A new methodology for use by a single caregiver to bathe bedridden elderly persons using advanced mechatronic systems

healthcare Article A New Methodology for Use by a Single Caregiver to Bathe Bedridden Elderly Persons Using Advanced Mechatronic Systems Karolina Bezerra 1, JoséMachado 1,2,* , Vítor Carvalho 3,4 , Filomena Soares 4,5 , Demétrio Matos 6, Marcelo Castro 2, Filipe Pereira 1,4 and Hugo Lopes 3 1MEtRICs Research Center, School of Engineering, University of Minho, 4800-058 Guimarães, Portugal; [email protected] (K.B.); filipe.as.per[email protected] (F.P.) 2Mechanical Engineering Department, School of Engineering, University of Minho, 4800-058 Guimarães, Portugal; marcelovieiracastr[email protected] 32Ai-EST-IPCA, Polytechnic Institute of Cávado and Ave, 4750-810 Barcelos, Portugal; [email protected] (V.C.); [email protected] (H.L.) 4ALGORITMI Research Centre, School of Engineering, University of Minho, 4800-058 Guimarães, Portugal; [email protected] 5Industrial Electronics Department, School of Engineering, University of Minho, 4800-058 Guimarães, Portugal 6ID+-ESD-IPCA, Polytechnic Institute of Cávado and Ave, 4750-810 Barcelos, Portugal; [email protected] *Correspondence: [email protected]; Tel.: +351-253-510-223 Received: 7 August 2019; Accepted: 22 October 2019; Published: 28 October 2019   Abstract: In the framework of this paper, we aimed to propose a methodology for giving baths to elderly, bedridden persons, when this task is performed by a single caregiver. Usually, two caregivers are required for nursing a bedridden patient, especially when certain important tasks are needed (e.g., bathing the patient) , but this is not always possible. The entire study considers the primary user’s perspective—the caregiver—who is responsible for a wide range of tasks; thus, suffering physical and psychological exhaustion over time. A physical prototype has been developed for allowing caregivers to perform tests in a life-like environment, by means of the device and the methodology. This technology, therefore, will represent an important contribution to the quality of life of caregivers. Considering an increase in the share of the elderly population and the related problems that arise in daily care, this project intends to be beneficial contemporarily. The presented methodology has been successfully tested and validated. Keywords: caregiver; mechatronic assistive devices; bathing bedridden persons; methodology for bathing bedridden persons by a single caregiver 1. Introduction Currently the population aging trend in Europe shows that older persons (aged 65 or more) account for 19.2% of the total population (an increase by 0.3% over the previous year and by 2.4% over the former 10 years) [1]. It is considered that the long-term population age structure tends to demonstrate an increasing proportion of elderly persons, along with a decreasing proportion of active persons in the total population. It is estimated that the share of the population over 65 will increase in all EU Member States, European States and candidate countries [1,2]. In recent years, life expectancy has grown, and eventually, it has influenced the structural changes in families, which in turn end up resorting to support for care. In order to meet the needs inherent in Healthcare 2019,7, 124; doi:10.3390/healthcare7040124 www.mdpi.com/journal/healthcare Healthcare 2019,7, 124 2 of 15 social problems, there is a sustainable system with two support networks: the informal and the formal one [3]—which successively configure the types of caregivers [4–6]. Knowing that there are more and more persons who prefer to benefit from healthcare in their homes, this work was directed to the informal care network, covering the home environment, where the caregiver is the main source of direct care and psychological support [ 1 – 6 ]. Research has shown that there is an absence of methodologies related to the execution of activities needed to assist an elderly person in their everyday life, as in the bathing process [ 7 – 13 ]. In order to carry out the activities safely and ensure the health of the caregivers and of the bedridden, it was identified that the caregivers’ tasks require the aid of a technology-assisted methodology to allow for a better quality of life [7–13]. Thecircumstances incountriessuchasEngland, Australia, Canada, are favourabletosocio-political strategies aimed at improving the last part of the life of bedridden persons and that encourage their treatment at home [ 14 – 20 ]. Several studies emphasize caregivers’ physical and emotional exhaustion and indicate the need to implement effective intervention strategies [21–36]. The informal caregiver is a single caregiver who is from the family. Therefore, it is necessary to elucidate the methodologies to assist informal caregivers in order to promote health policies and support them [14–20,37–44]. The opportunity to create the methodology is associated with the development of a mechatronic system for bathing with an embedded security function. The system consists of two parts: the water supply system and the bathing surface. The development of such a system allows families and countries to reduce resources used for tending bedridden persons. The remainder of the paper is organized as follows: •Section 2presents the hardware control system’s development; • Section 3: New Methodology for Bathing—One Caregiver, describes the final methodology developed as a result of the overall studies; • Section 4, Conclusion, summarizes the presented work and identifies directions for further improvements and developments. 