Telepresence Robot Design in the Amazon: An Application of Design for Manufacturing and Assembly (DFMA)

Telepresence Robot Design in the Amazon: An Application of Design for Manufacturing and Assembly (DFMA) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Telepresence Robot Design in the Amazon: An Application of Design for Manufacturing and Assembly (DFMA) Ingrid Marina Pinto Pereira, Marcelo Albuquerque de Oliveira, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4945009/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract This work aims to present a proposal for a telepresence robot designed for application in the Amazon region, where remote access areas are concentrated. To achieve this goal, an approach that integrates the steps of DFMA (Design for Manufacturing and Assembly) and 3D modeling combined with Additive Manufacturing (AM) is employed. Considering the key characteristics of the region, the objective is to offer a regional solution focused on mobility and interaction to facilitate use. In this study, the main difficulties faced by the population in the region in their daily lives regarding access to healthcare were highlighted. As a result, evidence was obtained of the use of outside methodologies combined with a reduction of approximately 78% in the quantity of project components and parts. Therefore, the importance of developing technologies aimed at addressing this need or driving studies for connectivity in the state of Amazonas is emphasized. Physical sciences/Engineering/Mechanical engineering Health sciences/Health care/Health services Telehealth DFMA 3D Modeling Additive Manufacturing Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 1 Introduction Telepresence is a well-known tool in the field of medicine, as it is also known as telemedicine. Telemedicine incorporates technology, such as robotics, virtual reality, and artificial intelligence, into medical practice. The term came into use when telepresence devices were used to carry out patient consultation and screening so that infectious diseases could be minimized [1]. As the internet and technology grew, telemedicine was developed in the 1950s. Telehealth covers the same topic but in a larger context than does telemedicine. Nevertheless, the Ministry of Health puts some limits on medical diagnoses using digital instruments in its guidance to such an examination. Similarly, practices of telediagnosis and classical teleconsultation or even executions in terms of teaching processes at digitally safe locations with limited access to health professionals also enable the trust relationship between them and their patients to be performed earlier [2]. Telehealth is mainly used across specialized outpatient clinics today through patient-centered apps, which are complex in terms of secondary care and tertiary hospital interactions. It also acts as a preferential alternative care in isolated areas [3]. The bulk of current telemedicine services are used in industrialized nations and target pressing needs, including widening access, increasing medical utilization by care providers and patients, lowering costs or rationing health expenditures, and further responding to demands for real-time monitoring and immediate feedback on public health problems [4]. The telehealth model adopted by Brazil connects universities with primary health care in the most distant municipalities through tele-education and tele-assistance activities [5]. The main issue with these tools is how much scientific and financial investment is needed to introduce the respective technology, making them a challenge for the Brazilian public sector, as they seem unable to understand what it truly requires in terms of cost to have access to an adequate quality system that can be used by health/medicine [6]. The launch of the robot prototype R1T1, developed within the Project Company in Brazil, was made at the University Hospital in Maringá in 2013. As part of the experimentation, the applicability of the robot was tested, and nine consultations were supported, in addition to visiting and discussing cases in different wards, which facilitated the bringing patients and families together during long hospital stays [7]. The restructured communication enabled by these robots will demand a certain investment, considering that they often adopt highly technological and complex structures, which makes it difficult for public applications owing to the greater number of resources employed, especially in underdeveloped nations, such as Brazil. Given this context, the realization of telepresence robots for the remote regions of the Amazon faces several challenges. The purpose of this study is to discuss some of these shortcomings and objectives throughout development, highlighting the aspects mentioned above. This research aims to integrate elements of product design to address the emerging needs arising from the healthcare landscape by introducing a prototype of a telepresence robot. The objective is to advance exploration in this field with a view toward extending the technology for use in hospitals to facilitate connections between families and patients, with a focus on understanding the emotional impact on individuals involved. The study illustrates aspects of telepresence technology, its implementation in public health settings, the integration of robots in telepresence systems and the design principles employed in developing the proposed solution. Consequently, the study also aims to describe the methodological process used through the principles of DFMA (Design for Manufacturing and Assembly) to reduce costs and optimize product development. This methodology can be applied in various existing projects, such as the work of Maidin et al. [8], where DFMA was used to reduce costs in a water faucet nozzle project. In this case, processes of part disassembly, product function definition, and design critique were utilized to analyze data and propose modifications, resulting in increased assembly efficiency from 23% to 25%, reduced assembly cost from RM28.64 to RM10.46 (RM being the currency of Malaysia), and reduced production time from 51.7 seconds to 28.3 seconds in the new design. Another example is the study by Samad and Yusuf [9], where the method was applied in the product development of a car passenger door. The steps included obtaining information about the product or assembly from drawings, prototypes, or an existing product; disassembling the product or assembly and assigning an identification number to each item on the basis of handling and insertion requirements; reassembling the product starting with the highest identification number and adding the remaining parts; and filling out the Design for Assembly worksheet, calculating the total manual assembly time and assembly efficiency. This resulted in a 22.2% increase in assembly efficiency. Finally, with these positive examples of method application, this study presents project development along with 3D modeling and prototyping by applying the central concepts of this methodology. 2 Literature Review 2.1 Telepresence Telehealth, as noted by the CMS (Center for Medicare & Medicaid Services), is defined as "the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision, and information from a distance." This involves both synchronous engagements, which are live and real-time, and asynchronous interactions, where data trends or messages are exchanged periodically between clinicians or are used for remote patient monitoring [10]. Furthermore, it is expected that by using this technology, telemedicine/telehealth services will be able to deliver better health services from healthcare providers to other users, improve health outcomes, and provide better capacity utilization and other related benefits. In recent years, telemedicine has moved from being several individual managers to being managed as a medical component of healthcare services and a foundational tool for information technology and communication services [11]. As telecommunications technology has developed, it has become easier for people to use this technology, which is driving the rise of telehealth, which aims to blend technology into healthcare and create a different patient experience [12]. While telemedicine may be relatively new for some medical professionals, it was rooted in the 1920s when the Royal Flying Doctor Service in Australia used radios for remote care. More recently, NASA (National Aeronautics and Space Administration) accelerated telemedicine when they funded research to find ways for doctors to provide medical care in space and to provide medical care for commercial airlines in flight. The 1960s to 2000 experienced exponential growth in the field in terms of the type of medical services available and the types of populations able to receive telemedicine, such as rural and prison health care [13]. The importance of health technology has become very clear with the arrival of the COVID-19 pandemic. Many hospitals have a limited number of patients, so the question quickly becomes how to protect both staff and other patients in a closed environment. With continuing lockdowns and the necessity of social distancing, it is important to consider ways to protect our physical and mental health to prevent the spread of disease [14]. The focus on mental health has increased in the context of social isolation, prompting mental health professionals to tailor mental health interventions to incorporate social considerations. According to Wosik et al. [15], Telehealth is seen as a suitable tool for reducing virus transmission while integrating technological and social resources. Randall and Winchester [16] reported various concerns about the use of telehealth, including access to broadband telecommunications services, the protection of personal health information through technology in a more private and confidential way, and the initial investments that need to be made. Thomas et al. [17] also mentioned barriers to telehealth, such as digital literacy and access, ambiguity about the quality of care given through virtual modes, privacy concerns, and preferences for in-person care. Additionally, telehealth has the potential to provide financial benefits, deliver more frequent monitoring care through quick screening and diagnosis, and offer remote patient care and management. Snoswel et al. [18] conducted a healthcare case study investigating data from all telehealth outpatient clinics in Queensland over a year-long period from July 2017 to July 2018. The results indicated that in Queensland alone, there were annual productivity gains of $9,176,052 or $304, for which a doctor's savings per consultation were saved. In connection with the robotics theme, the first robotic system came into existence in 1948; it was a remotely controlled machine that mimicked human movements, specifically a robotic arm that operated via an electrically controlled motor that followed signals from joysticks to replicate human activity. The purpose of this system was to replace human labor when it was deemed unsafe for use in certain environments or contexts. Despite this, there are earlier mentions and applications of telepresence robots in the current literature from the early 1990s, originating from academic bodies from Asia, Europe, and North America [19, 20]. Importantly, applications have taken a slightly different angle to the ideal design for human interaction within a human ecosystem, as noted by Bradwell et al. [21] in their recent exploration of how each robot interacts with a person within specific observed scenarios. Notably, their research showed that soft-friendly aesthetics supersed traditional robotic objective aesthetics, which can be referred to as anthropomorphic or biomorphic features, to increase social presence. 