Archives for category: healthcare

In some ways, a lasting traumatic brain injury (TBI) can be the worst kind of injury a person can endure in life. A TBI occurs when the brain is injured by force, and depending on the area affected, an individual is left with difficulty functioning and interacting with their environment. Our movement, sensation, communication, memory and learning is processed and controlled by the brain. When these functions are damaged, the interaction with our world is damaged as well.

Treating traumatic brain injuries may be one of the most emotionally and professionally difficult tasks. In an instant, the development of a person’s years of learning and communication can be erased from an injury such as a blow to the head, possibly leaving someone with the mental capacity and behavior of a toddler. Someone with a traumatic brain injury is often easily confused, unpredictable with their speech and actions, and occasionally aggressive as their frustration with communicating increases and appropriateness is inhibited. I recall treating an older gentleman who was the victim of violence, and just asking him to turn his head caused nausea, visual difficulty, and confusion in following just that simple command.

TBI’s can be divided into three main categories: mild, moderate, and severe. A mild injury often encompasses the kind of TBI that many people experience during their lifetime: a short-lasting concussion with possible loss of consciousness of up to a few minutes. Symptoms are often absent or mild, with some resulting nausea or headache. In a moderate injury, the force of the injury is greater and someone can be unconscious for up to 15 minutes with more lasting symptoms.

The third category is severe TBI’s, which can result from an event such as gunshot wound or the force of an explosion. Severe TBI’s cause permanent damage to the brain and leave lasting effects from which a person generally does not every fully recover. These chronic and lasting effects greatly affect a person’s ability to move, work, communicate with people, and function in society.

Until recently, treatment for people with chronic TBI’s was limited, but there is now hope for progress. A recent study by Chou et al introduced ISRIB, a drug tested in UCSF’s lab which was able to reverse the effects of a TBI in mice. This was done by inhibiting a stress response in the brain commonly associated with TBI. The integrated stress response has been shown to be chronically activated in someone with a TBI, affecting the hippocampus’ ability to store memory and influence healthy cognition. In addition, the drug was able to assist in synthesis of proteins which contribute to learning, in a process called Long Term Potentiation (LTP).

Because the effects of a severe traumatic brain injury can last for months or years before improving, results of treatment for TBI are often slow and inconsistent. Generally, there is no effective protocol treating chronic TBI’s because they are so varied in origin and presentation. This is why the breakthrough from UCSF is so impactive. To possibly reverse the effects of brain damage offers extensive hope and potential for TBI survivors, their families, and their care team.

The absolutely amazing aspect of ISRIB is that it affects chronic effects of TBI. Chronic effects of an injury are very difficult to reverse as the system has often acclimated to its chronic state, making the effects more stable and difficult to change. It is incredible that a drug has been developed to not only inhibit the pathway of a TBI, but reverse its deleterious and long-lasting effects. The potential implications of this medications are massive, possibly allowing people with TBI’s to not only restore memory but continue learning.

Thus far ISRIB has only been tested in mice, and the next phase is move it forward for human testing. ISRIB was licensed in 2015 to Calico, a California-based company which owns rights to discoveries in Dr. Walter’s biochemistry lab at UCSF.

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Regenerative medicine using biotherapy and bioprinting is providing much hope for previously irreversible conditions such as burns, muscle damage, and cancer. Cells and cellular environments are extremely difficult to reproduce once they are damaged, and much of regenerative medicine focuses on how to repair what our bodies originally made so easily.  3D cell production, versus 2D cell production, mimics the organic environment of our bodies to produce cells. In biotherapy, living organisms are used as the starter in this process.

The complexity in the specificity of our cells is part of why it is so difficult to reverse cell damage. Thus, stem cells are valuable biological material due to their ability to differentiate into any type of cell based on their environment and genetic factors. A stem cell starts out as a blank slate, and by receiving environmental and genetic signals, can become virtually anything in the human body, from a kidney to a blood cell to a muscle in the leg.

Placental stem cells are organically derived and the natural byproduct during a birth. Instead of being discarded, they can provide a very important product for placental cell therapy, which helps direct cells toward regeneration and promotes healing. In biotherapy, these placental stem cells can be very valuable for the cell production process.

