Health Care Technology Today
Check out this fascinating series of posts about technology from APTA’s May 2016 PTinMOTIONmag.org (© 2016 American Physical Therapy Association. All rights reserved).
COULD ‘BIORESORBABLE’ SENSORS HELP INDIVIDUALS RECOVER FROM BRAIN INJURY, SURGERY?
They melt in your brain, not in your hand.
Scientists at the University of Illinois at Urbana-Champagne have created a sensor they hope one day can be implanted in the brains of patients to monitor and wirelessly transmit data on pressure and temperature within the skull for a time, and then simply resorb into the body. Researchers believe the new approach could help make physical therapy less complicated for individuals recovering from brain injury or surgery (no more external wires in the way) and reduce the incidence of infection, allergic reaction, or other complications associated with implanted sensors that require external wiring and eventual surgical removal.
Described in a report in Science Daily as “smaller than a grain of rice,” the sensors are made of thin sheets of naturally biodegradable silicon that send data to a transmitter “roughly the size of a postage stamp” implanted under the skin of the skull. This transmitter in turn feeds temperature and pressure data to monitoring equipment, all without the use of external wires.
So far, the new technology has only been tested on rats, but researchers tell Science Daily that the measurement precision of the dissolvable sensors “was just as good as that of the conventional devices.” Results of the animal testing were published in the January 18 issue of Nature.
Rory Murphy, a neurosurgeon at Washington University and part of the research team, told Science Daily that “the ultimate strategy is to have a device that you can place in the brain—or in other organs in the body—that is entirely implanted, intimately connected with the organ you want to monitor and can transmit signals wirelessly to provide information on the health of that organ, allowing doctors to intervene if necessary to prevent bigger problems. After the critical period that you actually want to monitor, it will dissolve away and disappear.”
According to Science Daily, researchers are “moving toward” human trials of the technology, and looking at other possible areas of the body that would be well-suited for this type of monitor-ing system. They also hope to investigate ways the technology could be used to deliver electrical stimulation or drugs.
INTERNET OF THINGS CROWDSOURCING COMPETITION BEGUN
A crowdsourcing competition has been launched to use the Internet of Things (IoT) to improve the quality of life for people who are elderly. The IoT is the network of physical objects—devices, vehicles, buildings, and other items embedded with electronics, software, sensors, and network connectivity—that enables these objects to collect and exchange data.
The AAL (Active and Assisted Living) Smart Aging Prize is offering a €50,000 (50,000 euros; about $54,700) cash prize for the winner. According to the promoters, the judges will be “looking for solutions that improve connectivity between older people in any aspect of life—at home or at work, with transport and mobility or with any other service older people may want or need.” The competition is being run by the AAL Programme, a €700 million funding initiative run by the European Commission focused on developing solutions for active and healthy aging.
Fifteen of the most promising applications will be chosen as ﬁnalists and will be invited to a dedicated social innovation mentoring academy in Brussels in July. The ﬁeld will be narrowed down to 5 applicants who will have the opportunity to attend the AAL Forum in Switzerland in September.
HEALTH APPS GET A CHECKUP: REPORT RATES IOS AND ANDROID OFFERINGS
If the multitude of health and ﬁtness apps
were lumped together and assigned an overall letter grade based on quality ratings from their customers, they’d be pulling an uninspiring “D,” according to a new analysis. But that doesn’t mean there aren’t some individual standouts among the nearly 8,000 apps and 4 million reviews included in the study.
The review, conducted by the ARC (Application Resource Center) research group, began with 8,000 apps but focused closely on the 65 most popular Android and iOS app brands in 5 catego-ries: ﬁtness, medical, nutrition, stress relief, and women’s health. Final ratings were based on app store feedback during 2015, and while the overall average was a fairly undazzling 66 out of 100, it’s a number that obscures what ARC describes as some of the “amazing” satisfaction ratings of a few individual offerings.
