Interactive Neonatal Resuscitation Training Simulator and Method

The present invention relates in general to medical training simulators, and more particularly, to an intelligent, interactive neonatal resuscitation training simulator and method employing an infant android of life-like appearance and response.

In the United States there are approximately 5,000 hospitals with delivery services in which approximately 3.7 million babies are born each year. Resuscitation is required for a significant number of these babies. Current research suggests that resuscitation is necessary for about 80 percent of the 30,000 babies with birth weights less than 1500 grams, and for an unspecified additional number of babies weighing more than 1500 grams at birth. Thus, asphyxia continues to be a major neonatal problem, with resuscitation frequently being required in institutions without specialized neonatal expertise. This challenge has been recognized by both the American Heart Association (AHA) and the American Academy of Pediatrics (AAP).

The Working Group on Pediatric Resuscitation, formed in 1978 under the auspices of the Emergency Cardiac Care Committee (ECC) of AHA, has developed guidelines for neonatal resuscitation. Further, a National Conference on Pediatric Resuscitation was convened in December, 1983 under the auspices of AHA, and one of their conclusions was that a training program for neonatal advanced life support was urgently needed. ECC's guidelines for neonatal resuscitation were updated in 1985 and endorsed by AAP. One of the stated goals of the guidelines is that "at least one person skilled in neonatal resuscitation should be in attendance at every delivery. An additional skilled person should be readily available . . . "

As at outgrowth of this work, a neonatal resuscitation course, by Bloom et al. entitled Textbook of Neonatal Resuscitation, (1987, 1990), has been jointly produced and made available by the American Heart Association and the American Academy of Pediatrics. The goal of the neonatal resuscitation course is to provide the materials and training necessary (according to AHA-AAP guidelines) for health professionals in the neonatal resuscitation field. Obviously, competent performance of resuscitation procedure is a matter of major importance since mistakes can result in injury or even death. For this reason, training and the use of training devices must be closely monitored by experts in neonatal resuscitation instruction. Supervised clinical experience is regarded as a prerequisite for any individual who is to assume responsibility for a portion of a neonatal resuscitation. The purpose of the present invention is to facilitate this instruction.

The interactive neonatal resuscitation simulator and method presented herein provide a trainee with a life-like simulation of a resuscitation process on a newborn infant, and in particular, a life-like simulation of what an attending physician would experience while resuscitating a newborn infant at a resuscitation station within a hospital's delivery room.

Briefly summarized, the present invention provides in a basic aspect an interactive human resuscitation training simulator which includes an android having an intelligent, interactive control mechanism. The control mechanism includes systems for simulating within the android a condition corresponding to a human condition requiring resuscitation, along with feedback systems for detecting and evaluating resuscitation activities on the android by a student employing the simulator. The control mechanism then adjusts the android's simulated condition in response to the student's resuscitation activities as sensed by the feedback system. The adjustment mimics a predetermined human reaction to resuscitation activity such as that performed on the android by the student employing the simulator.

In enhanced embodiments, the android is equipped with life-like human appearance and life-like human responses. Further, a resuscitation workstation having the appearance of a conventional resuscitation workstation is employed to present a more real-life simulation to the trainee. In a more specific embodiment, a virtual reality environment is created through the use one or more audiovisual system(s) which project prerecorded sights and sounds of a hospital room during an actual taped resuscitation procedure. Additional specific details of the simulator are also presented and claimed herein.

In another basic aspect, a method for conducting an interactive resuscitation training simulation is set forth. The method includes the steps of: providing an android having a life-like human appearance; simulating within the android asphyxiation; detecting resuscitation activities on the android by a trainee; evaluating in real time the trainee resuscitation activities; and adjusting the android's simulated condition in response to the trainees resuscitation activities. The adjustment in the android simulated condition mimics a predetermined human reaction to resuscitation activity such as that performed on the android by the trainee.

To restate, the interactive neonatal resuscitation training simulator and method presented employ an infant android of life-life appearance and response. The goal is to provide a trainee with a "real-life" clinical experience in resuscitation to enhance the trainee's learning experience and improve upon existing teaching methodologies. The simulator may be employed for certification and/or recertification of a trainee in neonatal resuscitation. By using the simulator, physicians and their associates gain knowledge which will directly impact on and reduce the error rate for resuscitation procedures performed today. The simulator provides an active, dynamic environment in which a trainee learns proper resuscitation in a variety of situations. This is accomplished by approximating the real working conditions, for example, in a delivery room of a hospital, during a resuscitation process and providing the trainee with accurate and timely feedback on the resuscitation procedure.

These and other objects, advantages and features of the present invention will be more readily understood from the following detailed description of certain preferred embodiments of the present invention, when considered in conjunction with the accompanying drawings in which:

FIG. 1 is a perspective view of one embodiment of resuscitation workstation and virtual reality enclosure components of an interactive neonatal resuscitation simulator pursuant to the present invention;

FIG. 2 is a block diagram representation of a virtual reality environmental system for a simulator pursuant to the present invention;

FIG. 3a is a perspective view of the resuscitation workstation of FIG. 1 in combination with an infant atomizer pursuant to the present invention;

FIG. 3b is a perspective view of the resuscitation workstation of FIG. 1 wherein a robotic infant connector well and a user keypad are depicted in expanded view;

FIG. 3c is a perspective view of the resuscitation workstation of FIG. 1 wherein a lighting system and a control keyboard layout are depicted in expanded view;

FIG. 4a is a top plan view of one embodiment of the resuscitation workstation and virtual reality enclosure of FIG. 1 shown in an operative setup;

FIG. 4b is a top plan view of the resuscitation workstation and virtual reality enclosure of FIG. 1 shown collapsed for storage;

FIG. 5 is a perspective view of a robotic infant (or android) pursuant to the present invention wherein cable connections for one embodiment of the automaton are shown;

FIG. 6 is a plan view of one embodiment of pressure sensor layout for the robotic infant of FIG. 5;

FIG. 7 is a plan view of one embodiment of speaker placement for the robotic infant of FIG. 5;

FIG. 8 is a plan view of a skeleton layout for the robotic infant of FIG. 5;

