WO2017118861A1 - Training aid - Google Patents

Training aid Download PDF

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Publication number
WO2017118861A1
WO2017118861A1 PCT/GB2017/050027 GB2017050027W WO2017118861A1 WO 2017118861 A1 WO2017118861 A1 WO 2017118861A1 GB 2017050027 W GB2017050027 W GB 2017050027W WO 2017118861 A1 WO2017118861 A1 WO 2017118861A1
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WO
WIPO (PCT)
Prior art keywords
simulated
blood pressure
pressure
cuff
wearable body
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Application number
PCT/GB2017/050027
Other languages
French (fr)
Inventor
Kevin STIRLING
Paul Christie
Robert Smith
Graham Arnold
Original Assignee
University Of Dundee
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by University Of Dundee filed Critical University Of Dundee
Publication of WO2017118861A1 publication Critical patent/WO2017118861A1/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A61B5/021—Measuring pressure in heart or blood vessels
    • A61B5/022—Measuring pressure in heart or blood vessels by applying pressure to close blood vessels, e.g. against the skin; Ophthalmodynamometers
    • A61B5/02208—Measuring pressure in heart or blood vessels by applying pressure to close blood vessels, e.g. against the skin; Ophthalmodynamometers using the Korotkoff method

Abstract

The invention relates to a training aid for facilitating simulated blood pressure measurements on a simulated patient or manikin, the training aid comprising: a wearable body configured to be fitted to a limb of the simulated patient or manikin, the wearable body having: a blood pressure measurement portion around which an inflatable cuff can be provided when the wearable body is fitted to the said limb, the said blood pressure measurement portion having at least one sensor configured to measure a parameter indicative of a pressure exerted by a said inflatable cuff on the said limb; one or more devices for outputting an audible and/or human palpable signal; and a controller configured to receive measurements of the said parameter from the said at least one sensor and to cause a change to the output of one or more of the said one or more devices responsive to the said received measurements to thereby facilitate a simulated blood pressure measurement in accordance with a predetermined simulated blood pressure.

Description

TRAINING AID Field of the invention The invention relates to training aids for facilitating simulated blood pressure measurements on a simulated patient or manikin, systems comprising a sphygmomanometer and a said training aid and methods of facilitating simulated blood pressure measurements on a simulated patient or manikin. Background to the invention Blood pressure (which typically refers to the pressure exerted by circulating blood on arterial walls of a human or animal) is a principal vital sign of a subject and the accurate measurement of subjects' blood pressure is therefore an important clinical skill which healthcare (and indeed veterinarian) practitioners are required to learn. As blood pressure varies during the activity cycle (contraction and relaxation) of the heart, two different blood pressure values are defined: systolic and diastolic. Systolic blood pressure refers to the blood pressure when the heart contracts, and the diastolic blood pressure refers to the blood pressure when the heart relaxes. Systolic blood pressure is therefore typically greater than diastolic. Measurement of a human patient's blood pressure can be performed in a number of different ways. One of the most accurate methods is auscultation. This method involves wrapping an inflatable cuff of a sphygmomanometer around the upper arm of the patient, inflating the inflatable cuff with a pressure which occludes blood flow in the brachial artery, deflating the inflatable cuff and, while the cuff is deflating, listening for "Korotkoff sounds" using a stethoscope positioned at the antecubital fossa of the subject. There are four Korotkoff sounds: a first "snapping" sound when the pressure in the cuff equals the systolic blood pressure (being indicative of blood flow returning to the artery following occlusion); then a second murmuring sound as the cuff pressure decreases from the systolic pressure towards the diastolic pressure; a third relatively loud tapping sound; and a fourth "thumping" sound. A fifth Korotkoff "sound" is also commonly referred to, but in fact relates to silence following the fourth Korotkoff sound. When the first Korotkoff sound is heard, the healthcare practitioner notes the cuff pressure as an estimate for the systolic blood pressure of the patient, and when the fourth Korotkoff sound ends (or the fifth Korotkoff "sound" begins) the healthcare practitioner notes the cuff pressure as an estimate for the diastolic blood pressure of the patient. Another way to measure systolic blood pressure is to fit and inflate the cuff as above while monitoring the radial pulse of the patient. When the radial pulse can no longer be palpated (indicating that blood flow through the brachial artery is occluded by the cuff), the healthcare practitioner notes the cuff pressure as an estimate of the systolic pressure of the patient. Diastolic pressure cannot be measured in this way. Throughout typical training programs, trainee healthcare practitioners are required to perform blood pressure measurements during simulation activities. Such simulation activities typically involve measurements being made on simulated patients (i.e. live humans) who portray the symptoms of a particular illness for the practitioner to diagnose. However, as the simulated patients do not typically have the particular illness in question, there is typically a contradiction between the physiological measurements (including blood pressure and radial pulse) recorded by the practitioner and those which would have been expected of a patient with that illness. To overcome this issue, it is common practice to provide physiological data to the practitioner to override the measured values on which to base their diagnosis. However, the contradiction between the actual measurements made and the physiological data provided to the practitioner can cause them to question or adapt their diagnosis and management plan which can adversely affect training outcomes. US2014/0342332 provides a sphygmomanometer simulator which includes an adapted upper arm cuff for a simulated patient. However, this sphygmomanometer simulator requires a special cuff to be used to perform simulated blood pressure measurements and does not facilitate simulated blood pressure measurements using standard sphygmomanometers. Accordingly, trainee healthcare practitioners cannot use the apparatus of US2014/0342332 to learn how to use the actual equipment they will ultimately use in clinical practice. Accordingly, ways of improving the training environment for trainee healthcare practitioners to learn blood pressure measurement skills are required. Summary of the invention A first aspect of the invention provides a training aid for facilitating simulated blood pressure measurements on a simulated (typically human) patient or manikin, the training aid comprising: a wearable body configured to be fitted to a limb of the simulated patient or manikin, the wearable body having: a blood pressure measurement portion around which an inflatable cuff (of a sphygmomanometer) can be provided when the wearable body is fitted to the said limb, the said blood pressure measurement portion having at least one (e.g. force) sensor configured to (typically directly) measure a parameter indicative of a pressure exerted by a said inflatable cuff on the said limb (e.g. at least one sensor configured to measure a force or pressure exerted by a said inflatable cuff on the said limb), typically when the inflatable cuff is provided around the wearable body fitted to the said limb; one or more devices for outputting an audible (e.g. by way of a stethoscope) and/or human palpable signal; and a controller configured to receive measurements of the said parameter from the said at least one sensor and to cause a change to the output of one or more of the said one or more devices responsive to the said received measurements to thereby facilitate a simulated blood pressure measurement in accordance with a predetermined simulated blood pressure. Typically the controller is configured to cause a change to the said output of the said one or more of the said one or more devices responsive to the said received measurements of the said parameter indicating that the pressure exerted by the said cuff on the said limb is in accordance with the predetermined simulated blood pressure (e.g. the received measurements of the said parameter indicating that the pressure exerted by the said cuff on the said limb is equal or substantially equal to a simulated blood pressure value of the said predetermined simulated blood pressure). Typically one or more of the at least one sensor is a force sensor, such as a force sensing transducer. Typically the said one or more of the at least one sensor is a force sensor, such as a force sensing transducer, configured to convert a force exerted thereon to an electrical signal (typically an electrical signal indicative of the pressure exerted on the said limb by the said cuff in use). For example, the said one or more of the at least one sensor may comprise a piezoelectric transducer or a strain gauge. It may be that the said at least one sensor comprises a plurality of (e.g. force) sensors (e.g. piezoelectric transducer or strain gauge) spaced from each other. It may be that the controller is configured to receive measurements of the said parameter indicative of a pressure exerted by said inflatable cuff on the said limb from the said plurality of (e.g. force) sensors (e.g. measured by the said sensors simultaneously) and to select the measurement of the said parameter which, of the said measurements, is indicative of the greatest pressure exerted by the cuff. It may be that the controller is configured to cause a change to the said output of one or more of the said one or more devices responsive to the said selected measurement to thereby facilitate a simulated blood pressure measurement in accordance with a predetermined simulated blood pressure. Typically the said at least one sensor comprises a pressure receiving surface which is moveable responsive to pressure exerted by a said inflatable cuff on the said pressure receiving surface (in use), the said at least one sensor being configured to measure the said parameter indicative of a pressure exerted by said inflatable cuff on the said limb in dependence on movement of the said pressure receiving surface. For example, the at least one sensor may comprise a force sensor (e.g. piezoelectric transducer or strain gauge) comprising the said pressure receiving surface. It may be that the pressure receiving surface is a pressure receiving surface of a piezoelectric transducer or strain gauge. In the former case, the pressure receiving surface may be configured to move by way of compression of the piezoelectric transducer caused by pressure exerted by said inflatable cuff on the said pressure receiving surface. In the latter case, the pressure receiving surface may be configured to move by way of deformation of a portion (e.g. a conductor or optical fibre) of the strain gauge caused by pressure exerted by said inflatable cuff on the said pressure receiving surface. In another example, the said pressure receiving surface is a surface of a deformable bladder, the said pressure receiving surface being moveable by deformation of the deformable bladder caused by pressure exerted by said inflatable cuff on the said pressure receiving surface. Typically the said pressure receiving surface is configured such that (in use) movement of the pressure receiving surface responsive to pressure exerted thereon by the said inflatable cuff causes a signal to be generated which is indicative of the pressure exerted by the said inflatable cuff on the said limb. It may be that the said signal is an electrical signal (e.g. electrical charge generated by deformation of a piezoelectric transducer comprising the said pressure receiving surface). It may be that the said signal is a fluid (e.g. liquid) pressure signal (e.g. an increased fluid pressure generated by deformation of a deformable bladder comprising the said pressure receiving surface). It may be that the said at least one sensor is configured to measure the said parameter indicative of a pressure exerted by said inflatable cuff on the said limb by way of the said signal. Typically the blood pressure measurement portion of the wearable body has an external surface around which the said inflatable cuff can be provided when the wearable body is fitted to the limb. Typically the said at least one sensor is provided on, or in (typically mechanical) communication with, the said external surface of the blood pressure measurement portion, typically so that the measurements of the said parameter made by the said sensor(s) are indicative of a pressure exerted by the said inflatable cuff on the said limb when the inflatable cuff is provided around the wearable body fitted to the said limb. It will be understood that, in use, the measurements of the said parameter received by the said controller from the said at least one sensor are indicative of a cuff pressure (i.e. a pressure of a fluid within an inflatable chamber) of the inflatable cuff provided around the said blood pressure measurement portion of the wearable body. By providing the said at least one sensor configured to measure a parameter indicative of the pressure exerted by a said inflatable cuff on the said limb, simulated blood pressure measurements can be made using a standard sphygmomanometer having a standard inflatable cuff by providing the standard inflatable cuff around the blood pressure measurement portion of the wearable body and monitoring the cuff pressure and the output of the one or more of the one or more devices. Thus, the training aid allows practitioners to perform simulated blood pressure measurements using the sphygmomanometer which they will ultimately use in clinical practice. This provides a more realistic training environment for practitioners, thereby improving the quality of the training provided and also skill retention by the practitioner. It may be that the controller is configured to process the said measurements of the said parameter received from the at least one sensor taking into account one or more calibration factors to provide calibrated measurements of the said parameter. Typically the wearable body comprises elastic material. Typically the wearable body comprises a sleeve for receiving the said limb. Typically the said one or more devices are fixedly coupled to the sleeve. Typically the said one or more devices comprise one or more loudspeakers configured to output an audible and/or human palpable signal. In some embodiments, the said one or more devices comprise one or more haptic devices or pressurised fluid containing bladders configured to output an audible and/or a human palpable signal. It may be that the said one or more devices for