Pluristem, a company quickly gaining international presence, produces 3D cultured placental stem cell therapies for various conditions. The company uses a 3D platform to produce their line of PLX products, mimicking the environment of the human body for cell production. This cell therapy is developed to provide cell therapy which is easy to use and does not require genetic or tissue matching. Once the therapy is administered, it promotes the body to heal itself in the target area.

Pluristem products provided regenerative therapy for a variety previously potentially irreversible conditions. Among these is acute radiation syndrome (ARS), which involves irreversible damage to organs and bone marrrow from radiation exposure. Pluristem also aims to provide therapy for vascular conditions such as critical limb ischemia, intermittent claudication, and pulmonary arterial hypertension, all which are dangerous and can lead to decreased life span or surgery.

Pluristem is currently in its clinical trial phase, with collaborations with several universities and industry partners, including the NIH.

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Overhead photo of Proteus patch, device and pills in persons hand

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In light of the upcoming Digital Health CEO Summit by Rock Health on March 30th, I would like to touch on the exponentially growing sector of digital health in the healthcare technology space. As lines slowly become blurred between biotechnology, medical devices, fitness tracking, and standard healthcare, an undeniable part of this changing landscape is the presence of wearable sensors.

Most of us are by now familiar with the presence of fitness trackers such as Fitbit and the presence of Apple Health in our daily lives, tracking our steps and movement patterns. A more unknown type of wearable sensor is an ingestible one. Ingestibles are sensors contained within a pill; once swallowed, the sensor sends signals to a device. These are sensors which can be used to track medication habits and other metrics without a person constantly having to keep track.

Proteus‘s product is targeted toward those with chronic health conditions and has four components: an ingestible pill which contains a sensor, a patch which receives the signal from the pill, an app where users can look at their data, and a portal which a provider can log into and  view patient data. The ingestible pill tracks people’s medication habits, measures metrics, and provides insights for both the user and their provider. These four components offer a well-rounded system to systematically involve both the user and their provider, and give the option to also give medication reminders.

For those with chronic health conditions such as diabetes and hypertension, medication compliance is normally very low: 50%, according to Proteus’s site. Proteus was created to improve adherence, decrease healthcare costs, and also allow both healthcare professionals and patients themselves to take a more active role in their own healthcare.

From experience, I have seen that without the investment and active participation of someone in their own health, the path to stable health becomes a difficult one. This lack of participation is often multifactorial, and the patient is not necessarily to blame. Chronic health conditions become a complicated system where one must take constant medication without always understanding or being engaged with what is actually happening in their own body. Education and active participation are vital, as is understanding the significance of self care.

Particularly when dealing with chronic conditions, it is very empowering for someone to have some type of feedback which gives their health regimen significance and involvement. The added bonus of metrics such such as steps, activity, blood pressure, heart rate, and weight give a person even more insight into their own system.

As healthcare changes and people become more in control of their own well being with knowledge, research, and digital insights, we hope to see more amazing products such as the one from Proteus.

 

 

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Anyone that has been witness to a person with Parkinson’s knows the debilitation that the physical effects of the disease can bring. As the disease progresses, individuals with Parkinson’s Disease  develop tremors, repetitive involuntary movements in the hands caused by declining circuitry between the brain and muscles. These tremors are not only physically uncomfortable, but make it extremely difficult to use the hands to perform regular gross and fine motor tasks such as eating, writing, grooming, and dressing. A type of tremor particularly characteristic to the disease is a “pill-rolling” tremor, a constant involuntary rubbing between the index finger and thumb as if one was rolling a pill..

Unfortunately, the physical manifestations of the neurological disease only worsen with time.

A brilliant product named GyroGlove, however, has been created to help offset the constant involuntary movements. Gyrogear has created a glove which uses gyrotonics to stabilize shaky hands by countering the force ‘instantaneously’ and ‘proportionately.” This is simple and amazing. Like a spinning top that wants to stay upright, the gyroscope within the glove works constantly to balance out the unnecessary movements of the tremors as they occur, stabilizing the hand.