Here is ARC’s list of the top 3 performers in each category:
- StrongLifts (muscle-building workouts) – average score: 88
- Sworkit Lite (“personalized video workouts”) – average score: 84.5
- Sports Tracker (activity tracker) – average score: 80
- GoodRx (prescription drug pricing and information) – average score: 84.5
- iTriage (medical information, symptom-based information) – average score: 82.5
- iPharmacy (drug and pill identiﬁer) -average score: 82.5
- Water Drink Reminder (“stay healthy and hydrated all day”) – average score: 85
- Calorie Counter by MyFitnessPal: -average score: 83
- LoseIt! (weight loss app) – average score: 82.5
- Relax Melodies – average score: 88.5
- White Noise – average score: 83.5
- White Noise (free version) – average score: 82
- Period Calendar/Tracker by Abishkking -average score: 94.5
- Period Tracker by GP Apps – average score: 88.5
- Period Tracker by SevenLogics -average score: 87
Surprisingly, some of the biggest names in health and ﬁtness apps were among those with “room to improve,” according to the ARC report, with quality scores that averaged below 50. Those lower-rated apps included FitBit (49.5), Weight Watchers Mobile (47), Google Fit (37 – Android only app), and Garmin Connect Mobile (21).
However, low-scoring apps aren’t necessarily destined to stay that way, the report notes. One example: Jawbone’s UP ﬁtness tracker improved its 2015 average to 54—a 12.5-point improvement over 2014’s rating average. The report links the improvement to the inclusion of a “Smart Coach” feature and a new line of bands that are more durable and ergonomic.
SENSOR TECHNOLOGY HELPS PEOPLE WHO ARE ELDERLY AGE IN PLACE
Sensor technology and onsite care coordination can help people who are elderly remain longer in an independent living community than in a setting without those features, according to researchers at the University of Missouri. In fact, care coordination doubled the length of stay; sensor technology again nearly doubled length of stay.
Researchers monitored length of stay at TigerPlace, an independent living community. The residents received care coordination from an onsite interdisciplinary team that addressed both physical health concerns and mental health and relationship-based concerns. Some of the residents had sensors in their apartments that monitored walking patterns for respiration rate, restlessness and pulse, falls, and increasing risk of falls. The information was relayed to the care coordinators.
Researchers found that residents who lived with sensors had an average length of stay of 4.3 years, compared with a stay of 2.6 years among residents without sensors. The national median for time older adults spend in senior housing is 1.8 years, according to the researchers. Comparing the cost of living at TigerPlace with the sensor technology versus living in a nursing home, the researchers calculated potential savings of about $30,000 per person. Savings to Medicaid-funded nursing homes, assuming the technology and care coordination were reimbursed, was estimated to be about $87,000.
Marilyn Rantz, curators professor emerita in the MU Sinclair School of Nursing, said, “With the sensors, [the health care providers] get a heads up several days or weeks before the health condition becomes serious—before people will even detect it themselves and complain about it. It’s all about early detection.”
Rantz M, Lane K, Phillips LJ, et al. Enhanced registered nurse care coordination with sensor technology: impact on length of stay and cost in aging in place housing. Nursing Outlook. 2015:63(6), 650-655.
WHEELCHAIR CONTROLLED WITH BRAIN-MACHINE INTERFACE
Neuroscientists at Duke Health report they have developed a brain-machine interface (BMI) that allows primates to use only their thoughts to navigate a robotic wheelchair. According to Miguel Nicolelis, MD, PhD, co-director of the Duke Center for Neuroengineering, “In some severely disabled people, even blinking is not possible. For them, using a wheelchair or device controlled by non-invasive measures like an EEG may not be sufficient. We show clearly that if you have intracranial implants, you get better control of the wheelchair than with non-invasive devices.”
The scientists began the experiments in 2012, implanting hundreds of microﬁlaments in the premotor and somatosensory regions of the brains of 2 rhesus macaques. They trained the animals by passively navigating the chair toward the goal, a bowl containing grapes.
