Andrea is a middle aged adult with congenital spastic diplegia cerebral palsy who is in search of a more efficient and less strenuous method to independently tie her shoes. With this diagnosis, Andrea experiences decreased hand dexterity and strength as well as proprioceptive deficits. Andrea requires her shoes to be tied extremely tight so she can receive adequate proprioceptive input for feet awareness in space to prevent tripping. This desired tightness is extremely difficult to achieve for Andrea and has led to wrist/arm/finger strain, shoulder and back pain, extreme fatigue, as well as hand calluses. Andrea has experimented with numerous shoe tying methods, adaptive tools, as well as adaptive shoes and shoelaces. Currently she is using a combination method of what the design team created her last year with things she has discovered on her own, but this method is still not sustainable. Andrea’s shoe tying process takes her around 30 minutes – 1 hour, more often than not requires the assistance of her mom, and is still extremely taxing on her body. Andrea’s ability to fully participate in her meaningful everyday occupations, such as work and self care, is often undermined by the time consuming and physically demanding process of getting her shoes tight enough for her to feel comfortable to walk safely.
User Need Statement:
Andrea is a female adult with congenital spastic diplegia cerebral palsy who experiences proprioceptive deficits requiring her shoes to be extremely tight to provide adequate input for foot awareness while walking. Due to symptoms associated with her conditions, she experiences extreme difficulty achieving this timely and efficiently due to decreased finger dexterity and strength, upper limb strain, back pain, and overall fatigue. Andrea requires deep pressure in her feet, particularly the top, in order to receive ample proprioceptive input for balance, safety, and coordination while ambulating.
How can we help Andrea achieve the desired proprioceptive input to her feet more efficiently and less strenuously in order for her to independently tie her shoes to ambulate?
Compartmentalization of Andrea’s current shoe tying techniques to identify components to incorporate into our design
|Lacing every two pairs of eyelets provided more individualized control over stabilizing and tightening the laces||Takes anywhere from 18-180 tries to reach desired tightness averaging about an hour leading to hand callus, back and upper extremity pain, and fatigue
|Uses Leather laces which provide nonslip properties||Leather laces break often and need to be replaced|
|Traditional hand tying mechanism requires mother’s help to hold lace in place|
Initial Design and Prototype
Our initial design incorporated a cluster of ideas that we developed through brainstorming, researching,and speaking with Andrea. This design would use compression socks with focus on the upper foot, a removable weighted pouch attached to either the sock or the inside of the tongue of the shoe to provide more proprioceptive input, as well as two spin buckle laces each serving 3 hole sets positioned on the sides to allow for easy tightening. We also considered heated socks and heel inserts. A crank was also explored for turning the buckle to prevent wrist and finger pain. This mechanism would ease the shoe tying process as well as provide proprioceptive input as if she was tightening them to the extent she was before without having to.
Our next prototype design continues to use the compression socks that focus on the upper foot, the removable weighted pouch attached to the inside of the tongue of the shoe, however, we used a different lacing design. In this design, we no longer use the spin buckle laces, but use Andreas current lacing set up of 3 laces per shoe (1lace for 2 aglets) and a new locking system. This locking system has no spring components and is made of heavy duty materials for strength but still is small enough for a sleek design that isn’t too cumbersome.
Revisions and Design Updates
In showing Andrea or initial design she was thrilled by the amount of thought we had already put in and was open to the toe pouch and compression sock, but had concerns regarding wrist pain associated with turning the crank lace lock. We theorized a crank to help but ultimately realized the thin wire lace required for that lock would not be sufficient for compressing the material of her desired shoe (thick leather shoe). Additionally, Andrea likes the ability to adjust sections of the shoe at a time, so having 3 sections of lacing is important to her. Lastly, Andrea emphasized that the pain, fatigue, and hand callus are results of her having to repeatedly readjust to reach the desired tightness, but would be able to perform tightening techniques if she only had to do each one time. For this reason we incorporated the wheeled cord lace locker which doesn’t incorporate a spring.
Upon our second meeting with Andrea she expressed concern about the size of the pouch that was created and would be interested in the concept but with a smaller pouch and slightly different placement.
When speaking with Virginia she encouraged the weighted pouch but emphasized that it can not be too heavy, cannot bunch in the shoe, needs to stay in place, and be made of a comfortable material for her foot. Additionally, she noted that Andrea tightened her shoes to the point that the eyelets are nearly overlapping.
Based on feedback and further brainstorming the following changes made from our previous prototype (arrows represent order and progression in which changes were made):
- Knee high compression sock → Mid calf compression toe sock to provide additionally proprioceptive input to toe region
- Leather laces → wax coated laces tied in a knot at the ends to create a hook shape
- Provide padded handle for pulling laces
- Traditional cross style lacing pattern → adapted lacing style in a sideways “U” pattern from right to left in order to utilize her strong side and lacing top 2 sets of eyelets back to front to create a perpendicular “U” shape to other laces→
- Weighted toe pouch constructed from fabric to go on inside of tongue → Cushion shoe inserts adapted to hold weighted beads inside of tongue to provide added proprioceptive input→ provide two adapted shoe inserts with weighted beads (small and large) and place velcro in shoe “T” shape to allow placement and weight options for client.