Though the product has not yet launched, GyroGlove is certain to improve the life of those so handicapped by tremors. Those that are interested in volunteering to test the product or subscribing for updates should visit the site.

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Anyone that has ever seen the effects of a stroke knows that they can be physically devastating. Within a day, a physically functional person can lose strength to an entire side of their body and face; leaving them dependent on caretakers or suddenly forced to spend a long period in the hospital. Though a stroke is an injury to the brain, whichever part of the brain it affects means that part of the body’s command center has been injured. In effect this severs the signal to the body, leaving muscles without direction.

Due to disuse after a stroke, the muscles will atrophy and fail to function properly, aligning with the common knowledge of “use it or lose it.”

However, if there is something to intervene early, and assist with rehabilitation and movement, it could possibly accelerate the recovery process.

The Rapael Smart Glove by Neofect is a brilliant way to engage stroke patients in movement and monitor progress. By assigning tasks to the user and simultaneously assisting them with the appropriate movements, the Smart Glove retrains the body in proper movement patterns. Through a mathematical analysis, these ‘task-training games’ are also adjusted for the user’s stroke level, ranging from mild to severe.

Though still in the prototype phase, the product is a brilliant solution to assist with the challenges of retraining stroke patients. Oftentimes, though a person wants to carry out a certain movement, they are unable. A product such as this assists with carrying out the planned movement, helping to bridge the injured signal between the mind and body. The system assists with 3 vital movements in upper body mobility: rotation of the forearm, upward and downward bending of the wrist, and opening and closing the hand.

 

 

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Termed, a ‘collaborative robot’ and starting its commercialization phase, C-Bot from Spain-based FisioBot is designed as an automated physical therapy room which includes are two robotic arms designed to administer treatment. The C-Bot is designed so far mostly for simple procedures and modalities: vacuum (suction) therapy, hot air therapy, electrotherapy, and laser therapy. These treatments can be adjusted for depth and intensity, and the robot is deemed safe for human use as there is a limit of how much physical pressure it can apply.

For use, A 3D scan of the patient’s body is performed, giving each patient an identification card of a map of their body. The treatment of choice is then administered, with the possibility of simultaneous treatments.

As robotics grows in healthcare, the implications of the C-Bot for PT are interesting, and it seems a short matter of time before robots are assisting in more involved procedures during manual therapy.

See the videos below for a demonstration (video in Spanish), and an automated video.

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One of the problems with technology is that especially when it first becomes available, many of those that would benefit from it cannot afford it. So while there are many new great options becoming available for amputees, those that don’t have access to funds are unable to benefit. This is why when a $50 dollar option for a printed mechanical hand is offered to the medical world, it should be embraced and supported.

The E-Nable project is truly amazing. It is a network of over 1500 volunteers dedicated to helping provide affordable 3D printed prosthetics for those that can otherwise not afford the multi-thousand dollar ticket that many prosthetics cost. From 3D printing companies to robotics companies to doctors, this project has a worldwide growing network of people willing to design and contribute to low cost prosthetics for amputees. Crowdfunding and generous donations have also contributed to the cause.

In addition to listing participants that can contribute resources or services, the site offers a number of open source designs available so that those with access to a 3D printer can print and assemble their own hand and finger prostheses.  Currently Included are more basic options, as well as those with myoelectric capabilities. Each option provides open source software and video tutorials on how to assemble. The various options accommodate different types of amputations, for those at the wrist or fingers. There is even an prosthetic for a partial finger amputation, the Owen Replacement Finger.

I cannot fully describe everything involved in this project, please visit the site.  The project will hold its first conference titled “Prosthetists meet Printers” on September 28th, 2014 at Johns Hopkins Hospital to involve more of the medical community and introduce them to the options that are available to their underprivileged patients. This will include physician Dr. Albert Chi, a renowned trauma surgeon at the hospital who has been involved in the project.

To donate supplies or funds, click here.

Below is a sample of one of the instructional videos available, in this case it is the Cyborg Beast :