Innovative Method for Sensor-Based Frailty Assessment in Survivors of Childhood Cancer
Survivors of childhood cancer are at risk for premature onset of aging-associated health conditions and higher rates of physical impairment than an age-matched general population. The Fried criteria measure physical features of frailty and have been applied to large cohorts of adult survivors of childhood cancer. However, this method is time-consuming and requires specialized training to administer. Alternatively, the upper extremity frailty (UEF) meter leverages sensor technology to rapidly and accurately predict frailty and pre-frailty. The application of this technology has thus far been limited to geriatric populations. In our collaboration with children hospital, we are testing the feasibility of UEF assessment in adolescent and young adult survivors of childhood cancer, and compare mean frailty index (MFI) in survivors to age-matched controls.
Collaborator: Dr. Bijan Najafi, Dr. Maria M. Gramatges, Dr, Mohsen Zahiri, Dr. Gu Kang.
Tele-Rehabilitation for Patients with Chronic Obstructive Pulmonary Disease
COPD and CHF are a chronic inflammatory lung disease that causes obstructed airflow from the lung and a chronic heart disease that cannot pump blood adequately to the body, respectively. They affect millions of people in the United States, and are leading causes of death. Lifestyle change, disease education, and regular exercise is critical to reduce negative effects of COPD and CHF and improving the quality of life. However, receiving specialty care within the Veteran Affair is challenging since some veterans live in rural area where access is limited. Furthermore, function mobility in patients with COPD and CHF is limited; therefore, regular transport to the clinic is problematic. To improve accessibility of care to veterans, the VA has piloted the use to remote tele-rehabilitation to bring care into home; thus reducing the need to visit the clinic. In this collaborative project, a cardiovascular and pulmonary tele-rehabilitation clinic is setup at the VA medical center in Houston, Texas. Using wearable sensor, we aim to develop objective metrics to measure the improvement of the function performance of patients undergoing the intervention.
Collaborators: Bijan Najafi, Ph.D. (PI), Amir Sharafkhaneh, M.D. (PI), Mon S. Bryant, Ph.D., P.T., Christina Nguyen, R.R.T., R.P.S.G.T., Gu Kang, Ph.D., Ilse Ruiz, M.D.
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)
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 patients 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)
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.
Mobility performance assessment for chemotherapy decisions
Accurate performance status (PS) assessment is important for chemotherapy decisions throughout the illness trajectory, but current tools to assess PS are subjective, static and prone to inter-observer and recall biases. Wearable activity monitors may provide both an objective and dynamic digital biomarker of PS. This was a feasibility study to compare ECOG PS to postural and walking data from a PAMSys monitor, a triaxial accelerometer, in patients receiving chemotherapy.
Contributors: Bijan Najafi (PI), Yvonne Hsiao-Fan Sada (PI), Sudha Yarlagadda (postdoc), Changhong Wang (postdoc), Jinna Chu (student intern)
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