Posts Tagged Heart Surgery

[WEB SITE] 8 ways augmented and virtual reality are changing medicine

Israeli companies are using futuristic technologies to simplify complex surgery, manage rehab, relieve pain, soothe autistic kids and much more.

The Realview HOLOSCOPE-i augmented reality system for cardiac surgery. Photo courtesy of Business Wire

Spine and heart surgeons will use augmented reality (AR) to simplify complex procedures. Autistic children will get relief from sensory overload with a calming virtual reality (VR) system.

These and other scenarios are made possible by Israeli innovations tapping into the tremendous potential of AR and VR for healing and wellbeing.

The methods are similar: AR superimposes static and moving images to enhance an actual environment, while VR immerses the viewer in a simulated three-dimensional environment.

“Israel is on the frontlines in some areas of this technology,” says Orit Elion, a professor of physical therapy at Israel’s Ariel University, which hosted a conference last year to strengthen cooperation between AR and VR developers and researchers for health applications.

Elion helped develop a VR-based tele-rehab service at the Gertner Institute of Chaim Sheba Medical Center in Tel Hashomer, now used across Israel to enable monitored home physical or occupational therapy sessions for patients living far from healthcare centers.

“There aren’t so many programs in the world like this — a service that has no geographic boundaries,” Elion tells ISRAEL21c.

Currently, she is investigating how VR training can help with balance and fall prevention in the elderly. “VR is a dream for that, because you can manipulate the environment with all kinds of visual input,” she says.

Here are other examples of Israeli AR and VR in the health sector.

Neurosurgery

Surgical Theater makes a portfolio of VR products based on the notion that surgeons could train for complex procedures much like the Israeli founders of the company trained for Israel Air Force missions. Neurosurgeons at major medical centers and academic institutions in the United States and elsewhere are utilizing Surgical Theater’s VR medical visualization platforms for surgical planning and navigation, patient education and engagement, and training surgical residents.

Heart surgery

In the first quarter of 2018, RealView Imaging will release its long-awaited HOLOSCOPE-i, designed to deliver live, in-air 3D holographic visualizations during interventional cardiology procedures.

Powered by the Intel RealSense SR300-Series camera based on RealView’s proprietary digital light shaping technology, HOLOSCOPE-i is the first commercial system allowing clinicians full and direct control of 3D images in real time. Surgeons can rotate, zoom, slice, mark and measure within the floating holograms.

Coming next from RealView Imaging are HOLOSCOPE-x for visualization of holograms inside the patient during interventional oncology procedures, and a holographic headset for non-medical professional applications.

Spine surgery

Augmedics develops xvision, an AR head-mounted display for spine surgery that allows surgeons to see the patient’s anatomy through skin and tissue, as if they had “x-ray vision.” The system can project the patient’s anatomy, in real time, directly onto the surgeon’s retina, with the aim of increasing safety in surgery, reducing x-ray radiation and facilitating minimally invasive procedures.

Using xvision, surgeons will be able to visually and accurately track all their surgical instruments well within their field of vision as they work. A combination of proprietary tracking algorithms, hardware, software, an image data merging unit, and specialized instruments guide the surgeon through the operating site during major and minor procedures.

The xvision system will also utilize sensors to collect surgical information, which, when connected to a big data system, will analyze and process the data, using profound learning algorithms to provide alerts and suggestions to assist the surgeon during the procedure.

Augmedics has already performed pre-clinical cadaver trials in the US and EU. The company will start clinical studies in Q2 2018 in Israel, and later this year at the Johns Hopkins Hospital in Baltimore, Maryland.

Sensory modulation

Using VR goggles, the Calma system immerses an autistic child in a simulated underwater scene filled with corals, colorful fish, bubbles and divers.

“Children on the autism spectrum typically suffer from sensory moderation disorder, traditionally treated in a ‘white room’ where various objects are gradually introduced. This is costly and not always readily available. Our initiative simulates the white room with VR,” says Dan Kohen-Vacs, a senior computer science researcher at Holon Institute of Technology (HIT), where Calma was invented by students last year.