outputting an audible and/or human palpable signal comprises a device (e.g. loudspeaker or deformable bladder) configured or configurable to output (e.g. palpable) pressure pulses. It may be that the controller is configured to control the pressure pulses output by the said device responsive to the said received measurements to thereby facilitate a simulated blood pressure measurement in accordance with the said predetermined simulated blood pressure. It may be that the controller is configured to receive a selection of a pressure pulse set from a plurality of different candidate predetermined pressure pulse sets and to cause the said device to output pressure pulses in accordance with the selected pressure pulse set. It may be that each of the plurality of candidate predetermined pressure pulse sets is associated with a respective medical condition. Alternatively, the controller may be configured to determine the (e.g. amplitude and/or regularity of the) said pressure pulses (and cause the said device to output the said determined pressure pulses) in dependence on the predetermined simulated blood pressure and/or in dependence on a selected simulated heart rate and/or in dependence on the said measured parameter. It may be that the said device comprises a deformable (e.g. pressurised fluid containing) bladder in fluid communication with a fluid (e.g. liquid) reservoir (e.g. by way of a tube), the bladder being configured or configurable to receive (e.g. pressurised) fluid (e.g. liquid) from and/or to output (e.g. pressurised) fluid to the said fluid reservoir (typically to thereby output the said audible and/or human palpable signal, typically by way of pressure pulses). Thus, it may be that the training aid comprises a fluid reservoir. The training aid may further comprise one or more (e.g. electronically controlled) valves configured to control fluid flow between the said bladder and the said reservoir. It may be that the fluid pressure of the said reservoir is adjustable (e.g. relative to the fluid pressure of the said deformable bladder) to thereby output pressurised fluid to or receive pressurised fluid from the said deformable bladder to thereby output said pressure pulses by way of the deformable bladder (e.g. the fluid pressure of the said reservoir may be adjustable by way of a fluid pump (e.g. a pump comprising a piston cylinder device in fluid communication with the reservoir, the piston being moveable within the cylinder to increase or decrease the fluid pressure of the reservoir)). It may be that the controller is configured or configurable to control the said pump and/or the said one or more (e.g. electronically controlled) valves to thereby cause the said deformable bladder to output pressure pulses which facilitate the said (e.g. oscillometric method) simulated blood pressure measurement responsive to said received measurements in accordance with the said predetermined simulated blood pressure. In this case, the controller is typically configured to control the said pump and/or the said one or more valves to thereby cause the said deformable bladder to output pressure pulses which cause (in use) corresponding fluctuations in a fluid pressure of said inflatable cuff provided around the said blood pressure measurement portion to thereby facilitate simulated oscillometric method blood pressure measurements. Typically the controller is configured to control amplitudes of said pressure pulses in dependence on the said received measurements (e.g. as the cuff is deflated after having been inflated with a fluid pressure above a simulated systolic blood pressure (or first predetermined blood pressure value - see below), and the said received measurements vary to indicate a decreasing cuff pressure, the controller is configured to increase the amplitudes of the pressure pulses to a maximum before the decreasing the said amplitudes with further reduction in cuff pressure to facilitate a simulated oscillometry method blood pressure measurement). Typically the controller is configured to receive a selection of a predetermined simulated heart rate. Typically the controller is configured to provide said pressure pulses (e.g. with a regularity) in accordance with the said selected predetermined simulated heart rate. It may be that the said blood pressure measurement portion of the wearable body comprises the said device (e.g. the deformable bladder or loudspeaker) configured or configurable to output pressure pulses. It may be that one or more of the said at least one sensor and one or more of the said one or more devices share one or more features in common. For example, it may be that one or more of the said at least one sensor and one or more of the said one or more devices share a or the deformable bladder in common. Thus, it may be that the said blood pressure measurement portion of the wearable body comprises a deformable bladder configured or configurable to receive (e.g. pressurised) fluid (e.g. liquid) from and/or to output (e.g. pressurised) fluid to a fluid reservoir (e.g. a said fluid reservoir) to thereby output a said audible and/or human palpable signal (typically by way of pressure pulses), the deformable bladder comprising a pressure receiving surface which is moveable responsive to pressure exerted by said inflatable cuff on the said pressure receiving surface, the said at least one sensor being configured to measure the said parameter indicative of a pressure exerted by said inflatable cuff on the said limb in dependence on movement of the said pressure receiving surface of the said bladder. Typically the wearable body portion comprises one or more or all of the said one or more devices. Typically one or more said devices are offset from the said blood pressure measurement portion of the wearable body. Typically the wearable body is configured to be fitted to an arm of the simulated patient or manikin. Alternatively, it may be that the wearable body is configured to be fitted to a leg of the simulated patient or manikin. In the latter case, it may be that the training aid (e.g. the wearable body) further comprises a modesty shield (such as a modesty panel) configured to shield the crotch of the simulated patient from the view of the medical practitioner in use. This helps to improve the comfort of both practitioner and simulated patient during the session. It may be that the training aid is configured to simulate oscillometric method and/or auscultation method blood pressure measurements on the simulated patient or manikin. Typically the said one or more devices for outputting an audible and/or human palpable signal comprise a first device for outputting at least an audible signal (e.g. a first loudspeaker), and the controller is configured to cause a change to the output of the said first device to thereby facilitate a simulated blood pressure measurement by causing the said first device to emit simulated Korotkoff sounds responsive to the said measurements of the said parameter in accordance with a predetermined simulated blood pressure. This allows the practitioner to measure simulated systolic and diastolic blood pressures of the simulated patient or manikin. Typically the predetermined simulated blood pressure comprises a first (maximum or systolic) predetermined simulated blood pressure value and a second (minimum or diastolic) predetermined simulated blood pressure value and the controller is configured to cause the said first device to begin emitting simulated Korotkoff sounds responsive to the received (typically calibrated) measurements of the said parameter indicating that a fluid pressure of a said cuff provided over the blood pressure measurement portion is equal to or less than the said first predetermined simulated blood pressure value and greater than the said second predetermined simulated blood pressure value, and to cause the said first device to stop emitting (or to not emit) simulated Korotkoff sounds (and to typically emit substantially no sound) responsive to the received (typically calibrated) measurements of the said parameter indicating that the fluid pressure of the said cuff provided over the blood pressure measurement portion is less than or equal to the second (minimum) predetermined simulated blood pressure value. It may be that the controller is configured to cause the said first device to begin emitting simulated Korotkoff sounds responsive to the received (typically calibrated) measurements of the said parameter indicating that a fluid pressure of a said cuff provided over the blood pressure measurement portion is greater than the said first predetermined simulated blood pressure value and then subsequently equal to or less than the said first predetermined simulated blood pressure value. Typically the first predetermined simulated blood pressure value is greater than the second predetermined simulated blood pressure value. Typically the controller is configured to cause the first device to emit simulated Korotkoff sounds responsive to the (typically calibrated) measurements of the said parameter indicating that the cuff pressure is between the first and second predetermined simulated blood pressure values. Typically, the controller is configured to cause the first device to sequentially emit simulated first, second, third and fourth Korotkoff sounds responsive to the said received (typically calibrated) measurements of the said parameter indicating a reduction in cuff pressure between the said first and second predetermined simulated blood pressure values. It will be understood that the simulated Korotkoff sounds may be synthetically generated Korotkoff sounds, or they may comprise recordings of real Korotkoff sounds emitted by a real patient. Typically the simulated Korotkoff sounds emitted by the said first device are audible by a human through a stethoscope. Typically the wearable body comprises the said first device, the wearable body being configured such that the said first device is provided over an antecubital fossa or a popliteal fossa of the simulated patient, or over a simulated antecubital fossa or simulated popliteal fossa of the manikin, when the wearable body is fitted to the simulated patient or manikin. Typically the first device is a first device for outputting audible signals and for outputting human palpable signals. It may be that the controller is configured to cause the said first device (or to cause an additional device of the training aid provided adjacent to the first device) to output a human palpable signal which simulates a brachial or popliteal pulse of the simulated patient or manikin responsive to the received (typically calibrated) measurements of the said parameter indicating that the cuff pressure is less than or equal to the second (minimum) simulated blood pressure value, typically in accordance with a selected heart rate (for example a selection of a heart rate from a plurality of different candidate heart rates or a selection of a medical condition with which the said heart rate is associated). Typically the said device (e.g. first loudspeaker) is configured to output the said human palpable signal which simulates the said brachial or popliteal pulse by way of mechanical movement, said mechanical movement being palpable (i.e. by a trainee healthcare practitioner when the wearable body is fitted to the arm or leg of the simulated patient or manikin in use). Typically the controller is configured to receive a selection of a Korotkoff sound set (typically from a plurality of different candidate Korotkoff sound sets) and to cause the first device to emit simulated Korotkoff sounds in accordance with the selected Korotkoff sound set. Typically different Korotkoff sound sets are associated with different medical conditions. Accordingly, by permitting a selection of a Korotkoff sound set to be made (typically from a plurality of different candidate Korotkoff sounds sets), different medical conditions can be readily simulated in simulation activities. Alternatively it may be that the said first device is a or the said device (e.g. loudspeaker or a or the said deformable bladder) configured or configurable to output (e.g. palpable and/or audible) pressure pulses which facilitate simulated oscillometric blood pressure measurements. In this case, the wearable body (typically the blood pressure measurement portion of the wearable body) typically comprises the said first device, the wearable body being configured such that the said first device is provided over an upper arm or thigh of the simulated patient, or over a simulated upper arm or thigh of the manikin, when the wearable body is fitted to the simulated patient or manikin. Additionally or alternatively, the training aid may be configured to simulate systolic blood pressure measurements by way of a simulated radial, femoral, posterior tibial or dorsalis pedis pulse of the simulated patient or manikin. Typically the said one or more devices for outputting an audible and/or human palpable signal comprise a second device for outputting a human palpable signal, and the controller is configured to cause the said second device to output a human palpable signal which simulates a radial, femoral, posterior tibial or dorsalis pedis pulse of the simulated patient or manikin. Typically the said second device comprises a (e.g. second) loudspeaker. Typically the second device (e.g. second loudspeaker) is configured to output a human palpable signal which simulates the said radial, femoral, posterior tibial or dorsalis pedis pulse of the simulated patient or manikin by way of mechanical movement, said mechanical movement being palpable. Typically the wearable body comprises the said second device, the wearable body being configured such that the said second device is provided over an underside of a wrist of the simulated patient or manikin when the wearable body is fitted to an or the arm of the simulated patient or manikin to thereby simulate a radial pulse of the simulated patient or manikin. Alternatively, the wearable body is configured such that the said second device is provided over an inner thigh of the simulated patient or manikin when the wearable body is fitted to a or the leg of the simulated patient or manikin to thereby simulate a femoral pulse of the simulated patient or manikin. Alternatively, the wearable body is configured such that the said second device is provided over a Pimenta's point (i.e. an inside of an ankle) of the simulated patient or manikin when the wearable body is fitted to a or the leg of the simulated patient or manikin to thereby simulate a posterior tibial pulse of the simulated patient or manikin. Alternatively, the wearable body is configured such that the said second device is provided over an upper surface of a foot of the simulated patient or manikin when the wearable body is fitted to a or the leg of the simulated patient or manikin to thereby simulate a dorsalis pedis pulse of the simulated patient or manikin. It may be that the simulated blood pressure value comprises a single predetermined (typically simulated systolic) blood pressure value and the controller is configured to cause a change to the output of the said second device to thereby facilitate a simulated blood pressure measurement by