2. Hardware Control System Development This section consists of two parts—one dedicated to the water supply prototype and the second to the conceptual design of a new bath surface equipped with the functional skills that allowed for the development of the methodology associated with the bathing process and that proved the success of the design; in the final part is presented the step-by-step development of the aforementioned methodology. 2.1. Water Supply Prototype The conceptual design of the proposed system is presented in Figure 1. The mechanical design of the water supply system, its requirements and specified parameters are detailed in [45]. The system has a robust structure due to the technical calculations that considered the need to accommodate a high quantity of water. Besides, it was necessary to choose from the components existing on the market, precisely to optimize its construction and to enable the first tests in a real environment. The material considered is Steel S 275 JR (1.0044 according to EN 10027-2: 2015). SOLIDWORKS ® Simulation tool was used for static simulations, such as the analysis of the minimal thickness of the tube of the structure in mechanical terms (Figure 2). The forces used to test the structure were applied to the points of incidence with 1000 N because the safety coefficient is 3 and the total mass to be supported by the structure is estimated to be of 100 kg. Healthcare 2019,7, 124 3 of 15 Healthcare 2019, 7, 124 3 of 15 Figure 1. Water supply system concept. The system has a robust structure due to the technical calculations that considered the need to accommodate a high quantity of water. Besides, it was necessary to choose from the components existing on the market, precisely to optimize its construction and to enable the first tests in a real environment. The material considered is Steel S 275 JR (1.0044 according to EN 10027-2: 2015). SOLIDWORKS ® Simulation tool was used for static simulations, such as the analysis of the minimal thickness of the tube of the structure in mechanical terms (Figure 2). The forces used to test the structure were applied to the points of incidence with 1000 N because the safety coefficient is 3 and the total mass to be supported by the structure is estimated to be of 100 kg. Figure 2. Result of the simulation of the pipe structure with a thickness of 0.5 mm. As a result of the simulation, the allowable tenure ratio and the yield stress of the structure were analysed with a result of the safety factor (SF) of 3.3 at the critical point indicated in Figure 2. We opted for a galvanized welded tube structure to avoid corrosion, especially in the welded zones. Nevertheless, it has the advantage of facilitating the construction of the prototype, as welding is an easy manufacturing option, and in this case, the superior thickness of the structure facilitates Figure 1. Water supply system concept. Healthcare 2019, 7, 124 3 of 15 Figure 1. Water supply system concept. The system has a robust structure due to the technical calculations that considered the need to accommodate a high quantity of water. Besides, it was necessary to choose from the components existing on the market, precisely to optimize its construction and to enable the first tests in a real environment. The material considered is Steel S 275 JR (1.0044 according to EN 10027-2: 2015). SOLIDWORKS ® Simulation tool was used for static simulations, such as the analysis of the minimal thickness of the tube of the structure in mechanical terms (Figure 2). The forces used to test the structure were applied to the points of incidence with 1000 N because the safety coefficient is 3 and the total mass to be supported by the structure is estimated to be of 100 kg. Figure 2. Result of the simulation of the pipe structure with a thickness of 0.5 mm. As a result of the simulation, the allowable tenure ratio and the yield stress of the structure were analysed with a result of the safety factor (SF) of 3.3 at the critical point indicated in Figure 2. We opted for a galvanized welded tube structure to avoid corrosion, especially in the welded zones. Nevertheless, it has the advantage of facilitating the construction of the prototype, as welding is an easy manufacturing option, and in this case, the superior thickness of the structure facilitates Figure 2. Result of the simulation of the pipe structure with a thickness of 0.5 mm. As a result of the simulation, the allowable tenure ratio and the yield stress of the structure were analysed with a result of the safety factor (SF) of 3.3 at the critical point indicated in Figure 2. We opted for a galvanized welded tube structure to avoid corrosion, especially in the welded zones. Nevertheless, it has the advantage of facilitating the construction of the prototype, as welding is an easy manufacturing option, and in this case, the superior thickness of the structure facilitates the use of this manufacturing process. Therefore, as a function of the mechanical design guidelines, the final result of the mechanical system is presented in Figure 3. Healthcare 2019,7, 124 4 of 15 Healthcare 2019, 7, 124 4 of 15 the use of this manufacturing process. Therefore, as a function of the mechanical design guidelines, the final result of the mechanical system is presented in Figure 3. Figure 3. Mechanical system. The prototype uses an