Cognitive and Motor Performance as a Predictor of PAD Vascular Surgical Outcomes

Postoperative assessment of vascular surgery outcomes is critical in clinic operation and health informatics since vascular surgery is associated with high rates of perioperative morbidity and mortality. Moreover, patients who undergo major vascular surgery are at increased risks of myocardial infarction, renal failure, respiratory complications, and death. Accurately identifying which patients are at a high risk of adverse effects or death after major surgery is key for early recognition and treatment of postoperative complications. This study aims to utilize a wearable technology-based system as an objective assessment of frailty for preoperative and postoperative patients to predict post-operational complications, length of hospital stay, and duration of recovery.

Collaborators:Dr. Bijan Najafi (PI), Dr. Joseph Mills (PI), Dr. Miguel Montero (PI), Dr. Ramyar Gilani (PI), Simon Hoeglinger (research intern), Vanessa Hinko (research intern), Noreen Siddiqi (research intern), Lauren Bokaie (research intern), Richard Tran (research intern), Dr. Hadi Rahemi (Postdoc) 

Quantifying the Pep in your Step: Assessing Frailty Status & Gait as Cognitive-Motor Metrics

Primary hyperparathyroidism (PHPT) affects approximately 1 percent of the adult population and is the 3rd most common endocrine disorder in the United States. Parathyroidectomy is the definitive treatment for classical PHPT, which is defined as the presence of symptoms such as osteitis fibrosa cystica, nephrolithiasis, and elevated blood calcium. A vast majority of PHPT patients, 80 percent, present asymptomatically with vague symptoms of the disease such as fatigue, weakness, joint pain, trouble concentrating, and memory impairment. For these asymptomatic PHPT patients, there are no clear guidelines for surgical intervention due to the dearth of objective information on the efficacy of parathyroidectomy in this population. Using wearable sensors, iCAMP designs custom-made algorithms to quantify the motor-cognitive manifestations of PHPT as a method to track outcomes following parathyroidectomy. Using this information, we seek to better understand how parathyroidectomy affects the motor-cognitive impairments experienced by asymptomatic PHPT patients and facilitate the evidence-based clinical decision making in their plan of care.

Collaborators: Dr. Bijan Najafi (PI), Dr. James Suliburk (PI), Noreen Siddiqi (research intern), Dr. He Zhou (Postdoc), Dr. Hadi Rahemi (Postdoc)

Evaluation of Surgical Skills Using Wearable Technology

Surgical trainees are challenged with gaining technical proficiency. In recent times, objective assessment is futile with observer-based methods which is also time consuming and does not follow a strong standard. This challenge has underscored the importance of alternative surgical training techniques outside of the operating room such as hand motion analysis by electromagnetic tracking (EMT) devices. This has been introduced to improve dexterity and reduce the possibility of developing poor technique at early stages. However, the majority of EMT equipment is susceptible to noise, discomfort, and high costs. Despite, ICAMP has developed a novel method of evaluation with new flexible sensors, which are placed on the dorsum of each surgeon’s hands. Capturing parameters (total distance traveled, total time, number of hand movements) among different levels of surgeons can be useful in providing feedback to trainees regarding their progression during residency, and improving their skills.

Collaborators: Dr. Ramyar Gilani (PI), Dr. Bijan Najafi (PI), Dr. Nestor Arita (Resident), Dr. Hadi Rahemi (Postdoc), Dr. Javad Razjouyan (Postdoc)

Using Wearable Technology for Predicting Adverse Events and Outcomes Post-LVAD Implantation

Continuous-flow left ventricular assist device (LVAD) has been used increasingly in patients with end-stage heart failure as a destination therapy and as a bridge to heart transplant. Despite improved technologies and patient management strategies, neurologic complications, including stroke, remains a devastating complication during support of LVAD (10-20%). Neurocognitive impairment is frequent in patient with end-stage heart failure with prevalence ranging from 25-75%, and it is thought to be related to poor cerebral perfusion caused by low-cardiac output, low systolic blood pressure, and impaired cerebral autoregulation. Subsequently, impairment of neurocognitive function can lead to increased risk for neurological complications after LVAD implantation. Therefore, accurate assessment of neurocognitive function is crucial for end-stage heart failure patient before LVAD implantation for understanding risk of postoperative neurologic complications. Using iCAMP-developed algorithms, cognitive function and frailty is assessed pre-LVAD implantation and monitored during ICU recovery. Understanding cognitive recovery post-LVAD implantation may help reduce the number of complications in this population.

