User/Caretaker Survey

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Contact Information

Name *

First

Last

Date

Type of Disability (SCI, ALS, Parkinson's, etc.) OR Type of Organization/Business (e.g. Physical Therapy Clinic) *

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Phone Number (Used only for this Government-funded research project) *

Email (Used only for this Government-funded research project) *

Email

Confirm Email

Thank you for sharing with us today. Here's what's important: your 5 minutes spent telling us about your daily challenges with a bathroom faucet will help 5,000 disabled persons! The answers you provide will greatly improve our ability to develop an assistive device that will truly meet the needs of individuals with motor impairments.

1. Describe daily frustrations that impact you as an individual with a motor impairment when using the bathroom faucet? *

Other similar disabilities include: Chronic Arthritis, MS, MD, Cerebral Palsy, Spina Bifida, TBI, Polio, Parkinsons's, Huntington's, ALS, Blindness, Strokes, etc.

2. What is the most important activity you do related to the bathroom faucet? *

3. Describe your experiences and feelings completing the activity listed in Question 2.

4. What about teeth brushing takes up the most time and energy for yourself and any caretakers? *

5. Tell us about other ways you currently or would like to use the bathroom faucet, such as for getting a drink of water, rinsing shaving cream or facial cleanser, etc. Are you able to do any of that now? What if you could, would it help you daily? *

6. Have you ever needed to rinse your eyes but didn't have an easy way to do so?

Yes
No

7. What other ways do you currently use or would like to use the bathroom faucet? Check all that apply. *

Getting a drink of water
Rinsing after brushing teeth
Rinsing makeup/facial cleanser/shaving cream
Using it as an eyewash for irritated eyes
Give hair a light rinse
Take a pill or vitamin
Refill a bottle or tall cup that doesn't fit under a normal faucet

8. What strategies or tools have you used to help solve your faucet-related challenges already? *

9. If you could wave a magic wand and solve any problem with your bathroom faucet, what problem would you want to solve? *

10. If you know anyone who has motor difficulties or SCI that might like to participate, we’d love to reach out to them. Please provide their name and contact information (email or phone number or both) below. List as many as you'd like.

Is there anything else that you would like to share with us?

May we contact you in the future about your answers?

Yes, sure!
No, this is good enough