2.2 DFMA The capability of Design for eXcellence (DFX) was created to assist in the design of products and processes with the objective of optimizing costs and increasing quality throughout the life cycle of a product. Given the necessity of handling high complexity and the large number of different requirements and specifications in product development, it is important to consider these requirements and specifications in all phases of the product lifespan, such as manufacturing, assembly, maintenance, disposal, etc. For this purpose, DFX is employed. The use of Df and DFMA philosophies, along with integrated CAD (Computer Aided Design)/CAM (Computer Aided Manufacturing) solutions, allows us to analyze the design and assembly to identify and correct possible errors during the design phase, reducing the project time and development costs, since corrections can be made in the early stages of the project, when changes are less time-consuming and easier to implement [22, 23, 24]. As seen in the work of Boothroyd, Knight and Dewhurst [25], design is the first step in product manufacturing. It is the stage where sketches of parts and components are made for detailed drawings and CAD models. This detailed information is then passed on to manufacturing and assembly engineers, who may request design changes due to issues in the assembly stage, causing delays and increased project costs. To assist in this process, the DFMA methodology exists, which guides the product design process and includes criteria to be examined, as listed below: ● As you take a product and use it, how inert shall be that part in relative motion with all other assembled parts during operations of the product? Negative changes are considered only when they are significant; minor movements, however small, can always be taken by integral elastic elements. ● Does it need to be a different material than the other parts that will go into assembly with this part or simply stand out in some way? Acceptable reasons are related only to the properties of the materials. ● Must the part be separated from all other assembled parts because assembling or disassembling other parts would be impossible? In the work of Tan et al. [26], we can check the history of this methodology. According to the authors, the DfMA originated from the weapon production processes developed by Ford and Chrysler during World War II. In a more formal sense, DfM - Design for Manufacturing and DfA - Design for Assembly, which together form DfMA, began to be cited in the late 1960s. Additionally, the authors mention that since its adoption in manufacturing, DfMA has helped many companies increase their profits through optimized design with concrete guidelines to help designers reduce difficulties in the fabrication and assembly of a product. Gao, Jin and Lu [27] emphasized that there is a sequence of steps for applying the methodology. DfA should be considered first, leading to a simplification of the product structure. Following this, materials and processes with initial cost estimates are selected. With the materials chosen, a DfM analysis is assisted with guidelines for the standardization, design, and assembly of components to reduce the total manufacturing cost. In the studies of Alfaify, Saleh, Abdullah and Al-Ahmari [28], the advantages of using DFMA in conjunction with other methodologies, including Additive Manufacturing (AM), are also detailed. The authors assert that the combined approach aims to (1) supply tools, techniques and guidelines to enable the design to adapt within a particular set of final manufacturing constraints; (2) demonstrate and understand the impact on the design process in relation to the manufacturing system to improve the quality of the product; and (3) identify the relationship between design and manufacturing and the consequences for designers and practices. Deka and Behdad [29] also emphasized that AM can play a crucial role in DFMA in terms of increasing productivity and producing complex parts with desired mechanical functionalities. Another work addressing this topic is that of Haruna and Jiang [30], which asserts that the conventional design methodology, Design Theory and Methodology (DTM), concerning Design for Manufacturing (DFM), Design for Assembly (DFA), and Design for Performance (DFP), is not qualified to embrace these new opportunities. This intensifies the necessity of using AM to achieve optimized design. 2.3 Additive Manufacturing There is a need for optimization of existing robotic platforms and the discovery of new methods to create and apply innovative robotic instruments such as grippers and new mechanisms. Recently, AM technologies have been widely adopted in robotics and biomedicine owing to their feasibility in employing flexible materials, easily creating complex structures, using multiple materials in the same manufacturing cycle, and fabricating smart structures [31, 32]. According to Alfattni [33], in 1986, Charles Hull introduced the concept of AM, also known as 3D printing. It involves a group of advanced manufacturing techniques that produce three-dimensional physical items from a 3D CAD model, using an additive printing process layer by layer, point by point, or line by line. In industry, AM has also gained significant focus, especially in terms of rapid prototyping, fast manufacturing, mass customization, mass production, the creation of bold shapes without creativity limits, and the potential to revolutionize compared with traditional manufacturing methods. This is already evident from the findings of the 2023 Wohlers report, where global growth in AM products and services is estimated at 18.3%, with substantial increases in materials, software, 3D printing services, and hardware, which are expected to grow by an estimated 23% in 2022 [34, 35]. To gain a full appreciation of the topic, it is important to describe a typical 3D printing process. In accordance with Grivet-Brancot, Boffito and Ciardelli [36], the process starts with the existence of a 3D Computer-Aided Design (CAD) model that can be exported in .STL file format. The file is then sliced by slicing software, which then produces a fila called G-code, and the code is sent to the printer so that it can interpret the layers and create the desired final object. Although initially conceived for rapid prototyping, AM also has a branch focused on mass production owing to its high versatility, reduced material waste, and ability to manufacture geometries that would otherwise be impossible to achieve. As a result, various AM technologies have emerged to process a wide range of materials, such as polymers, metals, ceramics, and concrete. The most well-known technologies mentioned earlier include Fused Deposition Modeling (FDM), Powder Bed Fusion (PBF), Stereolithography (SLA), Direct Energy Deposition (DED), and Laminated Object Manufacturing (LOM) [37]. The study will be carried out using technology that relies on FDM. This technique works by guiding filaments of thermoplastics as they are pushed through a heated nozzle. The materials and reinforced materials used in FDM are composed of thermoplastic materials, including Acrylonitrile Butadiene Styrene (ABS), Polylactic Acid (PLA), Polycarbonate, Unfilled Polyetherimide (PEI), Polyether Ether Ketone (PEEK), Polyethylene Terephthalate Glycol (PETG), and reinforced materials like Thermoplastic Polyurethane (TPU) [38]. The printing process using the FDM technique involves a filament of a specific thickness wound on a reel of a specific weight/size. This filament is moved with the help of bearings that assist in pushing the material, which is directed by the nozzle with a temperature control unit. This temperature control unit must have settings for both itself and the print bed, which serves as the printing platform [39]. 3 Methodology To carry out the data analysis, the first step involved defining the project idea and description. A prototype and a tool were created via the DFMA concepts, although it was more dynamic than in previous studies conducted on telepresence robots, along with a comparative study from the literature. Theoretical elements to be applied on the basis of the conceptualization and project schedule bringing together DFMA concepts include the following: • 3D CAD Modeling Software, which can be about SolidWorks or SolidEdge • Additive manufacturing, often called 3D printing, to make physical prototype applications. During this ideation phase, brainstorming was used to identify the key characteristics of the robot in development, both by selecting the main sketches and attributes of the robot while addressing the pain points of the persona developed from the previous phase. To do that, we developed a mind map of those key aspects. According to Guelton [40], maps and diagrams can either work together or apart, acting as organizational structures for complex information, while offering fundamental organizational patterns to help navigate between physical, social, and conceptual spaces. Considering the regional aspects and important characteristics regarding the target audience, mobility, simplicity, and regional scope of application, this set conceived the physical form of the proposed project. The intention was to resemble the physical shape of the toy "Peteca," which is part of a game that aims to keep the object in the air for as long as possible through exchanges between participants. This intention is driven by the project's goal to target the regional youth audience. According to Santos [41], Peteca originated long before the arrival of colonizers in Brazil and has native roots. Traditionally, petecas are adorned with feathers and filled with straw. Taking these aspects into account, 3D modeling was performed via SolidWorks software, which assists in the design of complex products or parts, with dimensioning and other experimental analyses [42]. The project was named "Kaiapó," derived from the Tupi–Guarani indigenous language, meaning "life," and referred to the goal of the work being developed, the illustration of the work can be seen in Figure 1, which represents the first 3D model of the robot. 