Collaborators:Dr. Bijan Najafi (PI), Dr. Masa Ono (PI), Dr. Mary Kim (MS1), Mr. Arash Hamvatan (Research intern), Dr. He Zhou (Postdoc)

Sleep Study: Assessing Heart Rate Response as a Result of Intervention or Disorder Using Body Worn Sensors

iCAMP Sleep Study (320x240)
credit: iCAMPBody worn sensors for sleep study

Objective sleep assessment is needed to diagnose sleep disorders. The gold standard, Polysomnography (PSG-medical code 95810 or 95811), consists of an overnight study in a sleep lab in which patients come to a sleep laboratory where multiple channels of data are collected including:  measures of total sleep time (TST); sleep efficiency (SE); wake after sleep onset (WASO); sleep architecture; and identification of pathological events, including apneas, hypopneas, and periodic leg movements. Advances in PSG equipment have made the collection of these data in their usual sleeping environment, this is the exception. Whether in the sleep lab or home, the collection of PSG data is invasive, disruptive to sleep, and costly (ranging from $1200 to $8,000 in a recent 2013 assessment).  

Actigraphy utilizes a single channel that collects motion data, which is used to infer time spent asleep and wake. Actigraphy is less invasive, less expensive, and the Actigraphy can be worn for extended periods of time in the natural sleep setting. Actigraphy performed over multiple nights may provide more reliable data on sleep measures than PSG, which is more typically performed for only one night. Actigraphy data, usually averaged over several nights, typically includes (TST), (SE), (WASO), information about daytime inactivity, and circadian rhythm data. Many prior studies have compared PSG to Actigraphy. These studies have used different actigraph systems, making direct comparison of devices difficult, as patterns of activity and rest may differ and influence the overall accuracy of specific algorithms for inferring sleep. Population differences in age, gender, and morbidity also influence the accuracy of differing approaches. Sleep duration and quality are important predictors of health outcomes, with growing recognition of the importance of sleep in geriatric populations. It is stated that sleep and sleep quality have profound impact on daily life and quality of life. Sleep, as a part of circadian rhythm, plays an essential role on the general health of elders and is associated with depression. There is a need to identify the optimal approaches for measuring sleep parameters in older populations. Poorer Actigraphy reliability in older adults may be attributable to less activity, which may be misinterpreted as sleep by the wrist-worn Actigraphy, or sleep may be underestimated due to the more frequent nocturnal arousals experienced by elders.

Recent development of body worn sensors has allowed less obtrusive monitoring of sleep, and may provide additional data as they measure activity in three dimensions (three planes: vertical, frontal and lateral), in addition to ECG, and Heart and Respiratory Rate, which are wirelessly transmitted and recorded, and may be readily collected in the natural home setting over a series of days.

Ergonomics: Assessing Heart Rate Response as a Result of Intervention or Disorder Using Body Worn Sensors

surgeon stress (320x240)
credit: iCAMPWearable tech to monitor stress in surgeon in real-time

Physical stress associated with fixed-posture of neurosurgeons over extended periods of time can result in discomfort, fatigue, and musculoskeletal disorders. There are two general factors, an increase in static head and trunk postures and a greater amount of movement required in surgical procedures that contribute to this physical stress. This study is to evaluate the head and trunk motion patterns of neurosurgeons while conducting surgery and to compare the ergonomic variability in movement between skill level of attending and resident surgeons.