FIG. 9 is a plan view of one embodiment of motion cable layout for the robotic infant of FIG. 5;

FIG. 10 is a plan view of one embodiment of fluid insertion/extraction tubes and throat-tube sensor connections for the robotic infant of FIG. 5;

FIG. 11 is a plan view of one embodiment of naval/anal insertion/excretion fluid tubing for the robotic infant of FIG. 5;

FIG. 12a is a cutaway view of an assembled leg structure for the robotic infant of FIG. 5;

FIG. 12b is a cross-section of FIG. 12a taken along lines A--A;

FIG. 13 is a block diagram of one embodiment of organization and interconnections for major system modules within a resuscitation workstation pursuant to the present invention;

FIGS. 14a-14d depict a high level schematic of a computer system control pursuant to the present invention, wherein one embodiment of input/output control lines is shown;

FIG. 15a is a plan view of one embodiment of a linear servo motion system pursuant to the present invention;

FIG. 15b is a side elevational view of the linear servo motion system of FIG. 15a;

FIG. 15c is an enlarged side elevational view of a single linear servo motor depicted in FIGS. 15a and 15b;

FIG. 16 depicts one embodiment of a motion cable connector configuration pursuant to the present invention;

FIG. 17 depicts one embodiment of a fluid management system pursuant to the present invention;

FIG. 18 depicts one embodiment of a pneumatic management system pursuant to the present invention;

FIG. 19 is a plan view of a specific skeletal structure for a robotic infant pursuant to the present invention;

FIGS. 19a & 19b depict a dual axis motion joint and a single axis motion joint, respectively, for a robotic infant pursuant to the present invention;

FIG. 20 is a side elevational view of a mouth motion system for a robotic infant pursuant to the present invention;

FIGS. 20a-20c depict front elevational views of the mouth motion system of FIG. 20, wherein the mouth is shown in open, partially open and closed positions, respectively;

FIG. 21 is a side elevational view of one embodiment of an eye motion system for a robotic infant pursuant to the present invention;

FIGS. 21a-21c depict front elevational views of the eye motion system of FIG. 21, wherein the eye is shown in open, partially open and closed positions, respectively;

FIG. 22 is an elevational view of one embodiment of a throat-tube system for a robotic infant pursuant to the present invention;

FIG. 23a is a side elevational view of one embodiment of a chest plate system for a robotic infant pursuant to the present invention;

FIG. 23b is a top plan view of the chest plate system embodiment of FIG. 23a showing one positioning embodiment of external pressure sensing transducers within the chest system;

FIG. 24 is a side elevational view of one assembled embodiment of the head motion control and fluid flow assemblies for a robotic infant pursuant to the present invention;

FIG. 25 is a side elevational view of one embodiment of a head frame structure for a robotic infant pursuant to the present invention;

FIG. 26 is a block diagram representation of one embodiment of system software pursuant to the present invention; and

FIG. 27 is a block diagram representation of one embodiment of robotics control software pursuant to the present invention.

In general, the interactive neonatal resuscitation training simulator and training method of the present invention are designed to present a life-like simulation of the resuscitation process of a newly born infant. The system accurately simulates what an attending physician might encounter when resuscitating a newborn infant within a hospital delivery room.

The neonatal resuscitation simulation training system includes the following major components: (1) a neonatal workstation; (2) a robotic infant; (3) a virtual reality environment enclosure; (4) a robotics system; and (5) supporting/controlling system software. Each of these components is described in detail herein with reference to the accompanying drawings, wherein the same reference numbers are used throughout multiple figures to designate the same or similar components.

FIG. 1 depicts a neonatal resuscitation simulation and training system, generally denoted 10, pursuant to the present invention. System 10 includes a resuscitation workstation 12 disposed within a virtual reality environment enclosure 14. The purpose of enclosure 14 is to simulate the working environment within a typical delivery room during an actual neonatal resuscitation process. In the particular embodiment depicted, enveloping enclosure 14 includes two side panels 16a, 16b and a back panel 16c. Preferably, side panels 16a, 16b pivotally connect at edges 18a, 18b to back panel 16c for selective collapsing of the enclosure as described below.

Visually, a virtual reality environment is generated by two large projection TV systems 20, each of which is disposed on one of side panels 16a, 16b of enclosure 14. Additionally, a stereophonic audio system having two speakers 22, 24 is associated with each projection TV system. The audio systems are employed to playback actual delivery room sounds during a neonatal resuscitation procedure, and may be mounted on the hinged/movable side panels 16a, 16b and back panel 16c as shown in FIG. 1. Two audiovisual systems are preferably employed to enhance the reality of the enclosure by providing a left side and right side environment. The virtual reality environment sub-system, denoted 29, is shown in greater detail in FIG. 2.

Virtual reality sub-system 29 consists of a dual deck video cassette player 30, two rear projection TV systems 20 and their associated stereophonic audio systems 22 & 24. A first TV system 20 and its associated audio system 22 are connected as shown to a first video/stereo audio playback component 32 of the dual deck cassette player 30, and a second TV system 20 and its associated audio system 24 are connected to a second video/stereo audio playback component 34 of the dual deck cassette player 30. Player 30, which has start, stop and rewind tape control functions, is started at the beginning of a simulation by a system processor 40 (e.g., positioned in the base of the resuscitation workstation 12 (FIG. 1)). Tape play may be for approximately 30 minutes per cassette which would accommodate approximately five resuscitation training sessions before having to be rewound for replay.

Returning to FIG. 1, resuscitation workstation 12 is to the extent possible a faithful replication of an actual resuscitation workstation found within a hospital delivery room. This is to assist in presenting a true-to-life simulation. Workstation 12, depicted in greater detail in FIGS. 3a-3c, includes an upper section 50, which conventionally contains a radiant heating system used to warm the outer surface of a newborn under temperature control. As described below (FIG. 3c), however, section 50 of workstation 12 is employed as part of an ultra-violet lighting system which assists in a color change "illusion" of an infant android positioned on a supporting surface 60 of workstation 12.