4 Robot development For 3D modeling, SolidWorks software was used to design the necessary parts for assembling the structure (excluding screws and device mounts). In the software, files were saved in (.STL) format to enable their use with slicing software for 3D printing. Slicing was performed via Ultimaker Cura software, where the mentioned file format can be converted to GCode, facilitating the printing process. The interface used for this can be seen in Figure 2, which demonstrates an example of a piece in the slicing software. The Ender 3 printer was used with settings for PLA filament. This polymer was chosen for prototyping because of its low cost, detailed printing capabilities, and ease of handling. The figure 3 shows the parts, components, and step-by-step assembly of the first robot version. In conducting the assembly test of the project, the total quantity of 203 parts and 12 types of robot components shown opens up room for optimization. By applying the principles of DFMA, a version 2.0 of the robot was developed to address improvement gaps identified after the first version was assembled. The first step was to switch the material of the parts to ABS to achieve greater robustness and strength. Following this, a modification to the parts joining mechanism was considered, transitioning from screws to snap-fit connections to simplify the assembly process. For this purpose, three test pieces were developed for the mechanism: a female part, a male part, and the unlocking key for the joint. This mechanism can be seen in Figure 4. When securing the test piece and considering what modification might need to be done to suit the Version 2 robot, a concern was raised whether maintenance and part replacement would be difficult when a problem occurred with the joint mechanism. The replacement of parts would incur higher costs. Therefore, the judgment was suspended, and normal screw installation was performed with a focus on reducing the number of screws and strengthening them. The second point was to reduce the variety of parts, particularly focusing on the conveyor belt parts, which were numerous. To achieve this, another filament type, thermoplastic polyurethane (TPU), known for its flexibility, was considered for printing. With respect to the 3D printer parameter settings, PLA was used for the first prototype because of its ease of printing, whereas for the second prototype, materials such as ABS were chosen for increased robustness. The ABS was used for parts such as the side supports of the wheel and the wheel itself, whereas the TPU was selected for the conveyor belt structure. For the 3D printer settings: PLA: Extruder nozzle temperature 205°C, bed temperature 65°C TPU: Extruder nozzle temperature 240°C, bed temperature 100°C ABS: Extruder nozzle temperature 225°C, bed temperature 90°C These settings were adjusted to optimize the printing quality and material performance, as shown in the Figure 5 below. With the intention of replacing the conveyor system, a new structure was modeled, taking into consideration that it will be printed using a TPU filament. By using this flexible material, it was possible to reduce the majority of parts in the project. This new structure can be seen in the figure 6. Upon comparison, we found that the number of parts decreased from 203 to 44, resulting in a decrease of approximately 78% in total quantity. The types of parts also decreased from 12 to 10, with the addition that in the second version, decorative feathers were included to align with the project's audience. This impact on simplifying the project via DFMA concepts can also be seen in the visual Figure 7 below, where the shift from a visually complex aspect of the project is evident. The final images of the project compared with those of version 1.0 of the proposed project are also shown in the Figure 8, demonstrating that the surface finish of the ABS is different from that of the previous version with the PLA. 5 Conclusion It was clear from the analysis that the use of tools such as DFMA and AM make important contributions to the management of production and operations, particularly in the area of product engineering. The joint action was extremely beneficial in structuring the whole process of development of the proposed project, offering visibility on the aspects to be verified and aligned so that the telepresence robot initiative clearly reflected what it should propose itself to do. The DFMA methodology, allied with modeling, prototyping, design and redesign, follows this chain that permits the proposal product to be developed in a structured process receiving enhancements that are mutual to each of the components. The concept of a telepresence robot was designed with the target audience in mind to present what we are trying to accomplish in this project. Once we had the conceived object, DFMA was used to generate two feasible forms of the structure of the telepresence robot and the parts it would require. It looks at all the DFMA gaps and simplifications that are relevant to the DFMA concepting exercise. The use of AM expedited the idea generation process, creating reassurance that any modeling, dimensioning, or structural mistakes could be quickly corrected to keep going and not restart from the beginning. The demonstration of the different ways to guide the application of these methodologies and the flexibility to work with different types of welding in AM on the joining side is coherent and aligned with the maintenance principles that the DFMA and DFX bring to their principles. Considering all the points highlighted throughout the work, it becomes evident that the proposal can be further enriched, especially with respect to how the mechanical structure can incorporate electronic and information technology elements, to test this mechanical structure’s physical robustness with its full functionality and foster research on connectivity in the Amazon. Declarations Funding The authors declare that no funds, grants, or other support was received during the preparation of this work. Competing Interests The authors have no relevant financial or nonfinancial interests to disclose. Author Contributions All the authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Ingrid Pereira and Marcelo de Oliveira. The first draft of the manuscript was written by Gabriela Veroneze, Antonio Alves and Marcos Santos and all the authors commented on previous versions of the manuscript. All the authors have read and approved the final manuscript. Data availability All data generated or analysed during this study are included in this published article. References C. Quispe-Juli, P. Vela-Anton, M. Meza-Rorigues, and V. Moquillaza-Alcántara, “Covid-19: Uma Pandêmica Na Era Da Saúde Digital,” Health Sciences , 2020. S. de C. Catapan and M. C. M. Calvo, “Teleconsulta: Uma Revisão Integrativa Da Interação Médico-aciente Mediada Pela Tecnologia,” Rev Bras Educ Med , vol. 44, no. 1, pp. 1–13, 2020, doi: 10.29327/cbtms9.144795. A. C. Rañó, M. M. Moldes, and B. B. Sancho, “Telemedicina: una nueva herramienta para la gestión del dolor. Resultados de su implementación en una estructura organizativa de gestión integral (EOXI),” Revista de la Sociedad Española del Dolor , vol. 27, no. 2, pp. 97–103, 2020, doi: 10.20986/resed.2020.3756/2019. J. M. S. de V. Maldonado, A. B. Marques, and A. Cruz, “Telemedicina: Desafios à sua difusão no Brasil,” Cad Saude Publica , vol. 32, pp. 1–12, 2016, doi: 10.1590/0102-311X00155615. R. F. Damasceno and A. P. Caldeira, “Factors associated with the non-use of telehealth consultancy by physicians of the family health strategy,” Ciencia e Saude Coletiva , vol. 24, no. 8, pp. 3089–3098, 2019, doi: 10.1590/1413-81232018248.28752017. B. S. Zanotto et al . , “Economic evaluation of a telemedicine service to expand primary health care in Rio Grande do Sul: Teleoftalmo’s microcosting analysis,” Ciencia e Saude Coletiva , vol. 25, no. 4, pp. 1349–1360, 2020, doi: 10.1590/1413-81232020254.28992019. M. F. Carreira, G. C. Antonelli, A. H. Dianin, A. S. Culchesk, and B. M. Gerônimo, “Proposta de coleta dados utilizando robô de telepresença em sistema HealtCare do Hospital Universitário de Maringá,” Simpósio de Engenharia de Produção de Maringá/PR , vol. 1, 2018. N. A. Maidin et al . , “Reducing Product Cost by Implementing DFMA Methodology-Lucas Hull: A Case Study Reducing Product Cost by Implementing DFMA Methodology-Lucas Hull: A Case Study ARTICLE HISTORY ABSTRACT,” ESTEEM Academic Journal , vol. 14, pp. 12–23, 2018, [Online]. Available: https://www.researchgate.net/publication/323028730 M. F. A. Samad and K. Yusuf, “Application of design for manufacture and assembly (DFMA) method to passenger car door design,” in Proceedings of Innovative Research and Industrial Dialogue , Taylor and Francis Ltd., Mar. 2018, pp. 144–145. D. Mahtta, M. Daher, M. T. Lee, S. Sayani, M. Shishehbor, and S. S. Virani, “PUBLIC HEALTH POLICY (SS VIRANI AND D MAHTTA, SECTION EDITORS) Promise and Perils of Telehealth in the Current Era,” 2021, doi: 10.1007/s11886-021-01544-w/Published. S. N. Gajarawala and J. N. Pelkowski, “Telehealth Benefits and Barriers,” Journal for Nurse Practitioners , vol. 17, no. 2, pp. 218–221, Feb. 2021, doi: 10.1016/j.nurpra.2020.09.013. D. C. Alverson, E. A. Krupinski, K. A. Erps, N. S. Rowe, and R. S. Weinstein, “The Third National Telemedicine & Telehealth Service Provider Showcase Conference: Advancing Telehealth Partnerships,” Telemedicine and e-Health , vol. 25, no. 4, pp. 332–340, Apr. 2019, doi: 10.1089/tmj.2018.0096. N. R. Wijesooriya, V. Mishra, P. L. P. Brand, and B. K. Rubin, “COVID-19 and telehealth, education, and research adaptations,” Sep. 01, 2020, W.B. Saunders Ltd . doi: 10.1016/j.prrv.2020.06.009. J. M. Fegert, B. Vitiello, P. L. Plener, and V. Clemens, “Challenges and burden of the Coronavirus 2019 (COVID-19) pandemic for child and adolescent mental health: A narrative review to highlight clinical and research needs in the acute phase and the long return to normality,” May 12, 2020, BioMed Central . doi: 10.1186/s13034-020-00329-3. J. Wosik et al . , “Telehealth transformation: COVID-19 and the rise of virtual care,” Jun. 01, 2020, Oxford University Press . doi: 10.1093/jamia/ocaa067. M. H. Randall and D. E. Winchester, “The New Role of Telehealth in Contemporary Medicine,” Mar. 01, 2022, Springer . doi: 10.1007/s11886-022-01640-5. L. T. Thomas, C. M. Y. Lee, K. McClelland, G. Nunis, S. Robinson, and R. Norman, “Health workforce perceptions on telehealth augmentation opportunities,” BMC Health Serv Res , vol. 23, no. 1, Dec. 2023, doi: 10.1186/s12913-023-09174-4. C. L. Snoswell, A. C. Smith, M. Page, P. Scuffham, and L. J. Caffery, “Quantifying the Societal Benefits From Telehealth: Productivity and Reduced Travel,” Value Health Reg Issues , vol. 28, pp. 61–66, Mar. 2022, doi: 10.1016/j.vhri.2021.07.007. J. Leoste et al . , “Keeping distance with a telepresence robot: A pilot study,” Front Educ (Lausanne) , vol. 7, Jan. 2023, doi: 10.3389/feduc.2022.1046461. T. B. Tuli, T. O. Terefe, and M. M. U. Rashid, “Telepresence Mobile Robots Design and Control for Social Interaction,” Int J Soc Robot , vol. 13, no. 5, pp. 877–886, Aug. 2021, doi: 10.1007/s12369-020-00676-3. H. L. Bradwell, G. E. Aguiar Noury, K. J. Edwards, R. Winnington, S. Thill, and R. B. Jones, “Design recommendations for socially assistive robots for health and social care based on a large scale analysis of stakeholder positions: Social robot design recommendations,” Health Policy Technol , vol. 10, no. 3, Sep. 2021, doi: 10.1016/j.hlpt.2021.100544. L. Atilano, A. Martinho, M. A. Silva, and A. J. Baptista, “Lean Design-for-X: Case study of a new design framework applied to an adaptive robot gripper development process,” in Procedia CIRP , Elsevier B.V., 2019, pp. 