Stress Analysis in Surgery Resident: Assessing Heart Rate Response as a Result of Intervention or Disorder

FLS lab 5 (320x240)
credit: Scott HolmesFLS Lab Practicals

Simulation-based training has gained popularity recently. However, few objective and modifiable parameters that may influence operative performance have been identified. This study proposes the usage of an innovative wearable technology to assess physiological stress response during an intensive laparoscopic training course and examine its association with residents’ operative performance. This study examines the association between residents’ operative performance and spontaneous stress level during an intensive laparoscopic training course. The initial results are promising and may open new avenues for identifying objective and modifiable parameters to improve surgical training.

Unobtrusive Physiological Signal Detection During Sedentary Behavior

iCAMP uses wearable tech to assess stress and sedentary behavior in office workers (320x240)
iCAMP uses wearable tech to assess stress and sedentary behavior in office workers

Since office workers spend three fourth of their working hours sitting, unobtrusive physiological signal detection during sedentary behavior may be beneficial to develop a system for early detection of individual serious physiological distress. Conventional heart rate and respiratory monitoring device is obtrusive, inconvenient or uncomfortable so impractical for long-term monitoring. Although wearable devices are more comfortable than conventional ones, they may lead to a problem related to adherence to wearing sensor. This study aims to present a method for unobtrusive monitoring respiration during sedentary behavior using a smart residential flooring or carpet system. Moreover, this study is the first step for designing smart residential carpet or flooring system which can screen physical and physiological activities unobtrusively.

Evaluation of OxySpur Wound Dressing with TransCu O2 to Study Diabetic Foot Wound Healing

Lack of foot sensation with poor skin perfusion could increase risk of limb amputation (320x240)
Lack of foot sensation with poor skin perfusion could increase risk of limb amputation

Specialized wound dressings have the ability to improve specific physiological processes that facilitate healing. However, their specific benefits and target wounds is not well understood. Consequently, these are either underutilized in clinical practice or over utilized without any well-defined criteria. OxySpur dressing in concert with TransCu Oxygen delivery system is a novel wound healing therapy that promises to enhance vascular conditions at the wound bed and expediting wound healing. The body of work in this area suggests opportunities for better patient care using a simple, inexpensive approach that has few adverse effects.

Physical and Cognitive Exercise for Older Adults

iCAMP designed innovative sensor-based virtual reality program to assessing and improving motor-cogn
iCAMP designed innovative sensor-based virtual reality program to assessing and improving motor-cognitive performance

This cross sectional research is to determine if there are difference in gait and frailty measure across the cognitive spectrum between elder groups of “Health”, “Mild Cognitive Impairment (MCI)”, and “Alzheimer’s”. By comparing with the traditional paper based cognitive trail marking test, we plan to show that the participant can benefit much more by using wearable inertial sensors and real-time visual feedback based motorial-cognitive exercises.

STTR Phase I: Smart Residential Carpet for Promoting Aging in Place

iCAMP team explored the application of flexible sensors to track motion and identify risk of falling
iCAMP team explored the application of flexible sensors to track motion and identify risk of falling in older adults

The continuing growth of senior citizen population will bring significant financial and logistical burdens on the nation’s healthcare system. Instead of going to a nursing home or older adults living community, aging in place, enabling senior citizens to continue safely and economically living in their own residences as long as possible, is becoming more and more critical. Aging in place is a promising solution to alleviate financial and logistical burdens on the nation’s healthcare system as well as provide the senior citizen a happy and healthy life. However, currently aging in place is still facing several challenges: in-home detection or prevention of fall and frailty which are clinically crucial because those are major health conditions associated with aging and may cause an increase in delirium, disability, hospitalization, long-term care and death.

To ensure safe and secure aging in place, this project aims to design and commercialize a novel smart carpet system for tele-activity monitoring which not only can track gradual changes in gait and motor performance but also can recognize an emergency circumstance in order to manage the health in senior citizens in unsupervised condition when the risk of falls and frailty are becoming increasingly significant. The proposed technology will have a significant positive impact because it: 1) focuses on aging in place to promote quality of life and alleviate the healthcare costs in senior citizens; 2) focuses on an essential public health issues—risk of falls and frailty—in senior citizens; 3) aims to reduce the possibility of injuries and death in senior citizens using tele-monitoring technique; and 4) provides an objective tool appropriate for context-aware system for successful aging in place in senior citizens.