Below section 50 in the center of an overhead structure support frame 54 is a large (e.g., 20 inch diagonal) VGA color display system 52. Display system 52 is under computer control and provides help information to an attending physician during a simulation process. This system is tutorial for the user and instructs the trainee on how to set up and start the simulation process. Preferably, prompting or assistance to the person being trained is also provided while the simulation is underway. Below display system 52 is a resuscitation instrument arm 56 which holds breathing assist apparatus and suctioning devices 57 for use during the simulation process. Arm 56 is identical in form to what is found in an actual resuscitation workstation. Next is infant support bed 60 where a robotic infant (i.e., android; see FIGS. 5-12b) is located on the surface, preferably with its head to the front in the same manner as in an actual live resuscitation procedure.

At the front of infant work surface 60 is a small touch-sensitive keypad 62 which is used by the person operating the simulator and experiencing the simulation. Keypad 62 allows the operator to control starting, stopping and selecting of tape simulation scenarios to be experienced. To the right of user keypad 62 is a full computer compatible keyboard 64 mounted on a swing out frame. Keypad 62 and keyboard 64 are described below in greater detail with reference to FIG. 3b & 3c, respectively.

Finally, workstation 12 includes two drawers 66 at the front of a base portion 68. Drawers 66 house the various instruments and devices, which may be necessary during a resuscitation process, normally found at an actual resuscitation workstation. Preferably, the drawers are "half depth" in order to provide room for an internal computer system (FIGS. 14a-14d) which is to control the simulator. The bottom blank panel 70 is an access panel to the internal computer system.

Referring to FIG. 3a, an infant android atomizer 80 is preferably provided to cover an infant android (FIGS. 5-12b) with a thin film of moisture (e.g., distilled water), and thereby simulate an infant's skin condition immediately following delivery. Atomizer 80, fabricated for example of a lightweight plastic, consists of a fluid reservoir 82 and a hand pump 84 which is used to "spray" an infant android with distilled water. Multiple depressions of the hand pump mechanism may be required to adequately cover the infant android with a water film. This moisturizing operation can be performed by a "system administrator" or by the medical professional using the simulator.

FIG. 3b depicts in detail one embodiment of user keypad 62. Keypad 62 includes a start simulation scenario control 90, a stop simulation control 92, a scenario select display control 94, a help screen control 96, and training scenario selection pads 98. Preferably, keypad 62 is a touch-sensitive membrane keypad which is stain resistant and waterproof. Again, this keypad is the main control panel which a person operating the simulator employs to interface with the system.

Recessed within infant support surface 60 is a connector well 100 which contains various connectors for the automation systems within the infant android (FIGS. 5-12b). In the embodiment depicted and described herein, well 100 has motion cable connectors 102, fluidics connectors 104, pneumatics connectors 106 and electrical (small signal) connectors 108. These connectors provide all electrical, motion, fluidic and pneumatic connections between the robotic infant and the main processing and control systems located within the workstation. The connectors are preferably recessed in well 100 such that the infant android will lie flat upon the workstation support surface 60. (Each set of connectors is discussed in detail below.)

FIG. 3c depicts one embodiment of a system keyboard 64 for the system administrator. This keyboard comprises a standard 101 keyboard and is disposed to the right of user keypad 62. Keyboard 64 is preferably mounted to a swing out frame 63 for easy use by the system administrator in preparing a simulation exercise. Keyboard 64 may also be used to access a series of self-diagnostics to test the entire system prior to beginning a simulation to ensure proper operation. Maintenance technicians will also use this keyboard for any routine and special maintenance requirements. The keyboard may be locked out of the way during training sessions to prevent inadvertent activation of undesired functions.

As already noted, an ultra-violet lighting system 51 is partially disposed within upper section 50 of workstation 12. In one embodiment, ultra-violet lighting system 51 comprises six lamps disposed as shown in FIG. 3c. These lamps are controlled by a servo motor controlled shutter (not shown) which itself is under control of the main processor (FIGS. 14a-14d) in the base 68 of workstation 12. The ultra-violet lighting system utilizes 15 watt fluorescent lamps, which predominantly have "black light" output in the ultra-violet (UV) spectrum.

FIG. 4a is a top plan view of an operative setup of resuscitation workstation 12 and virtual reality enclosure 14 of system 10. Preferably, workstation 12 is movable (for example, the workstation could be placed on rollers 17) and the associated virtual reality enclosure 14 is collapsible in order to minimize storage space when the simulation system 10 is not in use. "Slide away" storage of workstation 12 and environment 14 is shown in FIG. 4b. Enclosure 14 is preferably hinged at three locations 15 in order that it may be readily folded as illustrated in FIG. 4b for storage. Each unit is preferably supported by ball casters, such as casters 17 supporting workstation 12.

The robotic infant (RI), described below with reference to FIGS. 5-12b, is a life-like representation of an actual newborn infant. Various length and color infants will preferably be available. The RI is positioned on the workstation's 12 support surface 60 (FIG. 1) head to the front and on its back, as would be expected of any newborn infant needing resuscitation. The robotic infant is connected to the simulation system via a series of "umbilical" cables exiting from the base of the spine of the android and coupling to the connectors in well 100 in the workstation's infant support surface 60 (FIG. 1). These umbilical cables are flexible and long enough to permit "handling" of the RI as would normally be required during a resuscitation process.

Numerous automation systems are embodied within the robotic infant in order to present a life-like infant android with life-like actions/reactions during the resuscitation procedure. The techniques employed by the present invention include:

1) Full RI motion of the head, facial elements, chest and limbs accomplished by a linear action servo system via control cable motion transmission.

2) Fluidics system which manages and controls the excretion of fluids from the infant (through the nose, mouth and anal passage) and monitors the insertion of fluids via the umbilical stub.

3) Pressure sensing system which detects the application of pressure on the RI during the resuscitation process. The points monitored are the underside of both hands and feet as well as multiple points on the chest and upper abdomen.

4) Internal Body Sounds (heartbeat). Two low frequency audio transponders in the chest create a left side or right side heart beat.

5) Throat Insertion Sensing. A series of sensors are located within a "throat tube mechanism" which detects the insertion of instruments (laryngoscopes etc.) during the resuscitation process. These sensors detect the actual position of the inserted instrument to verify proper application and use.