667–672. doi: 10.1016/j.procir.2019.04.190. I. M. Pita, G. Nagî, V. Merticaru, M. I. Rîpanu, and M. Cuco, “Analyses and redesign of a technological device for automated assembly, using Design for Manufacturing and Assembly approach,” in IOP Conference Series: Materials Science and Engineering , Institute of Physics Publishing, Oct. 2019. doi: 10.1088/1757-899X/564/1/012058. C. L. C. Roxas et al . , “Design for Manufacturing and Assembly (DfMA) and Design for Deconstruction (DfD) in the Construction Industry: Challenges, Trends and Developments,” May 01, 2023, MDPI . doi: 10.3390/buildings13051164. G. Boothroyd, W. A. Knight, and P Dewhurst, Product design for manufacture and assembly , 2nd ed. 2002. T. Tan et al . , “Construction-Oriented Design for Manufacture and Assembly Guidelines,” 2020, doi: 10.1061/(ASCE)CO.1943. S. Gao, R. Jin, and W. Lu, “Design for manufacture and assembly in construction: a review,” Building Research and Information , vol. 48, no. 5, pp. 538–550, Jul. 2020, doi: 10.1080/09613218.2019.1660608. A. Alfaify, M. Saleh, F. M. Abdullah, and A. M. Al-Ahmari, “Design for additive manufacturing: A systematic review,” Oct. 01, 2020, MDPI . doi: 10.3390/SU12197936. A. Deka and S. Behdad, “Part separation technique for assembly based design in additive manufacturing using genetic algorithm,” Elsevier B.V., 2019, pp. 764–771. doi: 10.1016/j.promfg.2019.06.208. A. Haruna and P. Jiang, “A Design for Additive Manufacturing Framework: Product Function Integration and Structure Simplification,” in IFAC-PapersOnLine , Elsevier B.V., 2020, pp. 77–82. doi: 10.1016/j.ifacol.2021.04.127. N. Kladovasilakis, P. Sideridis, D. Tzetzis, K. Piliounis, I. Kostavelis, and D. Tzovaras, “Design and Development of a Multi-Functional Bioinspired Soft Robotic Actuator via Additive Manufacturing,” Biomimetics , vol. 7, no. 3, Sep. 2022, doi: 10.3390/biomimetics7030105. G. Stano, S. M. A. I. Ovy, J. R. Edwards, M. Cianchetti, G. Percoco, and Y. Tadesse, “One-shot additive manufacturing of robotic finger with embedded sensing and actuation,” International Journal of Advanced Manufacturing Technology , vol. 124, no. 1–2, pp. 467–485, Jan. 2023, doi: 10.1007/s00170-022-10556-x. R. Alfattni, “Comprehensive Study on Materials used in Different Types of Additive Manufacturing and their Applications,” International Journal of Mathematical, Engineering and Management Sciences , vol. 7, no. 1, pp. 92–114, 2022, doi: 10.33889/IJMEMS.2022.7.1.007. M. A. El youbi El idrissi, L. Laaouina, A. Jeghal, H. Tairi, and M. Zaki, “Modeling of Energy Consumption and Print Time for FDM 3D Printing Using Multilayer Perceptron Network,” Journal of Manufacturing and Materials Processing , vol. 7, no. 4, Aug. 2023, doi: 10.3390/jmmp7040128. A. Nicolau, M. A. Pop, S. V. Georgescu, and C. Coșereanu, “Application of Additive Manufacturing Technology for Chair Parts Connections,” Applied Sciences , vol. 13, no. 21, p. 12044, Nov. 2023, doi: 10.3390/app132112044. A. Grivet-Brancot, M. Boffito, and G. Ciardelli, “Use of Polyesters in Fused Deposition Modeling for Biomedical Applications,” Oct. 01, 2022, John Wiley and Sons Inc . doi: 10.1002/mabi.202200039. M. Martini, M. Scaccia, G. Marchello, H. Abidi, M. D’imperio, and F. Cannella, “An Outline of Fused Deposition Modeling: System Models and Control Strategies,” Jun. 01, 2022, MDPI . doi: 10.3390/app12115400. A. D. Tura, H. G. Lemu, and H. B. Mamo, “Experimental Investigation and Prediction of Mechanical Properties in a Fused Deposition Modeling Process,” Crystals (Basel) , vol. 12, no. 6, Jun. 2022, doi: 10.3390/cryst12060844. O. Ulkir, “Energy-Consumption-Based Life Cycle Assessment of Additive-Manufactured Product with Different Types of Materials,” Polymers (Basel) , vol. 15, no. 6, Mar. 2023, doi: 10.3390/polym15061466. B. Guelton, “‘Mental maps’: Between memorial transcription and symbolic projection,” Front Psychol , vol. 14, 2023, doi: 10.3389/fpsyg.2023.1142238. R. M. dos Santos, “HISTÓRIA DA PETECA - CBP,” https://cbpeteca.org.br/historia-da-peteca/. A. Arora, A. Pathak, A. Juneja, P. Shakkarwal, and R. Kumar, “Design & analysis of progressive die using SOLIDWORKS,” in Materials Today: Proceedings , Elsevier Ltd, 2021, pp. 956–960. doi: 10.1016/j.matpr.2021.06.335. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 10 Oct, 2024 Reviews received at journal 30 Sep, 2024 Reviewers agreed at journal 19 Sep, 2024 Reviews received at journal 13 Sep, 2024 Reviewers agreed at journal 03 Sep, 2024 Reviewers invited by journal 02 Sep, 2024 Editor assigned by journal 02 Sep, 2024 Editor invited by journal 29 Aug, 2024 Submission checks completed at journal 28 Aug, 2024 First submitted to journal 20 Aug, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4945009","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":357546864,"identity":"19741b71-01c3-4c27-b7bf-a548e80b7fdd","order_by":0,"name":"Ingrid Marina Pinto Pereira","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYBACNhCRACKZwXwbIGZsPECKljSQlga8WpA0gsFhMIlXC590+7UPD8q2yZu38x78wLjjvN3a9sNAW2psonGaL3OmeEbCuduGcw7zJUswnrmdvO1MIlDLsbTcBlxaJHKSGRLbbjPOYOYxkGBsu51sdgCohbHhMEEt9kAtxj8Y284lm51/SEhL+mGQlkSgFjOgLQfszG4QtoWZAeiXZJAWi8QzyQlmN4C2JODxi/yM9MeMP8pu287gP2N84+MOO3uz8+kPH3yoscGphYGBxwDBTmwAISBIwKkcBNgfINiMDQz2eBWPglEwCkbBiAQADJ1fdXlTrGUAAAAASUVORK5CYII=","orcid":"","institution":"Federal University of Amazonas","correspondingAuthor":true,"prefix":"","firstName":"Ingrid","middleName":"Marina Pinto","lastName":"Pereira","suffix":""},{"id":357546865,"identity":"3f995879-37f0-40a6-9914-d8ecd3624eaa","order_by":1,"name":"Marcelo Albuquerque de Oliveira","email":"","orcid":"","institution":"Federal University of Amazonas","correspondingAuthor":false,"prefix":"","firstName":"Marcelo","middleName":"Albuquerque","lastName":"de Oliveira","suffix":""},{"id":357546866,"identity":"6f92be4e-bd39-4af4-a816-01336e393139","order_by":2,"name":"Gabriela de Mattos Verenoze","email":"","orcid":"","institution":"Federal University of Amazonas","correspondingAuthor":false,"prefix":"","firstName":"Gabriela","middleName":"de Mattos","lastName":"Verenoze","suffix":""},{"id":357546867,"identity":"49b1c67b-64ab-40d7-81c5-a4aa17e11b6f","order_by":3,"name":"Antonio do Nascimento Silva Alves","email":"","orcid":"","institution":"Federal University of Amazonas","correspondingAuthor":false,"prefix":"","firstName":"Antonio","middleName":"do Nascimento Silva","lastName":"Alves","suffix":""},{"id":357546868,"identity":"5232a086-681c-4442-a380-c274ae695755","order_by":4,"name":"Marcos Dantas dos Santos","email":"","orcid":"","institution":"University of the State of Amazonas","correspondingAuthor":false,"prefix":"","firstName":"Marcos","middleName":"Dantas dos","lastName":"Santos","suffix":""}],"badges":[],"createdAt":"2024-08-20 12:36:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4945009/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4945009/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":65421467,"identity":"4fa28e0e-1511-429b-9553-e14c790ed785","added_by":"auto","created_at":"2024-09-27 08:20:21","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":46648,"visible":true,"origin":"","legend":"\u003cp\u003eTelepresence Robot.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4945009/v1/c21d086a4d65e302c4cc5508.png"},{"id":65422451,"identity":"c7cda3d2-edc2-4205-adf4-b57c082e5e28","added_by":"auto","created_at":"2024-09-27 08:28:20","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":232925,"visible":true,"origin":"","legend":"\u003cp\u003eUltimaker Cura Interface\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4945009/v1/a87876e3980fc02a8150d24e.png"},{"id":65421462,"identity":"50c76af3-4241-40bc-aacb-0de6f61ca902","added_by":"auto","created_at":"2024-09-27 08:20:20","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":937483,"visible":true,"origin":"","legend":"\u003cp\u003eParts and Stages Prototype Version 1.0. (a) Conveyor belt; (b) disassembled bottom part. (c) Assembled bottom part; (d) Prototype assembled with all parts. (e) Side view of the prototype with the device; (f) Front view of the prototype with the device.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-4945009/v1/15aec7eb949aa2090fb07888.png"},{"id":65421463,"identity":"3eca8b61-8f2c-438a-a58c-1f9d84b80d36","added_by":"auto","created_at":"2024-09-27 08:20:20","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":209548,"visible":true,"origin":"","legend":"\u003cp\u003eTest pieces for the locking mechanism\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4945009/v1/bb3f628c5305cb9a95f3c496.jpeg"},{"id":65421465,"identity":"a7e7b4b5-3289-4e25-9e0f-0d80be9cb58a","added_by":"auto","created_at":"2024-09-27 08:20:20","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":862817,"visible":true,"origin":"","legend":"\u003cp\u003ePrinter configuration. (a) PLA; (b) TPU; (c) ABS.\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-4945009/v1/7deedb30bbc4ac46ae09fbe5.png"},{"id":65422449,"identity":"5ea63e78-658b-4e97-b0e5-a54a256cfe58","added_by":"auto","created_at":"2024-09-27 08:28:20","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":328551,"visible":true,"origin":"","legend":"\u003cp\u003eBelt mechanism. (a) 3D Modeling. (b) Printed final object.\u003c/p\u003e","description":"","filename":"floatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-4945009/v1/e194c7bb0a2525d7fbb97d9f.png"},{"id":65422450,"identity":"d59265b1-bc75-4f77-8044-291e7ca2cdbc","added_by":"auto","created_at":"2024-09-27 08:28:20","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":162699,"visible":true,"origin":"","legend":"\u003cp\u003eTelepresence Robot DFMA Application\u003c/p\u003e","description":"","filename":"floatimage7.png","url":"https://assets-eu.researchsquare.com/files/rs-4945009/v1/696c173642f603375a09434a.png"},{"id":65421468,"identity":"b0c85f00-1732-447e-854d-2c57e1b79d1c","added_by":"auto","created_at":"2024-09-27 08:20:21","extension":"jpeg","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":203461,"visible":true,"origin":"","legend":"\u003cp\u003eTelepresence Robot Final Version 2.0\u003c/p\u003e","description":"","filename":"floatimage8.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4945009/v1/8790d95595ecf15118da8988.jpeg"},{"id":65422586,"identity":"bb1b6990-7f0e-4edc-b0ad-d71ace7389b7","added_by":"auto","created_at":"2024-09-27 08:36:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3257066,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4945009/v1/65047545-e6a1-4089-aae2-dff75834501c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eTelepresence Robot Design in the Amazon: An Application of Design for Manufacturing and Assembly (DFMA)\u003c/p\u003e","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eTelepresence is a well-known tool in the field of medicine, as it is also known as telemedicine. Telemedicine incorporates technology, such as robotics, virtual reality, and artificial intelligence, into medical practice. The term came into use when telepresence devices were used to carry out patient consultation and screening so that infectious diseases could be minimized [1].