causing the said second device to cease outputting a human palpable signal responsive to the (typically calibrated) received measurements of the said parameter indicating that a fluid pressure of a said cuff provided over the blood pressure measurement portion is equal to or greater than the said predetermined simulated blood pressure value. It will be understood that the controller is typically configured to cause the said second device to output a human palpable signal which simulates the said radial, femoral, posterior tibial or dorsalis pedis pulse of the simulated patient or manikin responsive to the received measurements of the said parameter indicating that the fluid pressure of a said cuff provided over the blood pressure measurement portion is less than the said predetermined simulated blood pressure value, or that no cuff is fitted around the blood pressure measurement portion of the body, to thereby simulate the said radial, femoral, posterior tibial or dorsalis pedis pulse of the simulated patient or manikin. Typically the controller is configured to receive a selection of a predetermined simulated heart rate and to cause the said second device to output a human palpable signal which simulates the radial, femoral, posterior tibial or dorsalis pedis pulse of the simulated patient or manikin which is dependent on the selected predetermined simulated heart rate. Typically the controller is configured to receive a selection of a predetermined simulated heart rate and to cause the first device to emit simulated Korotkoff sounds which are dependent on the selected predetermined heart rate. Typically the controller is configured to cause the first device to emit simulated Korotkoff sounds having amplitudes dependent on the predetermined simulated blood pressure (e.g. the greater the simulated blood pressure, the greater the amplitudes of the said Korotkoff sounds). Typically the controller is configured to receive a selection of the said predetermined simulated heart rate from a plurality of different candidate predetermined simulated heart rates. It may be that each of the said candidate predetermined simulated heart rates is associated with a respective medical condition. Typically the controller is configured to cause the said second device to output a human palpable signal which simulates the radial, femoral, posterior tibial or dorsalis pedis pulse of the simulated patient or manikin, the amplitude of the said human palpable signal being dependent on the predetermined simulated blood pressure (e.g. the greater the simulated blood pressure, the greater the amplitude of the said signal). Typically the controller is configured to cause the second device to output a human palpable signal which simulates the radial, femoral, posterior tibial or dorsalis pedis pulse of the simulated patient or manikin, the amplitude of the said human palpable signal being dependent on the said measured parameter (e.g. a measured parameter being indicative of a greater pressure on the said blood pressure measurement portion may cause a lower amplitude signal to be output by the said second device to simulate a weaker pulse). Typically the controller is configured to cause the said first device (or said additional device) to output a human palpable signal which simulates a brachial or popliteal pulse of the simulated patient or manikin responsive to the received (typically calibrated) measurements of the said parameter indicating that the cuff pressure is less than or equal to the second (minimum) simulated blood pressure value. It may be that an amplitude of the said signal (e.g. sounds) is dependent on the predetermined simulated blood pressure (e.g. the greater the simulated blood pressure, the greater the amplitude of the said sounds). It may be that the said one or more devices for outputting an audible and/or human palpable signal (or the training aid) comprise(s) a third device (e.g. loudspeaker or deformable bladder) configured or configurable to output pressure pulses responsive to said received measurements for facilitating simulated oscillometric method blood pressure measurements in accordance with the said predetermined simulated blood pressure. The wearable body (typically the blood pressure measurement portion of the wearable body) typically comprises the said third device, the wearable body being configured such that the said third device is provided over an upper arm or thigh of the simulated patient, or over a simulated upper arm or thigh of the manikin, when the wearable body is fitted to the simulated patient or manikin. Typically the controller is configured to receive a selection of the said predetermined simulated blood pressure from a plurality of different candidate predetermined simulated blood pressures. It may be that each of the plurality of predetermined simulated blood pressures is associated with a respective medical condition. It may be that each of the said plurality of different candidate Korotkoff sound sets is associated with a respective medical condition. It may be that a respective one of the plurality of different candidate predetermined simulated blood pressures and/or a respective one of the candidate predetermined simulated heart rates and/or a respective one of the candidate Korotkoff sounds sets and/or a respective one of the candidate pressure pulse sets are associated with a respective medical condition. It may be that the controller is configured to receive a selection of the predetermined simulated blood pressure and/or a or the predetermined simulated heart rate and/or a Korotkoff sound set and/or a pressure pulse set by receiving a selection of a respective medical condition from a plurality of different candidate medical conditions, the said respective medical condition being associated with the said predetermined simulated heart rate and/or the predetermined simulated blood pressure and/or the Korotkoff sound set and/or the pressure pulse set. Typically the controller is configured to cause the first device to emit sounds in accordance with the selected Korotkoff sound set responsive to the said (typically calibrated) measurements of the said parameter received from the sensor in accordance with the said selected blood pressure. Typically the controller is configured to cause the said second device to output a human palpable signal which simulates a or the radial, femoral, posterior tibial or dorsalis pedis pulse of the simulated patient or manikin in accordance with the selected predetermined simulated heart rate responsive to the said (typically calibrated) measurements of the said parameter received from the sensor in accordance with the said selected blood pressure. Typically the controller is configured to cause the first device (or said additional device) to output a human palpable signal which simulates a or the brachial or popliteal pulse of the simulated patient or manikin in accordance with the selected predetermined simulated heart rate responsive to the said (typically calibrated) measurements of the said parameter received from the sensor in accordance with the said selected simulated blood pressure. Typically one or more of the one or more devices (e.g. the first and/or second and/or third devices) comprises a device body, the device body being configured to damp real arterial (e.g. Korotkoff or radial pulse) sounds emitted by and/or movements of a (e.g. a radial or brachial artery of a) simulated patient (e.g. movements of an artery of the simulated patient) in use. Typically the training aid comprises one or more dampers configured to damp real arterial (e.g. Korotkoff, brachial or radial pulse) sounds emitted by and/or movements of a (e.g. a radial or brachial artery of a) simulated patient (e.g. movements of an artery of the simulated patient) in use. Typically the one or more dampers are configured to be provided between at least one of the one or more devices and the simulated patient or manikin in use. Typically the wearable body comprises the one or more dampers. Typically the wearable body is configured such that the one or more dampers are provided over: the antecubital fossa or popliteal fossa; the upper arm or thigh; and/or the underside of the wrist or the inner thigh or the upper surface of the foot or the Pimenta's point of a simulated patient in use. Typically the one or more dampers are distinct from the one or more devices. It may be that the one or more dampers comprise a plastic sheet. It may be that one or more or each of the at least one sensor and/or one or more or each of the device(s) are in communication with a first portion of the controller by way of a wired connection. It may be that the said first portion of the controller is in wireless communication with a second portion of the controller by way of a wireless communications module in wired communication with the first portion of the controller. The first portion of the controller may be provided in a housing which is couplable to a belt of the simulated patient or manikin. It may be that the housing comprises the pump and/or the valves and/or the reservoir (where provided). The wireless communications module may be in wired communication with the said one or more or each sensor and/or the said one or more or each said device(s). Typically the first portion of the controller comprises circuitry configured to receive the measurements of the said parameter from the sensor (and optionally to process the said received measurements of the said parameter in accordance with said calibration factor(s)) and to control the output(s) of the device(s) responsively in order to facilitate simulated blood pressure measurements. Typically the second portion of the controller is configured to receive selection of predetermined simulated blood pressures and/or predetermined simulated heart rates and/or predetermined Korotkoff sound sets and/or pressure pulse sets and to communicate (typically wirelessly) the selections to the first portion of the controller. Typically at least part (e.g. the second portion) of the controller is provided by a portable electronic communications device such as a smartphone, tablet, personal digital assistant, laptop, netbook, wearable electronic device or the like. Typically the sphygmomanometer further comprises a fluid pump for providing pressurised fluid to an inflatable chamber of the inflatable cuff to thereby inflate the inflatable cuff and a pressure gauge (typically having a visible output of the pressure measurement of the pressure gauge) configured to measure the fluid pressure in the said inflatable cuff. The inflatable cuff is also typically deflatable. It may be that the sphygmomanometer further comprises a valve for selectably releasing fluid from the inflatable cuff to thereby deflate the inflatable cuff. Alternatively, the fluid pump may be reversible so that it can be selectively configured to pump fluid out of the inflatable chamber to thereby deflate the inflatable cuff. It will be understood that the first and second (and/or first and third and/or second and third and/or first and second and third) devices may be provided in combination, or (e.g. individually) independently of each other. A second aspect of the invention provides a method of facilitating simulated blood pressure measurements on a simulated (typically human) patient or manikin, the method comprising:
fitting a wearable body of a training aid to a limb of the simulated patient or manikin, the wearable body having: a blood pressure measurement portion comprising at least one (e.g. force) sensor;
fitting one or more devices for outputting an audible and/or human palpable signal to the said limb;
providing an inflatable cuff of a sphygmomanometer around the blood pressure measurement portion of the wearable body;
inflating the inflatable cuff by providing pressurised fluid (e.g. air) to an inflatable chamber of the inflatable cuff;
the at least one sensor measuring a parameter indicative of a pressure exerted by the pressurised cuff on the limb (e.g. the at least one sensor measuring a force or pressure exerted by the said pressurised cuff on the said limb); and
causing a change to the output of one or more of the one or more devices responsive to the said measurements of the said parameter to thereby facilitate a simulated blood pressure measurement in accordance with a predetermined simulated blood pressure. Typically the method comprises causing a change to the said output of the said one or more of the said one or more devices responsive to the said received measurements of the said parameter indicating that the pressure exerted by the said cuff on the said limb is in accordance with the predetermined simulated blood pressure (e.g. the received measurements of the said parameter indicating that the pressure exerted by the said cuff on the said limb is equal or substantially equal to a simulated blood pressure value of the said predetermined simulated blood pressure). It may be that the said at least one sensor comprises a plurality of (e.g. force) sensors (e.g. piezoelectric transducer or strain gauge) spaced from each other. It may be that the method comprises receiving measurements of the said parameter indicative of a pressure exerted by said inflatable cuff on the said limb from the said plurality of (e.g. force) sensors (e.g. measured by the said sensors simultaneously) and selecting the measurement of the said parameter which, of the said measurements, is indicative of the greatest pressure exerted by the cuff. It may be that the method comprises causing a change to the said output of one or more of the said one or more devices responsive to the said selected measurement to thereby facilitate a simulated blood pressure measurement in accordance with a predetermined simulated blood pressure. Typically the said at least one sensor comprises a pressure receiving surface which is moveable responsive to pressure exerted by a said inflatable cuff on the said pressure receiving surface (in use). In this case, the step of the at least one sensor measuring a parameter indicative of a pressure exerted by said inflatable cuff on the said limb typically comprises the at least one sensor measuring a parameter indicative of a pressure exerted by said inflatable cuff on the said limb in dependence on movement of the said pressure receiving surface caused by pressure exerted by said inflatable cuff on the said pressure receiving surface. Typically the method comprises movement of the pressure receiving surface responsive to pressure exerted thereon by the said inflatable cuff causing a signal to be generated which is indicative of the pressure exerted by the said inflatable cuff on the said limb. It may be that the method comprises the at least one sensor measuring said parameter by way of said signal. Typically one or more of the at least one sensor is a force sensor, such as a force sensing transducer. Typically the said one or more of the at least one sensor is a force sensor, such as a force sensing transducer, configured to convert a force exerted thereon (e.g. on a pressure receiving surface thereof) to an electrical signal (typically an electrical signal indicative of the pressure exerted on the said limb by the said cuff in