6) Anatomical Throat Representation. When the throat is viewed via a laryngoscope, the medical professional will "see" a replication of the throat internals. This is partially accomplished by a throat tube wall coating material such that when viewed through a laryngoscope, the throat appears as expected.

7) Vocal Sounds are created via a small speaker located within the head (and rear of the upper throat tube mechanism) of the RI. This speaker is driven via an audio synthesizer (as part of the system's processor) and replicates the expected vocal sounds of a newborn.

8) Pneumatics System, which is a control system for the fluidics system. This system controls the excretion of RI fluids.

9) Color Change System. There are two techniques employed to create the expected color change of a newborn during resuscitation. The first technique is via the external "black-light" system (discussed above). The second technique is a "color controlled," shaped strip which makes up the lips of the RI. The black light system utilizes deep UV lighting from six light sources mounted on the workstation at specific locations. These light sources, when activated (via a shutter mechanism) "excite" UV (ultra-violet) sensitive particles preferably imbedded within the surface material of the RI. When excited, these particles change their color to a blue-tint and thereby create the illusion of skin surface color change. The six light sources are under control of the processor so that an "uneven" color change can be created to replicate the expected color change during resuscitation. Additionally, various concentrations of UV particles are located on the RI skin surface to enhance the blue-tint intensity at selected locations. The color controlled, shaped strips (lips) are included to accentuate the color change of the lips during resuscitation. This is under processor control and is activated and controlled by a current change through the color variant material. This additional color system is preferably included since lip color is an important queue to determining a newborn's reaction to a resuscitation process.

Skin Surface Material. This is a latex compound which has a texture replicating the "feel" of a newborn's skin. Additionally, the natural color of the material is such that the fully resuscitated newborn color of pink, light brown or dark brown can be fabricated.

All control systems for the RI (e.g., motion servos, pumps, etc.) are located external to the RI so that the internal mechanisms of the RI are as simple as possible and "quiet" during operation. The quietness of operation is important so that no false audio queues are inadvertently created during the RI's resuscitation which would disturb the "illusion" of life-like action and reaction.

Referring now to FIGS. 5-12b, one detailed embodiment of a robotic infant, denoted 200, pursuant to the present invention is discussed below.

FIG. 5 illustrates input and output cable links between RI 200 and the main system processor (not shown), i.e., via the well connectors (102, 104, 106, 108) in the infant support surface of workstation 12 (FIG. 3b). These cables, which by way of example may be approximately 8 inches in length, include a motion control interface connector 202, a fluidics connector 204, a pneumatics connector 206, and a small signal electrical connector 208. The cables enter RI 200 through a cable way 210 (e.g., a section of nylon "skeleton" in the back of RI 200) and interface with the corresponding mating halves located within the "connector well" on the work surface of the resuscitation workstation (i.e., motion cable connectors 102, fluidics connectors 104, pneumatics connectors 106 and small signal electrical connectors 108 of FIG. 3b). Again, the robotic infant is normally positioned "head-to-physician" and the 8 inch cable length provides enough mobility so that the robotic infant may be realistically moved upon the workstation surface.

A plurality of pressure sensors are employed within the robotic infant as part of a feedback system to evaluate an attending physician's resuscitation performance. FIG. 6 depicts RI 200 with 13 pressure sensors disposed within the android. Nine pressure sensors 222 are arranged in a grid in a chest plate system 220, while the underside of the robotic infant's hands and feet each contain a single pressure sensor 224 & 226, respectively. Each pressure sensor is of a resistance change type such that the sensor's resistance is directly proportional to pressure applied to the sensor. Each sensor is connected to the system's main processor via cables as illustrated, such as cable 227. These cables pass through the cable way 210 in the back of robotic infant 200.

Speaker placement for one embodiment of the robotic infant is depicted in FIG. 7. In this embodiment, three speakers are employed. A speaker 230 is positioned within the head of the robotic infant to emit vocal sounds, while speakers 232 are disposed within the chest to emit chest sounds, such as a heart beat and breathing sounds. By way of example, each speaker may comprise an 8 ohm, low power speaker. Cables, such as cable 234, connect speakers 230 & 232 (via the cable way) to a main processor audio synthesizer module (discussed below).

FIG. 8 depicts in phantom one embodiment of a robotic infant skeleton 240. Skeleton 240, which may be fabricated with nylon or plastic spars, includes a head frame assembly 242, a chest plate mounting assembly 244, cable way 210, arm assemblies 246 and leg assemblies 248. As discussed further herein, a plurality of rotary joints are employed within the robotic infant. These rotary joints include both dual axis rotary joints 250 and single axis hinge joints 252. As shown, skeleton 240 also contains eye mechanism mount frames 254 and a mouth mechanism mount frame 256.

Each joint of the skeletal mechanism, as well as the eye and mouth motion assemblies presented below, are computer system controlled (via cables) to provide accurate simulation of robotic infant movement. FIG. 9 illustrates one motion cable layout pursuant to the present invention. The cables are preferably constructed of teflon sleeves (similar to that of a catheter) where a center strand slides back and forth to operate one of various motion joints fixedly secured to a distal end. The mechanism is similar to that of a "automatic break cable" yet constructed of thin gauge teflon material. Cables 260 control eye opening/closing motion, cable 262 allows control of mouth opening/closing and tongue motion, cables 264 control the neck rotary joint, cables 266 control rotary shoulder joints, cables 268 control chest plate motion, cables 270 control arm motions, cables 272 control rotary hip joints, and cables 274 control leg motions. All motion cables exit robotic infant 200 via cable way 210, and are connected to a linear servo motion assembly system (described below) located within the base of the resuscitation workstation.