industrial programmable logic controller (PLC) and the controller program was specified using SFC [46] and it was implemented using Ladder programming language [47]. The HMI (human-machine interface) console was used, in order to allow the user to interact with the system developed and to display information. (Figure 4). Figure 4. Electronic system and interface (controller). The final result of the prototype construction is shown in Figure 5. Figure 3. Mechanical system. The prototype uses an industrial programmable logic controller (PLC) and the controller program was specified using SFC [ 46 ] and it was implemented using Ladder programming language [ 47 ]. The HMI (human-machine interface) console was used, in order to allow the user to interact with the system developed and to display information. (Figure 4). Healthcare 2019, 7, 124 4 of 15 the use of this manufacturing process. Therefore, as a function of the mechanical design guidelines, the final result of the mechanical system is presented in Figure 3. Figure 3. Mechanical system. The prototype uses an industrial programmable logic controller (PLC) and the controller program was specified using SFC [46] and it was implemented using Ladder programming language [47]. The HMI (human-machine interface) console was used, in order to allow the user to interact with the system developed and to display information. (Figure 4). Figure 4. Electronic system and interface (controller). The final result of the prototype construction is shown in Figure 5. Figure 4. Electronic system and interface (controller). The final result of the prototype construction is shown in Figure 5. The controller is responsible for assigning the desired functions; namely, filling the device with water, heating it, bathing and emptying the device. These steps are described as follows. First, the device must be connected to an external water supply. This connection is made via an adapter placed between the outlet of the water supply and the reservoir. In the next step, the device must be connected to the power supply; the caregiver activates the “Start” button placed on the control panel to boot the device. Then, he or she must select the “filling” function and the device starts the supply of water from the reservoir. When the sensors indicate that they are full, the user removes the connection between the device and the water supply. Then, the “heating” function must be selected, initiating heating of the water in the hot water tank. While the water is heating up, the caregiver can prepare the bedridden patient for the bath. The “bath” function is then activated, which requires setting the desired outlet temperature so that the system allows the bath to start. Finally, the last step is a manual process that requires the caregiver to perform the act of bathing the patient and control the outflow Healthcare 2019,7, 124 5 of 15 of water through the shower and the interface. The “emptying” function is activated when the bath finishes (the level sensors check if there is any water left in the tank); the remaining water must be evacuated. Afterward, finally, the water supply system is switched off. Healthcare 2019, 7, 124 5 of 15 Figure 5. Prototype in test environment. The controller is responsible for assigning the desired functions; namely, filling the device with water, heating it, bathing and emptying the device. These steps are described as follows. First, the device must be connected to an external water supply. This connection is made via an adapter placed between the outlet of the water supply and the reservoir. In the next step, the device must be connected to the power supply; the caregiver activates the “Start” button placed on the control panel to boot the device. Then, he or she must select the “filling” function and the device starts the supply of water from the reservoir. When the sensors indicate that they are full, the user removes the connection between the device and the water supply. Then, the “heating” function must be selected, initiating heating of the water in the hot water tank. While the water is heating up, the caregiver can prepare the bedridden patient for the bath. The “bath” function is then activated, which requires setting the desired outlet temperature so that the system allows the bath to start. Finally, the last step is a manual process that requires the caregiver to perform the act of bathing the patient and control the outflow of water through the shower and the interface. The “emptying” function is activated when the bath finishes (the level sensors check if there is any water left in the tank); the remaining water must be evacuated. Afterward, finally, the water supply system is switched off. 2.2. Experimental Tests The steps’ sequence runs until the tests are completed; the final results are described in the course of this section. The tests seek to establish a comparison between the expected result and the result obtained, in order to conduct a compliance analysis of the project parameters. 2.2.1. Test of Technical Perception Technical tests were carried out to guarantee the proper operation and to minimize the possible problems of this prototype. The technical test (Table 1) requires the evaluator to check the results obtained in the tests against the parameters set in the column of expected results and to evaluate whether there was compliance, or not, in terms of the operation of the prototype. Figure 5. Prototype in test environment. 