During the training phase, the scientists recorded the macaques’ large-scale electrical brain activity. The researchers then programmed a computer to translate brain signals into digital motor commands that controlled the movements of the wheelchair. As the monkeys learned to control the wheelchair just by thinking, they became more efficient at navigating toward the grapes and completed the trials more quickly.
The procedure measured the activity of nearly 300 neurons in each monkey. The lab previously had reported the ability to record up to 2,000 neurons using the same technique. The team said it hopes to expand the experiment by recording more neuronal signals to increase the accuracy and ﬁdelity of the primate BMI before seeking trials for an implanted device in humans, Nicolelis said.
The researchers added, “The present results support our recent clinical observation that when paraplegic patients are subjected to intense BMI training, they not only become capable of regaining walking, using a robotic exoskeleton, but they also can exhibit signs of partial neurological recovery of sensorimotor and autonomic functions … . We raise the hypothesis that BMIs can lead to partial neuro-logical recovery or even augment brain function because their chronic and continuous use may trigger widespread cortical plasticity and the emergence of new cortical representations. As such, BMIs will likely have a profound clinical impact.”
Rajanagam S, Tseng, PH, Yin A, et al. Wireless cortical brain-machine interface for whole-body navigation in primates. Sci Rep March 2016. doi:10.1038/srep22170.
DEEP BRAIN STIMULATION TECHNIQUES TO BE TESTED ON SPINE
A researcher at Vanderbilt University is investigating whether intraspinal microstimulation technology can restore complex body movements. Peter Konrad, MD, PhD, and his research team are seeking volunteers to participate in a proof of concept experiment. Konrad notes that another researcher has shown that there are areas along the spinal cord, called central pattern generators, that are programmed to elicit certain types of body responses—what Konrad calls “a sweet spot of stimulation that can induce complex stepping movements.”
Researchers at the University of Louisville have used a method called epidural stimulation, which involves placing electrodes along the outside of the spinal cord to spur movement. This procedure is commonly used to implant stimulators for pain control. However, Konrad would place tiny wires into the spinal cord, a concept he says is similar to deep brain stimulation surgery. The wires would be much smaller than a strand of human hair.
“We are talking about a 0.1 millimeter to 0.2 millimeter sweet spot on the cord,” Konrad explains. “That makes it a very small area. If you stimulate one area of the cord, you can get a certain type of movement. You move it half a millimeter; you get another type of movement. If we can ﬁnd that this sweet spot is lying dormant in people who are paralyzed, then there will be an enormous incentive to develop a device to awaken it.”
USDA ISSUES DRAFT GUIDANCE FOR INTEROPERABLE MEDICAL DEVICES
The US Food and Drug Administration (FDA) has issued draft guidance on design considerations and pre-market submission recommendations for interoperable medical devices. Such devices can exchange and use information through an electronic data interface with another medical device, product, technology, or system. They can range from simple 1-way transmission of data to command and control of other devices.
As the FDA explained, “The failure to establish and implement appropriate functional, performance, and interface requirements during product development may lead to the exchange of inaccurate, untimely, or misleading information. It may also lead to device malfunction, including the failure to operate, and can lead to patient injury and even death.”
The document issued by the FDA provides manufacturers with design considerations when developing interoperable devices and recommendations regarding information to include in premarket submissions and device labeling.
The draft guidance listed the following considerations:
- Purpose of the electronic data interface. This should include the type of data exchanges—whether the device is sending, receiving, or issuing commands.
- The anticipated users. These may include clinical users, biomedical engineers, IT professionals, system integra-tors, system designers, and medical device designers.
- Risk management. Manufacturers should consider ways to mitigate risks such as those that arise from others connecting to the electronic data interface, including the risk of inappropriate access to the device.
- Veriﬁcation and validation. Manufacturers should implement and maintain appropriate veriﬁcation and val-idation to ensure that their devices work correctly prior to delivery, during the integration process, and while in use.
- Labeling considerations. Manufacturers should include information that users may need to connect predictably and safely to the interface.