use). For example, the said one or more of the at least one sensor may comprise a piezoelectric transducer or a strain gauge. Accordingly, it may be that the method comprises the at least one sensor measuring a parameter indicative of a pressure exerted by the pressurised cuff on the limb by converting a force exerted thereon to an electrical signal indicative of the said pressure exerted on the said limb. It may be that the at least one sensor comprises a deformable bladder having a or the pressure receiving surface, the step of the at least one sensor measuring a parameter indicative of a pressure exerted by said inflatable cuff on the said limb comprising pressure exerted by said inflatable cuff on the said pressure receiving surface deforming the deformable bladder, thereby causing movement of the said pressure receiving surface, and the said sensor measuring a parameter indicative of a pressure exerted by said inflatable cuff on the said limb in dependence on said movement of the said pressure receiving surface. Typically the blood pressure measurement portion of the wearable body has an external surface. Typically the step of providing the inflatable cuff around the blood pressure measurement portion comprises providing the inflatable cuff around the external surface of the blood pressure measurement portion. Typically the said at least one sensor is provided on, or in (typically mechanical) communication with, the said external surface of the blood pressure measurement portion, typically so that the measurements of the said parameter made by the said sensor(s) are indicative of a pressure exerted by the said inflatable cuff on the said limb when the inflatable cuff is provided around the wearable body fitted to the said limb. Typically the sphygmomanometer comprises a pressure gauge (typically having a visible output of pressure measurements by the pressure gauge) configured to measure the cuff pressure. Typically the method further comprises making a simulated blood pressure measurement by monitoring audible and/or human palpable signals output by the said one or more devices and the pressure measured by the pressure gauge to thereby measure the simulated blood pressure. It may be that the method is a method of facilitating simulated auscultation method blood pressure measurements on a simulated patient or manikin. It may be that the method is a method of facilitating simulated oscillometric method blood pressure measurements on a simulated patient or manikin. The predetermined simulated blood pressure typically comprises a first (maximum or systolic) predetermined simulated blood pressure value and a second (minimum or diastolic) predetermined simulated blood pressure value. Typically, the step of inflating the inflatable cuff comprises increasing the cuff pressure above the first predetermined simulated blood pressure value and subsequently deflating the inflatable cuff (e.g. to below the second predetermined simulated blood pressure value). Typically the said devices comprise a first device (e.g. first loudspeaker) for outputting an audible signal. The method typically further comprises causing a change to the output of one or more of the one or more devices to thereby facilitate a simulated blood pressure measurement by causing the said first device to start emitting simulated Korotkoff sounds responsive to the said measurements of the said parameter by the said at least one sensor indicating that the fluid pressure of an inflatable chamber of the inflatable cuff is equal to or less than the first predetermined simulated blood pressure value and greater than the second predetermined simulated blood pressure value, and causing the said first device to subsequently cease to emit simulated Korotkoff sounds responsive to the said measurements of the said parameter by the said at least one sensor indicating that the fluid pressure of the inflatable chamber of the inflatable cuff is equal to or less than the second predetermined simulated blood pressure value. Typically the step of inflating the cuff comprises inflating the cuff such that the fluid pressure in the inflatable chamber of the cuff exceeds the first predetermined simulated blood pressure value. Typically the method comprises causing the first device to start emitting simulated Korotkoff sounds responsive to the said measurements of the said parameter by the said at least one sensor indicating that the fluid pressure of an inflatable chamber of the inflatable cuff is greater than the first predetermined simulated blood pressure value and then subsequently equal to or less than the first predetermined simulated blood pressure value. It may be that the said devices comprise a first device (a loudspeaker or a deformable bladder) configured or configurable to output (e.g. palpable and/or audible) pressure pulses for facilitating simulated oscillometric blood pressure measurements. In this case, the method typically comprises providing the said first device over an upper arm or thigh of the simulated patient, or over a simulated upper arm or thigh of the manikin, by fitting the wearable body to the simulated patient or manikin (the said wearable body typically comprising the said device). It may be that the method comprises causing a change to the output of one or more of the one or more devices to thereby facilitate a simulated blood pressure measurement by: inflating the cuff such that the fluid pressure in the inflatable chamber of the cuff exceeds the first predetermined simulated blood pressure value; deflating the cuff; and a said device outputting pressure pulses responsive to the said measured parameter at least until the cuff pressure is less than the second predetermined simulated blood pressure value. It may be that the method comprises increasing the amplitudes of said pressure pulses responsive to the said measured parameter as the cuff deflates and subsequently decreasing the amplitudes of said pressure pulses as the cuff continues to deflate to thereby facilitate a simulated oscillometry method blood pressure measurement. Typically the wearable body comprises the said one or more or all of the said one or more devices. Typically the wearable body (e.g. blood pressure measurement portion) comprises at least the said first device. Typically the step of fitting the wearable body of the training aid to a said limb of the simulated patient or manikin comprises fitting the said wearable body to an arm of the said simulated patient or manikin such that the first device is provided over an antecubital fossa or popliteal fossa or upper arm or thigh of the simulated patient, or over a simulated antecubital fossa or simulated popliteal fossa or simulated upper arm or thigh of the manikin. It may be that the method is a method of facilitating simulated blood pressure measurements by way of a simulated radial, femoral, posterior tibial or dorsalis pedis pulse of the simulated patient or manikin. In this case, the predetermined simulated blood pressure typically comprises a single predetermined simulated blood pressure value. Typically the one or more devices comprises a second device for outputting a human palpable signal. Typically the method comprises causing the said second device to output a human palpable signal which simulates a radial, femoral, posterior tibial or dorsalis pedis pulse of the said simulated patient or manikin. Typically the step of inflating the inflatable cuff comprises increasing the cuff pressure to a value equal to or above the said predetermined simulated blood pressure value. Typically the step of causing a change to the output of one or more of the one or more devices to thereby facilitate a simulated blood pressure measurement comprises causing the said second device to cease outputting a human palpable signal which simulates the radial, femoral, posterior tibial or dorsalis pedis pulse of the simulated patient or manikin (and typically to provide no human palpable signal) responsive to the said measurements of the said parameter received from the said sensor(s) indicating that the said cuff pressure is equal to or greater than the said predetermined simulated blood pressure value. Typically the wearable body comprises at least the said second device. Typically the step of fitting the wearable body of the training aid to a said limb of the simulated patient or manikin comprises fitting the said wearable body to an arm of the said simulated patient or manikin such that the said second device is provided over an underside of the wrist of the simulated patient, or over an underside of a simulated wrist of the manikin. Alternatively, the step of fitting the wearable body of the training aid to a said limb of the simulated patient or manikin comprises fitting the said wearable body to a leg of the said simulated patient or manikin such that the said second device is provided over an inner thigh of the simulated patient, or over a simulated inner thigh of the manikin. Alternatively, the step of fitting the wearable body of the training aid to a said limb of the simulated patient or manikin comprises fitting the said wearable body to a leg of the said simulated patient or manikin such that the said second device is provided over an upper surface of a foot of the simulated patient, or over an upper surface of a foot of the manikin. Alternatively, the step of fitting the wearable body of the training aid to a said limb of the simulated patient or manikin comprises fitting the said wearable body to a leg of the said simulated patient or manikin such that the said second device is provided over a Pimenta's Point of the simulated patient, or over a simulated Pimenta's point of the manikin. Typically the said second device comprises a (e.g. second) loudspeaker. Typically the method further comprises damping real arterial sounds emitted by and/or movements of a simulated patient to thereby inhibit (e.g. audible or palpable) interference between said real sounds and/or movements and the simulated sounds emitted by and/or movements of the said one or more devices. It may be that the one or more devices (e.g. blood pressure measurement portion of the wearable body) (or the training aid) comprise(s) a third device (e.g. loudspeaker or deformable bladder) configured or configurable to output pressure pulses responsive to said received measurements for facilitating simulated oscillometric method blood pressure measurements in accordance with the said predetermined simulated blood pressure. In this case, the wearable body (typically the blood pressure measurement portion of the wearable body) typically comprises the said third device, the wearable body being configured such that the said third device is provided over an upper arm or thigh of the simulated patient, or over a simulated upper arm or thigh of the manikin, when the wearable body is fitted to the simulated patient or manikin. A third aspect of the invention provides a system for facilitating simulated blood pressure measurements on a simulated (typically human) patient or manikin, the system comprising: a sphygmomanometer comprising: an inflatable cuff having an inflatable chamber; a fluid (e.g. air) pump for providing pressurised fluid (e.g. air) to the inflatable chamber to thereby inflate the inflatable cuff; and a pressure gauge configured to measure fluid (e.g. air) pressure in the said inflatable chamber of the said inflatable cuff; and a training aid comprising: a wearable body configured to be fitted to a limb of the simulated patient or manikin, the wearable body having: a blood pressure measurement portion around which the said inflatable cuff of the said sphygmomanometer can be provided when the wearable body is fitted to the said limb, the said blood pressure measurement portion having at least one (e.g. force) sensor configured to measure a parameter (e.g. force or pressure) indicative of a pressure exerted by the said inflatable cuff on the said limb (e.g. at least one sensor configured to measure a force or pressure exerted by a said inflatable cuff on the said limb), the said measurements typically being indicative of the fluid (e.g. air) pressure of the inflatable cuff in use; one or more devices for outputting an audible and/or human palpable signal; and a controller configured to receive measurements of the said parameter from the said at least one sensor and to cause a change to the output of one or more of the said one or more devices responsive to the said received measurements to thereby facilitate a simulated blood pressure measurement in accordance with a predetermined simulated blood pressure. Typically the blood pressure measurement portion of the wearable body has an external surface around which the said inflatable cuff can be provided when the wearable body is fitted to the limb. Typically the said at least one sensor is provided on, or in (typically mechanical) communication with, the said external surface of the blood pressure measurement portion, typically so that the measurements of the said parameter made by the said sensor(s) are indicative of a pressure exerted by the said inflatable cuff on the said limb when the inflatable cuff is provided around the wearable body fitted to the said limb. Typically the wearable body comprises one or more or all of the said one or more devices. Typically the inflatable cuff is deflatable. For example it may be that the sphygmomanometer further comprises a valve for selectably releasing fluid (e.g. air) from the inflatable cuff to thereby deflate the inflatable cuff. Alternatively, it may be that the fluid (e.g. air) pump is reversible such that it can pump fluid (e.g. air) out of the inflatable chamber to thereby deflate the cuff. It may be that the system further comprises a said simulated patient or manikin. A fourth aspect of the invention provides a training aid for facilitating simulated blood pressure measurements on a simulated patient or manikin, the training aid comprising: a wearable body configured to be fitted to a limb of the simulated patient or manikin, the wearable body having a blood pressure measurement portion around which an inflatable cuff can be provided when the wearable body is fitted to the said limb, the blood pressure measurement portion having a pressure receiving surface which is moveable responsive to pressure exerted by a said inflatable cuff on the said pressure receiving surface; at least one sensor configured to measure a parameter indicative of a pressure exerted by said inflatable cuff on the said limb in dependence on movement of the said pressure receiving surface; one or more devices for providing a blood pressure measurement simulation output; and a controller configured to receive measurements of the said parameter from the said at least one sensor and to cause a change to the said output of one or more of the said one or more devices responsive to the said received measurements to thereby facilitate a simulated blood pressure measurement in accordance with a predetermined simulated blood pressure. Typically the wearable body comprises elastic material. Typically the wearable body comprises a sleeve for receiving the said limb. Typically one or more of the said one or more devices are fixedly coupled to the sleeve.
