Neurologic examination procedures require not only abundant knowledge but also prominent skills. During medical education and training, several methods will be put to use such as watching video, reading books, making use of the simulated patient (SP), and so on. These can help medical staffs, especially novices, to master the skills and accumulate experiences. To make up for the drawbacks of the above methods, such as lack of active interactions, limitation of multi-symptom reproductions, etc, the medical training simulators have been developed to improve training effectiveness. However, most of these simulators only mimic the symptoms. They have no the abilities to show the pathology of diseases. This limits the training effectiveness. In this paper, we propose an elbow robot named WKE-1(Waseda Kyotokagaku Elbow Robot No.1) for neurologic examination training as one part of the whole body patient robot named WKP (Waseda Kyotokagaku Patient). In this robot, we simulate various symptoms occurring during the examination of elbow force, biceps tendon reflex, involuntary action, and also make a physiological neurological model to simulate the pathology of the nervous system. Taking advantage of this robot, the trainee can get a systematic training on both the skills and knowledge. Finally, we take a set of experiments to verify our proposed mechanism and system. The experimental results lead to the consideration that the approach is worth following in further research.

Neurologic examination takes an important role in diagnosis of the nerve system diseases. Neurologic medical staffs, especially the novices, need to be trained on this skill. There are many methodologies which can help to accumulate experiences, such as watching video, reading books, making use of the simulated patient (SP), and so on. However, the best way is to practice on the real patient. All the above methods have their own drawbacks such as lack of active interactions, limitation of multi-symptoms' reproducing, etc. To improve the training effectiveness, an arm robot is proposed in this paper for neurologic examination training as one part of the whole body patient robot named Waseda Kyotokagaku Patient (WKP). In this robot, various symptoms of the elbow force, biceps tendon reflex, involuntary action, and so on, are simulated and shown to the trainee. Finally, a set of experiments was carried out to verify our proposed mechanism and control system. Three neurologists with over 30 years' experience were invited to show their opinions on the reproductions of patients' symptoms, and to discuss the results. The effectiveness of this system was confirmed. The experimental results lead to the consideration that the approach is worth following in further research.

In recent years advanced robotic technology has seen more use in the medical field to assist in the development of efficient training systems. Such training systems must fulfill the following criteria: they must provide quantitative information, must simulate the real-world conditions of the task, and assure training effectiveness. We developed Waseda Kyotokagaku Airway series to fulfill all of those requirements. The WKA series we had developed does not consider external appearance such as patient skin, or internal appearance such as the pharynx, larynx, and esophagus. Moreover, the tongue mechanism of the previous system can not precisely measure the force applied by medical devices and cannot simulate muscle stiffness. In addition, the mandible mechanism of the previous system could not adequately reproduce various airway difficulties or apply force control. For these reasons, we propose the WKA-4, which has high-fidelity simulated human anatomy, and we have improved the mechanism over the previous system. We have also attached a lung to the proposed system to improve simulation of the real-world conditions of the task. In this paper, we present how to design several organs with various embedded sensors and actuators, for a conventional patient model with high-fidelity simulated human anatomy. We also present the control system for the WKA-4. Finally, we present a set of experiments carried out using doctors as subjects, and they gave their valuable opinions about our system.

Recently, in medical field, different training methods for medical staff have been proposed. However, the lack of knowledge on the real improvements of trainees makes difficult the real effectiveness of those proposed methods. Therefore, we are proposing an Active Training system for the effective medical training. The Active training system is characterized by providing quantitative information of the trainee's performance of the task to the trainee, simulating real-world conditions of the task, and assuring training effectiveness. In order to fulfill each of these characteristics, we have developed Waseda Kyotokagaku Airway No.3 (WKA-3) which makes it possible to obtain quantitative information for the trainee's performance and reproduce the various cases, individual differences for the airway difficulties for the simulating real-world conditions of the task. In this paper, we are proposing a patient scenario generation which can reproduce the characteristics of the patient simulating real-world conditions of the task for WKA-3. In emergent situation or surgical operation, the characteristics of patients are presented in the three parameters such as: patient initial conditions, time variant status change, and reflex action. By adjusting, and combining each of the three parameters, we can reproduce the various patient scenarios. In this paper, we also state how to generate the Patient Scenario Generation using the position control and virtual compliance control. Finally, a set of experiments has been carried out to the doctor subjects in order to verify effectiveness of the proposed Patient Scenario Generation, and discuss the doctors about the result of the experiments.

An active training system is characterized by providing quantitative information of the trainee's performance of the task to the trainee, simulating real-world conditions of the task, and assuring training effectiveness. For this purpose, the authors have been developing an Airway management training system. In particular, we have previously presented an evaluation model system to acquire quantitative information for the trainee's performance, and an actuated model system for real-world conditions of the task. In order to fulfill all of the characteristics of the active training system; in this paper, we would like to propose an integrated system, Waseda Kyotokagaku Airway No.3 (WKA-3) which integrates the function of both system models. For this reason, we have focused on embedding sensors and actuators with the link drive mechanism and the wire drive mechanism to a conventional patient model towards the development of a patient robot. In this paper, we present WKA-3 how to design the mechanism and how to redesign several organs to embed the sensors for the measurement of the trainee's performance. A set of experiment have been carried out to doctor subjects using the WKA-3 to verify the effectiveness of the proposed system by asking doctors to evaluate the proposed system.