Placement of fluid insertion/extraction tubes and throat-tube sensor connections within the robotic infant are depicted in FIG. 10. Excretion and purging of infant fluids are accomplished via plastic tubing as depicted (see also FIG. 22). Preferably, fluids simulate the nasal and throat fluid excretion of a newborn. The fluid is a non-sticky, non-staining teflon based emulsion which is pumped up to the robotic infant under control of the main workstation processor (not shown). Tube 280 provides nasal fluid excretion which emits from a nasal port 282 in RI 200. Tubes 284 purge (via suction) fluids from the throat tube mechanism 286, and insert fluid into the throat tube mechanism at both the top and bottom as illustrated. The tube which inserts fluids into the upper throat tube also inserts fluids into the mouth assembly. Single lines 282 are employed to connect proximity detectors 290 to the main computer system (FIGS. 14a-14d) for detecting throat tube instrument insertion by the main processor. These control lines exit RI 200 and fan out, for example, in a flat cable connect to provide multiple lines to the main processor sensing input ports (described below).

FIG. 11 depicts a simulated umbilical "stub" 292 which houses a magnetic proximity detector (similar to those in the throat tube depicted in FIG. 22) to detect the insertion of medication administration tubes within the umbilical stub. Anal fluid excretion is pumped from the robotic infant via tube 294 and the simulation fluid excretes from the anal passage of the robotic infant. As discussed further below, this is a separate fluid from the fluids described in connection with FIG. 10.

A single leg limb is shown in FIGS. 12a & 12b to illustrate a preferred construction for the robotic infant. This leg limb 300 includes an outer skin surface 302 made from a latex compound of soft composition to accurately replicate the feel of a newborn infant's skin texture. The inner structure comprises a teflon spar 304 surrounded by a polyester fiber material 306, which together provide basic shape support of the outer skin material 302. Material 306 also provides the feel of a readily "pliable" surface as expected of an actual newborn. The spar extensions add additional support throughout the internal area. Numerous control cables 305 (as described above), extend throughout the robotic infant. FIG. 12a also depicts a dual axis, hip rotary joint 250.

The various control modules or "sub-systems" located within the base of the resuscitation workstation 12 (FIG. 1) are depicted in FIG. 13. Each module is mounted (or housed) within its own enclosure to facilitate unit assembly and maintenance. As shown in FIG. 13, robotic infant connectors (102, 104, 106, 108) are housed in well 100 within the workstation's infant support surface 60. Extending from well 100 are pneumatic tubes 309, motion cables 311, electric cable connects 313 and fluid hoses 315. A linear servo motion control system 312 provides physical actuation to motion cables 311. Motion control system 312 (FIGS. 15a-16) is electrically connected via servo system control cable 314 to a main computer 324 (FIGS. 14a-14d). Cabling 314 may comprise a ribbon type cable connection. A pneumatic system 316 (FIG. 18) receives pneumatic tubes 309 and is responsive to main computer 324 via pneumatic system control cable 318. A fluid management system 320 (FIG. 17) connects to fluid hoses 315 and is responsive to the main computer's 324 signals received over fluid management system control cable 322.

In one embodiment, multi-conductor ribbon cable is used to connect all control modules to the computer system with appropriate connectors at each end. An additional cable (not shown) from the computer system to the external devices of the workstation (keypad, keyboard, UV lighting, help screen, report printer, resuscitation instruments) emanates from the rear of computer 324 and connects to the rear wall of the workstation. System modules 312, 316, 320, 324 and their interconnections are described below in greater detail with reference to FIGS. 14a-18.

FIGS. 14a-14d depicts one embodiment of a central processing system 324 pursuant to the present invention. This processing system controls and operates the resuscitation workstation, robotic infant, and virtual reality environment system. Processing system 324, located, for example, in the base of the resuscitation workstation, is a PC compatible system having a state-of-the-art central processor 330 such as a "486" microprocessing chip with 8 Mb of RAM. A PC compatible system is selected because of its compatibility with a wide array of special peripheral devices, such as user keypad 62, keyboard 64 and monitor 52. Additionally, the basic structure of the system permits the use of software modules and software development tools within wide use throughout the robotics and medical automation/instrumentation industry.

Processor 330 is provided with a 150 or 300 megabyte hard drive 332, a tape backup 334, a dual floppy disk 336 and a report printer 338. In addition to such standard PC components, an A to D/D to A robotics control module 340 and an audio synthesizer module 342 are employed. Module 340 allows processor 330 to interact with and control the functionings of the robotic infant and the associated workstation. In one embodiment, there are 160 discrete input and output control lines to operate the system. The various inputs and outputs may be functionally grouped as indicated in FIGS. 14a-14d. The audio synthesizer module is programmable and used to generate infant sounds produced within the robotic infant's head speaker and chest transducers, discussed above.

One embodiment of a linear servo mechanism for generating robotic infant motion is depicted in FIGS. 15a, 14b & 15c. As noted with respect to FIG. 13, linear servo motion system 312 is preferably located within the base of the workstation. In the depicted embodiment, 30 linear servo motors 350 are employed, each of which is under control of the main processing system 324. These motors are supported by a mount plate 352, and each includes a linear plunger 354 with the speed, distance and direction of motion being under processor control. Each linear motion plunger 354 is connected to a unique motion cable 311 which couples to a particular joint within the robotic infant. Motion cable 311 is supported by a top plate assembly 358.

Each servo is a small reversible dc motor driving an internal worm mechanism which translates rotary to linear motion. The servos are operated by plus and minus 12 volts dc. Additionally, RI detectors enable the servo control mechanism (i.e., the central processor) to be aware of the general position of each servo's linear plunger. This permits the inclusion of a "servo-home" command to reset the system when required. The travel of each mechanism is approximately 1 inch, with a slew rate in excess of 1 inch per second. This is more than adequate to replicate the maximum speed of infant motion required to effect "life-like" motion. (The one inch per second is only a fraction of the actual limb speed achieved by the robotic infant since the linear motion is being re-translated into angular motion at each RI motion joint.)

As noted, the motion cable connectors provide a positive motion connection between the robotic infant and the linear servo system which is under computer control. There are thirty independent connections within the device which transmit all linear cable motion to the robotic infant. Connection is achieved by a "spear and socket" arrangement for the center strand of the motion cable. The connector is keyed and locked in place by two threaded locking posts accessible from the conductor well 100 (FIG. 13) located in the center of the workstation's work surface.