It may be that the said one or more devices comprise one or more loudspeakers configured to provide the blood pressure measurement simulation output. It may be that the said one or more devices comprise one or more deformable bladders configured to provide the blood pressure measurement simulation output. It may be that the pressure receiving surface is a pressure receiving surface of a force sensor (e.g. piezoelectric transducer or strain gauge) of the said blood pressure measurement portion of the wearable body. For example, the pressure receiving surface may comprise a pressure receiving surface of a piezoelectric transducer or strain gauge. In the former case, the pressure receiving surface may be configured to move by way of compression of the piezoelectric transducer caused by pressure exerted by said inflatable cuff on the said pressure receiving surface. In the latter case, the pressure receiving surface may be configured to move by way of deformation of a portion (e.g. a conductor or optical fibre) of the strain gauge caused by pressure exerted by said inflatable cuff on the said pressure receiving surface. In another example, the said pressure receiving surface is a surface of a deformable bladder, the said pressure receiving surface being moveable by deformation of the deformable bladder caused by pressure exerted by said inflatable cuff on the said pressure receiving surface. It may be that the said at least one sensor comprises a plurality of (e.g. force) sensors (e.g. piezoelectric transducer or strain gauge) spaced from each other (e.g. in or on the blood pressure measurement portion of the body). It may be that the controller is configured to receive measurements of the said parameter indicative of a pressure exerted by said inflatable cuff on the said limb from the said plurality of (e.g. force) sensors (e.g. measured by the said sensors simultaneously) and to select the measurement of the said parameter which, of the said measurements, is indicative of the greatest pressure exerted by the cuff. It may be that the controller is configured to cause a change to the said output of one or more of the said one or more devices responsive to the said selected measurement to thereby facilitate a simulated blood pressure measurement in accordance with a predetermined simulated blood pressure. Typically the said pressure receiving surface is configured such that (in use) movement of the pressure receiving surface responsive to pressure exerted thereon by the said inflatable cuff causes a signal to be generated which is indicative of the pressure exerted by the said inflatable cuff on the said limb. It may be that the said signal is an electrical signal (e.g. electrical charge generated by deformation of a piezoelectric transducer comprising the said pressure receiving surface). It may be that the said signal is a fluid (e.g. liquid) pressure signal (e.g. an increased fluid pressure generated by deformation of a deformable bladder comprising the said pressure receiving surface). It may be that the said at least one sensor is configured to measure the said parameter indicative of a pressure exerted by said inflatable cuff on the said limb by way of the said signal. It may be that the training aid is configured to facilitate simulated oscillometric method and/or auscultation method blood pressure measurements on the simulated patient or manikin. It may be that the said blood pressure measurement simulation output comprises a human audible (e.g. audible by a human by way of a stethoscope, e.g. to thereby simulate Korotkoff sounds for simulated auscultation method blood pressure measurements) and/or a human palpable signal (e.g. to thereby simulate a radial, femoral, posterior tibial or dorsalis pedis pulse of the simulated patient or manikin). For example it may be that the said one or more devices comprises a loudspeaker or deformable bladder configured to receive and/or output pressurised fluid to thereby provide the human audible and/or human palpable signal. It may be that the said blood pressure measurement simulation output comprises pressure pulses (e.g. to thereby cause fluctuations in a fluid pressure of said inflatable cuff provided around the said blood pressure measurement portion (in use) to thereby facilitate simulated oscillometry method blood pressure measurements). For example, the said one or more devices may comprise a device configured or configurable to output pressure pulses (e.g. a loudspeaker or a deformable bladder configured to receive and/or output pressurised fluid to thereby provide said pressure pulses). It may be that the controller is configured to control the pressure pulses output by the said device responsive to the said received measurements in accordance with the said predetermined simulated blood pressure. It may be that the controller is configured to receive a selection of a pressure pulse set from a plurality of different candidate predetermined pressure pulse sets and to cause the said device to output pressure pulses in accordance with the selected pressure pulse set. It may be that each of the plurality of candidate predetermined pressure pulse sets is associated with a respective medical condition. Alternatively, the controller may be configured to determine the (e.g. amplitude and/or regularity of the) said pressure pulses (and cause the said device to output the said determined pressure pulses) in dependence on the predetermined simulated blood pressure and/or in dependence on a selected simulated heart rate and/or in dependence on the said measured parameter. It may be that the said one or more devices for providing the said blood pressure measurement simulation output comprises a deformable (e.g. pressurised fluid containing) bladder in fluid communication with a fluid (e.g. liquid) reservoir (e.g. by way of a tube), the bladder being configured or configurable to receive (e.g. pressurised) fluid (e.g. liquid) from and/or to output (e.g. pressurised) fluid to the said fluid reservoir (typically to thereby provide the said blood pressure measurement simulation output, e.g. pressure pulses). Thus, it may be that the training aid comprises a fluid reservoir. The training aid may further comprise one or more (e.g. electronically controlled) valves configured to control fluid flow between the said bladder and the said reservoir. It may be that the fluid pressure of the said reservoir is adjustable (e.g. relative to the fluid pressure of the said deformable bladder) to thereby output pressurised fluid to or receive pressurised fluid from the said deformable bladder (e.g. adjustable by way of a fluid pump (e.g. a pump comprising a piston cylinder device in fluid communication with the reservoir, the piston being moveable within the cylinder to increase or decrease the fluid pressure of the reservoir)). It may be that the controller is configured or configurable to control the said pump and/or the said one or more (e.g. electronically controlled) valves to thereby cause the said deformable bladder to output pressure pulses which facilitate the said (e.g. oscillometry method) simulated blood pressure measurement responsive to the said received measurements in accordance with the said predetermined simulated blood pressure. In this case, the controller is typically configured to control the said pump and/or the said one or more valves to thereby cause the deformable bladder to output pressure pulses to thereby cause (in use) corresponding fluctuations in a fluid pressure of said inflatable cuff provided around the said blood pressure measurement portion responsive to the said received measurements to thereby facilitate simulated oscillometric method blood pressure measurements in accordance with the said predetermined simulated blood pressure. Typically the controller is configured to control amplitudes of said pressure pulses in dependence on the said received measurements (e.g. as the cuff is deflated after having been inflated with a fluid pressure above a simulated systolic blood pressure (or first predetermined blood pressure value), and the said measured parameter varies to indicate a decreasing cuff pressure, the controller may be configured to increase the amplitudes of the pressure pulses to a maximum before decreasing the said amplitudes with further reduction in cuff pressure to facilitate a simulated oscillometric method blood pressure measurement). Typically the controller is configured to receive a selection of a predetermined simulated heart rate. Typically the controller is configured to provide said pressure pulses (e.g. with a regularity) in accordance with the said selected predetermined simulated heart rate. It may be that the said blood pressure measurement portion of the wearable body comprises the said device configured or configurable to output pressure pulses. It may be that one or more of the said at least one sensor and one or more of the said one or more devices share one or more features in common. For example, it may be that one or more of the said at least one sensor and one or more of the said one or more devices share a or the deformable bladder in common. Thus, it may be that the said blood pressure measurement portion of the wearable body comprises a deformable bladder configured or configurable to receive (e.g. pressurised) fluid (e.g. liquid) from and/or to output (e.g. pressurised) fluid to a fluid reservoir (e.g. a said fluid reservoir) to thereby output a said blood pressure measurement simulation output, the deformable bladder comprising the said pressure receiving surface which is moveable responsive to pressure exerted by said inflatable cuff on the said pressure receiving surface, the said at least one sensor being configured to measure the said parameter indicative of a pressure exerted by said inflatable cuff on the said limb in dependence on movement of the said pressure receiving surface of the said bladder. Typically the wearable body portion comprises one or more or all of the said one or more devices. Typically one or more said devices (e.g. one or more said devices for outputting an audible signal) are offset from the said blood pressure measurement portion of the wearable body. It may be that the blood pressure measurement portion of the wearable body comprises one or more said devices (e.g. a said device configured or configurable to output pressure pulses). A fifth aspect of the invention provides a system for facilitating simulated blood pressure measurements on a simulated (typically human) patient or manikin, the system comprising: a sphygmomanometer comprising: an inflatable cuff having an inflatable chamber; a fluid (e.g. air) pump for providing pressurised fluid (e.g. air) to the inflatable chamber to thereby inflate the inflatable cuff; and a pressure gauge configured to measure fluid (e.g. air) pressure in the said inflatable chamber of the said inflatable cuff; and a training aid comprising: a wearable body configured to be fitted to a limb of the simulated patient or manikin, the wearable body having a blood pressure measurement portion around which an inflatable cuff can be provided when the wearable body is fitted to the said limb, the blood pressure measurement portion having a pressure receiving surface which is moveable responsive to pressure exerted by a said inflatable cuff on the said pressure receiving surface; at least one sensor configured to measure a parameter indicative of a pressure exerted by said inflatable cuff on the said limb in dependence on movement of the said pressure receiving surface; one or more devices for providing a blood pressure measurement simulation output; and a controller configured to receive measurements of the said parameter from the said at least one sensor and to cause a change to the output of one or more of the said one or more devices responsive to the said received measurements to thereby facilitate a simulated blood pressure measurement in accordance with a predetermined simulated blood pressure. A sixth aspect of the invention provides a method of facilitating simulated blood pressure measurements on a simulated patient or manikin, the method comprising: fitting a wearable body of a training aid to a limb of the simulated patient or manikin, the wearable body having a blood pressure measurement portion comprising a pressure receiving surface; providing one or more devices for providing a blood pressure measurement simulation output; providing an inflatable cuff around the blood pressure measurement portion of the wearable body; inflating the inflatable cuff, thereby exerting a pressure on, and moving, the pressure receiving surface; (e.g. at least one sensor) measuring a parameter indicative of a pressure exerted by the inflatable cuff on the said limb in dependence on the said movement of the pressure receiving surface; and causing a change to the output of one or more of the one or more devices responsive to the said measurement of the said parameter to thereby facilitate a simulated blood pressure measurement in accordance with a predetermined simulated blood pressure. It may be that the method is a method of facilitating simulated oscillometric method and/or auscultation method blood pressure measurements on a simulated patient or manikin. Typically the method comprises movement of the pressure receiving surface responsive to pressure exerted thereon by the said inflatable cuff causing a signal to be generated which is indicative of the pressure exerted by the said inflatable cuff on the said limb. It may be that the method comprises (e.g. the at least one sensor) measuring said parameter by way of said signal. It may be that the step of measuring a parameter indicative of a pressure exerted by the inflatable cuff on the said limb in dependence on the said movement of the pressure receiving surface is performed by at least one sensor. It may be that the said at least one sensor comprises a plurality of (e.g. force) sensors (e.g. piezoelectric transducer or strain gauge) spaced from each other (e.g. in or on the blood pressure measurement portion). It may be that the method comprises receiving measurements of the said parameter indicative of a pressure exerted by said inflatable cuff on the said limb from the said plurality of (e.g. force) sensors (e.g. measured by the said sensors simultaneously) and selecting the measurement of the said parameter which, of the said measurements, is indicative of the greatest pressure exerted by the cuff. It may be that the method comprises causing a change to the said output of one or more of the said one or more devices responsive to the said selected measurement to thereby facilitate a simulated blood pressure measurement in accordance with a predetermined simulated blood pressure. It may be that the at least one sensor comprises a deformable bladder having a or the pressure receiving surface, the step of (e.g. the at least one sensor) measuring a parameter indicative of a pressure exerted by said inflatable cuff on the said limb comprising pressure exerted by said inflatable cuff on the said pressure receiving surface deforming the deformable bladder, thereby causing movement of the said pressure receiving surface, and the said sensor measuring a parameter indicative of a pressure exerted by said inflatable cuff on the said limb in dependence on said movement of the said pressure receiving surface. The said one or more devices may comprise a device (e.g. loudspeaker or deformable bladder) for outputting pressure pulses responsive to said measurement of the said parameter to thereby facilitate a simulated (oscillometric method) blood pressure measurement in accordance with the said predetermined simulated blood pressure. The method may comprise the said device outputting pressure pulses responsive to said measurement of the said parameter to thereby cause fluid pressure fluctuations in (e.g. an inflatable chamber of) the said cuff. The method may comprise determining a simulated blood pressure by monitoring pressure fluctuations in (e.g. the inflatable chamber of) the said cuff. It may be that the cuff is provided in (typically mechanical) communication with the said device for outputting pressure pulses. The preferred and optional features of each aspect of the invention disclosed herein are preferred and optional features of each other aspect of the invention to which they are applicable. For the avoidance of doubt, the preferred and optional features of each aspect of the invention are also preferred and optional features of all of the other aspects of the invention, where applicable. Description of the Drawings An example embodiment of the present invention will now be illustrated with reference to the following Figures in which: Figure 1a illustrates the positions along the arm of a patient at which radial and brachial pulses can be palpated; Figure 1 b is a schematic diagram of a sphygmomanometer; Figure 2 is a schematic diagram of a training aid according to the invention; Figure 3 is a schematic diagram of a portable personal communications device running an application (computer program code) which enables the training aid to be configured for a simulation activity; Figure 4 is a sectional view of a portion of a wearable body of the training aid of Figure 2; Figure 5 illustrates an alternative wearable body for the training aid of Figure 2; and Figure 6 is a schematic diagram of an alternative training aid according to the invention. Detailed Description of an Example Embodiment Figure 1 a shows the arm 1 of a live human, the arm having an upper arm portion 2, a lower arm portion 4 and an antecubital fossa 6 provided between the upper arm portion 2 and the lower arm portion 4. The lower arm portion 4 comprises a wrist 8 having an underside 10. A radial pulse of the human can be palpated on the underside 10 of the wrist 8. A brachial pulse of the human can be palpated at the antecubital fossa 6. As shown in Figure 1 b, a sphygmomanometer 20 comprises an inflatable cuff 22 comprising an inflatable internal chamber 24 in fluid communication with a fluid (typically air) pump 26 and a mercury column 28 (or other pressure gauge, typically having a visible output of the pressure measurement by the pressure gauge) configured to measure the fluid (typically