\u003c/p\u003e\n\u003cp\u003eAs the internet and technology grew, telemedicine was developed in the 1950s. Telehealth covers the same topic but in a larger context than does telemedicine. Nevertheless, the Ministry of Health puts some limits on medical diagnoses using digital instruments in its guidance to such an examination. Similarly, practices of telediagnosis and classical teleconsultation or even executions in terms of teaching processes at digitally safe locations with limited access to health professionals also enable the trust relationship between them and their patients to be performed earlier [2]. Telehealth is mainly used across specialized outpatient clinics today through patient-centered apps, which are complex in terms of secondary care and tertiary hospital interactions. It also acts as a preferential alternative care in isolated areas [3].\u003c/p\u003e\n\u003cp\u003eThe bulk of current telemedicine services are used in industrialized nations and target pressing needs, including widening access, increasing medical utilization by care providers and patients, lowering costs or rationing health expenditures, and further responding to demands for real-time monitoring and immediate feedback on public health problems [4]. The telehealth model adopted by Brazil connects universities with primary health care in the most distant municipalities through tele-education and tele-assistance activities [5]. The main issue with these tools is how much scientific and financial investment is needed to introduce the respective technology, making them a challenge for the Brazilian public sector, as they seem unable to understand what it truly requires in terms of cost to have access to an adequate quality system that can be used by health/medicine [6].\u003c/p\u003e\n\u003cp\u003eThe launch of the robot prototype R1T1, developed within the Project Company in Brazil, was made at the University Hospital in Maring\u0026aacute; in 2013. As part of the experimentation, the applicability of the robot was tested, and nine consultations were supported, in addition to visiting and discussing cases in different wards, which facilitated the bringing patients and families together during long hospital stays [7].\u003c/p\u003e\n\u003cp\u003eThe restructured communication enabled by these robots will demand a certain investment, considering that they often adopt highly technological and complex structures, which makes it difficult for public applications owing to the greater number of resources employed, especially in underdeveloped nations, such as Brazil. Given this context, the realization of telepresence robots for the remote regions of the Amazon faces several challenges. The purpose of this study is to discuss some of these shortcomings and objectives throughout development, highlighting the aspects mentioned above.\u003c/p\u003e\n\u003cp\u003eThis research aims to integrate elements of product design to address the emerging needs arising from the healthcare landscape by introducing a prototype of a telepresence robot. The objective is to advance exploration in this field with a view toward extending the technology for use in hospitals to facilitate connections between families and patients, with a focus on understanding the emotional impact on individuals involved. The study illustrates aspects of telepresence technology, its implementation in public health settings, the integration of robots in telepresence systems and the design principles employed in developing the proposed solution.\u003c/p\u003e\n\u003cp\u003eConsequently, the study also aims to describe the methodological process used through the principles of DFMA (Design for Manufacturing and Assembly) to reduce costs and optimize product development. This methodology can be applied in various existing projects, such as the work of Maidin et al. [8], where DFMA was used to reduce costs in a water faucet nozzle project. In this case, processes of part disassembly, product function definition, and design critique were utilized to analyze data and propose modifications, resulting in increased assembly efficiency from 23% to 25%, reduced assembly cost from RM28.64 to RM10.46 (RM being the currency of Malaysia), and reduced production time from 51.7 seconds to 28.3 seconds in the new design.\u003c/p\u003e\n\u003cp\u003eAnother example is the study by Samad and Yusuf [9], where the method was applied in the product development of a car passenger door. The steps included obtaining information about the product or assembly from drawings, prototypes, or an existing product; disassembling the product or assembly and assigning an identification number to each item on the basis of handling and insertion requirements; reassembling the product starting with the highest identification number and adding the remaining parts; and filling out the Design for Assembly worksheet, calculating the total manual assembly time and assembly efficiency. This resulted in a 22.2% increase in assembly efficiency.\u003c/p\u003e\n\u003cp\u003eFinally, with these positive examples of method application, this study presents project development along with 3D modeling and prototyping by applying the central concepts of this methodology.\u003c/p\u003e"},{"header":"2 Literature Review","content":"\u003cp\u003e\u003cstrong\u003e2.1\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eTelepresence\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTelehealth, as noted by the CMS (Center for Medicare \u0026amp; Medicaid Services), is defined as \u0026quot;the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision, and information from a distance.\u0026quot; This involves both synchronous engagements, which are live and real-time, and asynchronous interactions, where data trends or messages are exchanged periodically between clinicians or are used for remote patient monitoring [10].\u003c/p\u003e\n\u003cp\u003eFurthermore, it is expected that by using this technology, telemedicine/telehealth services will be able to deliver better health services from healthcare providers to other users, improve health outcomes, and provide better capacity utilization and other related benefits. In recent years, telemedicine has moved from being several individual managers to being managed as a medical component of healthcare services and a foundational tool for information technology and communication services [11].\u003c/p\u003e\n\u003cp\u003eAs telecommunications technology has developed, it has become easier for people to use this technology, which is driving the rise of telehealth, which aims to blend technology into healthcare and create a different patient experience [12].\u003c/p\u003e\n\u003cp\u003eWhile telemedicine may be relatively new for some medical professionals, it was rooted in the 1920s when the Royal Flying Doctor Service in Australia used radios for remote care. More recently, NASA (National Aeronautics and Space Administration) accelerated telemedicine when they funded research to find ways for doctors to provide medical care in space and to provide medical care for commercial airlines in flight. The 1960s to 2000 experienced exponential growth in the field in terms of the type of medical services available and the types of populations able to receive telemedicine, such as rural and prison health care [13].\u003c/p\u003e\n\u003cp\u003eThe importance of health technology has become very clear with the arrival of the COVID-19 pandemic. Many hospitals have a limited number of patients, so the question quickly becomes how to protect both staff and other patients in a closed environment. With continuing lockdowns and the necessity of social distancing, it is important to consider ways to protect our physical and mental health to prevent the spread of disease [14].\u003c/p\u003e\n\u003cp\u003eThe focus on mental health has increased in the context of social isolation, prompting mental health professionals to tailor mental health interventions to incorporate social considerations. According to Wosik et al. [15], Telehealth is seen as a suitable tool for reducing virus transmission while integrating technological and social resources.\u003c/p\u003e\n\u003cp\u003eRandall and Winchester [16] reported various concerns about the use of telehealth, including access to broadband telecommunications services, the protection of personal health information through technology in a more private and confidential way, and the initial investments that need to be made. Thomas et al. [17] also mentioned barriers to telehealth, such as digital literacy and access, ambiguity about the quality of care given through virtual modes, privacy concerns, and preferences for in-person care. Additionally, telehealth has the potential to provide financial benefits, deliver more frequent monitoring care through quick screening and diagnosis, and offer remote patient care and management.\u003c/p\u003e\n\u003cp\u003eSnoswel et al. [18] conducted a healthcare case study investigating data from all telehealth outpatient clinics in Queensland over a year-long period from July 2017 to July 2018. The results indicated that in Queensland alone, there were annual productivity gains of $9,176,052 or $304, for which a doctor\u0026apos;s savings per consultation were saved.\u003c/p\u003e\n\u003cp\u003eIn connection with the robotics theme, the first robotic system came into existence in 1948; it was a remotely controlled machine that mimicked human movements, specifically a robotic arm that operated via an electrically controlled motor that followed signals from joysticks to replicate human activity. The purpose of this system was to replace human labor when it was deemed unsafe for use in certain environments or contexts. Despite this, there are earlier mentions and applications of telepresence robots in the current literature from the early 1990s, originating from academic bodies from Asia, Europe, and North America [19, 20].\u003c/p\u003e\n\u003cp\u003eImportantly, applications have taken a slightly different angle to the ideal design for human interaction within a human ecosystem, as noted by Bradwell et al. [21] in their recent exploration of how each robot interacts with a person within specific observed scenarios. Notably, their research showed that soft-friendly aesthetics supersed traditional robotic objective aesthetics, which can be referred to as anthropomorphic or biomorphic features, to increase social presence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eDFMA\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe capability of Design for eXcellence (DFX) was created to assist in the design of products and processes with the objective of optimizing costs and increasing quality throughout the life cycle of a product. Given the necessity of handling high complexity and the large number of different requirements and specifications in product development, it is important to consider these requirements and specifications in all phases of the product lifespan, such as manufacturing, assembly, maintenance, disposal, etc. For this purpose, DFX is employed. The use of Df and DFMA philosophies, along with integrated CAD (Computer Aided Design)/CAM (Computer Aided Manufacturing) solutions, allows us to analyze the design and assembly to identify and correct possible errors during the design phase, reducing the project time and development costs, since corrections can be made in the early stages of the project, when changes are less time-consuming and easier to implement [22, 23, 24].