One embodiment of the motion cable connectors 102, along with a cable destination layout, is depicted in FIG. 16. Motion cable connector 102 is connected to the linear servo motion system 312 via 30 motion cables 311. Motion cable connectors 102, disposed within the RI support surface well 100, include a female block 372 and a male block 374 which are maintained in position via threaded lock posts 376. As noted above, teflon motion cables 202 connect to the various joints within the robotic infant.

One embodiment of a fluid management system 320 is depicted in FIG. 17. This sub-system provides the fluid source and controlled fluid transmission to the robotic infant for subsequent secretion during a given resuscitation simulation. Again, two distinct fluids are utilized; one for the nasal, mouth and throat tube system and a second for the robotic infant's anal passage. A fluid purge function is also included to suction out any remaining fluids within the system upon the completion of a given simulation process. The fluid pumps and associated gate valves are under the control of the simulator's central computer 324 (FIG. 13).

The two different types of simulation fluids are housed in separate plastic containers 385, which preferably include quick connect/disconnect rubber stoppers 387 to permit rapid exchange of containers when fluid replacement is required. Fluid resident within purged fluid containers 386 may be reused as often as desired by being transferred into the respective simulation fluid containers 385. The fluidics connector 104 is located within the connector well 100 (FIGS. 3b & 13) in the robotic infant support surface of the workstation. As noted with respect to FIG. 13, the flow management system is preferably located within the base of the workstation near central computer system 324. Five unidirectional pumps 390 are employed with pressure directions as indicated in FIG. 17. Two dual ported gate valves 388 are needed to control "pumping out" and "purging back" fluid functions. A four way fluid splitter 384 connects to four of the fluidics connectors 104. Hoses 380 of connector 204 then provide transfer of the fluid within the robotic infant.

One embodiment of a pneumatics management system 316 is depicted in FIG. 18. The connectors 106 (FIG. 3b) for the pneumatic management system is located within the connector well 100 (FIG. 13) of the robotic infant support surface 60 and the pneumatic control sub-system is located within the base of the workstation. This system controls the opening and closing of small pneumatic gate valves (discussed above) located within the robotic infant for the purposes of controlling fluid excretion from the robotic infant. The system is configured so that the electrically operated gate valves are remotely located from the robotic infant to reduce the number of electrical control lines required to connect the android. Additionally, this allows the noise generated by operation of the electrical gate valves to be isolated from the robotic infant thereby reducing the probability of unwanted noise queues emanating from the robotic infant during resuscitation simulation. Each control valve is operated by the simulator's computer system 324 (FIG. 13), as are bleed valves which are used to reset the system's air pressure to one ATM following the completion of a simulation. The pump unit utilizes a self contained adjustable pressure regulator and the volume of space within the six way splitter acts as a reservoir for compressed air storage.

In the embodiment depicted in FIG. 18, air tubes of connectors 206 are connected to the well of the robotic infant support surface 60 which, via connector locking screws 392, connects to a female portion of the pneumatic connector 394. Connector portion 394 holds six air tubes 309 each of which is connected to a separate solenoid valve 399. Valves 399 are controlled by the central computer 324 (FIG. 13) via solenoid valve control lines 318. Each valve 399 includes a bleed valve 400. A six way tube splitter 402 connects with each solenoid valve 399 and is fed air by air pump 404. Pump 404 itself is controlled via lines 318 and includes an air filter and pressure regulator 408.

Further structural details of the preferred embodiment of a robotic infant are presented below with reference to FIGS. 19-25.

FIG. 19 depicts one embodiment of a robotic infant skeleton 500 pursuant to the present invention. Skeleton 500 includes 15 separate spars or spar assemblies including: head frame, shoulder, upper left arm, lower left arm, left hand, upper right arm, lower right arm, right hand, chest/spine/hip assembly, upper left leg, lower left leg, left foot, upper right leg, lower right leg, and right foot. The limb spars are made from stock size teflon, while the head and the chest/spine/hip units are fabricated from a nylon material. Head frame 502 includes eye mechanism mounts 504 and mouth mechanism mounts 506. Ball joints 508 interconnect the various spar assemblies as shown. In addition, hinge joints 510 are provided in the arms and legs. The chest/spine/hip assembly includes chest plate mount arms 512 and motion cable mount blocks 514. Cable way 210 is the support and tie point area for all motion, fluidic, pneumatic and electrical lines entering the robotic infant, and pressure transducers 511 (discussed above) are also shown at the hands and feet.

As briefly mentioned above, two types of motion joints are used within the robotic infant. First, a dual axis control ball joint 508 (FIG. 19a) is employed at the neck, shoulders and hip points of the robotic infant skeleton shown in FIG. 19. Second, a single axis control hinge joint 510 (FIG. 19b) is used at the elbows, wrists, knees and ankles of the skeleton. All joints are made of teflon and controlled via teflon pull cables 520. These cables (via their central control strand 522) are activated by their respective linear servo actuators of the motion control sub-system within the base of the workstation. A total of 17 joints are utilized for the robotic infant of FIG. 19, which requires a total of 22 separate motion control cables 520. (Each dual axis motion joint 508 requires two control cables for control of the associated ball joint 524.) Each cable is held in position by a cable brace 526 which partially surrounds one of the spars 528. In the single axis motion joint 510 of FIG. 19b, teflon controls 530 are employed to position the control cables relative to a rotary joint 531 and its nylon spars 532.

As shown in FIG. 20, two control cables operate the mouth and tongue motion mechanism 540. In particular, a forked motion cable 542 controls opening, closing and partial opening/closing of the mouth, while a tongue motion cable 544 controls the up/down motion of an RI tongue 546. The illustrated control configuration leaves the inside of the robotic infant's mouth clear to enable the insertion of instruments during a resuscitation simulation session and the appearance of fluids as required (see also FIG. 24). Tongue 546, fabricated, for example, of a latex material, is formed about a base structure 548 to which tongue motion control cable 544 is affixed as shown. Structure 548 pivots about a tongue motion pivot 550, which is fixedly secured to a facial frame member 552.