air) pressure in the internal chamber 24 of the cuff 22 (i.e. the "cuff pressure"). The cuff 22 can be inflated by providing pressurised fluid into the inflatable chamber 24 by way of the pump 26. The cuff 22 further comprises a valve 30 by which fluid (typically air) can be selectively released from the inflatable chamber 24 to thereby deflate the cuff 22. As discussed in the Background to the Invention, a blood pressure (i.e. the pressure exerted by circulating blood on the walls of the brachial artery) of the human can be measured by wrapping the inflatable cuff 22 of the sphygmomanometer 20 around the upper arm portion 2, inflating the inflatable cuff 22 by providing pressurised fluid into the inflatable chamber 24 by way of the pump 26 to a pressure which occludes blood flow in the brachial artery of the human, deflating the inflatable cuff by selectively opening the valve 30 (and typically by turning off or disconnecting the pump 26 from the inflatable chamber 24) and, while the cuff 22 is deflating, listening for "Korotkoff sounds" using a stethoscope at the antecubital fossa 6. The systolic blood pressure can be estimated by noting the cuff pressure on the mercury column when the first Korotkoff sound is heard. The diastolic blood pressure can be estimated by noting the cuff pressure when the fourth Korotkoff sound ends (or when the fifth Korotkoff "sound" begins). Additionally or alternatively, a blood pressure of the human can be measured by wrapping the inflatable cuff 22 of the sphygmomanometer 20 around the upper arm portion 2, inflating the inflatable cuff 22 by providing pressurised fluid into the inflatable chamber 24 by way of the pump 26 to a pressure which occludes blood flow in the brachial artery of the human, deflating the inflatable cuff by selectively opening the valve 30 (and typically by turning off or disconnecting the pump 26 from the inflatable chamber 24) and, while the cuff 22 is deflating, monitoring fluctuations in the cuff pressure measured by the pressure gauge caused by the occluded blood flow in the brachial artery of the human. The systolic blood pressure can be estimated by noting the cuff pressure above the mean arterial pressure (the mean arterial pressure being the pressure at which the amplitude of pressure fluctuations in the cuff pressure is at a maximum) at which the ratio of the amplitude of pressure fluctuations in the cuff pressure to the amplitude of pressure fluctuations in the cuff pressure at the mean arterial pressure is equal to 0.55. The diastolic blood pressure can be estimated by noting the cuff pressure below the mean arterial pressure at which the ratio of the amplitude of pressure fluctuations in the cuff pressure to the amplitude of pressure fluctuations in the cuff pressure at the mean arterial pressure is equal to 0.85. Additionally or alternatively, the systolic blood pressure can be estimated by wrapping the cuff 22 around the upper arm portion 2 and palpating the radial pulse at the underside 10 of the wrist 8 while inflating the cuff 22 as discussed above. The systolic blood pressure can be estimated by noting the cuff pressure when the radial pulse can no longer be palpated. Figure 2 is a schematic diagram of a training aid 40 for facilitating simulated blood pressure measurements on a simulated (human) patient or manikin. The training aid 40 comprises a wearable body 42 comprising a sleeve 44 for receiving an arm of the simulated patient or manikin. It will be assumed that the arm received by the sleeve is the arm 1 of the live human of Figure 1 for the purposes of the following description, but it will be understood that the arm could instead be either arm of any simulated (live) human patient or an arm of a (typically inanimate) manikin. The sleeve 44 is typically formed from an elastic material (such as lycra™) for ease of fitting to the arm 1 , and to accommodate variations in the size of the arm 1 of different simulated patients. The wearable body 42 further comprises a force sensor 46 fixedly coupled to an external surface of the sleeve 44 (the external surface of the sleeve being opposite an internal surface of the sleeve which engages the arm 1) and positioned such that, when the sleeve 44 is fitted to the arm 1 , the force sensor 46 is provided over the upper arm portion 2 of the arm 1. The portion of the sleeve 44 comprising the sensor 46 provides a blood pressure measurement portion of the sleeve 44. The wearable body 42 further comprises a first loudspeaker 48 fixedly coupled to the sleeve 44 and positioned such that, when the sleeve 44 is fitted to the arm 1 , it is provided over the antecubital fossa 6 of the arm 1. The wearable body 42 further comprises a second loudspeaker 50 fixedly coupled to the sleeve 44 and positioned such that it is provided over the underside 10 of the wrist 8 of the arm 1. The first and second loudspeakers 48, 50 and the force sensor 46 are in communication with a controller 52. More specifically, the first and second loudspeakers 48, 50 and the force sensor 46 are in wired communication with a first controller portion 54 of the controller 52 which is in wireless communication with a second controller portion 56 of the controller 52 by way of a wireless communications module 58. As discussed in the Background to the Invention, a common training technique for trainee healthcare practitioners involves the performance of simulation activities during which they are required to make physiological measurements (including blood pressure and radial pulse measurements) of a simulated patient who is portraying the symptoms of a particular illness for the practitioner to diagnose. A problem with this is that the measurements made by the practitioner do not typically match those which would be expected from a patient with the illness in question, and it is typically necessary to provide the practitioner with physiological data which overrides their measurements. The training aid 40 permits blood pressure and radial pulse measurements to be made on a simulated patient portraying the symptoms of a particular illness which match those which would be expected from a patient with that illness. The wearable body 42 is fitted to the arm 1 of the simulated patient by the sleeve 44 receiving the arm 1. As discussed above, when the wearable body 42 is fitted to the arm 1 , the force sensor 46 is provided over the upper arm portion 2, the first loudspeaker 48 is provided over the antecubital fossa 6 of the arm 1 and the second loudspeaker 50 is provided over the underside 10 of the wrist 8. In order to simulate a blood pressure measurement by auscultation, first and second predetermined simulated blood pressure values corresponding to the simulated systolic and diastolic blood pressures respectively are selected from a plurality of different candidate systolic and diastolic blood pressure values by way of a touch screen 59 of the second controller portion 56 (which in the illustrated embodiment comprises a mobile smartphone but which could alternatively be any suitable computing device including a tablet, laptop, personal digital assistant, personal computer, wearable electronic communications device and so on) and a user interface of a computer program application running on the second controller portion 56 as shown in Figure 3, the first predetermined simulated blood pressure value corresponding to the simulated systolic blood pressure (being illustrated on the left hand side under the heading "Blood Pressure" in Figure 3), and the second predetermined simulated blood pressure value corresponding to the simulated diastolic blood pressure (being illustrated on the right hand side under the heading "Blood Pressure" in Figure 3). The second controller portion 56 wirelessly communicates the selected blood pressure values to the first controller portion 54 by way of a wireless communications module of the second controller portion 56 (not shown) and the wireless communications module 58 of the first controller portion 54 and the first controller portion 54 stores the received blood pressure values in a local memory. The first controller portion 54 comprises a microcontroller having (or being in data communication with) the said local memory and a battery pack configured to provide electrical power to the microcontroller, the loudspeakers 48, 50 and the force sensor 46 (and optionally the local memory if it is separate from the microcontroller). The first controller portion 54 is configured to receive force measurements from the force sensor 46. When the inflatable cuff 22 of the sphygmomanometer is wrapped around the upper arm portion 2 of the arm 1 and the force sensor 46 of the wearable body 42, and when the inflatable cuff 22 is inflated by providing pressurised fluid (typically air) into the inflatable chamber 24 of the cuff 22, the force measurements by the force sensor 46 are indicative of the pressure of the fluid in the inflatable chamber 24 of the inflatable cuff 22 (the "cuff pressure"). In most cases, it is necessary for the first controller portion 54 to perform a calibration process on the raw force measurements received from the force sensor 46. Accordingly the first controller portion 54 is typically configured to calibrate the raw force measurements received from the force sensor 46 in accordance with one or more calibration factors. In order to perform a simulated auscultation method blood pressure measurement, the inflatable cuff 22 is fitted around the upper arm portion 2 and the force sensor 46 until the cuff pressure exceeds the expected systolic pressure. Next, the trainee healthcare practitioner selectably releases fluid (typically air) from the inflatable chamber 24 of the inflatable cuff 22 using the valve 30. Meanwhile, the first controller portion 54 monitors the cuff pressure by monitoring the (typically calibrated) force measurements received from the force sensor 46. When the first controller portion 54 determines from the (typically calibrated) force measurements that the cuff pressure equals the simulated systolic blood pressure which was selected on the second controller portion 56, the first controller portion 54 causes the first loudspeaker 48 to begin to emit Korotkoff sounds starting with the first Korotkoff sounds. As the cuff pressure continues to decrease, the first loudspeaker sequentially emits the second, third and fourth Korotkoff sounds. When the cuff pressure is equal to the diastolic pressure, the Korotkoff sounds cease (or the fifth Korotkoff "sound" is emitted). The trainee healthcare practitioner, assuming they apply the auscultation method correctly, monitors the antecubital fossa 6 of the arm 1 with a stethoscope throughout deflation of the cuff 22 and will detect the Korotkoff sounds emitted by the first loudspeaker 48. More specifically, the practitioner will note the cuff pressure by way of the reading on the mercury column 28 when the first Korotkoff sound is heard from the first loudspeaker 48 as a measurement of the systolic blood pressure and the cuff pressure when the fourth Korotkoff sound finishes (or the fifth Korotkoff "sound" begins) as a measurement of the diastolic blood pressure. The amplitudes of the Korotkoff sounds are also typically adapted for (or the Korotkoff sounds are selected responsive to and are associated with) the selected blood pressure. Typically, a simulated heart rate is also selected from a plurality of different candidate simulated heart rates by way of the touch screen 59 and the user interface of the application running on the second controller portion 56, which selected heart rate is communicated to the first controller portion 54. In this case, the controller 52 is typically configured to adapt the Korotkoff sounds (or to select Korotkoff sounds responsive to and associated with) the selected heart rate so that the Korotkoff sounds output by the first speaker are in accordance with the selected heart rate. Typically the second loudspeaker 50 is configured to output a human palpable signal which simulates the radial pulse of the simulated patient. More specifically, whenever the force measurements by the force sensor 46 are indicative that the cuff pressure is less than the diastolic pressure, it may be that the second loudspeaker 50 outputs a human palpable signal which simulates the radial pulse of the simulated patient, the simulated radial pulse rate being dependent on the selected simulated heart rate and the amplitude of the simulated radial pulse being dependent on the selected simulated blood pressure to improve the fidelity of the simulated radial pulse. Similarly, the first loudspeaker 48 outputs a human palpable signal which simulates the brachial pulse of the simulated patient when the force measurements by the force sensor 46 are indicative that the cuff pressure is less than the diastolic pressure, the simulated brachial pulse rate being dependent on the selected simulated heart rate and the amplitude of the simulated brachial pulse being dependent on the selected simulated blood pressure to improve the fidelity of the simulated brachial pulse. It will be understood that the first and second loudspeakers 48, 50 make human palpable mechanical movements when they output a signal (e.g. they may be piezoelectric loudspeakers). This allows the practitioner to palpate the output of the loudspeakers 48, 50, allowing them to make a palpation based simulated brachial or radial pulse measurement by touching the loudspeakers 48, 50 respectively. Additionally or alternatively, the training aid 40 can be used to simulate systolic blood pressure measurements by way of simulated measurements of the radial pulse. As above, the wearable body 42 is fitted to the arm 1 by way of the sleeve 44 receiving the arm, and the inflatable cuff 22 is fitted around the upper arm portion 2. A simulated systolic blood pressure value is selected on the user interface of the second controller portion 56 from the plurality of different candidate systolic blood pressures, which is then communicated to the first controller portion 54. A simulated heart rate is also selected from a plurality of different candidate simulated heart rates by way of the touch screen 59 and the user interface of the application running on the second controller portion 56, which selected heart rate is communicated to the first controller portion 54. Responsively, the first controller portion 54 causes the second loudspeaker 50 to output a human palpable signal which simulates a radial pulse of the simulated patient at the selected heart rate. The amplitude of the signal is also typically in accordance with the selected blood pressure (i.e. the greater the selected blood pressure, the greater the amplitudes of the simulated sounds); the amplitude of the signal may be selected responsive to the selected blood pressure, or the amplitude of the signal may be adapted in dependence on the selected blood pressure. Next, the practitioner increases the cuff pressure using the sphygmomanometer pump 26 until the cuff pressure is equal to the simulated systolic blood pressure value selected on the second controller portion 56. When the first controller portion 54 detects from the (typically calibrated) force measurements of the force sensor 46 that the cuff pressure has reached the simulated systolic blood pressure value, the first controller portion 54 responsively causes the second loudspeaker 50 to stop emitting sounds which simulate the radial pulse (thereby simulating occlusion of the brachial artery by the cuff). The trainee healthcare practitioner, who monitors the simulated radial pulse output by the second loudspeaker 50, detects the stopping of the radial pulse and notes the cuff pressure at this point as an estimate of the simulated systolic blood pressure. When the inflatable cuff 22 of the sphygmomanometer is wrapped around the upper arm portion 2 of the simulated patient and inflated and deflated, it may cause the simulated patient's brachial artery to occlude and then open again, thereby emitting real Korotkoff sounds. However, the first loudspeaker 48 is positioned on the sleeve 44 such that a body 60 (see Figure 4 which is a sectional view of a portion of the wearable body comprising the loudspeaker 48, between the arrows labelled A in Figure 2) of the loudspeaker 48 is provided over the antecubital fossa of the simulated patient which not only improves the fidelity of the training exercise (such that the loudspeaker 48 emits Korotkoff sounds where they would be expected) but the body 60 of the loudspeaker 48 also damps any real Korotkoff sounds which are generated by the simulated patient, thereby reducing or preventing any real Korotkoff sounds from interfering with those emitted by the first loudspeaker 48. Optionally, in order to improve the damping of any real Korotkoff sounds emitted by the simulated patient, a damper 62 (such as a plastic sheet) may be provided between the loudspeaker body 60 and the sleeve 44 (and/or between the sleeve 44 and the arm 1) in order to further damp real Korotkoff sounds emitted by the simulated patient. Similarly, the simulated patient will also typically have a real radial pulse. The second loudspeaker 50, however, is positioned such that it covers the underside of the wrist of the simulated patient. As above, as well as improving the fidelity of the training exercise (such that the loudspeaker 50 outputs a human palpable signal which simulates the radial pulse where it would be expected), the body of the loudspeaker 50 damps any real radial pulse sounds or movements, thereby reducing or preventing their interference with the signal output by the loudspeaker 50. Optionally, in order to improve the damping of any radial pulse sounds or movements, a damper (such as a plastic sheet) may be provided between the body of the second loudspeaker 50 and the sleeve 44 (and/or between the sleeve 44 and the arm 1) in order to further damp real radial pulse sounds or movements of the simulated patient. As illustrated by Figure 5, the sleeve 44 does not necessarily need to cover the entire arm 1 of the simulated patient (indeed the wearable body need not comprise a sleeve at all), as long as the force sensor 46 and the loudspeakers 48, 50 are held in their desired positions relative to the arm 