University of Waterloo
Date
Title of Project: (Insert Title)
Principal Investigator: (Insert Name of Researcher)
University of Waterloo, Department (Insert Dept Name)
519-884-4567 Ext. (Insert extension)
Student Investigator: (Insert Name of Student Researcher, if applicable)
University of Waterloo, Department of (Insert Dept Name)
519-884-4567 Ext. (Insert extension)
The purpose of this study is to investigate how normal healthy people pick up
objects. The findings from this study will be important in advancing our
understanding of how the sense of touch (haptics) and vision are used in the
control of reaching and grasping movements. These findings have potential
application in the rehabilitation of reaching and grasping abilities after brain
injury, and in the design of robot hands.
Sixty people in total will be asked to pick up a small disk that has been fitted with
a mechanism that can measure how much force you produce, or how hard you
press with your fingers when you grasp the disk. As a participant in this study,
you will be assigned to one of three different groups. One group will be asked to
pick up a disk that weighs either 150g, 200g or 250g and the disk will be covered
with different textures (e.g., silk, suede or sandpaper). There will be color codes
relating a single colour to a mass or texture. A second group will grasp the same
objects. However, there will be no relationship between the colour codes and the
mass or texture of the object. Finally, a third group will grasp the same objects
with no colour coding. You will have a one in three chance of being in any of the
groups. In total, each participant will perform 110 lifts. The study will require
about one hour of your time.
The collected data will be coded with participant numbers (not names) and will be
kept in a locked area for five years after publication. After this time, all paper
copies will be shredded and computer disks erased. Average data will be
presented in all publications, and if an individual participant’s data are presented
in a figure, names or any identifying information will not be included. You may
withdraw from the study at any time without penalty by verbally indicating this to
the researcher. There are no known risks associated with participating in this
study.
I would like to assure you that this study has been reviewed and received ethics
clearance through a University of Waterloo Research Ethics Committee.
However, the final decision about participation is yours. Should you have any
comments or concerns resulting from your involvement in this study, please
contact Dr. Maureen Nummelin, the Director, Office of Research Ethics, at 1-519888-4567, Ext. 36005 or maureen.nummelin@uwaterloo.ca.
If you have any questions later or require additional information about the study,
please feel free to contact either of the researchers at 519-884-4567 Ext. (Insert
extension).
CONSENT FORM
By signing this consent form, you are not waiving your legal rights or releasing
the investigator(s) or involved institution(s) from their legal and professional
responsibilities.
______________________________________________________________________
I agree to take part in a research study being conducted by Dr. (Insert
researcher name) and (Insert student researcher name) of the Department of
(Insert Dept Name), University of Waterloo.
I have made this decision based on the information I have read in the Information
letter. All the procedures, any risks and benefits have been explained to me. I
have had the opportunity to ask any questions and to receive any additional
details I wanted about the study. If I have questions later about the study, I can
ask one of the researchers (list names, departments, telephone numbers of
investigators).
I understand that I may withdraw from the study at any time without penalty by
telling the researcher.
This project has been reviewed by, and received ethics clearance through a
University of Waterloo Research Ethics Committee. I am aware that I may
contact this office (519-888-4567, ext. 36005) if I have any concerns or questions
resulting from my involvement in this study.
____________________________
Printed Name of Participant
____________________________
Signature of Participant
____________________________
Dated at Waterloo, Ontario
____________________________
Witnessed