Using Body-Worn Sensors to Determine the Effect of Stress on Wound Healing in the Diabetic Foot

Excessive wound healing times are a significant risk factor that may lead to amputation of the diabetic foot. To date, objective measures of stress have not been used to determine if stress affects the rate at which wounds heal. Our study used novel real-time monitoring of patient’s heart rate variability to objectively determine stress levels of patients visiting a surgery clinic for wound dressing changes. Wound healing rates of patients with high stress levels were compared to healing rates of low-stress individuals to determine how stress affects wound healing among diabetics.

Postoperative Outcome Management

Assessing postoperative outcome after major pulmonary resection, such as lobectomy or pneumonectomy, is essential in clinic operation and health informatics since the major thoracic surgical procedures are associated with high morbidity and mortality rate. Moreover, patients with lung cancer who undergo a surgery experience greater fatigability, a reduction in exercise tolerance, muscle weakness and compromised quality of life as a direct consequence of their disease or as an indirect consequence of their cancer therapy. This project aims to design a wearable technology-based system for pre-operational and post-operational management of postoperative outcomes in patients who undergo lung surgery, which is able to not only assess pre-operative fragility, length of hospital stay and duration of recovery from surgical procedures but also pre-operative conditioning.

Managing Chemotherapy Induced Neuropathy in Cancer Patients Using Exergaming (R21)

Falls are a considerable health concern for older adults, including people with cancer. The Centers for Disease Control report that falls are the leading cause of injury and death. People who receive chemotherapy for cancer are more likely to fall compared to people who do not receive cancer treatment. Problems associated with cancer including anemia, fatigue, pain, and reduced functional status may contribute to fall risk. One of the major risk factors for falls in cancer patients is chemotherapy induced peripheral neuropathy (CIPN). CIPN is a dose limiting side effect of many important classes of chemotherapeutic agents, such as taxanes, platinum-based drugs, vinca alkaloids, proteasome inhibitors, and others. Although the incidence of CIPN varies among exposure to drug class, approximately 30-40 percent of cancer patients are affected by CIPN. Loss of balance (57%), muscle weakness (57 percent) or lack of coordination (14 percent) are major self-reported symptoms in patients with CIPN. Among different CIPN-related symptoms loss of balance and walking difficulty have been identified as the leading risk factors for falls.

The innovating proposed research project is using validated wearable technology for objectively assessing CIPN-related balance and gait deficits and estimating fall risk and improving balance and gait performance using Exergaming including sensor-based feedback from lower extremity joint movement and position. The interactive and game features in particular could be beneficial for cancer survivors, who often suffer from cancer-associated fatigue and depression and thus may require specific exercise strategies such as game-based training to foster adherence to home-based exercises.

AVEX FootBeat-Micro Mobile Foot Compression Device for Reducing Lower Extremity Edema in Patients with Diabetes

Diabetic foot ulceration (DFU) is a common and largely preventable complication of diabetes. While most of these ulcers can be treated successfully, some will persist and become infected. Ultimately, nearly one fifth of patients with infected lower-extremity diabetic ulcers will require amputation of the affected limb, resulting in staggering costs for both the patient and the healthcare system.

This area has received comparatively little attention from industry, academia, and insurance providers. AVEX Health has designed a novel low voltage, battery powered medical device to assist in the treatment of Diabetic Foot Ulcers. This device is portable and can be used in ambulatory settings providing increased venous blood flow and relief from concomitant lower extremity edema. Additionally, AVEX has teamed up with Boa Technology to incorporate an innovative shoe tightening device named ‘Clutch Reel’ which could enhance the ease of wearing diabetic shoes and provide the right amount of compression at lower extremities with minimal skin friction.

AVEX foot compression device can help improve lower extremity perfusion, whilst improving balance and spatio-temporal parameters of gait. In addition, we aim to assess the effectiveness of the Boa Technology ‘Clutch Reel’ at producing pre-set shoe tightening tension while enhancing the ease of wearing diabetic shoes with the AVEX insole and Clutch Reel, reducing skin friction, and improving patient’s confidence in their gait, mobility, balance, and daily physical activities.

