Positioning Technology Advances Medicine

August 5, 2009 By: Stephen Colwell

Consumer OEM Newsletter, August 2009

We all share one consumer market regardless of personal preference, color, size, or price. We all need medical care at one time or another. Like an organism maturing, the expanding use of positioning systems in medicine is charting success from the operating theater to the onslaught of Alzheimer’s and dementia.

As consumers we have more health care choices and technology available to us than any other time. Consumers today are far more informed and technology savvy and taking a more active role in choosing the right mix of medical services. Medical development engineers are targeting new non-invasive procedures that take less time and provide faster time to heal, while more efficiently managing and increasing the medical professional ability’s to treat additional patients. The market for medical devices has been a bulwark for many years, and 2009 markets continue to stay above the economic struggles inherent in other markets.

The forecast for new medical technology is upbeat and holding its own throughout the current economic recession. According to Seeking Alpha (a website that monitors technology trends and investment strategies) “First, the underlying demand for healthcare devices continues to grow with the continued aging of the population in the U.S. and Europe. 13,000 Americans will turn 60 years of age every day for the next 20 years. Second, much of spending in the U.S. for healthcare is tied to Medicare, which is a stable source of funding. Third, much of the demand for healthcare is not tied to discretionary spending.” These factors contribute to the wide spread adoption of devices that can speed delivery of a healthcare solution.

A wide range of medical devices that use GPS or RFID are rapidly gaining acceptance for a host of medical conditions prevalent today. For medical device manufacturers in 2009, the outlook appears equally bright. A study by medical device consulting firm Emergo Group reported positive domestic and international sales growth and continued optimism about prospects for the industry in 2009.

A quick overview of medical conditions shows the widespread influence positioning technology is delivering to the health-care consumer.

These include:

Peripheral Artery Disease (PAD)

People with PAD have clogged leg arteries that cause them severe pain when they walk. In a new study, researchers have used GPS devices and a computer spreadsheet to trace and analyze the maximal walking distance (MWD) of PAD patients as they strolled through a public park. MWD is the maximum distance a PAD patient can walk at a normal pace on a flat surface before leg pain forces them to stop.

Pierre Abraham, a physician at the vascular investigation laboratory at University Hospital in Angers, France, said, “Patients often report their walking capacity varies from one day to another and also varies from one moment to another within a single stroll. GPS allows for the analysis of the distanced walked, of course, but also the speed, duration of resting, and the number of walking bouts over a prolonged recording period.”

A treadmill test is the standard method of determining MWD. However, treadmill assessments are time-consuming, have to be done in vascular laboratories, and may not provide an accurate estimation of MWD or PAD-related disability.

Finding “Ground Zero” of Asthma Causes

Asthma Researcher leader David van Sickle, a Robert Wood Johnson Foundation Health and Society Scholar and a former disease detective in the Epidemic Intelligence Service at the Centers for Disease Control and Prevention (CDC) in Atlanta, leads the drive to map asthma sources.

“For the millions of chronic asthma patients, knowing the ‘where’ indicates the ‘what,’ which provides important clues in individual and epidemic out breaks of asthma attacks. Sufferers are treated with a blanket of probable treatments with out indication of what exactly triggered the condition. Research is under way to develop a GPS inhaler that records the position or onslaught of an attack.” Van Sickle’s goal is to map where and when environmental exposures trigger asthma symptoms, prompting them to puff on their “rescue” inhalers, which deliver the medicine that keeps them breathing.

It’s easy to predict problems when an asthmatic visits a “cat lady” or runs through a field of ragweed. But van Sickle plans to use global positioning technology to find previously unknown causes of the lung disease and help doctors better monitor whether treatment is controlling symptoms and improving quality of life. A dramatic example includes an epidemic outbreak of asthma attacks in Barcelona that overwhelmed hospitals and emergency centers. “An epidemic of severe asthma struck Barcelona throughout the 1980s,” van Sickle said. “On more than 20 days, emergency rooms were overwhelmed with people having severe, and sometimes fatal, asthma attacks. Barcelona put together a group of scientists to look at the meteorology, climatology, and levels of standard air pollutants and pollens in the city, but there wasn’t anything exceptional about those days.”

Finally, they asked where the patients had been when they got sick: All reported that their symptoms started near the waterfront. Further investigation showed that the port had been unloading giant heaps of soybeans from container ships. “The victims were exposed to massive clouds of soybean dust because the appropriate filters weren’t installed in harbor silos,’’ he says. “It took the group nearly eight years to prove, but it was the first time soybean dust had been shown to be a potent allergen.”

Tracking Dementia Patients

The onslaught of dementia is a veritable cornucopia of issues related to patient management, immediate family ability to provide care, and a safety net for the patient based on his or her ongoing dementia condition.

The Oxfordshire and Buckinghamshire Mental Health NHS Foundation Trust (http://www.obmh.nhs.uk/) in the UK is concluding a two-year project to evaluate the use of GPS devices to track dementia patients, by using new GPS technologies aimed at prolonging the length of time people can spend living in their own homes and also to monitor patients when they are outside.