2.2. Experimental Tests The steps’ sequence runs until the tests are completed; the final results are described in the course of this section. The tests seek to establish a comparison between the expected result and the result obtained, in order to conduct a compliance analysis of the project parameters. 2.2.1. Test of Technical Perception Technical tests were carried out to guarantee the proper operation and to minimize the possible problems of this prototype. The technical test (Table 1) requires the evaluator to check the results obtained in the tests against the parameters set in the column of expected results and to evaluate whether there was compliance, or not, in terms of the operation of the prototype. Based on the results of seven technical tests, it was concluded that the prototype meets most of the operating parameters, as can be verified in the column “compliance: yes or no.” It is important to consider that parameter 11 “output temperature set in controller” complies with the functionality, since it renders the final temperature of the resulting mixture of cold and hot water, which is of the utmost importance for patient safety. The “flow” parameter is also fulfilled because a maximum value of 6.5 L/min is obtained, and even lower values can be obtained if desired. However, it has been noted that there is still a need to improve the system so that the flow variations are smaller than those that took place during the tests. In the next prototype, greater attention should be given to parameters 7 “total mass of the device” and 10 “partial/total filling of the reservoirs.” Healthcare 2019,7, 124 6 of 15 Table 1. Final results of the technical test of the prototype. Description of Parameters Method Expected Result Obtained Result Compliance (Yes or No) Tank1-filling time Level sensor Temp1 ≤8 min 4 min 28 sec Yes Tank2-filling time Level sensor Temp2 ≤8 min 7 min 32 sec Yes Maximum temperature Temperature sensor T=60 ◦C 60 ◦C Yes Ensuring a temperature under 42 ◦C after mixing Temperature sensor 38 ◦C≥T≤42 ◦C 35/37 ◦C Yes Output flow Reservoirs Value ≈5 L/min ≈6.5 L/min Yes Usage time Timing Temp ≥10 min 10–15 min Yes Total mass of the device Balance Max. 100 kg ≈150 Kg No Heat loss analysis: maximum 1 ◦C in 10 min Temperature sensor Temp ≈10 min 1 ◦C Yes Noise produced Decibelimeter 60 dB (A) 47 dB (A) Yes Partial/total filling of reservoirs Level sensor Reading of level sensors Does not indicate partial filling/Indicates total filling of reservoirs No Output temperature set in controller Temperature sensor Final temperature resulting from mixing the water, against the temperature set in the controller Indicates the outlet temperature Yes Access to interior and all parts User Perception Assembly and disassembly There is access to all parts Yes 2.2.2. The Caregiver’s Perception on the Usability of the System (Performed in an Institution) The usability tests targeted caregivers of patients housed in a Portuguese institution in order to validate the use through the experience of the caregivers. In this phase, we obtained four results. The first observation relates to the formal aspect of the size of the equipment. Through the use of the prototype by the caregivers, the mobility parameters and the suitability of the tests in the real environment were validated. The test considered the functional aspects of the bathing experience, as assessed by the caregivers. They were asked to assess the aspects associated with this experienced via three answers corresponding to one of the two phases of the aspect. If an aspect was positive, they were asked to select “Yes.” If the aspect was not fully satisfactory, they were asked to select “More or Less,” and if it was negative, they had to select “No.” During the test procedure, all tests were satisfactory, with tests 2 and 4 performing better than tests 1 and 3. In the latter, there were certain features of the prototype that did not match the expected ones, but the “bathing” task was not compromised. It proved the benefits of the fact that we could carry out the tests in the real environment: that made it possible to perceive the limitations and the positives aspects, and define the improvement directions for the evolution of the project. Healthcare 2019,7, 124 7 of 15 2.3. Conceptual Design of a New Bathing Surface Taking into account the limitations of bathing in any environment, the need to create a new concept was identified. Here, we describe the system design that gave rise to the concept of the bathing surface. Based on the requirements defined above, six concepts were developed (Table 2). Table 2. Bathing Surface Concepts. Number Concept 1 Healthcare 2019, 7, 124 8 of 16 Table 2. Bathing Surface Concepts. Number Concept 1 2 3 4 5 6 Concept 6 is considered the conceptual surface that meets all requirements. It was considered for being inflatable and enabling mobility, hygiene and safety; moreover, it is the most suitable model for performing the bathing assistance function. The use of the surface corresponding to concept 6 is presented in Figure 6. 2 Healthcare 2019, 7, 124 8 of 16 Table 2. Bathing Surface Concepts. Number Concept 1 2 3 4 5 6 Concept 6 is considered the conceptual surface that meets all requirements. It was considered for being inflatable and enabling mobility, hygiene and safety; moreover, it is the most suitable model for performing the bathing assistance function. The use of the surface corresponding to concept 6 is presented in Figure 6. 