Introduction
This project is about designing a tailor-made hand orthosis for hand support of patients with Amyotrophic Lateral Sclerosis (ALS) -Limb onset to increase independence during desired activities. According to the National Institute of Neurological Disorders and Stroke (2014), ALS, is a progressive neurodegenerative disease which attacks motor neurons in the brain and spinal cord. This results in the wasting away of muscles, by which they are weakened. Patients gradually lose the ability to move, speak, swallow, and, eventually, to breathe unaided within an average of two to four years after the onset of the symptoms (Andersen, P. M., Abrahams, S., Borasio, G. D., de Carvalho, M., Chio, A., Van Damme, P., Weber, M. (2012).
Discover
According to the ALS Association (n.d.), ALS limb onset starts with distal muscle weakness (further away from the heart) and gradually move in the proximal direction (closer to the heart). This means that in most cases, finger strength is lost before weakness in the wrist appears, which is followed by loss of power in the arm. This study starts by evaluating if an arm balancing exoskeleton contributes to performing activities of daily living (ALDs) for ALS patients. However, not being able to control hand movement causes patients not being able to perform essential ALDs. An arm exoskeleton which lacks hand support will not contribute.
Prominent problem
Patients become highly dependent on the care of informal caregivers and assistive aids, which is emotionally and mentally burdensome for both. When patients can perform small tasks like ADLs themselves with assistive aids, it will contribute to the level of independence and unburden the informal caregivers. This study aims to investigate the most prominent problems occurring in the daily life of patients by interviewing four patients. It is found that patients primary prefer to complete dining activities independently because of alleviating their informal caregivers and avoiding home care during these valued times.
Develop
Based on this insight, exploration research is done to find the best way on how to support ALS patients during dining activities. The activity is detailly analysed by dividing dining into smaller actions, which presents the underlying problems. This shows that grasping objects is the first problem which limits patients. A second study compares the applicability of three types of hand support which solve grasp failure: active (dynamic) support, hybrid support, and static support are researched. These supports are discussed with patients and medical experts. The type of support which is operated by patients in the simplest way regarding basic movements and straightforward controlling is chosen to continue for further development. ALS patients can longer operate this type of support, and use this assistive aid immediately without long learning time.
Deliver
A tailor-made static hand orthosis is developed, which provides independence to ALS patients during dining activities. By automatically connecting and releasing to frequently used tableware, no strength of their fingers is required. The orthosis contributes to the level of comfort and addresses the individual differences for patients because it is tailor-made. The orthosis connects to frequently used objects by using a designed connector with magnetic capabilities and a mechanical lock.
Evaluate
This first iteration is evaluated by an ALS patient having mild paralysis in hand. The orthosis is tested while consuming breakfast consisting of fluid and food intake. The orthosis connects well with frequently used objects and operates straightforwardly and simply, which results in performing the dining activities with more independence and ease. Secondly, the results of the study are evaluated with an occupational therapist who agrees that this assistive aid could increase the level of independence for ALS patients. This first iteration can form a base for further development. Still, many iteration steps combined with user tests should follow. The first step would consist of improving the usability of the current connection to cups and other utensils like a fork and a knife.

The aim of this thesis was to enable people in the last stage of dementia, that are confined to their bed or room, and the people around them with shared positive moments. In order to design an experimental concept proposal that could accomplish that aim, the emotional needs of people living with dementia and the people around them were explored. Research activities consisting of a literature review, documentaries review and conducting interviews were conducted to generate understanding of the context. Analysing the findings from these activities resulted in identifying the emotional needs and an overview was presented in a stakeholder journey map. It was discovered that due to dementia, people start to live in another ‘inner past world’ that looks a lot like the past. This causes a lot of anxiety to people living with dementia. It was revealed that by bringing back their personal memories from the past, people living with dementia are able to get out of their “inner past world’ and get back to the actual world. This causes them to feel at ease and happy. These personal memories are part of their identity, so focussing on their identity is very crucial in reducing their anxiety. However, bringing back memory events is not easy for people living with dementia. In the last phase, people living with dementia are only able to communicate when their senses are activated. Stimulating their senses is essential for them to connect with their identity and thus to get that at ease and happy feeling. From these insights the following design goal was formulated: “Making the Person living with Dementia to feel at ease by giving them the ability to reconnect with their identity and interests.” From this design goal and the findings in the analysis, a concept direction was driven. The concept direction describes that the concept consists of three parts: an input, an internal part and an output. The different parts are connected to each other over time. The concept starts with an input where the identity of the person living with dementia is explored with a tool, specifically focussing on personal experiences. The information gained during the input will be internally turned into sensory elements that are placed in the output’s part of the concept. When people living with dementia are in the last stage of dementia the concept’s output can stimulate them with the identity events gathered during the input. By presenting this output with sensory stimulation, people living with dementia are able to connect with the event. The concept direction was the foundation of the exploration during ideation. By combining findings from different ideation activities, ideas on how the input and the output of the concept could possibly look like were generated. The input of the concept should be in the shape of an interview with assignments. The person living with dementia should be supported during this interview by a family member/ the informal caregiver. The interview focuses on gaining information about the background and general likes, but goes deeper into activities that they enjoyed while aged 15 to 25 years old. The output of the concept should focus on stimulating as many senses as possible. Therefore the output consists of a digital element for visual and auditory stimulation and of a physical element for tactile and olfactory stimulation. These decisions were summarized in the concept’s scenario. The scenario was used to evaluate the feasibility of the concept. According to the addressed experts, the concept is very feasible. This is due to the fact that the concept stimulates the senses of people living with dementia to reconnect them with their most memorable memories. In order to clarify what the presented output could look like, examples from multi sensory environments were presented. The elements used in multi sensory environments can be used in the output of the concept, but in a personalised way. Also in comparison to the multi sensory environment, the concept’s output should be an experience brought to the person, instead of bringing the person to the experience. Based on the validation, it could be concluded that the proposed concept could serve as a base to further develop, test and research the possibilities of personalised multi sensory stimulation within the private room environment.