Control of the robotic infant's mouth position is about a center motion pivot 554. Rigid and curved center control cables 553 are connected to latex membrane lips 556. By way of example, FIG. 20a depicts the robotic infant's mouth in an open position with tongue 546 raised, FIG. 20b depicts the mouth in a partially open position, with the tongue lowered, and FIG. 20c depicts the mouth in a closed position with the tongue centered. Because two control cables are used, tongue and mouth positions and functions can be controlled independently.

The eye motion system is depicted in FIGS. 21-21c. Each eye, constructed as illustrated in FIG. 21, includes an eyeball 560 made, for example, of a plastic bearing material having two motion pivots 562 located on each side. If desired, the pupil may be a dark brown dot or disk 561 affixed to the front of each eyeball 560. A single motion cable can be employed to operate the eyelids to effect opening, closing and partial opening/closing in a manner similar to the mouth motion system of FIG. 20. Preferably, each eye is under separate control to permit the simulation of "uneven" eyelid motion. Forked motion cable 564 includes a common control cable 566 disposed within an outer sheath 568. The control cables split as shown to connect at an upper end to a rigid and curved center cable portion 570 and at a lower end to a rigid and curved center cable portion 572. By way of example, FIG. 21a depicts an eye in an open position, while FIGS. 21b & 21c depict partially open and closed positions, respectively.

Referring to FIG. 22, one embodiment of a throat tube system 600 pursuant to the present invention is shown. Throat tube system 600 performs the following functions: (1) provides an anatomical simulation of an actual throat tube for laryngoscope viewing; (2) senses the insertion of instruments within the mechanism via "magnetic proximity rings"; (3) simulates the opening and closing of vocal cords; (4) produces fluids within the nasal, mouth, esophagus and breathing passages (trachea/l-r main bronchus); and (5) allows purging of inserted fluids.

Throat tube 600 is fabricated via injection molding utilizing an appropriate latex compound. The tube is formed of two major sections, an upper section from the trachea/esophagus junction to the nasal/mouth passages and a lower section from the trachea/esophagus junction to the ends of the bronchus. The lower section includes a left main bronchus 602, a right main bronchus 604 and an esophagus 606. Each of these tubes terminates at a fluid purge tube 608. Left main bronchus 602 and right main bronchus 604 meet at the trachea 610 wherein a vocal cords control mechanism 612 is disposed. Control mechanism 612 operates a vocal cords restriction flap 614, which can reciprocate between a closed and an open position as shown.

This unit simulates an infant's closed vocal cords and prevents instrument insertion past that point. The device consists of a small linear actuator 612 which is electrically operated. When energized, the actuator (measuring 0.75 inches in width and height) closes the flap 614 via a flexible nylon curved arm 613. When de-energized, the flap swings open resulting from a return spring force within the linear actuator mechanism itself. The actuator is controlled via 12 volts dc and is interfaced to the simulator's main computer control.

The overall length of the assembled molded sub-system may be approximately 6 inches long for a full term infant simulation. When the system is assembled it is fluid tight with the exception of the nasal 616 and mouth ports 618. Entering the molded throat tube are two flexible plastic tubes 620 which allow for fluid insertion under control of the fluidic system, discussed above.

In the embodiment depicted, 16 inductors or "magnetic ring sensors" 622 encircle various sections of the throat tube to detect the presence of an inserted instrument. This is accomplished by affixing small steel tips to the instruments so that when an instrument is passed within a given sensor coil a flux density change is produced which is detected by the electronics interface module, via lines 624, and subsequently signalled to the simulator's computer control.

One embodiment of a chest sub-system 650, is depicted in FIGS. 23a & 23b. This system incorporates two sound speakers 232 (for heartbeat and respiration noise) and nine external pressure transducers 222. Note that although two audio sound transducers are preferred, the system may incorporate only one device if desired and still maintain adequate simulation effect of infant chest sounds. A chest plate 656 is driven by four motion pistons 658, each of which is activated by an independent motion control cable 660 ultimately controlled by the central computer.

The illustrated pressure transducers 222 are analog devices which change resistance depending upon the amount of external pressure applied to them. These devices register the location and amount of external pressure applied to the robotic infant's chest area by the person using the simulator. This enables the simulator's computer system to recognize when, where, and how much chest pressure is being applied during a resuscitation training session.

Four independent motion pistons 658 are preferably used so that an uneven or undulating chest motion pattern can be created. This agrees with the type of actual chest motion occurring within a live infant during resuscitation. The chest motion plate 656 is affixed to the robotic infant's skeleton frame (FIG. 19).

FIG. 24 depicts the head portions of the RI motion and fluid sub-systems in assembled position. In this composite illustration the throat tube sub-system is also partially depicted. Preferably, the nasal fluid tube is split just above the nasal passage to effect fluid excretion from both nostrils. The mouth fluid tube is a single tube located at the roof of the mouth port to effect fluid insertion into the mouth.

Referring to FIG. 25, skeletal head frame 502 is depicted positioned within the robotic infant's head, shown in phantom. Head frame 502 is the support mechanism for all motion, fluid and sound generation (speaker) devices located within the robotic infant's head. As noted above, the frame is preferably fabricated from teflon spars and connected to the ball joint motion joint 508 at the base of the RI's neck. The eye mechanism mount point 504 and mouth mechanism mount point 506 are also shown in this figure.

Referring to FIG. 26, the system software consists of five major categories as follows:

1) Basic operating system 700 which is the system software foundation on which all resident programs run. This is the O/S-2 system by IBM (a standard and widely used operating system). It is a multi-tasking operating system which is well suited for the simulator's requirements. This program also provides all the basic utility functions to control all system peripherals such as keyboard(s), video monitors, disk drives and printers.

2) Robotics control system 702: This system provides all the basic control, sensing commands and functions to operate the RI. It is resident within the main processing unit as well as resident within "imbedded" microprocessors located on the robotics control card (A to D and D to A modules).

3) System manager 704: This program controls all the major functions of the simulator, such as the command of the RI, the reading of sensing data from the RI, the coordination of events, such as help screen operation, the logging of data resultant from a given simulation scenario, etc. It is not accessible to the user and/or the system administrator since it is an internal program.

