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Advanced Haptics Development to Support Medical Simulated Training Environments



OBJECTIVE: The purpose of this SBIR topic is to improve upon haptics devices and integrate them with synthetic (virtual/augmented/mixed reality, or xR) training environments to train hands-on medical procedures to novice trainees with limited medical experience. This will provide medical trainees realistic and anatomically accurate tactile feedback from xR haptic devices, improving training value by building muscle memory and self-efficacy. 

DESCRIPTION: Tactile feedback is critical for accurate medical treatment and consequently medical training. Computer based training is cost effective but is insufficient for developing cognitive and psychomotor skills. Recent training advances have moved beyond keyboard, mouse and display schemes into virtual reality (VR), augmented reality (AR), and mixed reality (MR) environments. However, VR/MR rely on handheld controllers and AR relies on real objects to facilitate interactions. Handheld controllers are intuitive, but they do not allow users to practice procedures to gain the muscle memory for the real world. Augmenting with real objects and simulated patients is realistic but it introduces significant technical challenges in integration and registration. Neither solution delivers a comprehensive, realistic, immersive training experience. Recent advances in haptic technologies can help overcome these limitations by forcing trainees to realistically interact with the environment without sacrificing the flexibility of AR/VR/MR training. With advanced haptic delivery systems, physical sensations are mapped to the trainee’s visual and spatial perception within the environment. These combined technologies foster natural trainee interactions to perform medical procedures in the environment. Rather than moving a controller and clicking a trigger to grab a virtual object, users can reach out and grasp, feel, and manipulate virtual entities, just as they would with a real object. This research proposes to refine the haptic delivery technologies by reducing the hardware footprints and reducing costs while expanding utility within a widely used military training environment for Tactical Combat Casualty Care (TC3). Prototype haptic technologies have been integrated into a virtual training application with promising results. Users can perform a needle chest decompression and apply a tourniquet onto virtual patients using fine motor skills to manipulate the medical equipment. This proposed effort will expand the haptics-based training scenarios inside a virtual training simulation to include additional medical tasks, and to integrate soldier tasks such as weapon manipulation. The intent is to demonstrate the applicability of advanced haptics to interact with soft entities (patients) and hard entities (weapons) within a warfighting simulation in the Army’s new Synthetic Training Environment.  

PHASE I: Phase I will consist of research into emerging haptic devices and determine their ability to replicate the tactile feedback of one or more basic Tactical Combat Casualty Care (TC3) skills that require both gross motor skills (e.g., palpating an anatomical landmark) and fine motor skills (e.g., IV insertion). Applicability of the chosen haptic device to integrate with one or more government-funded virtual training simulations should be taken into consideration. During this phase, the offeror should focus on portions of the human hand for haptic delivery. As a proof of concept, the physical footprint of any equipment delivered will not be limited. The intent of this phase is as follows: 1) to produce a lab-based initial proof of concept and/or prototype for the haptic delivery system; 2) to provide considerations for interoperability with future and existing military medical training systems (e.g. AR/VR/MR training environments, physical medical training devices and patient simulations (rigid, semi-rigid, and soft structures), the Army Synthetic Training Environment, and any possible combinations of these); 3) to provide a detailed evaluation of appropriate sensing technologies to merge the virtual training environment with the physical training environment; and 4) to develop a detailed set of initial scenarios for the haptic delivery system designed to demonstrate items 2 and 3. Deliverables from this phase must demonstrate the feasibility of the concepts described within this topic. Upon completion, the performer will submit a final report including these analyses, and provide an initial demonstration describing the current state of development, along with details for the Phase II development plan. 

PHASE II: Phase II will consist of improvements to the prototype that supports haptic training for needle chest decompression and tourniquet application, as well as other TC3 tasks (e.g. operating or reloading a weapon) in an xR environment, exhibiting highly accurate fine and gross motor movements. The offeror will iteratively develop, demonstrate, and validate prototype units capable of haptic simulations for a variety of procedures that are common in point of injury care and care under fire. Building off of work in Phase I, the offeror will develop haptic models for a variety of structures to be used in relevant TC3 training scenarios, including rigid (rifle components, scissors, scalpels, etc.) and soft structures (surface tissues and deep tissues, tourniquets, gauze, etc.). These haptic models must be integrated into demonstrations of training solutions across the xR spectrum. Engineering design improvements will minimize the overall footprint and logistical cost of the system, while also maximizing haptic fidelity and expanding sensitivity to more areas of the hand as required. Phase II will include opportunities for demonstrations to key military and commercial stakeholders, both at the midpoint and during the final stages of development. Phase II will culminate in a usability evaluation and a training effectiveness evaluation of all features of the prototype system(s) with a relevant military training population, to be determined by key military stakeholders. Offerors looking towards a Phase III for development will complete Phase II by describing initial efforts to identify and secure potential military and commercial clients, as well as initial considerations for productization, including but not limited to affordability, manufacturability, durability, failure rates, and reparability, within the context of the work completed during Phase II and any challenges encountered. 

PHASE III: Contingent upon available funding and a successful conclusion of Phase II work, in this phase the offeror will have developed a commercially viable, easy to use haptic delivery system capable of being used with a variety of military medical training systems, and also capable of satisfactorily merging the virtual training environment with the physical training environment. The offeror will dedicate Phase III towards optimizing affordability, manufacturability, durability, failure rates, reparability, and other productization considerations, including open-source software tools and authoring capabilities. Phase III must also establish solid pathways towards transition and commercialization, pursuing both DoD and commercial markets. This haptic delivery system has broad applications for providing military medical training, but other types of medical training should be considered as well. The offeror will demonstrate the product at one or more potential “customer” sites. All demonstrations, dates, and times at military training sites will be selected by the Synthetic Training Environment Cross Functional Team under Army Futures Command. Phase III will consist of additional refinements to the prototype unit(s) developed under Phase II. Building upon the Phase II work, Phase III will finalize research and development to integrate Point of injury care procedures will be extended to include additional deep tissue surgical procedures. Additional work will involve establishing complete integration (hardware and software) into the broader Army Synthetic Training Environment, as well as related environments from other DoD training programs. In addition to TC3 tasks, the prototype system shall haptically simulate additional, relevant, complex warfighter tasks. Phase III will culminate in a usability evaluation and a training effectiveness evaluation of all of the features of the prototype system(s) with a relevant military training population. The offeror will coordinate with a military and/or commercial partner to ensure compliance with all applicable DoD/service-specific certifications required for full transition. 


1: Fulkerson, Matthew, "Touch", The Stanford Encyclopedia of Philosophy (Spring 2016 Edition), Edward N. Zalta (ed.), URL = <>.

2:  Hauck, R. (2017). Virtual surgery and orthopaedic surgery: towards training using haptic technology (Doctoral dissertation, University of Nottingham).

3:  Linde, A. S., Caridha, J., & Kunkler, K. J. (2017). Incorporating Present Knowledge in SkillsDecay into Future Augmented Reality Haptic Medical Simulation Training Interfaces. MHSRS Abstract# MHSRS-17-0520.

4:  Mathur, A. S. (2015, March). Low cost virtual reality for medical training. In Virtual Reality (VR), 2015 IEEE (pp. 345-346). IEEE.

KEYWORDS: Haptics, Virtual Simulations, Synthetic Training Environment, Tactical Combat Casualty Care 

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