This reports the graduation project aimed to investigate the occurrence of rebellious play through the X-eo prototype. Rebellious behaviour is often referred to as going against the norm and derives its value from breaking rules. Previous academic research (Gielen & Van Leeuwen, 2013), on the subject, has provided suggestions and techniques to design for this. However, there has been no clear or obvious conclusion as of yet, whether or how rebellious play can be promoted and supported through design.Therefore the brief for this graduation assignment was to “ re-think the bangerik & develop the Bangerik concept and investigate the occurrence of rebellious behaviour during play. As secondary goals; gain insights in designing and researching for rebellious play.”X-eo builds upon the bangerik concept developed during the compulsory DFI master‘s course Interactive Technology Design (ITD) during the 2013/2014 academic year at the faculty of IDE at the Delft University of Technology. Bangerik is an interactive free-flowing game that encourages children to be rebellious in a playful context. It consisted of a wearable worn on the wrist, where the goal of the game to raise their opponent‘s heart rate by scaring them and then steal their lives by tapping their wristband. The project is broken down into four distinct phases: Understand, Ideate, Make and Evaluate. Understand: The “understand“ phase was an immersion into the terminology behind the assignment through literature, an investigation of the original concept, online research of current rebellious concepts and potential technology that could be integrated into the final design to be tested at the end of the project. A definition of rebellious play was created and defined as “Where children can actively challenge what is in place and explore their behavioural boundaries, without having to face or endure any serious or lasting consequences“ This definition accompanied by a model of rebellious play was used to support the start of the ideate phase. The phase concluded with the establishment of research gaps to be investigated during the next stage of the project.Ideate: The “ideate“ phase consisted of 2 iterative design loops to find information that could not be obtained from traditional research methods such as literature reviews and interviews. Ideation focussed on the following research gaps, with prototypes created for each aspect and tested with children at a local school:How to play tag with Bangerik?How to attach something to the body?Where to place the tagging locations on the upper body?How to raise and lower heart rate during play and should this aspect remain in aspect?The video data from the testing sessions were analysed with the following conclusions established: The upper arms and chest are the most suitable tagging locations on the upper body. A garment is best to accommodate the tagging areas on the upper body. The heart rate aspect was a vital element and should be integrated into the final design. Feedback should be integrated into the final design to indicate when the players the heart rate is high and when they have lost a life. Make:The “make“ phase consisted of finalising the concept design and establishing aspects to be examined during the pilot study. Aesthetics, prototype behaviour and functions were finalised.From this point onwards the Bangerik concept evolved into the X-eo concept, a wearable garment tag game that offers the children the opportunities to steal lives from each other by raising other player’s heart rate. The tagging, heart rate and visual behaviour aspects of the concept were selected to be embodied into minimal viable prototypes for the pilot study. Evaluate: The “evaluate“ phase brought a close to the project with the prototypes being tested during the pilot study. The main focus for the pilot was whether the prototype provoked the occurrence of rebellious play behaviour and recommendations for design and research activities with the prototypes in the future. The following sub-questions were operationalised to determine conclusions to the overriding research questions:What strategies do the children implement during gameplay and are they rebellious?Do the children understand the visual feedback when their heart rate is high, when their lives are stolen, when they are out of the game and when their lives are reviving?A hierarchy of rules framework was created, so rebellious tendencies through the children‘s strategies could be identified and classified based on the rules they violated. In conclusion, rebellious behaviour was present during the testing session with all rules within the hierarchy framework being violated, with contextual and societal rules being the most popular. However it cannot be defined whether these behaviours were directly provoked due to the prototype, the context or the motivational state the children were in before completing the test. The hierarchy framework was a useful tool for classifying rebellious play behaviour. The report concludes with an evaluation of the research methodology applied, research & design recommendations and reflections with regards to conducting future research with the X-eo concept and on rebellious play behaviour.