EH 4_2015

www.mediaform.de Secure identification No medical treatment errors Personalised medication labels Bedside scanning SCAN2PRINT: MORE PATIENT SAFETY EUROPEAN HOSPITAL  Vol 24 Issue 4/15 4 NEWS & MANAGEMENT Sensory-enhanced leg prosthesis sends messages from sole to brain On the wrist is better than in a mobile Just like a healthy foot Smart watch promises smarter medicationWhile Swatch and Rolex count the hours until their smart watches overwhelm the time market, medical informatics researchers have already been working on solutions to improve healthcare. Some demonstrated their work on a medication reminder application during the Medical Informatics Europe conference in Madrid. Report: Michael Krassnitzer ‘It’s like a new lease on life,’ says Wolfgang R, ‘I can feel the differ- ence between grass and concrete again.’ Eight years ago the Austrian teacher‘s lower leg had to be ampu- tated following thrombosis. Today, he is the first leg amputee, world- wide, to sport a sensory-enhanced prosthesis. ‘For the wearer the pros- thesis is not a numb object, but a part of the body,’ says Dr Hubert Egger, who developed this unique and highly advanced device in the Department of Medical Engineering at the University of Applied Sciences, Upper Austria. Just like a healthy leg, the sensory- enhanced prosthesis sends informa- tion from the sole to the brain. The new prosthesis is based on a commercially available high-tech prosthetic foot with auto-adaptive joint and a carbon sole by British manufacturer Blatchford. ‘The moment the wearer’s sole touches the ground the sensors register the pressure,’ Dr Egger explains. The electric signals are transmitted to the prosthetic shaft where actuators – similar to those we know from smartphones – start to vibrate. The vibrations are detected by receptors in the stump, converted into electri- cal signals and transmitted to the brain via sensory nerves. However, the transmission process requires the stump to be surgically reinnervated. During an amputa- Report: Mélisande Rouger Successful therapy depends on various factors and the patient’s adherence to treatment is key. However, everyone knows it’s just as easy to swallow a pill as to forget doing so; and the more pills needed, the higher the probability is to not remember when and which pill to take, and how many. The smart phone industry tack- led the issue first and several apps have been designed for this purpose. However, research shows that those tools are not as effective as they should be, said research associate at the medical informatics depart- ment at Heilbronn University, Monika Pobiruchin, when presenting her team’s work on a multiple medication reminder solution during the confer- ence. ‘People simply forget to look at their phones or to put the alarm on,’ she said. ‘They sometimes miss the alarm, especially when their phone is at the bottom of their bags, and so on.’ In addition, smart phones are not appropriate for the digitally illiter- ate and many elderly people. Smart phones are complex, multi-purpose devices and readability and interac- tion concepts can become technologi- cal barriers for the non-initiated, such as the elderly, who are more likely to consume pills than any other popula- tion group. On the contrary, wristband watches have been increasingly used since WWII and the elderly tend to wear such devices; smart watch-based solu- tions are therefore an ideal option for this group, according to Pobiruchin, whose work targets a large group of patients regardless of age or technical affinity. She and her colleagues evaluated several smart watch models, some of which are already on sale, such as Androidly, Neptune Pine, Exetech XS-3, qOne Smart Watch, Omate TrueSmart, LG GD910 and Samsung Gear S. They looked at whether the operating systems of the devices were open and whether apps could be developed, and they also checked the watches’ battery capacity, auton- omy, weight and size. ‘It doesn’t make sense to have to recharge your watch every six hours, nor does it make sense to have an 18-hour-long autonomy only, as is the case for the Apple Watch. The smart watch shouldn’t be bulky, but light to wear around your wrist,’ Martin Wiesner, Pobiruchin’s col- league, pointed out. They singled the Samsung Gear S out as particularly handy because it works on a stand-alone mode, i.e. it doesn’t need to be connected to a computer or phone constantly. ‘The advantage is that you don’t need to pair it with a smartphone via a Bluetooth connection, so no extra device needs to be carried around,’ Wiesner explained. A multiple medication reminder solution for the elderly is only the beginning, as smart watch-based applications could also be developed for diabetics to measure their blood glucose level, or as a simple reminder for women to take their contracep- tive pill. A discrete alarm could also remind users that they need to take a medicine when for instance they have to deal with hypertension, Pobiruchin suggested. Wristband watches are associated with allergies and the smart versions are no exception. ‘I heard of some issues with the Apple Watch and that some people already had itch- ing and rashes,’ she said. ‘The smart watches we assessed are not labelled “allergy-proof” either.’ tion, usually the nerves are severed for protection purposes deep inside the residual limb’s soft tissue. For the sensory-enhanced prosthesis to function these nerves are reactivated so they can transmit sensory infor- mation again, a procedure called Targeted Sensory Reinnervation (TSR). Severed residual sensory nerves are brought back to the stump’s skin to establish connec- tions with the body’s receptors. In this particular case connections are realised at six points in the stump – where the prosthesis sensors are located. The brain quickly learns to link the vibrations in the prosthesis with the sole. ‘We assume a new repre- sentation of the sole is created in the brain,’ explains Dr Eva Maria Baur, the senior physician at the University Clinic for Reconstructive Plastic and Aesthetic Surgery in Innsbruck, who performed the TSR. appears – as Wolfgang R. confirms. Before his new prosthesis was fitted he had to take opiates intravenously to manage the pain. The inventor of the limb, present- ed in Vienna as a prototype, would like to see widespread use soon. ‘We are morally obliged to make this new technology available to as many people as possible,’ he underlines. He therefore offers his knowledge to technology companies free of charge and hopes that a start up will take this opportunity to enter the market and begin large-scale production of the sensory-enhanced limb. A major benefit for the amputee: phantom pain subsides! ‘Scientists think post-amputation phantom pain is caused by the brain overcompen- sating the lack of sensory informa- tion in the cortical representation of the missing limb. The brain becomes increasingly sensitive up to the point where it creates signals autono- mously,’ Dr Egger explains. When the brain receives information from the foot via the sensory-enhanced prosthesis it no longer has to over- compensate. The phantom pain dis- An electrical engineering graduate from the Technical University, Vienna, Hubert Egger gained his doctorate in Biomedical Technology and Physics there and at the Medical University Vienna and the Seibersdorf Research Centre. From 2000 to 2011, this native South Tyrolean worked for Otto Bock Healthcare Products, a Viennese-based manufacturer of prosthesis, where he developed a mind- controlled arm prosthesis (presented in 2007). The device is controlled by nerve impulses, transmitted via electrodes to enable intuitive and simultaneous move- ments. In 2012 Dr Egger became Professor of Prosthetics at the Upper Austrian University of Applied Sciences in Linz. Monika Pobiruchin received her Diploma in Medical Informatics (comparable with the MSc degree) at the University of Heidelberg in 2010. Currently she is a research associate at the GECKO Institute for Medicine, Informatics and Economics at Heilbronn University. She is also a fel- low of the Nachwuchsakademie Baden- Württemberg programme, and, has been a PhD student at the Medical Faculty of the University of Heidelberg since 2012. For her doctoral thesis she investigates the automatic generation of health economic disease models based upon real-world clinical data. Pobiruchin co-founded the project group Consumer Health Informatics within the German Association for Medical Informatics, Biometry and Epidemiology (GMDS) in 2014. With the new prosthesis the leg amputee can even go climbing. Six sensors were fitted to the foot sole of the lightweight prosthesies and these were then linked to stimulators inside the shaft where the amputee’s stump sits. Source:FHOberösterreich Source:Samsung

Pages Overview