\u003c/p\u003e\n\u003cp\u003eAs seen in the work of Boothroyd, Knight and Dewhurst [25], design is the first step in product manufacturing. It is the stage where sketches of parts and components are made for detailed drawings and CAD models. This detailed information is then passed on to manufacturing and assembly engineers, who may request design changes due to issues in the assembly stage, causing delays and increased project costs. To assist in this process, the DFMA methodology exists, which guides the product design process and includes criteria to be examined, as listed below:\u003c/p\u003e\n\u003cp\u003e●\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;As you take a product and use it, how inert shall be that part in relative motion with all other assembled parts during operations of the product? Negative changes are considered only when they are significant; minor movements, however small, can always be taken by integral elastic elements.\u003c/p\u003e\n\u003cp\u003e●\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Does it need to be a different material than the other parts that will go into assembly with this part or simply stand out in some way? Acceptable reasons are related only to the properties of the materials.\u003c/p\u003e\n\u003cp\u003e●\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Must the part be separated from all other assembled parts because assembling or disassembling other parts would be impossible?\u003c/p\u003e\n\u003cp\u003eIn the work of Tan et al. [26], we can check the history of this methodology. According to the authors, the DfMA originated from the weapon production processes developed by Ford and Chrysler during World War II. In a more formal sense, DfM - Design for Manufacturing and DfA - Design for Assembly, which together form DfMA, began to be cited in the late 1960s. Additionally, the authors mention that since its adoption in manufacturing, DfMA has helped many companies increase their profits through optimized design with concrete guidelines to help designers reduce difficulties in the fabrication and assembly of a product.\u003c/p\u003e\n\u003cp\u003eGao, Jin and Lu [27] emphasized that there is a sequence of steps for applying the methodology. DfA should be considered first, leading to a simplification of the product structure. Following this, materials and processes with initial cost estimates are selected. With the materials chosen, a DfM analysis is assisted with guidelines for the standardization, design, and assembly of components to reduce the total manufacturing cost.\u003c/p\u003e\n\u003cp\u003eIn the studies of Alfaify, Saleh, Abdullah and Al-Ahmari [28], the advantages of using DFMA in conjunction with other methodologies, including\u0026nbsp;Additive\u0026nbsp;Manufacturing (AM), are also detailed. The authors assert that the combined approach aims to (1) supply tools, techniques and guidelines to enable the design to adapt within a particular set of final manufacturing constraints; (2) demonstrate and understand the impact on the design process in relation to the manufacturing system to improve the quality of the product; and (3) identify the relationship between design and manufacturing and the consequences for designers and practices.\u003c/p\u003e\n\u003cp\u003eDeka and Behdad [29] also emphasized that\u0026nbsp;AM\u0026nbsp;can play a crucial role in DFMA in terms of increasing productivity and producing complex parts with desired mechanical functionalities. Another work addressing this topic is that of Haruna and Jiang [30], which asserts that the conventional design methodology,\u0026nbsp;Design\u0026nbsp;Theory and\u0026nbsp;Methodology (DTM), concerning\u0026nbsp;Design for\u0026nbsp;Manufacturing (DFM),\u0026nbsp;Design for\u0026nbsp;Assembly (DFA), and\u0026nbsp;Design for\u0026nbsp;Performance (DFP), is not qualified to embrace these new opportunities. This intensifies the necessity of using AM to achieve optimized design.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAdditive Manufacturing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is a need for optimization of existing robotic platforms and the discovery of new methods to create and apply innovative robotic instruments such as grippers and new mechanisms. Recently, AM technologies have been widely adopted in robotics and biomedicine owing to their feasibility in employing flexible materials, easily creating complex structures, using multiple materials in the same manufacturing cycle, and fabricating smart structures [31, 32].\u003c/p\u003e\n\u003cp\u003eAccording to Alfattni [33], in 1986, Charles Hull introduced the concept of\u0026nbsp;AM, also known as 3D printing. It involves a group of advanced manufacturing techniques that produce three-dimensional physical items from a 3D CAD model, using an additive printing process layer by layer, point by point, or line by line.\u003c/p\u003e\n\u003cp\u003eIn industry, AM has also gained significant focus, especially in terms of rapid prototyping, fast manufacturing, mass customization, mass production, the creation of bold shapes without creativity limits, and the potential to revolutionize compared with traditional manufacturing methods. This is already evident from the findings of the 2023 Wohlers report, where global growth in AM products and services is estimated at 18.3%, with substantial increases in materials, software, 3D printing services, and hardware, which are expected to grow by an estimated 23% in 2022 [34, 35].\u003c/p\u003e\n\u003cp\u003eTo gain a full appreciation of the topic, it is important to describe a typical 3D printing process. In accordance with Grivet-Brancot, Boffito and Ciardelli [36], the process starts with the existence of a 3D Computer-Aided Design (CAD) model that can be exported in .STL file format. The file is then sliced by slicing software, which then produces a fila called G-code, and the code is sent to the printer so that it can interpret the layers and create the desired final object.\u003c/p\u003e\n\u003cp\u003eAlthough initially conceived for rapid prototyping, AM also has a branch focused on mass production owing to its high versatility, reduced material waste, and ability to manufacture geometries that would otherwise be impossible to achieve. As a result, various AM technologies have emerged to process a wide range of materials, such as polymers, metals, ceramics, and concrete. The most well-known technologies mentioned earlier include Fused Deposition Modeling (FDM), Powder Bed Fusion (PBF), Stereolithography (SLA), Direct Energy Deposition (DED), and Laminated Object Manufacturing (LOM) [37].\u003c/p\u003e\n\u003cp\u003eThe study will be carried out using technology that relies on\u0026nbsp;FDM. This technique works by guiding filaments of thermoplastics as they are pushed through a heated nozzle. The materials and reinforced materials used in FDM are composed of thermoplastic materials, including Acrylonitrile Butadiene Styrene (ABS), Polylactic Acid (PLA), Polycarbonate, Unfilled Polyetherimide (PEI), Polyether Ether Ketone (PEEK), Polyethylene Terephthalate Glycol (PETG), and reinforced materials like Thermoplastic Polyurethane (TPU) \u0026nbsp;[38].\u003c/p\u003e\n\u003cp\u003eThe printing process using the FDM technique involves a filament of a specific thickness wound on a reel of a specific weight/size. This filament is moved with the help of bearings that assist in pushing the material, which is directed by the nozzle with a temperature control unit. This temperature control unit must have settings for both itself and the print bed, which serves as the printing platform [39].\u003c/p\u003e"},{"header":"3 Methodology","content":"\u003cp\u003eTo carry out the data analysis, the first step involved defining the project idea and description. A prototype and a tool were created via the DFMA concepts, although it was more dynamic than in previous studies conducted on telepresence robots, along with a comparative study from the literature. Theoretical elements to be applied on the basis of the conceptualization and project schedule bringing together DFMA concepts include the following:\u003c/p\u003e\n\u003cp\u003e\u0026bull;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;3D CAD Modeling Software, which can be about SolidWorks or SolidEdge\u003c/p\u003e\n\u003cp\u003e\u0026bull;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Additive manufacturing, often called 3D printing, to make physical prototype applications.\u003c/p\u003e\n\u003cp\u003eDuring this ideation phase, brainstorming was used to identify the key characteristics of the robot in development, both by selecting the main sketches and attributes of the robot while addressing the pain points of the persona developed from the previous phase. To do that, we developed a mind map of those key aspects. According to Guelton [40], maps and diagrams can either work together or apart, acting as organizational structures for complex information, while offering fundamental organizational patterns to help navigate between physical, social, and conceptual spaces.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsidering the regional aspects and important characteristics regarding the target audience, mobility, simplicity, and regional scope of application, this set conceived the physical form of the proposed project.\u003c/p\u003e\n\u003cp\u003eThe intention was to resemble the physical shape of the toy \u0026quot;Peteca,\u0026quot; which is part of a game that aims to keep the object in the air for as long as possible through exchanges between participants. This intention is driven by the project\u0026apos;s goal to target the regional youth audience.\u003c/p\u003e\n\u003cp\u003eAccording to Santos [41], Peteca originated long before the arrival of colonizers in Brazil and has native roots. Traditionally, petecas are adorned with feathers and filled with straw.\u003c/p\u003e\n\u003cp\u003eTaking these aspects into account, 3D modeling was performed via SolidWorks software, which assists in the design of complex products or parts, with dimensioning and other experimental analyses [42]. The project was named \u0026quot;Kaiap\u0026oacute;,\u0026quot; derived from the Tupi\u0026ndash;Guarani indigenous language, meaning \u0026quot;life,\u0026quot; and referred to the goal of the work being developed, the illustration of the work can be seen in Figure 1, which represents the first 3D model of the robot.\u003c/p\u003e"},{"header":"4 Robot development","content":"\u003cp\u003eFor 3D modeling, SolidWorks software was used to design the necessary parts for assembling the structure (excluding screws and device mounts). In the software, files were saved in (.STL) format to enable their use with slicing software for 3D printing. Slicing was performed via Ultimaker Cura software, where the mentioned file format can be converted to GCode, facilitating the printing process. The interface used for this can be seen in Figure 2, which demonstrates an example of a piece in the slicing software.