The FDA issued the draft guidance in January and asked for comments by March. It pointed out that guidance documents do not establish legally enforceable responsibilities. Instead, they describe the agency’s current views on a topic and should be viewed only as recommendations.
NEW BONE REPAIR TECHNIQUE USES BIODEGRADABLE NANO-SHELLS
Researchers from the University of Michigan have developed a new technique to aid bone repair. The process involves using polymer nano-shells—tiny, biodegradable microspheres—to transport microRNAs (miRNAs) across cell membranes to reach bone wound sites. Once the miRNAs reach the site they can instruct their host cells, switching on healing and bone-building mechanisms.
The problem has been that miRNAs are negatively charged, as are the cell membranes, making it difficult for the miRNAs to cross the membranes. In addition, “naked” miRNAs rapidly degrade. Putting them inside a shell allows them to cross the cell membranes and maintain their viability.
The process uses the body’s own cells—rather than foreign cells, which are more likely to be rejected. Polymer vectors, already in use, are less likely to trigger an immune response, but polymer vectors often have low transfection efficiency. Using the body’s own cells and the slowly degrading shells appears to help overcome these problems.
The researchers commented, “Approximately 200 million people suffer from osteoporosis worldwide, and their bone-healing capacity is severely compromised. In this work, the long-term highly efficient … delivery is shown to locally rescue the osteogenic capacity of osteoporosis-impaired osteogenic cells for bone regeneration, demonstrating the potential to repair bone for osteoporotic patients and possibly patients with other impaired bone regeneration capacities. This technology could deliver other therapeutic nucleic acids (DNAs, mRNAs, siRNAs, miRNAs, and so on) or their inhibitors to regenerate other tissues or to treat other diseases.”
Zhang X, Li Y, Chen YE, et al. Cell-free 3D scaffold with two-stage delivery of miRNA-26a to regenerate critical-sized bone defects. Nat Commun. 2016:7(10376). doi:10.1038/ncomms10376.
SOFT ROBOTIC GLOVE DEVELOPED
A research team from the National University of Singapore has developed a robotic glove that it says is an improvement from conventional robotic hand rehabilitation devices. According to the team, the EsoGlove “has sensors to detect muscle signals and conforms to the natural movements of the human hand, reducing discomfort and injury. This robotic glove is also compact and portable, so patients who are recovering at home or are bedridden could carry out rehabilitation exercises with greater ease and comfort.”
The EsoGlove is connected to a pump-valve control system that modulates the air pressure, which, in turn, directs the soft actuators. When the actuators are pressurized, they apply distributed forces along the length of the ﬁnger to promote ﬁnger movement. According to the researchers, the device uses an intuitive control mechanism that couples electromyography and radio-frequency identiﬁcation technologies.
“With this feature, the robotic glove can detect a patient’s intent to perform a hand action on a particular object, such as picking up a pen or holding a mug,” the researchers said.
APP DEVELOPED TO DEMONSTRATE SYMPTOMS OF SPORTS CONCUSSION
Students and professors at the University of Arizona have developed an app to demonstrate to athletes the symptoms of concussion.
Called BrainGainz, the app is used by placing a smartphone into Google Cardboard—a virtual-reality headset available for as little as $15—or a compatible box. With a smartphone slipped inside the cardboard headset, BrainGainz users ﬁnd themselves standing on the ﬁeld in Arizona Stadium. Users ﬁrst practice punt returns with a virtual teammate. Their response times and vision are normal. Later, after being virtually tackled by Arizona linebackers, users have to make a choice: Get back in the game or allow time for recovery. Users experience additional game-style plays and are repeatedly asked whether they want to give their heads and bodies time to recover, or stay in the game.
The longer the athlete stays in the game without allowing time for recovery, the more the virtual reality view shows the athlete how his vision and awareness would change with a concussion.
According to the school, “The app’s universal accessibility will allow it to [have an impact on] football players of all ages. High school coaches will have the opportunity to make daily BrainGainz use a requirement for teenagers who wish to remain on the team. Pros, with signiﬁcantly more independence, also will be able to take advantage of the app.”