New Technology May Help Doctors Monitor Concussions, Aging, and Neurological Function
Date: Feb 7, 2013
Harvard's Wyss Institute develops a computer tablet application that could rapidly assess neuromuscular performance at the bedside
Boston, MA -- Doctors routinely track their patients' hand-eye coordination to monitor any neuromuscular deficits, particularly as patients age or when they are injured -- but the tests they have been using to track this kind of information may be subjective and qualitative.
Researchers at the Wyss Institute for Biologically Inspired Engineering at Harvard University, the Beth Israel Deaconess Medical Center, and Hebrew SeniorLife, Boston (BIDMC), recently completed the first clinical study of a new rapid neuroassessment device they developed to quantitatively measure neuromuscular performance, as reported in yesterday's online Journal of Gerontology: Series A: Biological Sciences and Medical Sciences.
In the study, 150 healthy people from the Boston area aged 21 to 95 used a stylus to follow a moving target around a circle on a computer tablet. As every person performed this tracing task, proprietary computer methods developed at the Wyss Institute measured people's deviations from the circular path, which the researchers then analyzed as a function of age, sex, and handedness. Using this approach, a number can be obtained that can show differences in performance between various individuals or conditions. An older person performs quite differently on the tracing exercise, for example.
A team at Harvard's Wyss Institute and Beth Israel Deaconess have developed a computer tablet application that could rapidly and quantitatively assess neuromuscular performance.
"This new tool may hold great potential to augment existing protocols in a doctor's neuromotor assessment toolbox," said Wyss Senior Staff Engineer Leia Stirling, Ph.D., who led the study. "It is portable, repeatable, quick to administer, and easy to perform." Whereas current methods to assess a patient's neuromuscular function include subjective descriptions of a patient's reflexes and cognitive status, the tracing tool could add a slew of new information displayed as a "score." For example, doctors can record a "score" for "complexity," which relates to how well a person can adapt to changes, and "motion fluidity," which relates to how long the patient pauses during the task. Older subjects involved in the study had lower complexity and motion fluidity scores.
Wyss Core Faculty member Ary L. Goldberger, M.D., who is also the Director of the Margret & H. A. Rey Institute for Nonlinear Dynamics in Medicine at BIDMC, introduced the idea of studying complexity in the human body. "We have demonstrated in earlier studies that a loss of complexity is potentially associated with a range of human health issues from congestive heart failure and sleep apnea to aging," he said.
The team envisions a day when the technology -- which they informally called "NeuroAssess" -- might be used on the playing field and in doctor's offices worldwide. "One day it might sit next to the thermometer and pressure cuff in the doctor's office," Stirling said. "Just as your blood pressure is recorded during every visit, so could your neuromuscular score be tracked over time to determine progress through recovery and rehabilitation." The same technology could be used to assess off-target neurological side effects in human clinical trials.
In the NeuroAssess trial, which involved collaborators from Hebrew SeniorLife in Boston, participants were instructed to use a stylus to follow a moving target on the screen (as shown on the left). The right side of the video shows the performance of one participant, where the red line indicates a horizontal "unrolling" of the target's circular trajectory -- and the blue line indicates the distance from the line that is traced, to the target around the circle. The team developed a series of algorithms that take the data reflecting the distance from the line to compute an actual neuromuscular score for the tracing performance. View video...
Now that the baseline data have been collected from the healthy population of study subjects, the next goal is to determine NeuroAssess' potential to become a quantitative assessment tool for groups of people with neuromuscular pathologies, such as those who suffered concussions or have multiple sclerosis.
The team is currently conducting a study with athletes in the Boston area to determine the sensitivity of the technology in diagnosing concussions.
"The interdisciplinary team who masterminded this new technology represent the best of the Wyss Institute model, which makes it possible for scientists, engineers and clinicians who don't traditionally work together to sit down, dream up game-changing technologies, and more easily and quickly translate them into products for high value applications," said Wyss Founding Director Don Ingber, M.D., Ph.D.
The work was funded by the Wyss Institute, the National Institutes of Health, the G. Harold and Leila Y. Mathers Charitable Foundation, and the James S. McDonnell Foundation. In addition to Stirling and Goldberger, the team included Lewis A. Lipsitz, M.D., Professor of Medicine at Harvard Medical School, Chief of Gerontology at Beth Israel Deaconess Medical Center, and Director of the Institute for Aging Research at Hebrew SeniorLife; Mona Qureshi, Wyss Clinical Research Manager; Damian G. Kelty-Stephen, Ph.D., Wyss Staff Research Scientist; and Madalena D. Costa, Ph.D., Wyss affiliate, Assistant Professor of Medicine at Harvard Medical School and Associate Director of the Margret and H. A. Rey Institute for Nonlinear Dynamics in Medicine at Beth Israel Deaconess Medical Center.
For more information, contact Kristen Kusek
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About the Wyss Institute for Biologically Inspired Engineering at Harvard University
The Wyss Institute for Biologically Inspired Engineering at Harvard University (http://wyss.harvard.edu) uses Nature's design principles to develop bioinspired materials and devices that will transform medicine and create a more sustainable world. Working as an alliance among Harvard's Schools of Medicine, Engineering, and Arts & Sciences, and in partnership with Beth Israel Deaconess Medical Center, Brigham and Women's Hospital, Boston Children's Hospital, Dana Farber Cancer Institute, Massachusetts General Hospital, the University of Massachusetts Medical School, Spaulding Rehabilitation Hospital, Boston University and Tufts University, the Institute crosses disciplinary and institutional barriers to engage in high-risk research that leads to transformative technological breakthroughs. By emulating Nature's principles for self-organizing and self-regulating, Wyss researchers are developing innovative new engineering solutions for healthcare, energy, architecture, robotics, and manufacturing. These technologies are translated into commercial products and therapies through collaborations with clinical investigators, corporate alliances, and new start-ups. The Wyss Institute recently won the prestigious World Technology Network award for innovation in biotechnology.
About Beth Israel Deaconess Medical Center
BIDMC is a patient care, teaching and research affiliate of Harvard Medical School and currently ranks third in National Institutes of Health funding among independent hospitals nationwide. BIDMC is clinically affiliated with the Joslin Diabetes Center and is a research partner of the Dana-Farber/Harvard Cancer Center. BIDMC is the official hospital of the Boston Red Sox. For more information, visit www.bidmc.org