Sensing a problem
By David Goddard
One of the biggest stumbling blocks for medical practitioners is something that is inherent to patients themselves: human nature.
“People have a tendency to relate back to their doctors only the good news, unless something really bad happened,” says assistant professor of biomedical engineering Eric Wade. “It’s like how everyone tells their dentist that they foss regularly, when maybe they only remember once a week.
“You have the same thing with patients undergoing rehab or treatment who only relate back the progress they are making, but not the times that they took shortcuts.”
That’s where biomedical sensors come into play. Such sensors, capable of registering a wide array of data, could help patients, doctors, and facilities alike gain a better picture of two key populations: patients recovering from strokes, and those dealing with the mobility-impairing effects of Parkinson’s disease.
For stroke rehabilitation, incorporating prescribed exercises into daily living is vital for patients to rebuild muscle strength. The problem is what is known as the “vicious cycle:” Patients find the exercise hard, so they don’t do them fully or correctly. In turn, patients experience even more loss of function, making the exercises even harder to accomplish.
By monitoring these activities through wearable sensors, patients and doctors would know if they were doing the required amount of work, and doing it correctly.
“A lot of quality of life is related to being able to use your upper extremities,” said Wade. “What happens a lot of times is that patients might lean in with their torso to help lift an object or complete an exercise, but that limits the redevelopment of the motor function in their hands and arms. Sensors would help them distinguish between good and bad movement strategies.”
Wade’s research is being completed through a partnership with Columbia University and Chapman University. His team receives ongoing data from 20 stroke patients to help decide what information is most useful in developing the sensors, which resemble Fitbits that people use to track their steps.
Since what works best or is more important for one patient might not be true of another, Aaron Miller, a graduate research assistant on the team, is using an algorithm to figure out the best overall methodology for the devices to capture patient behavior.
The biggest hurdle is that most people do even the simplest tasks differently, so finding a “best fit” for overall use will prove critical. Eventually, the goal is to have the monitoring data available in real time via cell phone apps.
Improved mobility, awareness
Unlike stroke patients who can choose to stop their rehab exercises, patients with Parkinson’s may suffer from freezing of gait, an attribute that can lead to uncontrollable falling or instability. Wade is tackling the problem with backing from the National Science Foundation.
Parkinson’s patients have reduced levels of dopamine, a compound in the brain that helps transmit signals to the body that coordinate motion, among other things. As a result, neurological resources can rapidly become swamped when presented with too many decisions, leading to a freeze in motion. It can be as simple as just stopping in place or as dangerous as falling to the ground.
Wade partnered with neurologist Michelle Brewer—who sees roughly half of all Parkinson’s patients in East Tennessee—to develop a way to identify what might trigger such freezes.
“Our plan is to use advanced sensors to observe what happens in the body when patients come to a normal stop versus when they have a freezing gait episode,” said Wade. “If we can figure out the differences, we might be able to identify what causes such episodes and develop a way to prevent them.”
Past research has shown patients are less likely to fall when walking over tiled floors or carpets with patterns as opposed to walking on uniformly toned surfaces, for example.
In a separate project, Wade is using virtual reality to help train the Parkinson’s-affected brain for particular environments. Patients are able to “walk” through virtual recreations of environments they frequently encounter, helping pre-wire their brains to the layout. Ideally, once they are comfortable functioning in the virtual realm, their brains will have less to process in the real world.
Less processing equals more stability, helping ensure the safety and well-being of patients, one step at a time.