3 Healthcare 2019, 7, 124 8 of 16 Table 2. Bathing Surface Concepts. Number Concept 1 2 3 4 5 6 Concept 6 is considered the conceptual surface that meets all requirements. It was considered for being inflatable and enabling mobility, hygiene and safety; moreover, it is the most suitable model for performing the bathing assistance function. The use of the surface corresponding to concept 6 is presented in Figure 6. 4 Healthcare 2019, 7, 124 8 of 16 Table 2. Bathing Surface Concepts. Number Concept 1 2 3 4 5 6 Concept 6 is considered the conceptual surface that meets all requirements. It was considered for being inflatable and enabling mobility, hygiene and safety; moreover, it is the most suitable model for performing the bathing assistance function. The use of the surface corresponding to concept 6 is presented in Figure 6. 5 Healthcare 2019, 7, 124 8 of 16 Table 2. Bathing Surface Concepts. Number Concept 1 2 3 4 5 6 Concept 6 is considered the conceptual surface that meets all requirements. It was considered for being inflatable and enabling mobility, hygiene and safety; moreover, it is the most suitable model for performing the bathing assistance function. The use of the surface corresponding to concept 6 is presented in Figure 6. 6 Healthcare 2019, 7, 124 8 of 16 Table 2. Bathing Surface Concepts. Number Concept 1 2 3 4 5 6 Concept 6 is considered the conceptual surface that meets all requirements. It was considered for being inflatable and enabling mobility, hygiene and safety; moreover, it is the most suitable model for performing the bathing assistance function. The use of the surface corresponding to concept 6 is presented in Figure 6. Concept 6 is considered the conceptual surface that meets all requirements. It was considered for being inflatable and enabling mobility, hygiene and safety; moreover, it is the most suitable model for performing the bathing assistance function. The use of the surface corresponding to concept 6 is presented in Figure 6. The pressure inside the inflatable area should be set at the time of use and it is related to the surface and the mass of the bedridden person [ 48 ]. The simulation of the use of this area by a person with the stipulated mass of 120 kg is presented in Figure 7. The isotropic and static (time invariant) distributed load was obtained through the finite element simulation in ANSYS software. It determined the linear static analysis to be the best approach to study the structure in conditions that simulate actual use. Healthcare 2019,7, 124 8 of 15 Healthcare 2019, 7, 124 8 of 15 Concept 6 is considered the conceptual surface that meets all requirements. It was considered for being inflatable and enabling mobility, hygiene and safety; moreover, it is the most suitable model for performing the bathing assistance function. The use of the surface corresponding to concept 6 is presented in Figure 6. Figure 6. Surface concept 6. The pressure inside the inflatable area should be set at the time of use and it is related to the surface and the mass of the bedridden person [48]. The simulation of the use of this area by a person with the stipulated mass of 120 kg is presented in Figure 7. The isotropic and static (time invariant) distributed load was obtained through the finite element simulation in ANSYS software. It determined the linear static analysis to be the best approach to study the structure in conditions that simulate actual use. Evaluating the deformation and strain of a simulation required an inflatable structure between the two materials: the air that is inside the surface and the outside PVC material. Thus, the base was fixed and it was assigned a maximum load of 1177 N. In Figure 7 the largest deformation at the top, where there is a greater quantity of air, is identified, with a value of 0.0078 mm. Figure 7. Ansys simulation result—deformation. 2.4. Cost of the Prototype Developed Despite being the first version of the prototype, it is important to present an overview of its global costs. The authors would like to highlight that the optimization of costs and detailed value analysis has not been performed until this stage. The main goal of this prototype was the validation of the concepts presented in Table 3. The presented costs are an indication that the cost of final commercialized version will be much lower than this value. The next version of the prototype will include a rigorous value analysis and the global cost will be considerably lower. Figure 6. Surface concept 6. Healthcare 2019, 7, 124 8 of 15 Concept 6 is considered the conceptual surface that meets all requirements. It was considered for being inflatable and enabling mobility, hygiene and safety; moreover, it is the most suitable model for performing the bathing assistance function. The use of the surface corresponding to concept 6 is presented in Figure 6. Figure 6. Surface concept 6. The pressure inside the inflatable area should be set at the time of use and it is related to the surface and the mass of the bedridden person [48]. The simulation of the use of this area by a person with the stipulated mass of 120 kg is presented in Figure 7. The isotropic and static (time invariant) distributed load was obtained through the finite element simulation in ANSYS software. It determined the linear static analysis to be the best approach to study the structure in conditions that simulate actual use. Evaluating the deformation and strain of a simulation required an inflatable structure between the two materials: the air that is inside the surface and the outside PVC material. Thus, the base was fixed and it was assigned a maximum load of 1177 N. In Figure 7 the largest deformation at the top, where there is a greater quantity of air, is identified, with a value of 0.0078 mm. Figure 7. Ansys simulation result—deformation. 