The emerging field of medical robotics aims to introduce intelligent tools to assist a physician. The main challenges for developing efficient medical robotic training systems are simulating real-world conditions of the task and assuring training effectiveness. High anatomic fidelity has been achieved in current systems. However, those training systems are designed to reproduce specific conditions of the task (passive training). In this research, we are focusing in developing an airway management training systems designed to reproduce various cases of difficult airway. Such difficulties (i.e. restricted mouth opening, various shapes of oral cavity including tongue swallowing, etc) may provoke traumas on different organs of the patient during an emergency situation. For this purpose, the authors have proposed the development of more advanced training tools. For this purpose, we have focused in embedding sensors and actuators to a conventional patient model towards the development of a patient robot (in previous research, authors have presented the evaluation model which embeds sensors). In this paper, we present an airway training system which embeds actuators into a mannequin. In particular, the mechanism design of the Waseda Kyotokagaku Airway No.2 (WKA-2) is detailed. The WKA-2 is composed of twelve active and one passive degrees of freedom; which are designed to reproduce the various cases of difficult airway. For this purpose, the WKA-2 reproduces the human muscles around the upper airway based on a wire driving mechanisms (a total of sixteen wires are used). In particular, the head of the model is composed of a tongue and mandible with translational and rotational movements around kinematic axis. In addition, we present the details of the kinematic model of WKA-2 which enable the robot to reproduce the airway difficulties. Finally, we presented the design of a tension sensor designed to measure the applied tension on each of the wire driving mechanism of WKA-2. As preliminary experiments, we reproduce several cases of difficult airways using WKA-2.

The emerging field of medical robotics is aiming in introducing intelligent tools to perform medical procedures. In particular, robotic researchers have been proposed advanced medical training systems to enhance motor dexterities of trainees. An efficient medical training system should be designed to simulate real-world conditions and to assure their effectiveness as the representation of the motor skills often differs among trainees. Up to now, several training simulators have been developed by medical companies designed to reproduce with high fidelity the human body. However, such devices are not designed to provide any information to trainees. Therefore, we have proposed the development of a patient robot which embeds sensors and actuators into a conventional human model. Due to its complexity, as a first approach; we are presenting the development of a suture training system designed to simulate the real-world task conditions as well as providing quantitative assessments. In particular; the Waseda-Kyotokagaku Suture No.2 Refined II is presented, which includes a new evaluation function to provide more detailed information of the task. A set of experiments were proposed to analyze the performance of trainees. From the experimental results, we could confirm its effectiveness to detect differences of the performance of trainees.

Up to now, there is no widely accepted quantitative evaluation scheme. Nowadays, an objective structured clinical examination has been proposed as a modern type of examination often used in medicine to test skills such as medical procedures, etc. The assessment of skills is realized by practical exams, in which students are evaluated by experienced examiner using a check list. However, the examiner lacks of information which cannot be obtained trough the simple observation of the task. Thanks to the advances in robot technology in embedded systems, etc.; more advanced evaluation tools can be conceived. For this reason, at Waseda University, we have proposed the development of a patient robot as an advanced evaluation tool to provide more detailed information of the task. As a first approach of our long-term research target, we have proposed the development of a suture/ligature training system which provides quantitative information of the movement of a dummy skin as well as information of the quality of task. In this paper; we describe the functionalities of the newest version, the Waseda-KyotoKagaku Skin No.2 Refined (WKS-2R), which has been designed to provide quantitative information of the task. In addition, we are proposing a new evaluation function which includes performance indexes and weighting coefficients. As a first approach, the weighting coefficients were determined by using the discriminant analysis. A set of experiments were proposed to confirm the effectiveness of the proposed evaluation function. From the preliminary results, the evaluation function was useful in detecting differences among different levels of expertise as well as detecting improvements during the training process by computing the learning curve.

Airway management is provided by emergency medical technicians or anesthetists in order to save unconscious patients who are unable to breathe. Even though it is a basic technique, many accidents may occur when the procedure is not provided followed. In order to avoid any risks to patients, emergency medical technicians are required to practice airway management using training devices such as mannequins; which are designed to accurately reproduce the human anatomy. However, such training devices do not provide any quantitative information about the learning progress of trainees (passive training). For that purpose, we have proposed the development of a airway management training system which is designed to embed array of sensors so that quantitative information of trainees' performance can be acquired. In this paper, we are presenting the Waseda-KyotoKagaku airway No. 1 (WKA-1). The WKA-1 consists of three different kinds of array of sensors which are embedded into a conventional mannequin. In order to embed the array of sensors, we have simplified the design of some of the simulated organs (upper airway, oral cavity, tongue and teeth) of the mannequin. A set of evaluation parameters were proposed based on the information collected through the sensors. A set of experiments were proposed to experimentally verify the effectiveness of the proposed evaluation parameters to quantitatively detect differences among different levels of skills (anesthetists and unskilled persons).

Authors have proposed as a long-term goal, since 2004, the development of a patient robot which could serve for both training purposes as well as an evaluation tool of medical procedures. As a first approach, we have developed last year a suture and ligature training system named Waseda Kyotokagaku Suture No. 1 (WKS-1), which is composed by a commercial skin dummy with arrays of embedded sensors designed to acquire quantitative data of the task. The WKS-1 was designed to reproduce realistically the task conditions as well as providing objective assessment of the task performance. In particular, the proposed evaluation function considered the following performance indexes: time, displacement and force levels. By performing experiments with medical doctors and unskilled persons, we confirmed the effectiveness of WKS-1 to provide objective assessments of the task performance. However, the functionalities of WKS-1 were too restricted as few automatic procedures were implemented for the acquisition and processing of the collected data. Therefore; in this paper, we are presenting the Waseda Kyotokagaku Suture No. 2 (WKS-2). The WKS-2 has been designed to provide more detailed information of the task performance as well as improving its portability, connectivity, and usability. In addition, thanks to the design improvements on the WKS-2, we have proposed additional evaluation parameters to measure the quality of the suture (after the task has been completed). For this purpose, we proposed a image processing algorithm to automatically measure the width of sutures, the distance among them and the wound area. Preliminary experiments were carried out to verify its effectiveness.