According to lead researcher Rupert McShane, "30% of people with dementia get lost at some point and about 25% of them are locked in their houses by worried relatives. With the development of GPS technology, we think people with dementia might have more freedom to go out and they might be safer if they do go out, if it’s possible to know where they are if they get lost."

Alzheimer's: O Brother, Where Art Thou?

Placing some sort of GPS tracking device on patients has proven incredibly useful for knowing the whereabouts of patients who are likely to go missing, escape, or wander off and not receive the care they require for their condition. The Alzheimer’s Association reports that in 2009:

As many as 5.3 million people in the United States are living with Alzheimer’s.
Alzheimer's and dementia triple healthcare costs for Americans age 65 and older.
Every 70 seconds, someone develops Alzheimer’s.
Alzheimer's is the seventh-leading cause of death.
The direct and indirect costs of Alzheimer's and other dementias to Medicare, Medicaid and businesses amount to more than $148 billion each year.

There are many GPS devices marketed to both care givers and medical professionals. A higher degree of sophistication has led to more thoughtful ergonomic designs and a wider range of tracking and reporting capabilities. Both RFID and GPS have provided solutions, with GPS having a definite advantage in its ability to locate without regard to specialized receivers found in RFID systems.

Current emphasis on designs are for bracelet and belt devices, special placement in clothing, and newly introduced GPS-equipped shoes. The challenge for this disease is securing the device to be nonobtrusive and affixed to a patient without his or her ability to remove it. Digital Angel was an early pioneer in this space, with the more recent Columbia medical bracelet becoming available in the U.S. The Columba is monitored via Assisted GPS and has a GSM/GPRS transmitter/receiver with a SIM card for voice and data.

Emergency Accident Identification and Transport

We have all seen the years of OnStar ads on television and radio. It’s not hype. Onstar works and works very well. If you are in an accident with airbag deployment, OnStar maps the location and initiates contact with the potential injured individual. OnStar has been around long enough to have perfected the technology elements that come together to reduce the time for aid to reach the motorist.

Once the patient is secured in the ambulance, different navigation technologies provide information such as the nearest medical facility, a route analysis of road congestion, road closure and maintenance alerts, and traffic updates. Emergency room doctors and nurses can track the estimated time of arrival of the ambulance and use the extra time to prepare critical medical services to the injured.

GPS for Back Surgery

The accurate placement of screws used in back surgery is a critical element that can heal or cause additional pain for patients living through Back problems. Misplaced screws have been a constant issue in back pain procedure since their inception. Using high-accuracy positioning technology surgeons can, with relative ease, guarantee exact placement of screws used to join injured bones. "In an ideal world, where you're doing day-to-day surgery, your misplacement rate is probably in the order of 10 percent," said Neurosurgeon Richard Spiro. In very complicated cases, experts say surgical screws can be misplaced up to 40 percent of the time. Spiro is pioneering a procedure that guides the screw placement. Doctors take a scan of the spine, creating a 3-D image. Cameras in the operating room communicate with transmitters on the tips of surgical tools. A computer monitors the movement. "Then we're able to place the hardware based on that real-time information, just like a GPS gives you when you're trying to make decisions about whether to turn right or turn left. We're doing the same thing."

Doctor’s are reporting nearly perfecting the system based on more than 100 surgeries to date. For the patient, the results are fewer complications and a faster recovery.

Robotic Surgery and Telemedicine

Robots equipped with precise positioning capabilities are driving innovation in products developed to provide emergency remote care on human patients while medical professional may be thousands of miles away. Still in the development process, many Gen One systems are finding their way to test trials while some products have begun to be deployed.

The markets targeted are remote medical assistance in hard-to-reach areas, such as battlefield surgery units (BSUs) where the injured combat solider is retrieved by a “carry-all” robot that delivers the patient to a BSU. Robotic arms can provide anesthesiology, start IV medical drips, analyze wounds, and provide imaging and diagnosis. If the patient is critical, robotic arms guided by a surgeon far away can perform the operation using positioning information, imaging scans, and direct audio and visual connectivity. The Defense Advanced research Projects Administration (DARPA) has been an early funder of battlefield surgery technology for the last 15 years.

Conclusion

Late one evening in 1994 I was at home in my study reviewing the day’s activity when the phone rang. The individual on the line apologized for the late hour and indicated my secretary had provided my home number. He introduced himself as a senior surgeon for John Hopkins University and wanted to brainstorm the possibility of using GPS in a remote operating environment where no doctor or surgeon was available to treat an emergency or life-threatening condition. Both of us had served during the Vietnam War and used that experience as an example of how soldier lives could have been saved if such technology was available. We talked for many hours, and we both found a sense of relief with the understanding that perhaps one day technology could provide the difference between living or dying in combat. We were friends for many years after that, and you will just have to guess the results of these early conversations.