4) Scenario generator 706: This system provides the programming utilities for the professional medical administrator (physician) to develop the actual training scenarios for the entire simulator. It provides (in a user friendly manner by making use of "pull-down" menus, point-and-click operations, etc.) the basic utility to create the precise training scenario to be presented to the actual user (person being trained by the simulator). This program is available to the medical professional administrator and not to the "end user" or "institutional administrator/manager." This is an important system security function since the scenario generator creates the actual training "plans" and is responsible for defining and controlling all action and reactions that the simulator will present to the "end user" during a training session. It is the "medical authenticity" creation and control of the entire system.

5) Use administration system 708: This program provides the institutional administrator the basic functions to initialize the simulator, preparing it for use by the end-user, shut the system down after a day or "shift" operation, scheduling the simulator for a day or shift use (name of user, etc.), initialize the self-test feature of the system to verify proper system operation, interchange RI's (full-term, small, preemie, etc.) and test for proper operation, etc. It is an "office administration" function and would be generally used by either a nurse, paramedical staff member or department administrator. This system is also user friendly by making use of pull-downmenus and point-and-click operations as well.

A summary listing of each program and its major functions are as follows:

1) Basic Operating System (IBM):

a) O/S 2, basic computer utilities.

2) Robotics Control System:

a) RI motion control

b) RI sensing

c) RI sound generation (via synthesizer module)

d) RI color change control

e) RI fluid management

f) RI pneumatics management

g) Imbedded micro system (Burr Brown/Analog Devices).

3) System Manager:

a) I/O calls, RI control

b) File management

c) Context Sensitive help screen manager

d) Report generator (to printer)

e) Scoring system manager.

4) Scenario Generator:

a) I/O call sub-routines ("pre-packaged motion")

b) Randomization (type-range) I/O call sub-routines

c) Help-Screen Composer

d) Sensing Input reader sub-routine call

e) Sequence Composer

f) Printer Report Composer

g) Audio Output sub-routine call

h) Sequence Composer, "teaching mode".

5) Use Administration System:

a) Start-up sequencer

b) Shut-down sequencer

c) Use scheduler

d) Use reporting (to printer)

e) Run Diagnostics and report results.

Robotic control system 710 controls all physical operation of the simulator.

It is a multi-processor system and is monitoring and controlling in excess of 160 points simultaneously in real time.

An operational overview is as follows:

The robotics "script" is derived from the scenario generator's scenario file and down-loaded into the robotics control system. The script is down-loaded in sections such that the scenario file and system manager can monitor the robotics operation.

A single script "element" consists of device I.D., action required or action expected (to be "read").

An example is as follows:

Assume that the scenario generator calls for the head to move rapidly from side to side at a specific point in the simulation.

The script element will consist of the following data:

a) Device i.d.=head/neck Joint

b) Action Required=Left/Right Motion--Limit to limit Up-Down Motion+/-25% around center

Motion rate--maximum

Duration--10 seconds

c) Over-Ride Available=Yes

This data is then transferred to the loop control processor(s) (see FIG. 27) where the stated instructions are then carried out.

The loop control processor(s) operate autonomously without any assistance from the rest of the system. These are separate and dedicated processors located on the robotics input and output module within the main processor. The structure is generally termed a programmable I/O module, and may comprise any one of numerous commercially available industrial process control systems or standard point controllers.

With 160 such operations available, multi-process control is one of the key elements of the system, hence the autonomous structure.

The following tables set forth the software commands utilized to control the entire system:

The column entitled "COMMAND" defines the desired action of the simulator.

The column entitled "CMD. ID" is the software command name.

The column entitled "RESULT" is the actual action of the simulator required to create the desired robotic and system action.

These are effectively sub-routines called up by the various software commands.

(A "simple" scenario has been selected for purposes of description.)

The left hand side of this "Scenario Flow" diagram describes the actions taken by the medical professional being trained on the system while the right hand side describes the trainee actions monitored and actions/responses created by the simulator and presented to the trainee. The simulator's monitoring functions and actions are referenced to the various sub-systems within the simulator. Pease refer to the Sub-System I.D. reference table.

The "Initial Conditions" are the start characteristics assumed during birth and may be considered the "Title" of the training scenario.

First, the Robotic Infant (R.I.) is prepared for the start of a new simulation or "Training Scenario". This consists of the following steps:

1) Depress the "Master Reset" key on the User Keypad. This resets all robotic sub-systems to their initial start-up state. It also checks to see that all instruments, simulated medication vessels, etc. are in proper position and condition to begin a new training session.

2) Remove any simulation fluids that may be remaining from the previous simulation. This is accomplished by simply wiping off the robotic infant and work surface with a clean cloth if required.

3) Place the IAU (Infant Atomizer Unit) over the RI and depress the top panel three or four times. This sprays a coating of distilled water over the infant to simulate the "Web-Born" initial conditions. Once completed remove the IAU.

4) Via the UKP (User-Keypad) and VDU (Visual Display Screen) depress the select scenario key. The VDU will then display a listing of all available training scenarios stored within the system at that time. Using the up-down key on the UKP, roll the "scenario screen" until the desired scenario is within a highlighted "select" window on the VDU. Then depress the "O.K." key. The system then access the scenario file from its disk and begins its "initialization" sequence.

For this example assume the "Full-Term, Prolapsed Cord C/Section and Breach Delivery, Stat Conditions" scenario has been selected.

5) Simulator Response to Scenario Selection:

Upon selection of the above scenario the simulator "initializes" the system as follows;

a) Sets RI color to "Pallor (pale white) via the CCS.

b) Inserts fluid into mouth, nasal passages and throat via the FCS.

Upon completion of these two operations the VDU then displays the message "READY TO BEGIN".

The trainee then depresses the "GO" key on the UKP and the simulation begins.

Although specific embodiments of the present invention have been illustrated in the accompanying drawings and described in the foregoing detailed description, it will be understood that the invention is not limited to the particular embodiments described herein, but is capable of numerous rearrangements, modifications and substitutions without departing from the scope of the invention. The following claims are intended to encompass all such modifications.