\u003c/p\u003e\n\u003cp\u003eThe Ender 3 printer was used with settings for PLA filament. This polymer was chosen for prototyping because of its low cost, detailed printing capabilities, and ease of handling. The figure 3 shows the parts, components, and step-by-step assembly of the first robot version.\u003c/p\u003e\n\u003cp\u003eIn conducting the assembly test of the project, the total quantity of 203 parts and 12 types of robot components shown opens up room for optimization. By applying the principles of DFMA, a version 2.0 of the robot was developed to address improvement gaps identified after the first version was assembled.\u003c/p\u003e\n\u003cp\u003eThe first step was to switch the material of the parts to ABS to achieve greater robustness and strength. Following this, a modification to the parts joining mechanism was considered, transitioning from screws to snap-fit connections to simplify the assembly process. For this purpose, three test pieces were developed for the mechanism: a female part, a male part, and the unlocking key for the joint. This mechanism can be seen in Figure 4.\u003c/p\u003e\n\u003cp\u003eWhen securing the test piece and considering what modification might need to be done to suit the Version 2 robot, a concern was raised whether maintenance and part replacement would be difficult when a problem occurred with the joint mechanism. The replacement of parts would incur higher costs. Therefore, the judgment was suspended, and normal screw installation was performed with a focus on reducing the number of screws and strengthening them.\u003c/p\u003e\n\u003cp\u003eThe second point was to reduce the variety of parts, particularly focusing on the conveyor belt parts, which were numerous. To achieve this, another filament type, thermoplastic polyurethane (TPU), known for its flexibility, was considered for printing. With respect to the 3D printer parameter settings, PLA was used for the first prototype because of its ease of printing, whereas for the second prototype, materials such as ABS were chosen for increased robustness. The ABS was used for parts such as the side supports of the wheel and the wheel itself, whereas the TPU was selected for the conveyor belt structure. For the 3D printer settings:\u003c/p\u003e\n\u003cp\u003ePLA: Extruder nozzle temperature 205\u0026deg;C, bed temperature 65\u0026deg;C\u003c/p\u003e\n\u003cp\u003eTPU: Extruder nozzle temperature 240\u0026deg;C, bed temperature 100\u0026deg;C\u003c/p\u003e\n\u003cp\u003eABS: Extruder nozzle temperature 225\u0026deg;C, bed temperature 90\u0026deg;C\u003c/p\u003e\n\u003cp\u003eThese settings were adjusted to optimize the printing quality and material performance, as shown in the Figure 5 below.\u003c/p\u003e\n\u003cp\u003eWith the intention of replacing the conveyor system, a new structure was modeled, taking into consideration that it will be printed using a TPU filament. By using this flexible material, it was possible to reduce the majority of parts in the project. This new structure can be seen in the figure 6.\u003c/p\u003e\n\u003cp\u003eUpon comparison, we found that the number of parts decreased from 203 to 44, resulting in a decrease of approximately 78% in total quantity. The types of parts also decreased from 12 to 10, with the addition that in the second version, decorative feathers were included to align with the project\u0026apos;s audience. This impact on simplifying the project via DFMA concepts can also be seen in the visual Figure 7 below, where the shift from a visually complex aspect of the project is evident.\u003c/p\u003e\n\u003cp\u003eThe final images of the project compared with those of version 1.0 of the proposed project are also shown in the Figure 8, demonstrating that the surface finish of the ABS is different from that of the previous version with the PLA.\u003c/p\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eIt was clear from the analysis that the use of tools such as DFMA and AM make important contributions to the management of production and operations, particularly in the area of product engineering. The joint action was extremely beneficial in structuring the whole process of development of the proposed project, offering visibility on the aspects to be verified and aligned so that the telepresence robot initiative clearly reflected what it should propose itself to do. The DFMA methodology, allied with modeling, prototyping, design and redesign, follows this chain that permits the proposal product to be developed in a structured process receiving enhancements that are mutual to each of the components.\u003c/p\u003e\n\u003cp\u003eThe concept of a telepresence robot was designed with the target audience in mind to present what we are trying to accomplish in this project. Once we had the conceived object, DFMA was used to generate two feasible forms of the structure of the telepresence robot and the parts it would require. It looks at all the DFMA gaps and simplifications that are relevant to the DFMA concepting exercise. The use of AM expedited the idea generation process, creating reassurance that any modeling, dimensioning, or structural mistakes could be quickly corrected to keep going and not restart from the beginning.\u003c/p\u003e\n\u003cp\u003eThe demonstration of the different ways to guide the application of these methodologies and the flexibility to work with different types of welding in AM on the joining side is coherent and aligned with the maintenance principles that the DFMA and DFX bring to their principles. Considering all the points highlighted throughout the work, it becomes evident that the proposal can be further enriched, especially with respect to how the mechanical structure can incorporate electronic and information technology elements, to test this mechanical structure\u0026rsquo;s physical robustness with its full functionality and foster research on connectivity in the Amazon.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no funds, grants, or other support was received during the preparation of this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or nonfinancial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Ingrid Pereira and Marcelo de Oliveira. The first draft of the manuscript was written by Gabriela Veroneze, Antonio Alves and Marcos Santos and all the authors commented on previous versions of the manuscript. All the authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eC. Quispe-Juli, P. Vela-Anton, M. Meza-Rorigues, and V. Moquillaza-Alc\u0026aacute;ntara, \u0026ldquo;Covid-19: Uma Pand\u0026ecirc;mica Na Era Da Sa\u0026uacute;de Digital,\u0026rdquo; \u003cem\u003eHealth Sciences\u003c/em\u003e, 2020.\u003c/li\u003e\n\u003cli\u003eS. de C. Catapan and M. C. M. Calvo, \u0026ldquo;Teleconsulta: Uma Revis\u0026atilde;o Integrativa Da Intera\u0026ccedil;\u0026atilde;o M\u0026eacute;dico-aciente Mediada Pela Tecnologia,\u0026rdquo; \u003cem\u003eRev Bras Educ Med\u003c/em\u003e, vol. 44, no. 1, pp. 1\u0026ndash;13, 2020, doi: 10.29327/cbtms9.144795.\u003c/li\u003e\n\u003cli\u003eA. C. Ra\u0026ntilde;\u0026oacute;, M. M. Moldes, and B. B. Sancho, \u0026ldquo;Telemedicina: una nueva herramienta para la gesti\u0026oacute;n del dolor. Resultados de su implementaci\u0026oacute;n en una estructura organizativa de gesti\u0026oacute;n integral (EOXI),\u0026rdquo; \u003cem\u003eRevista de la Sociedad Espa\u0026ntilde;ola del Dolor\u003c/em\u003e, vol. 27, no. 2, pp. 97\u0026ndash;103, 2020, doi: 10.20986/resed.2020.3756/2019.\u003c/li\u003e\n\u003cli\u003eJ. M. S. de V. Maldonado, A. B. Marques, and A. Cruz, \u0026ldquo;Telemedicina: Desafios \u0026agrave; sua difus\u0026atilde;o no Brasil,\u0026rdquo; \u003cem\u003eCad Saude Publica\u003c/em\u003e, vol. 32, pp. 1\u0026ndash;12, 2016, doi: 10.1590/0102-311X00155615.\u003c/li\u003e\n\u003cli\u003eR. F. Damasceno and A. P. Caldeira, \u0026ldquo;Factors associated with the non-use of telehealth consultancy by physicians of the family health strategy,\u0026rdquo; \u003cem\u003eCiencia e Saude Coletiva\u003c/em\u003e, vol. 24, no. 8, pp. 3089\u0026ndash;3098, 2019, doi: 10.1590/1413-81232018248.28752017.\u003c/li\u003e\n\u003cli\u003eB. S. Zanotto et al\u003cem\u003e.\u003c/em\u003e, \u0026ldquo;Economic evaluation of a telemedicine service to expand primary health care in Rio Grande do Sul: Teleoftalmo\u0026rsquo;s microcosting analysis,\u0026rdquo; \u003cem\u003eCiencia e Saude Coletiva\u003c/em\u003e, vol. 25, no. 4, pp. 1349\u0026ndash;1360, 2020, doi: 10.1590/1413-81232020254.28992019.\u003c/li\u003e\n\u003cli\u003eM. F. Carreira, G. C. Antonelli, A. H. Dianin, A. S. Culchesk, and B. M. Ger\u0026ocirc;nimo, \u0026ldquo;Proposta de coleta dados utilizando rob\u0026ocirc; de telepresen\u0026ccedil;a em sistema HealtCare do Hospital Universit\u0026aacute;rio de Maring\u0026aacute;,\u0026rdquo; \u003cem\u003eSimp\u0026oacute;sio de Engenharia de Produ\u0026ccedil;\u0026atilde;o de Maring\u0026aacute;/PR\u003c/em\u003e, vol. 1, 2018.\u003c/li\u003e\n\u003cli\u003eN. A. Maidin et al\u003cem\u003e.\u003c/em\u003e, \u0026ldquo;Reducing Product Cost by Implementing DFMA Methodology-Lucas Hull: A Case Study Reducing Product Cost by Implementing DFMA Methodology-Lucas Hull: A Case Study ARTICLE HISTORY ABSTRACT,\u0026rdquo; \u003cem\u003eESTEEM Academic Journal\u003c/em\u003e, vol. 14, pp. 12\u0026ndash;23, 2018, [Online]. Available: https://www.researchgate.net/publication/323028730\u003c/li\u003e\n\u003cli\u003eM. F. A. Samad and K. Yusuf, \u0026ldquo;Application of design for manufacture and assembly (DFMA) method to passenger car door design,\u0026rdquo; in \u003cem\u003eProceedings of Innovative Research and Industrial Dialogue\u003c/em\u003e, Taylor and Francis Ltd., Mar. 2018, pp. 144\u0026ndash;145.\u003c/li\u003e\n\u003cli\u003eD. Mahtta, M. Daher, M. T. Lee, S. Sayani, M. Shishehbor, and S. S. Virani, \u0026ldquo;PUBLIC HEALTH POLICY (SS VIRANI AND D MAHTTA, SECTION EDITORS) Promise and Perils of Telehealth in the Current Era,\u0026rdquo; 2021, doi: 10.1007/s11886-021-01544-w/Published.\u003c/li\u003e\n\u003cli\u003eS. N. Gajarawala and J. N. Pelkowski, \u0026ldquo;Telehealth Benefits and Barriers,\u0026rdquo; \u003cem\u003eJournal for Nurse Practitioners\u003c/em\u003e, vol. 17, no. 2, pp. 218\u0026ndash;221, Feb. 2021, doi: 10.1016/j.nurpra.2020.09.013.\u003c/li\u003e\n\u003cli\u003eD. C. Alverson, E. A. Krupinski, K. A. Erps, N. S. Rowe, and R. S. Weinstein, \u0026ldquo;The Third National Telemedicine \u0026amp; Telehealth Service Provider Showcase Conference: Advancing Telehealth Partnerships,\u0026rdquo; \u003cem\u003eTelemedicine and e-Health\u003c/em\u003e, vol. 25, no. 4, pp. 332\u0026ndash;340, Apr. 2019, doi: 10.1089/tmj.2018.0096.\u003c/li\u003e\n\u003cli\u003eN. R. Wijesooriya, V. Mishra, P. L. P. Brand, and B. K. Rubin, \u0026ldquo;COVID-19 and telehealth, education, and research adaptations,\u0026rdquo; Sep. 01, 2020, \u003cem\u003eW.B. Saunders Ltd\u003c/em\u003e. doi: 10.1016/j.prrv.2020.06.009.\u003c/li\u003e\n\u003cli\u003eJ. M. Fegert, B. Vitiello, P. L. Plener, and V. Clemens, \u0026ldquo;Challenges and burden of the Coronavirus 2019 (COVID-19) pandemic for child and adolescent mental health: A narrative review to highlight clinical and research needs in the acute phase and the long return to normality,\u0026rdquo; May 12, 2020, \u003cem\u003eBioMed Central\u003c/em\u003e. doi: 10.1186/s13034-020-00329-3.