1. In this case, the force sensor 46 and loudspeakers 48, 50 are held together (and to the arm 1) by channels 70 of material extending between them along the arm 1. It will be understood that either the first or second loudspeakers 48, 50 could be omitted (i.e. it may be that the wearable body comprises only one of the first and second loudspeakers 48, 50) and the training aid would still be usable to make simulated blood pressure measurements using the one of the first and second loudspeakers provided (either by auscultation if the first loudspeaker is provided, or by monitoring the radial pulse if the second loudspeaker is provided). In order to increase the fidelity of the simulation further, it may be that each of the arms of the simulated patient or manikin is fitted with a respective wearable body 42 each having a force sensor and first and/or second loudspeakers in communication with the controller 52 as discussed above. This would allow the trainee healthcare practitioner to select the arm on which to perform their measurements. It will be understood that the training aid 40, and in particular the wearable body 42, could be adapted for use on the leg (rather than the arm) of a simulated patient or manikin. In this case, the blood pressure measurement portion of the sleeve is typically configured to be fitted around the knee such that the first loudspeaker 48 is positioned at the popliteal fossa. In this case, auscultation based blood pressure measurements may be simulated by simulating occlusion of the popliteal (rather than the brachial) artery (by providing a cuff around the blood pressure measurement portion, increasing the cuff pressure above the simulated systolic pressure and then decreasing the cuff pressure below the simulated systolic pressure) and the practitioner listening to simulated Korotkoff sounds emitted by the first loudspeaker 48 at the popliteal fossa (rather than antecubital fossa in the case of the arm above). In addition, the training aid may be configured such that, when the sleeve is fitted to the leg of the simulated patient or manikin, second loudspeaker 50 is provided at any of: the inner thigh of the simulated patient or manikin to simulate a femoral pulse of the simulated patient or manikin; at Pimenta's point of the simulated patient or manikin to simulate a posterior tibial pulse of the simulated patient or manikin; or the upper surface of the foot of the simulated patient or manikin to simulate a dorsalis pedis pulse of the simulated patient or manikin. The controller 52 is configured in this case to cause the second speaker 50 to output a human palpable signal which simulates a said pulse responsive to the force measurements on the cuff being indicative of the cuff pressure being less than the systolic blood pressure, and to cause the second speaker 50 to cease outputting said signal responsive to the force measurements on the cuff being indicative of the cuff pressure being greater than or equal to the systolic blood pressure (in the same way as the radial pulse for the arm above). Such a training aid adapted for use on the leg typically further comprises a modesty shield (such as a modesty panel) configured to shield the crotch of the simulated patient from the view of the medical practitioner during the simulation session. This helps to improve the comfort of both practitioner and simulated patient during the session. In order to increase the fidelity of the simulation further, it may be that each of the legs of the simulated patient or manikin is fitted with a respective wearable body so adjusted and each having a force sensor and first and/or second loudspeakers in communication with the controller 52. This would allow the trainee healthcare practitioner to select the leg on which to perform their measurements. In order to increase the fidelity of the simulation yet further, it may be that each of the arms and each of the legs of the simulated patient or manikin is fitted with a respective wearable body each having a force sensor and first and/or second loudspeakers in communication with the controller 52. This would allow the trainee healthcare practitioner to select an arm or leg on which to perform their measurements. Although Figure 4 illustrates the simulated blood pressure and heart rates being selected directly on the user interface of the application running on the second controller portion 56, it may be that the simulated blood pressure and/or heart rates are selected indirectly by selecting a medical condition from a plurality of different candidate medical conditions by way of the touch screen 59 and the user interface of the application running on the second controller portion 56, each candidate medical condition being associated with a predetermined simulated heart rate and a predetermined simulated blood pressure (systolic or systolic and diastolic). In this case, the second controller portion 56 specifies the said predetermined simulated heart rate and predetermined simulated blood pressure associated with the selected medical condition to the first controller portion 54 which causes the loudspeakers to emit sounds responsive to the force measurements in accordance with the specified predetermined simulated heart rate and blood pressure as described above. Each candidate medical condition may also be associated with a particular set of Korotkoff sounds associated with that condition. In this case, the second controller portion 56 is further configured to specify that particular set of Korotkoff sounds (which may be different from those associated with other said candidate medical conditions) to the first controller portion 54, which is configured to cause the first loudspeaker to emit that particular set of Korotkoff sounds responsive to the said (typically calibrated) force measurements in accordance with the simulated blood pressure. The controller may also be configured to adapt the selected Korotkoff sounds in dependence on the specified predetermined simulated heart rate and blood pressure as described above. The second controller portion 56 may be configured to receive a (direct) selection of a set of Korotkoff sounds from a plurality of different candidate Korotkoff sounds, and to specify the selected set of Korotkoff sounds to the first controller portion 54. The first controller portion 54 is then configured to emit the selected set of Korotkoff sounds responsive to the said (typically calibrated) force measurements in accordance with the simulated blood pressure. The Korotkoff sounds may be selected in dependence on the selected heart rate and blood pressure. Figure 6 schematically illustrates an alternative training aid 100 for facilitating simulated blood pressure measurements by the oscilliometric method. The training aid 100 has a wearable sleeve 102 fitted around the upper arm 2 of the human. The sleeve 102 has a deformable bladder 104 provided on, or in (typically mechanical) communication with, the external surface of the sleeve 102. The deformable bladder 104 is positioned such that, when the sleeve 102 is fitted to the arm 1 , the deformable bladder 104 is provided over the upper arm 2. The portion of the sleeve 102 comprising the deformable bladder 104 provides a blood pressure measurement portion of the sleeve 102. A damper 106 is provided between the deformable bladder 104 and the upper arm 2 of the human. The inflatable cuff 22 of the sphygmomanometer 20 is wrapped around the sleeve 102 and in force communication with the bladder 104. The sleeve 102 is typically formed from an elastic material (such as lycra™) for ease of fitting to the arm 1 , and to accommodate variations in the size of the arm 1 of different simulated patients. The bladder 104 is provided in selective fluid communication with a reservoir 108 (which may be provided in the wearable sleeve 102 or external to the sleeve 102 as illustrated in Figure 6) by way of an electronically controlled valve 1 10 and thin tubing 1 12. The valve 1 10 is normally closed such that there is no fluid communication between the bladder 104 and the reservoir 108. A pressure transducer 1 14 (e.g. piezoelectric transducer or strain gauge) is provided (either in the blood pressure measurement portion of the sleeve 102 or external to the blood pressure measurement portion of the sleeve, either as part of the sleeve or external to the sleeve) to convert the fluid pressure in the tubing 1 12 between the bladder 104 and the valve 1 10 to an electrical signal. The pressure transducer 1 14 is configured to provide the electrical signal to the first controller portion 54 of the controller 52 (typically by a wired connection). The controller 52 is configured to control the fluid pressure in the deformable bladder by controlling the fluid pressure in the reservoir 108 and by controlling whether the valve 1 10 is open or closed to determine whether there is fluid communication between the bladder 104 and the reservoir 108. The controller 52 controls the fluid pressure in the reservoir 108 by way of a fluid pump 1 16 comprising a piston 1 18 moveable within a cylinder 120 to increase or decrease the fluid pressure in the reservoir 108. The first controller portion 54 comprises a microcontroller having (or being in data communication with) the said local memory and a battery pack configured to provide electrical power to the microcontroller, the pump 1 16, the pressure transducer 1 14 and the valve 1 10 (and optionally the local memory if it is separate from the microcontroller). The first controller portion 54 is configured to receive electrical signals from the pressure transducer 1 14 indicative of the fluid pressure in the tube 1 12 and to control the pressure of fluid in the deformable bladder by controlling the pump 1 16 and the valve 1 10 responsive to the received electrical signals. In order to facilitate a simulated oscillometric method blood pressure measurement using the training aid 100, first and second predetermined simulated blood pressure values corresponding to the simulated systolic and diastolic blood pressures respectively are selected from a plurality of different candidate systolic and diastolic blood pressure values as before by way of a touch screen 59 of the second controller portion 56 and a user interface of a computer program application running on the second controller portion 56 as shown in Figure 3, the first predetermined simulated blood pressure value corresponding to the simulated systolic blood pressure, and the second predetermined simulated blood pressure value corresponding to the simulated diastolic blood pressure. In addition, a simulated heart rate is selected as before. The second controller portion 56 wirelessly communicates the selected blood pressure values and the selected simulated heart rate to the first controller portion 54 by way of the wireless communications module of the second controller portion 56 and the wireless communications module 58 of the first controller portion 54 and the first controller portion 54 stores the received blood pressure values and heart rate in local memory. In order to perform an oscillometry method simulated blood pressure measurement, the cuff 22 is inflated to a pressure greater than the first predetermined simulated blood pressure value. As the cuff is inflated, it exerts an increasing pressure on a pressure receiving surface of the deformable bladder 104, which is sandwiched between the cuff 22 and the damper 106 (and thus the arm 1) such that the fluid pressure in the deformable bladder 104 increases (due to a reduction in an inner volume of the bladder). This pushes fluid out of the bladder 104 into the tube 1 12 which in turn increases the fluid pressure in the tube 1 12, causing the electrical signal output by the transducer 1 14 to increase in magnitude. The controller 52 thus determines that the pressure being exerted by the cuff 22 on the upper arm 2 is being increased. When the cuff pressure has reached a maximum (greater than the first predetermined simulated blood pressure value), the trainee healthcare practitioner selectively releases fluid (typically air) from the inflatable chamber 24 of the inflatable cuff 22 using the valve 30 and the pressure exerted by the cuff on the upper arm 2 reduces. This causes a reduction in the fluid pressure of the deformable bladder 104, and a consequent reduction in the fluid pressure in the tube 1 12 and the magnitude of the signal output by the pressure transducer 1 14, thereby allowing the controller 52 to determine that the pressure being exerted by the cuff 22 on the upper arm 2 is being reduced. As the cuff pressure reduces, the controller 52 is programmed to cause the bladder 104 to output pressure pulses (which simulate an occluded blood flow in the brachial artery of the simulated patient 1) by selectively increasing and reducing the fluid pressure in the reservoir 108 and by selectively opening and closing the valve 1 10 responsive to the electrical signal it receives from the pressure transducer 1 14. The controller 52 causes the pressure pulses to occur at a regularity in accordance with the selected simulated heart rate. The controller 52 is configured to increase the amplitudes of the pressure pulses output by the bladder 104 towards a maximum amplitude at a simulated mean arterial pressure as the cuff pressure reduces before reducing in amplitude as the cuff pressure reduces further. In a similar way to the occluded blood flow causing fluctuations in the cuff pressure in a real oscillometric method blood pressure measurement, the pressure pulses of the bladder 104 cause fluctuations in the fluid pressure in the chamber 24 of the cuff 22. The systolic blood pressure can be estimated by noting the cuff pressure above the mean arterial pressure at which the ratio of the amplitude of pressure fluctuations in the cuff pressure to the amplitude of pressure fluctuations in the cuff pressure at the mean arterial pressure is equal to 0.55. The diastolic blood pressure can be estimated by noting the cuff pressure below the mean arterial pressure at which the ratio of the amplitude of pressure fluctuations in the cuff pressure to the amplitude of pressure fluctuations in the cuff pressure at the mean arterial pressure is equal to 0.85. The damper 106 (provided between the bladder 104 and the upper arm 2) prevents the simulated patient's real blood pressure pulses from affecting the pressure in the cuff 22 by damping movements of the brachial artery of the simulated patient. In alternative embodiments, the bladder 104 may be substituted for a (relatively powerful, in order to overcome the cuff pressure in use) loudspeaker configured to output pressure pulses which cause fluctuations in the cuff pressure to thereby facilitate simulated oscillometric method blood pressure measurements. The embodiment of Figure 6 could be adapted for use on a leg of a human by positioning the bladder such that it is provided over the thigh of the human in use. As before, to improve the fidelity of the training exercise, training aids in accordance with the embodiment of Figure 6 could be applied to each arm and/or each leg of the human. Further modifications and variations may be made within the scope of the invention herein disclosed. For example, the first and second loudspeakers may be substituted for any suitable device for outputting an audible and/or human palpable signal. It will be understood that, for simulating auscultation method blood pressure measurements, a device used in place of the first loudspeaker 48 should at least be capable of outputting audible (e.g. by way of a stethoscope) signals in order to produce the simulated Korotkoff sounds. Preferably, the device used in place of the first loudspeaker is also capable of outputting human palpable signals in order to simulate the brachial pulse. It will also be understood that the device used in place of the second loudspeaker 50 should at least be capable of outputting human palpable signals in order to simulate the radial pulse. Additionally or alternatively, any other suitable types of sensor (e.g. the deformable bladder of Figure 6) capable of measuring one or more parameters indicative of a pressure exerted by the cuff on the blood pressure measurement portion of the sleeve may be used in place of the force sensor(s) described above in respect of the embodiment of Figures 2-5. Similarly, any other suitable types of sensor capable of measuring one or more parameters indicative of a pressure exerted by the cuff on the blood pressure measurement portion of the sleeve may be used in place of the deformable bladder of the embodiment of Figure 6. However, it is noted that the deformable bladder typically provides more accurate results than force sensors which require a force to be applied over their entire surface areas in order to provide accurate results. This is primarily due to crinkles in the wearable sleeve which can prevent force being applied across the entire surface areas of such force sensors. In an alternative embodiment, a plurality of force sensors may be provided which are spaced from each other (e.g. in or on the blood pressure measurement portion), in which case the controller 52 is typically configured to receive measurements of the said parameter indicative of a pressure exerted by said inflatable cuff on the said limb from the said plurality of force sensors (typically measured by the said sensors simultaneously) and to select the measurement of the said parameter which, of the said measurements, is indicative of the greatest pressure exerted by the cuff. The controller is also in this case configured to cause a change to the said output of one or more of the said one or more devices (e.g. loudspeaker, deformable bladder) responsive to the said selected measurement to thereby facilitate a simulated blood pressure measurement in accordance with the simulated blood pressure. It will be understood that, in other embodiments, any suitable combinations of features from the embodiments of Figures 2 to 5 and the embodiment of Figure 6 could be provided, for example, to facilitate both oscillometric and auscultation method blood pressure measurement simulations (and optionally to facilitate simulation of the pulse of the simulated patient or manikin).

