The three student research team members with the proof of concept prototype

Improving Tools for Pediatric Patients with Spinal Cord Injuries (Wichita State University)


Photo of the three research team members

Research Team Photo, from left to right: Ms. Krugh, Mr. Mehraein, & Ms. Howard

Kaitlyn Howard, Courtney Krugh, Hootan Mehraein


There are few tools on the market designed specifically for improving quality of life in pediatric spinal cord injury (SCI) patients.  The student research team identified needs in a pediatric, quadriplegic patient’s life, both physical and emotional, stemming from their recent SCI. The team found that the patient needs a device that encourages them to explore and become involved with their environment and can respond and adapt to the patient’s abilities. From the problem statement, the team worked to develop the StylusStick, an updated and advanced mouth stick. The StylusStick can be used to complete a variety of tasks and encourages individuals, who are typically dependent on family and health care aides, to exercise a degree of independence leading to an improved quality of life.


Spinal cord injuries (SCI) are challenging, life altering events that could happen in anyone.  Physical disability is not the only consequences; changes in social, economic, emotional and financial status often befall individuals concurrently.  The effect of SCI is very unique in children due to distinctive physiological features the in pediatric population. Approximately 1,455 children suffer every year from SCI with 230 to 500 SCI cases occurring to individuals under the age of fifteen(1).  The major causes of SCI within all groups is motor vehicle accidents.  In the pediatric population, seat belt injury are common, especially those weighting forty pounds or less1.  Other causes include falls, firearm, and violence.

Pediatric patients with SCI have unique considerations impacting their long term quality of life.  Thirty to thirty-eight percent of pediatric SCI patients suffer from post-traumatic stress disorder (PTSD)(1).  Children with SCI are more as likely to drop out of school and have vocational issues(2). Children’s need for the right equipment is critical with SCI.  Our research team worked with a local pediatric SCI patient gaining insight of their needs from both observations and interactions in clinical settings, school, and at home.

Much of the needs generation done in the early design process was developed from the team’s interaction with a single, specific, pediatric patient but the observations were supplemented with research and literature reviews as well as speaking to adults with SCI.  The pediatric patient particularly enjoyed activities that could be done independently.  Currently, all of their play has to be facilitated by adults and there was not an opportunity to create their own fun.  While certainly there are physical health considerations, the biggest impression the researchers were left with was a strong need to allow the patient a way to be independent in small, daily tasks.  From observation it was noted that even the ability to change the television channels themselves would greatly increase their quality of life.  Existing research confirms that tetraplegics who use electronic devices as aids in daily living report higher quality of life scores then those who do not use the aids(3).  Tetraplegic patients consistently report wanting assistive devices to increase their independence(4).   The team generated a large list of needs, which were filtered to the final problem statement.

Problem Statement

The patient needs a device that encourages them to explore and become involved with their environment and can respond and adapt to the patient’s abilities.


Concept generation was started by first considering the requirements of the device.  First, the device must only require minimal technical expertise to operate.  The device should be intuitive to use; a first time user should have little trouble navigating the device.  Audio and pictures should be incorporated as much as possible to allow the device to be used independently by the patient, even as they learn to read.  The final product must be multipurpose and engage the user with their environment rather than keeping them hidden constantly behind a screen. The device should be able to grow with the abilities of the user, adapting to their needs.

This led our team to develop the StylusStick; a mouth stick device used to complete a variety of tasks such as writing, painting, manipulating touch screen devices (tablets), and indicating alerts when needed.  This device will have different tips that will attach to the end of the device so that the operator can do the different tasks as mentioned.  Many different sub-functions of the StylusStick were generated and then filtered using a weighted matrix as seen in Table 1.

Weighted design matrix of the sub-functions

Table 1: Sub-Function Filtration

From the weighted matrix we find that the top five sub-functions are: paint brush, writing utensil for class, touch screen stylus, remote control for toys, and signal teacher.


The final design will be a mouth stick with five different tips.  The tips will secure into a mouthpiece so that they are interchangeable.  The mouthpiece will have soft material covering the end where the patient will be putting the device into their mouth.  Figure 1 shows an early prototype being used by a pediatric patient with a high-level SCI.

Photo of a research team member with a child using an StylusStick prototype

Figure 1: Early prototype in use by pediatric patient with high-level SCI

For the mouthpiece, a lightweight, durable, and teeth safe material was needed.  The cylindrical shaft of the mouthpiece will be made of high quality aluminum to make the mouthpiece lightweight and durable.  The end of the shaft that will go into the patient’s mouth will be covered in FDA approved Food-Grade Silicone which is free of BPA, PVC, latex, rubber, and lead.  This silicone is soft enough to not damage teeth, it is a material often used for teething babies, but strong enough to withstand the patient biting on the material.

The paint brush, writing utensil, and stylus will have long cylindrical shafts make of the same, high quality aluminum as used in the mouth piece.  The mouthpiece plus the tip will be twelve inches long.  The pain brush will have a size 2 fan tipped paint brush made, the writing utensil a 4mm thick felt tipped marker, and the stylus a 5mm wide tip made of conductive rubber.  Each tip will secure to the mouthpiece using a magnet.

The toy remote and the signal to the teacher will have their battery and circuitry housed in an aluminum shaft which will secure to the mouth piece (figure 2).  The tip and mouthpiece will be not more than 4” long.  The signal to the teacher will transmit to a small box housing the LED lights which signal if the patient has questions or answers in class.

Block diagram showing input, processor, and output for the StylusStick

Figure 2: Block Diagram Toy Remote Function


Currently, there are few mouth sticks on the market. Many who use mouth sticks jury-rig existing products to mouthpieces. The StylusStick will deliver a much higher quality product then can be produced at home as well as an array of accessories to amplify the StylusStick’s abilities and functions(figure 3). We expect the StylusStick to compete with other assistive technology such as; chin joystick mouse cursers, voice activated technology, and eye tracking systems. The primary advantage of our product being the ability to use it on any touch screen device as well as physical medium. By allowing the user to engage with many devices there will be increased opportunities to interact and engage with their community, allowing them to move beyond their home technology.

The three student research team members with the proof of concept prototype

Figure 3: Research team with proof of concept prototype.


1. Grisham, S., & Deming, L. (2011). Pediatric life care planning and case management (2nd ed.). Boca Raton, FL: CRC Press.

2. Songhuai, L., Olver, L., Jianjun, L., Kennedy, P., Genlin, L., Duff, J., & Scott-Wilson, U. (2008). A comparative review of life satisfaction, quality of life and mood between Chinese and British people with tetraplegia. Spinal Cord, 82-86.

3. Rigby, P., Ryan, S., & Campbell, K. A. (2011). Electronic aids to daily living and quality of life for persons with tetraplegia. Disability & Rehabilitation: Assistive Technology, 6(3), 260-267.

4. Caltenco, H.A., Breidegard, B., Jönsson, B. & Andreasen Struijk, L.N.S. (2012). Understanding Computer Users With Tetraplegia: Survey of Assistive Technology Users. International Journal of Human-Computer Interaction, 28(4), 258-268.

Contact Author: Kaitlyn Howard


Mailing:Wichita State University, Biomedical Engineering
204 Engineering Building, 1845 Fairmount
Box 66
Wichita, KS 67260-0066


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