First Round of Updates/ Modifications made to Prototype:
To modify the tightening mechanism of her shoes we utilized wheeled cord lace locks for every two eyelets (3 laces per shoe), wax coated laces to achieve a non-slip property to hold the tension that Andrea creates as she ties, as well as an adapted shoe lacing style in which a sideways “U” pattern is made going from right to left in order to utilize Andreas strong side when tying. This sideways “U” lacing style will be done for the bottom 4 pairs of eyelets with 1 shoe lace per two pairs. The first 2 pairs of eyelets will be overlapped, with the left side layered over the right. The shoelace aglets will be strung through the layered eyelets from the inside out in a “U” shape back to front. With this mechanism Andrea is still required to pull the lace tight, so to ease the possible strain and calluses on her hand the lace will be knotted, ends cauterized off, and a cushioned hand hook will be provided to go over the hook shape that will be easier to pull. To address overall proprioceptive input to her feet we paired our lacing design with mid calf compression toe socks with emphasis on the toes and cushion shoe inserts which we adapted to hold weighted beads inside. The shoe insert is to be placed on the underneath of the tongue via velcro and the loop side of the velcro will be attached to the bottom of tongue to allow the placement of the pouch to be adjustable.
FINAL DESIGN PLAN
For our final design we combined the best parts of our prototypes into a design that we hope will help Andrea decrease the amount of times it takes for her to tie her shoes independently and in turn lessen the overall strain and fatigue she is experiencing. This design includes components to address both the tightening mechanism of the shoe as well as general proprioceptive input to her feet. To modify the tightening mechanism of her shoes we utilized wheeled cord lace locks for every two eyelets (3 laces per shoe), wax coated laces to achieve a non-slip property to hold the tension that Andrea creates as she ties, as well as an adapted shoe lacing style in which a sideways “U” pattern is made by lacing through the outside of the left eyelets through the inside of the right then back through the loop created on the left side. To tighten pull out to the left then in a rainbow motion to the right. This sideways “U” lacing style will be done for the bottom 4 pairs of eyelets with 1 shoe lace per two pairs. The first 2 pairs of eyelets will be overlapped, with the left side layered over the right. The shoelace aglets will be strung through the layered eyelets from the inside out in a “U” shape back to front. With this mechanism Andrea is still required to pull the lace tight, so to ease the possible strain and calluses on her hand the lace will be knotted, ends cauterized off, and a cushioned hand hook will be provided to go over the hook shape that will be easier to pull. To address overall proprioceptive input to her feet we paired our lacing design with mid calf compression toe socks with emphasis on the toes and client will be provided cushion shoe inserts both small and large which we adapted to hold weighted beads inside. Velcro will be placed under the shoe in a “T” shape pouches can be placed where it feels most comfortable and secure for the client.
- Wheeled Cord Lace Locker x6
- Wax coated laces x6
- Cushion shoe inserts x2
- Velcro (with adhesive side)
- Weighted glass beads
- Compression toe socks
- Sewing supplies
- Sewing machine
- Pipe liner cushion material
- Wheeled Cord Lock Stopper from Amazon (10pcs) : $11.25
- Wax Coated Laces from Walmart (6 pcs): $7.74
- Cushion Shoe Inserts from Walmart (3pcs): $4.64
- Mid Calf Compression Toe Socks from Amazon: $10.98
- Weighted Glass Beads: $10
- Sewing supplies and fabric: $5
- Velcro: $2.50
- Pipe liner material: 99c
Client’s Final Feedback
Andrea has to face numerous challenges when it comes to tying her shoes. The associated symptoms of her diagnosis including decreased finger dexterity and strength and proprioceptive deficits are both the reason for and why she has difficulty with tying her shoes extremely tight. With this in mind we aimed to design a shoe tying mechanism to help Andrea address both the reasons for and consequences of her shoe tying experience. While Andrea greatly appreciated all the time and effort we put into developing a strategy for her to independently tie her shoes, ultimately our overall design did not satisfy her needs. With the setup of the shoe it was able to get tighter and the wheel locks held the tightness in place, but this set up also made it difficult for Andrea to get a good hold on the laces and pull to the extent necessary to reach the desired tightness. On the other hand, Andrea did have success with the small weighted pouches and the toe socks and believe they will help her receive more input to her feet.
- Toe compression socks were able to provide more input to her individual toes
- Small pouch provided extra input and was easily movable
- Laces still allowed individual adjustments of different parts of the shoe
- Wheel locks had no kickback and stayed in place when locked
- Set up allows use of strong side and doesn’t require force from both hands at once
- Tightening mechanism still required client to use some force to get shoes to desired tightness
- Laces were difficult for client to grip in loop design
- Large weighted pouch was too bulky
- Wheels locks still weren’t able to secure laces at desired tightness
Suggestions to Improve Future Design
- Find another mechanism to join the two laces other than a knot so that the lock stopper can be replaced if needed
- Loop laces in a fashion that they can be easily grasped and tightened
- Add two small weighted pouches per shoe instead of one
- Explore other tactile input methods
- Pursue other tightening mechanisms such as the surgeon’s knot or methods that allow manipulation of shoe
- Ability to manipulate actual shoe such as sowing or adding hooks
Manufacturing and user instructions: Instructions
Student designers: Shiri Abramovitch, Mahira Ali, William McDonald, Jessica Simpson