Claims

Claims 1. A training aid for facilitating simulated blood pressure measurements on a simulated patient or manikin, the training aid comprising: a wearable body configured to be fitted to a limb of the simulated patient or manikin, the wearable body having: a blood pressure measurement portion around which an inflatable cuff can be provided when the wearable body is fitted to the said limb, the said blood pressure measurement portion having at least one sensor configured to measure a parameter indicative of a pressure exerted by a said inflatable cuff on the said limb; one or more devices for outputting an audible and/or human palpable signal; and a controller configured to receive measurements of the said parameter from the said at least one sensor and to cause a change to the output of one or more of the said one or more devices responsive to the said received measurements to thereby facilitate a simulated blood pressure measurement in accordance with a predetermined simulated blood pressure.
2. The training aid according to claim 1 wherein the wearable body comprises a sleeve for receiving the said limb.
3. The training aid according to claim 1 or claim 2 wherein the wearable body is configured to be fitted to an arm of the simulated patient or manikin.
4. The training aid according to any one preceding claim wherein the said one or more devices for outputting an audible and/or human palpable signal comprise a first device for outputting an audible signal, and wherein the controller is configured to cause a change to the output of at least the first device to thereby facilitate a simulated blood pressure measurement by causing the said at least first device to emit simulated Korotkoff sounds responsive to the said measurements of the said parameter in accordance with a predetermined simulated blood pressure.
5. The training aid according to claim 4 wherein the predetermined simulated blood pressure comprises a first predetermined simulated blood pressure value and a second predetermined simulated blood pressure value and wherein the controller is configured to cause the said first device to begin emitting simulated Korotkoff sounds responsive to the received measurements indicating that a fluid pressure of a said cuff provided over the blood pressure measurement portion is equal to or less than the said first predetermined simulated blood pressure value and greater than the said second predetermined simulated blood pressure value, and to cause the said first device to stop emitting simulated Korotkoff sounds responsive to the received measurements indicating that the fluid pressure of the said cuff provided over the blood pressure measurement portion is less than or equal to the second predetermined simulated blood pressure value.
6. The training aid according to claim 4 or claim 5 wherein the wearable body comprises the said first device, the wearable body being configured such that the said first device is provided over an antecubital fossa or a popliteal fossa of the simulated patient, or over a simulated antecubital fossa or a simulated popliteal fossa of the manikin, when the wearable body is fitted to the simulated patient or manikin.
7. The training aid according to any one of claims 4 to 6 wherein the controller is configured to receive a selection of a Korotkoff sound set and to cause the first device to emit simulated Korotkoff sounds in accordance with the selected Korotkoff sound set.
8. The training aid according to any one preceding claim wherein the said one or more devices for outputting an audible and/or human palpable signal comprise a second device for outputting a human palpable signal, and wherein the controller is configured to cause the said second device to output a human palpable signal which simulates a radial, femoral, posterior tibial or dorsalis pedis pulse of the simulated patient or manikin.
9. The training aid according to claim 8 wherein the wearable body comprises the said second device, the wearable body being configured such that the said second device is provided over an underside of a wrist of the simulated patient or manikin when the wearable body is fitted to an or the arm of the simulated patient or manikin to thereby simulate a radial pulse of the simulated patient or manikin.
10. The training aid according to claim 8 or claim 9 wherein the simulated blood pressure value comprises a single predetermined simulated blood pressure value and wherein the controller is configured to cause a change to the output of the said second device to thereby facilitate a simulated blood pressure measurement by causing the said second device to cease outputting human palpable signals which simulate the radial, femoral, posterior tibial or dorsalis pedis pulse responsive to the received measurements indicating that a fluid pressure of a said cuff provided over the blood pressure measurement portion is equal to or above the said predetermined simulated blood pressure value.
1 1. The training aid according to any one of claims 8 to 10 wherein the controller is configured to receive a selection of a predetermined simulated heart rate and to cause the said second device to output a human palpable signal which simulates the radial, femoral, posterior tibial or dorsalis pedis pulse of the simulated patient or manikin in accordance with the selected predetermined simulated heart rate.
12. The training aid according to any one preceding claim wherein the controller is configured to receive a selection of the predetermined simulated blood pressure and/or a or the predetermined simulated heart rate and/or a Korotkoff sound set by receiving a selection of a respective medical condition from a plurality of different candidate medical conditions, the said respective medical condition being associated with the said predetermined simulated heart rate and/or the predetermined simulated blood pressure and/or the Korotkoff sound set.
13. The training aid according to any one preceding claim further comprising one or more dampers configured to damp real arterial sounds emitted by, and/or movements of, a simulated patient in use.
14. The training aid according to any one preceding claim wherein the said at least one sensor comprises a pressure receiving surface which is moveable responsive to pressure exerted by a said inflatable cuff on the said pressure receiving surface, the said at least one sensor being configured to measure the said parameter indicative of a pressure exerted by said inflatable cuff on the said limb in dependence on movement of the said pressure receiving surface.
15. The training aid according to claim 14 wherein the said pressure receiving surface is a surface of a deformable bladder, the said pressure receiving surface being moveable by deformation of the bladder.
16. The training aid according to any one preceding claim wherein the said one or more devices for outputting an audible and/or human palpable signal comprises a device configured or configurable to output pressure pulses.
17. The training aid according to claim 16 wherein the said blood pressure measurement portion of the wearable body comprises the said device configured or configurable to output pressure pulses.
18. A method of facilitating simulated blood pressure measurements on a simulated patient or manikin, the method comprising:
fitting a wearable body of a training aid to a limb of the simulated patient or manikin, the wearable body having: a blood pressure measurement portion comprising at least one sensor;
fitting one or more devices for outputting an audible and/or human palpable signal to the said limb;
providing an inflatable cuff of a sphygmomanometer around the blood pressure measurement portion of the wearable body;
inflating the inflatable cuff by providing pressurised fluid to an inflatable chamber of the inflatable cuff;
the at least one sensor measuring a parameter indicative of a pressure exerted by the pressurised cuff on the limb; and
causing a change to the output of one or more of the one or more devices responsive to the said measurements of the said parameter to thereby facilitate a simulated blood pressure measurement in accordance with a predetermined simulated blood pressure.
19. A system for facilitating simulated blood pressure measurements on a simulated patient or manikin, the system comprising: a sphygmomanometer comprising: an inflatable cuff having an inflatable chamber; a fluid pump for providing pressurised fluid to the inflatable chamber to thereby inflate the inflatable cuff; and a pressure gauge configured to measure fluid pressure in the said inflatable chamber of the said inflatable cuff; and a training aid comprising: a wearable body configured to be fitted to a limb of the simulated patient or manikin, the wearable body having: a blood pressure measurement portion around which the said inflatable cuff of the said sphygmomanometer can be provided when the wearable body is fitted to the said limb, the said blood pressure measurement portion having at least one sensor configured to measure a parameter indicative of a pressure exerted by the said inflatable cuff on the said limb; one or more devices for outputting an audible and/or human palpable signal; and a controller configured to receive measurements of the said parameter from the said at least one sensor and to cause a change to the output of one or more of the said one or more devices responsive to the said received measurements to thereby facilitate a simulated blood pressure measurement in accordance with a predetermined simulated blood pressure.
20. A training aid for facilitating simulated blood pressure measurements on a simulated patient or manikin, the training aid comprising: a wearable body configured to be fitted to a limb of the simulated patient or manikin, the wearable body having a blood pressure measurement portion around which an inflatable cuff can be provided when the wearable body is fitted to the said limb, the blood pressure measurement portion having a pressure receiving surface which is moveable responsive to pressure exerted by a said inflatable cuff on the said pressure receiving surface; at least one sensor configured to measure a parameter indicative of a pressure exerted by said inflatable cuff on the said limb in dependence on movement of the said pressure receiving surface; one or more devices for providing a blood pressure measurement simulation output; and a controller configured to receive measurements of the said parameter from the said at least one sensor and to cause a change to the said output of one or more of the said one or more devices responsive to the said received measurements to thereby facilitate a simulated blood pressure measurement in accordance with a predetermined simulated blood pressure.
21. A method of facilitating simulated blood pressure measurements on a simulated patient or manikin, the method comprising: fitting a wearable body of a training aid to a limb of the simulated patient or manikin, the wearable body having a blood pressure measurement portion comprising a pressure receiving surface; providing one or more devices for providing a blood pressure measurement simulation output; providing an inflatable cuff around the blood pressure measurement portion of the wearable body; inflating the inflatable cuff, thereby exerting a pressure on, and moving, the pressure receiving surface; measuring a parameter indicative of a pressure exerted by the inflatable cuff on the said limb in dependence on the said movement of the pressure receiving surface; and causing a change to the output of one or more of the one or more devices responsive to the said measurement of the said parameter to thereby facilitate a simulated blood pressure measurement in accordance with a predetermined simulated blood pressure.
PCT/GB2017/050027 2016-01-07 2017-01-06 Training aid WO2017118861A1 (en)

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US7510398B1 (en) * 2000-10-30 2009-03-31 Board Of Regents Of The University Of Texas System Apparatus for simulating a pulse and heart beat and methods for using same to train medical professionals
US20140342332A1 (en) * 2013-05-17 2014-11-20 Kb Port Llc Universal sphygmomanometer simulator for live training and evaluation

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US7510398B1 (en) * 2000-10-30 2009-03-31 Board Of Regents Of The University Of Texas System Apparatus for simulating a pulse and heart beat and methods for using same to train medical professionals
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