Sometimes the Simplest Things Make the Biggest Difference

By Richard Merritt

For Annette Lauber, one of morning’s seemingly simplest routines was often a moment of anxiety.

She has cerebral palsy, a neurological disorder that effects muscle movement and coordination. She can walk for short periods of time with the aid of crutches, but she finds her wheelchair to be a more efficient tool to use throughout the day. And while working full time for 30 years for the state of North Carolina, the last 15 years as funding specialist for the N.C. Assistive Technology Program in the N.C. Division of Vocational Rehabilitation Services, the act of putting on her shoes each morning loomed as a daily challenge.

“When figuring out when to get up each morning, I’d always make sure I’d leave enough time to get my shoes on,” she said. “Some mornings, depending on how I was doing, it could take more than 30 minutes.”

She had tried the commercially available long-handled assistive shoehorn-like devices, but they turned out to be awkward and clumsy. They weren’t, as she pointed out, designed for someone using a wheelchair.

After having little luck with any of these devices, she decided to try something different.

She contacted Larry Bohs, assistant research professor in biomedical engineering in Duke's Pratt School of Engineering, who teaches the course BME 260: Devices for People with Disabilities. What started off 11 years ago as single class with a handful of students has since grown into a class offered every semester packed with 18 students. At the beginning of the semester, the class is divided up and each small group is assigned a particular client with a specific need – their mission is to conceive, design and manufacture a solution.

Students in past classes had developed other helpful devices for Lauber, such as an exercise machine with accompanying frame, an adjustable table to get things in an out of the oven, a long-handled toe-nail clipper and a pulley system for getting her wheelchair up the ramp to her front door in inclement weather.

This year, she came to the class with her shoe problem. A team of three biomedical engineering students who graduated this spring – John Perkins, Andy Huang and Alyx Rosen-- took Lauber’s challenge.

“When we first met with her, she showed us how she attempted to use the long shoehorn,” Rosen said. “She had difficulty reaching behind her legs while in the wheelchair, and as she tried to put her shoe on and roll forward, most of the time her heel would get stuck.”

For less than $30, the team devised a custom-made device out of moldable thermoplastic that not only helps Lauber guide her foot toward the shoe, but provides the heel support to easily push her foot forward while in the wheelchair. After testing a few prototypes, they realized that a few small alterations to the device would allow her to just as easily pull her socks on.

“During the whole process, they’d come over once a week and try out each version with various shoes as they improved it – I felt like Cinderella,” Lauber recalls laughing. “It didn’t take them long to come up with the idea, and they spent the rest of the time refining their design. It was wonderful working with the students and getting to know them as individuals. They have a great combination of ability, creativity and attitude.”

The team has dubbed their invention the Shoe Helper. In July, they entered it into the annual competition held by the Rehabilitation and Assistive Technology Society of North America (RESNA). Out of 65 teams from across the country, the Duke team was honored as one the top five during a ceremony held in Washington, D.C.

“It was an incredible experience,” Rosen said of the competition. “The other devices presented were more technical, involving electronics and other mechanics. The simplicity of our device is something that everyone appreciates because it is so functional.”

Lauber added: “I’m so pleased that the people judging the contest recognized the value of having a device that is so simple but makes such a profound difference for its user.”

The team is in the process of filing a patent application for the Shoe Helper, and will soon begin contacting different companies to gauge their interest in manufacturing it.

“I look at it as a hands-on practical experience,” Bohs said of his class. “Working with a real live client is very different than most classes, and it is also a reason for students to get motivated to apply existing engineering skills and to learn new ones. They learn about tools, materials, how to use their hands and machining tools in the course of a semester. Many of these students go on to medical school and fields outside engineering, so this direct people focus is a good experience for them.”

Over the years, Bohs has made contacts with patients, therapists and teachers who provide him with ideas for individuals that could use his class’s help. After a vigorous screening process, he selects those challenges that offer the most potential help for the client, as well as those offering a unique learning experience for his students.

“It’s important to not only give the students a challenging project, but also one that by the end of the semester they can feel a true sense of accomplishment,” Bohs said. “For me, I get satisfaction knowing we are doing something for someone that makes a difference, while hopefully awakening some new interests in the students.”

Lauber thinks that after these four years working with Bohs and his students, Duke has pretty much solved all of her issues that could be addressed by engineering.

“They have done something that has really saved me a lot of time, but more importantly, they have taken away some of my doubts about whether or not I can do something,” Lauber said. “I love being able to put my shoes on in a matter of seconds – it makes me smile every time I do it. Sometimes the simplest things make the biggest difference.”