2.4. Cost of the Prototype Developed Despite being the first version of the prototype, it is important to present an overview of its global costs. The authors would like to highlight that the optimization of costs and detailed value analysis has not been performed until this stage. The main goal of this prototype was the validation of the concepts presented in Table 3. The presented costs are an indication that the cost of final commercialized version will be much lower than this value. The next version of the prototype will include a rigorous value analysis and the global cost will be considerably lower. Figure 7. Ansys simulation result—deformation. Evaluating the deformation and strain of a simulation required an inflatable structure between the two materials: the air that is inside the surface and the outside PVC material. Thus, the base was fixed and it was assigned a maximum load of 1177 N. In Figure 7the largest deformation at the top, where there is a greater quantity of air, is identified, with a value of 0.0078 mm. 2.4. Cost of the Prototype Developed Despite being the first version of the prototype, it is important to present an overview of its global costs. The authors would like to highlight that the optimization of costs and detailed value analysis has not been performed until this stage. The main goal of this prototype was the validation of the concepts presented in Table 3. The presented costs are an indication that the cost of final commercialized version will be much lower than this value. The next version of the prototype will include a rigorous value analysis and the global cost will be considerably lower. The global cost of prototype developed (1st version)—jointly with the bathing surface—was 5814 Euros, according to the detailed description presented in Table 3. The authors believe that it will be possible to considerably reduce the global cost of the final system, resulting in a lower final price of the version of the device that will be commercialized—about 3000 Euros (final consumer price). If this goal is achieved, it will be a great plus for families featuring bedridden persons, mainly because—with this solution—a single caregiver will be able to give a bath to a bedridden person while performing all the tasks needed. In addition, many families will have financial capacity to afford it. Healthcare 2019,7, 124 9 of 15 Table 3. Cost of prototype developed (1st version). Description of Components Cost (Euros) Mechanical Structure 550 Mechanical components (pipes, accessories, etc.) 390 Programmable Controller 420 Electronic components (cards, temperature sensors, etc.) 768 Mechatronic components (filters, electro-valves, pumps, etc.) 1396 HMI 560 Tanks 260 Assembling work 1050 Bath Surface and accessories 420 Total 5814 From the point of view of society—and answering to a serious societal challenge: the high percentage of aged persons in developed countries—this device seems to be a very important solution to be used and will save funds in the social systems of those countries, since nowadays those persons are institutionalized, resulting in very high costs for the social systems of such countries. 2.5. First Studies and Tests Complementarily to the system, a surface was proposed that could be mounted in any space, and could, that way, ensure a bathing system that could achieve a higher quality and that requires less effort on the part of the caregiver. This section describes a study that was carried out using a bathing surface already extant in the market [ 47 ], and thus, later, the development of the concept that best suited our needs. It is essential to take into account that in a case study, the value lies not only in studying a phenomenon, but also in its context. To be able to generalize the existence of a prior theory is important [48]. In this study, the EZ-BATHE ® surface [ 48 ] was used to validate the physical product of the surface in real environments in care institutions, via usability tests, performed by a single caregiver. Thus, based on the bed bath methodology, a sequence of tests was performed, following a methodology organized in five stages: Stage 1: organization of the environment; Stage 2: assembly; Stage 3: use; Stage 4: cleaning/drying; Stage 5: disassembly. As a result, we performed five tests; only three were performed by a single caregiver. As noted, during the test, the caregiver used as a base, a flat support structure. In the total of the five stages of the test 26 steps that were performed, the following should be noted: first, step 2 (Stage 2), the beginning of the filling process (Figure 8); then the emptying step 5 (Stage 3) was performed (Figure 9); to exemplify the drying of the bedridden, step 13 (Stage 4) is shown in Figure 10; and finally, stage 5 is exemplified with step 21, where the caregiver alone removed the layer from the surface (Figure 11). When the structure is being cleaned with the bedridden inside, the process is difficult and time consuming. The caregiver uses a leaning PVC structure, through which the remaining water can flow to a single location and the structure is then cleaned.