved walking. Our findings indicate that kinematic laws, probably emerging from the interaction of spinal neural networks and mechanical oscillators, subserve the production of both straight-ahead and curved walking. During locomotion, the descending command tunes basic spinal networks so as to produce the changes in amplitude and phase relationships of the spinal output, sufficient to achieve the body turn.

Journal of Neurophysiology Published 1 April 2004 Vol. 91 no. 4, 1524-1535 DOI: 10.1152/jn.00817.2003

Early Anatomy and Contemporary Robotics

Towards the end of his life, Leonardo da Vinci was given permission to dissect human cadavers for scientific research at Santa Maria Nuova. The Hospital of Santa Maria Nuova (Ospedale di Santa Maria Nuova) is the oldest hospital still active in Florence, Italy. It was these very studies which laid the ground work for future anatomy documents and literature for educating the surgeons of the world, as well as Leonardo's designs for the world's first robot.

In 2000, the FDA approved a robotic surgical system, inspired by and named after Leonardo's work. Intuitive Surgical states: "...His study of human anatomy eventually led to the design of the first known robot in history. This design, which has come to be known as "Leonardo's Robot," was probably made around the year 1495 but was rediscovered in the 1950s. da Vinci was intrigued by mechanics and automation. He developed a number of mannequins including a mechanical knight."

 

- See more at: http://www.intuitivesurgical.com/company/history/#sthash.rJGrgKOG.dpuf

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