\u003c/li\u003e\n\u003cli\u003eJ. Wosik et al\u003cem\u003e.\u003c/em\u003e, \u0026ldquo;Telehealth transformation: COVID-19 and the rise of virtual care,\u0026rdquo; Jun. 01, 2020, \u003cem\u003eOxford University Press\u003c/em\u003e. doi: 10.1093/jamia/ocaa067.\u003c/li\u003e\n\u003cli\u003eM. H. Randall and D. E. Winchester, \u0026ldquo;The New Role of Telehealth in Contemporary Medicine,\u0026rdquo; Mar. 01, 2022, \u003cem\u003eSpringer\u003c/em\u003e. doi: 10.1007/s11886-022-01640-5.\u003c/li\u003e\n\u003cli\u003eL. T. Thomas, C. M. Y. Lee, K. McClelland, G. Nunis, S. Robinson, and R. Norman, \u0026ldquo;Health workforce perceptions on telehealth augmentation opportunities,\u0026rdquo; \u003cem\u003eBMC Health Serv Res\u003c/em\u003e, vol. 23, no. 1, Dec. 2023, doi: 10.1186/s12913-023-09174-4.\u003c/li\u003e\n\u003cli\u003eC. L. Snoswell, A. C. Smith, M. Page, P. Scuffham, and L. J. Caffery, \u0026ldquo;Quantifying the Societal Benefits From Telehealth: Productivity and Reduced Travel,\u0026rdquo; \u003cem\u003eValue Health Reg Issues\u003c/em\u003e, vol. 28, pp. 61\u0026ndash;66, Mar. 2022, doi: 10.1016/j.vhri.2021.07.007.\u003c/li\u003e\n\u003cli\u003eJ. Leoste et al\u003cem\u003e.\u003c/em\u003e, \u0026ldquo;Keeping distance with a telepresence robot: A pilot study,\u0026rdquo; \u003cem\u003eFront Educ (Lausanne)\u003c/em\u003e, vol. 7, Jan. 2023, doi: 10.3389/feduc.2022.1046461.\u003c/li\u003e\n\u003cli\u003eT. B. Tuli, T. O. Terefe, and M. M. U. Rashid, \u0026ldquo;Telepresence Mobile Robots Design and Control for Social Interaction,\u0026rdquo; \u003cem\u003eInt J Soc Robot\u003c/em\u003e, vol. 13, no. 5, pp. 877\u0026ndash;886, Aug. 2021, doi: 10.1007/s12369-020-00676-3.\u003c/li\u003e\n\u003cli\u003eH. L. Bradwell, G. E. Aguiar Noury, K. J. Edwards, R. Winnington, S. Thill, and R. B. Jones, \u0026ldquo;Design recommendations for socially assistive robots for health and social care based on a large scale analysis of stakeholder positions: Social robot design recommendations,\u0026rdquo; \u003cem\u003eHealth Policy Technol\u003c/em\u003e, vol. 10, no. 3, Sep. 2021, doi: 10.1016/j.hlpt.2021.100544.\u003c/li\u003e\n\u003cli\u003eL. Atilano, A. Martinho, M. A. Silva, and A. J. Baptista, \u0026ldquo;Lean Design-for-X: Case study of a new design framework applied to an adaptive robot gripper development process,\u0026rdquo; in \u003cem\u003eProcedia CIRP\u003c/em\u003e, Elsevier B.V., 2019, pp. 667\u0026ndash;672. doi: 10.1016/j.procir.2019.04.190.\u003c/li\u003e\n\u003cli\u003eI. M. Pita, G. Nag\u0026icirc;, V. Merticaru, M. I. R\u0026icirc;panu, and M. Cuco, \u0026ldquo;Analyses and redesign of a technological device for automated assembly, using Design for Manufacturing and Assembly approach,\u0026rdquo; in \u003cem\u003eIOP Conference Series: Materials Science and Engineering\u003c/em\u003e, Institute of Physics Publishing, Oct. 2019. doi: 10.1088/1757-899X/564/1/012058.\u003c/li\u003e\n\u003cli\u003eC. L. C. Roxas et al\u003cem\u003e.\u003c/em\u003e, \u0026ldquo;Design for Manufacturing and Assembly (DfMA) and Design for Deconstruction (DfD) in the Construction Industry: Challenges, Trends and Developments,\u0026rdquo; May 01, 2023, \u003cem\u003eMDPI\u003c/em\u003e. doi: 10.3390/buildings13051164.\u003c/li\u003e\n\u003cli\u003eG. Boothroyd, W. A. Knight, and P Dewhurst, \u003cem\u003eProduct design for manufacture and assembly\u003c/em\u003e, 2nd ed. 2002.\u003c/li\u003e\n\u003cli\u003eT. Tan et al\u003cem\u003e.\u003c/em\u003e, \u0026ldquo;Construction-Oriented Design for Manufacture and Assembly Guidelines,\u0026rdquo; 2020, doi: 10.1061/(ASCE)CO.1943.\u003c/li\u003e\n\u003cli\u003eS. Gao, R. Jin, and W. Lu, \u0026ldquo;Design for manufacture and assembly in construction: a review,\u0026rdquo; \u003cem\u003eBuilding Research and Information\u003c/em\u003e, vol. 48, no. 5, pp. 538\u0026ndash;550, Jul. 2020, doi: 10.1080/09613218.2019.1660608.\u003c/li\u003e\n\u003cli\u003eA. Alfaify, M. Saleh, F. M. Abdullah, and A. M. Al-Ahmari, \u0026ldquo;Design for additive manufacturing: A systematic review,\u0026rdquo; Oct. 01, 2020, \u003cem\u003eMDPI\u003c/em\u003e. doi: 10.3390/SU12197936.\u003c/li\u003e\n\u003cli\u003eA. Deka and S. Behdad, \u0026ldquo;Part separation technique for assembly based design in additive manufacturing using genetic algorithm,\u0026rdquo; Elsevier B.V., 2019, pp. 764\u0026ndash;771. doi: 10.1016/j.promfg.2019.06.208.\u003c/li\u003e\n\u003cli\u003eA. Haruna and P. Jiang, \u0026ldquo;A Design for Additive Manufacturing Framework: Product Function Integration and Structure Simplification,\u0026rdquo; in \u003cem\u003eIFAC-PapersOnLine\u003c/em\u003e, Elsevier B.V., 2020, pp. 77\u0026ndash;82. doi: 10.1016/j.ifacol.2021.04.127.\u003c/li\u003e\n\u003cli\u003eN. Kladovasilakis, P. Sideridis, D. Tzetzis, K. Piliounis, I. Kostavelis, and D. Tzovaras, \u0026ldquo;Design and Development of a Multi-Functional Bioinspired Soft Robotic Actuator via Additive Manufacturing,\u0026rdquo; \u003cem\u003eBiomimetics\u003c/em\u003e, vol. 7, no. 3, Sep. 2022, doi: 10.3390/biomimetics7030105.\u003c/li\u003e\n\u003cli\u003eG. Stano, S. M. A. I. Ovy, J. R. Edwards, M. Cianchetti, G. Percoco, and Y. Tadesse, \u0026ldquo;One-shot additive manufacturing of robotic finger with embedded sensing and actuation,\u0026rdquo; \u003cem\u003eInternational Journal of Advanced Manufacturing Technology\u003c/em\u003e, vol. 124, no. 1\u0026ndash;2, pp. 467\u0026ndash;485, Jan. 2023, doi: 10.1007/s00170-022-10556-x.\u003c/li\u003e\n\u003cli\u003eR. Alfattni, \u0026ldquo;Comprehensive Study on Materials used in Different Types of Additive Manufacturing and their Applications,\u0026rdquo; \u003cem\u003eInternational Journal of Mathematical, Engineering and Management Sciences\u003c/em\u003e, vol. 7, no. 1, pp. 92\u0026ndash;114, 2022, doi: 10.33889/IJMEMS.2022.7.1.007.\u003c/li\u003e\n\u003cli\u003eM. A. El youbi El idrissi, L. Laaouina, A. Jeghal, H. Tairi, and M. Zaki, \u0026ldquo;Modeling of Energy Consumption and Print Time for FDM 3D Printing Using Multilayer Perceptron Network,\u0026rdquo; \u003cem\u003eJournal of Manufacturing and Materials Processing\u003c/em\u003e, vol. 7, no. 4, Aug. 2023, doi: 10.3390/jmmp7040128.\u003c/li\u003e\n\u003cli\u003eA. Nicolau, M. A. Pop, S. V. Georgescu, and C. Coșereanu, \u0026ldquo;Application of Additive Manufacturing Technology for Chair Parts Connections,\u0026rdquo; \u003cem\u003eApplied Sciences\u003c/em\u003e, vol. 13, no. 21, p. 12044, Nov. 2023, doi: 10.3390/app132112044.\u003c/li\u003e\n\u003cli\u003eA. Grivet-Brancot, M. Boffito, and G. Ciardelli, \u0026ldquo;Use of Polyesters in Fused Deposition Modeling for Biomedical Applications,\u0026rdquo; Oct. 01, 2022, \u003cem\u003eJohn Wiley and Sons Inc\u003c/em\u003e. doi: 10.1002/mabi.202200039.\u003c/li\u003e\n\u003cli\u003eM. Martini, M. Scaccia, G. Marchello, H. Abidi, M. D\u0026rsquo;imperio, and F. Cannella, \u0026ldquo;An Outline of Fused Deposition Modeling: System Models and Control Strategies,\u0026rdquo; Jun. 01, 2022, \u003cem\u003eMDPI\u003c/em\u003e. doi: 10.3390/app12115400.\u003c/li\u003e\n\u003cli\u003eA. D. Tura, H. G. Lemu, and H. B. Mamo, \u0026ldquo;Experimental Investigation and Prediction of Mechanical Properties in a Fused Deposition Modeling Process,\u0026rdquo; \u003cem\u003eCrystals (Basel)\u003c/em\u003e, vol. 12, no. 6, Jun. 2022, doi: 10.3390/cryst12060844.\u003c/li\u003e\n\u003cli\u003eO. Ulkir, \u0026ldquo;Energy-Consumption-Based Life Cycle Assessment of Additive-Manufactured Product with Different Types of Materials,\u0026rdquo; \u003cem\u003ePolymers (Basel)\u003c/em\u003e, vol. 15, no. 6, Mar. 2023, doi: 10.3390/polym15061466.\u003c/li\u003e\n\u003cli\u003eB. Guelton, \u0026ldquo;\u0026lsquo;Mental maps\u0026rsquo;: Between memorial transcription and symbolic projection,\u0026rdquo; \u003cem\u003eFront Psychol\u003c/em\u003e, vol. 14, 2023, doi: 10.3389/fpsyg.2023.1142238.\u003c/li\u003e\n\u003cli\u003eR. M. dos Santos, \u0026ldquo;HIST\u0026Oacute;RIA DA PETECA - CBP,\u0026rdquo; https://cbpeteca.org.br/historia-da-peteca/.\u003c/li\u003e\n\u003cli\u003eA. Arora, A. Pathak, A. Juneja, P. Shakkarwal, and R. Kumar, \u0026ldquo;Design \u0026amp; analysis of progressive die using SOLIDWORKS,\u0026rdquo; in \u003cem\u003eMaterials Today: Proceedings\u003c/em\u003e, Elsevier Ltd, 2021, pp. 956\u0026ndash;960. doi: 10.1016/j.matpr.2021.06.335.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Telehealth, DFMA, 3D Modeling, Additive Manufacturing","lastPublishedDoi":"10.21203/rs.3.rs-4945009/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4945009/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis work aims to present a proposal for a telepresence robot designed for application in the Amazon region, where remote access areas are concentrated. To achieve this goal, an approach that integrates the steps of DFMA (Design for Manufacturing and Assembly) and 3D modeling combined with Additive Manufacturing (AM) is employed. Considering the key characteristics of the region, the objective is to offer a regional solution focused on mobility and interaction to facilitate use. In this study, the main difficulties faced by the population in the region in their daily lives regarding access to healthcare were highlighted. As a result, evidence was obtained of the use of outside methodologies combined with a reduction of approximately 78% in the quantity of project components and parts. Therefore, the importance of developing technologies aimed at addressing this need or driving studies for connectivity in the state of Amazonas is emphasized.\u003c/p\u003e","manuscriptTitle":"Telepresence Robot Design in the Amazon: An Application of Design for Manufacturing and Assembly (DFMA)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-27 08:20:15","doi":"10.21203/rs.3.rs-4945009/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-10T11:46:13+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-30T07:53:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"157498127619269789414927830876493545903","date":"2024-09-19T09:15:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-13T19:52:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"287979176325842022845431861346308161119","date":"2024-09-03T04:53:34+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-09-03T01:07:20+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-09-03T01:02:45+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-08-29T19:51:03+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-08-28T14:22:23+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-08-20T12:34:46+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4b2f9e7a-01bb-41a1-b511-34fb504b6fe8","owner":[],"postedDate":"September 27th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":38272995,"name":"Physical sciences/Engineering/Mechanical engineering"},{"id":38272996,"name":"Health sciences/Health care/Health services"}],"tags":[],"updatedAt":"2024-11-25T05:24:12+00:00","versionOfRecord":[],"versionCreatedAt":"2024-09-27 08:20:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4945009","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4945009","identity":"rs-4945009","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}