Osteoarthritis Initiative (OAI)

Osteoarthritis affects more than 27 million individuals in the United States. The NIH has long supported research to improve outcomes for patients with this debilitating disease. Knee osteoarthritis is associated with significant pain and development of disability over time. People who are severely compromised have few effective treatment options other than joint replacement. There are differences in the prevalence, incidence and severity of osteoarthritis between men and women and among races. Currently, there are no disease-modifying agents for the treatment of osteoarthritis. The discovery of osteoarthritis biomarkers—including structural characteristics that can be observed with MRI—could lead to identification of new treatment targets and mechanisms for shorter, more efficient trials of disease-modifying agents.

The Osteoarthritis Initiative (OAI) is a multicenter, longitudinal, prospective, observational study of knee osteoarthritis (OA) that was launched by NIH in 2002. The overall aim of the OAI is to develop a public-domain research resource to facilitate the scientific evaluation of biomarkers for osteoarthritis as potential surrogate endpoints for disease onset and progression. The goals of the OAI were to enroll approximately 5,000 subjects with risk factors for early knee osteoarthritis, and to collect clinical and imaging data and biological specimens from these participants for originally four, and now eight years of follow up.

Upper Extremity Frailty Assessment Tool

An older fit patient who goes though traumatic accident can benefit from routine emergency care, while a frail older individual with higher vulnerability to stressor requires a more complex care by a multidisciplinary team of clinicians to avoid adverse outcomes. This research will provide a quick and simple tool to improve identification of vulnerable frail population.

Portable Device for Telecare Monitoring of Elderly People (Funded by NIH/NIA STTR Phase IIB)

As baby boomers age, and their expected life span increases, the number of U.S. elders aged 65 and over will dramatically rise, producing unprecedented need for effective, low cost diagnosis, treatment and monitoring of home and community-dwelling elders. This study aims to develop and commercialize a novel wearable technology for activity monitoring of elders using a single and easily wearable sensor. The proposed technology allows remote and continuous clinimetrically relevant screening of elder’s risk of falling as well as early detection and targeted intervention of those at risk of frailty.

Managing Chemotherapy Induced Neuropathy in Cancer Patients Using Exergaming (Funded by NIH/NCI)

Cancer patients suffering from chemotherapy-induced peripheral neuropathy (CIPN) have a significantly higher risk of falling than their peers due to insensitivity in the lower extremities causing deficits in keeping balance during standing and walking; however, appropriate exercise training programs for these patients have not been developed. Conventional fall prevention training may not be well suited for these patients because 1) the exercises may be too difficult; and 2) many existing exercises do not incorporate visual feedback, which is critical, given the impaired proprioception associated with peripheral neuropathy. We propose to evaluate a system consisting of three wearable movement sensors and software that provides visual feedback of lower extremity position in a game-based, motivational, virtual environment to facilitate performance of specific exercises in cancer patients exposed to neurotoxic chemotherapy to mitigate CIPN-induced balance problems and increased fall risk.

Massive Weight Loss and Its Effect on Postural Stability and Fall Risks (Funded by NIH/NIAMS –R03)

Critical gap exists in how massive weight loss impacts postural stability and fall risks in obese adults with knee osteoarthritis (OA). Persistence of this gap delays reducing fall risks and improving motor function. The long-term goals are to create innovative interventions that minimize fall risks and to develop new methods of detecting fall risks in this population. The objective of the proposed study is to test if massive weight loss after bariatric surgery in adults with knee OA is sufficient to improve key factors contributing to postural instability and fall risks: knee pain, atypical gait, and a decreased ability to control the center of mass (COM). Despite the known effects of obesity on postural stability, we know little about if adults who have massive weight loss improve postural stability based on spatial-temporal gait and COM measures. There is also limited evidence on if improvements in postural stability occur on flat ground and tasks beyond flat ground walking. Most importantly, there are few objective measures after bariatric surgery related to activities outside of the lab. The proposed research is significant because it can lead to a new science focused on quantification, detection, and intervention