A management console allows the therapist to add, moderate or remove stimulants (including music) in response to the reaction of the child in real time. The goal is to train the child’s sensory regulation system to better handle auditory and visual stimulants and achieve emotional balance.

“We are completing the first proof-of-concept version and testing it in the Dekalim school in Jerusalem,” Kohen-Vacs tells ISRAEL21c. HIT’s tech-transfer company will work on commercializing the system.

“The plan is to expand to other locations. It may be possible to enable parents to use the system at home. You just need a smartphone and something like Google Cardboard that enables you to put the phone in it and wear it as headset,” says Kohen-Vacs.

Amit Bar-Tov, an occupational therapist at Dekalim, told Globes that the Calma pilot met with “great enthusiasm among the students for emotional regulation and sensory regulation, an improvement in learning capabilities, and a better connection with the environment.”

Burn rehab

Prof. Josef Haik, director of Sheba Medical Center’s Burn Center, has been using VR for more than a decade as a bedside tool to ease the painful process of rehabilitation from severe burns.

“It’s all about early mobilization and rehabilitation, getting back to the tasks of everyday life,” Haik tells ISRAEL21c.

In 2004, Sheba installed a large Computer Assisted Rehabilitation Environment (CAREN) system in a pioneering move toward VR in treatment and rehab. Burn patients couldn’t be moved to the CAREN room so Haik came up with an inexpensive portable alternative using EyeToy, a digital camera device for PlayStation. Today he’s using Kinect with games devised for patients with certain disabilities.

VR gaming therapy offer several advantages, says Haik: The games distract patients and thereby lessen their pain perception; allow patients to adapt to seeing and accepting the look of the scarred area of their body onscreen; and use rewards such as points to encourage continuation of therapy. Moreover, the patient does not have to wear or touch anything, eliminating any risk of cross infection.

Haik reported on the therapy in a 2006 study and has presented his approach to the American Burn Association and other associations around the world.

Stroke and traumatic brain injury  

The SeeMe VR rehab system was developed by physiotherapists at Beit Rivka Geriatric Rehabilitation Hospital in Petah Tikva in cooperation with Brontes Processing of Poland for stroke or traumatic brain injury patients.

It has been on the market since 2009, making it the first commercial VR system of its kind.

SeeMe’s technology transmits images to the patient’s computer via a Kinect controller or standard web camera and immerses the patient in a customized computer game requiring specific exercises set by the therapist.

The clinician can use the system to evaluate strength, endurance, range of motion, postural control, reaction time, proprioception, quality of movement, perception, divided attention and memory.

Parkinson’s disease and multiple sclerosis

Studies by scientists from the Technion-Israel Institute of Technology, Tel Aviv Medical Center and Tel Aviv University over the past decade have shown that incorporating VR headsets in gait training improved the walking abilities of people with multiple sclerosis and reduced fall risk in Parkinson’s patients. The latest study, published in Neurology in September, found that VR training actually modifies brain activation patterns in Parkinson’s patients.

PT and pain relief

Caesarea-based Motorika Medical’s ReoAmbulator robotic gait-training device helps adults and children improve walking, balance, coordination, posture or stamina while focusing on accomplishing VR tasks to improve motor or cognitive function including memory and selective attention. Combining these tasks in one session is meant to add a higher degree of challenge leading to better results. On the market since 2014, ReoAmbulator is used in two countries in Asia, five in Europe and in the United States — around 30 installations so far.

VRHealth of Tel Aviv and Boston is partnering with major players including Oculus, HTC and Microsoft to launch the first cross-platform-compatible VR medical application for rehab.

“We believe we are the only medical device company using an immersive headset as certified medical software,” founder Eran Orr tells ISRAEL21c. “What makes it a medical device is how you keep the data encrypted, how you can integrate electronic medical records and whether there is a billable insurance code for physicians to use. There is quality assurance and documentation for every app we are developing.”

VRHealth’s flagship VRPhysio software applications – two for neck therapy and one for shoulder therapy – got FDA clearance and are being implemented first in Spaulding Rehabilitation Hospital and Beth Israel Deaconess Medical Center in Boston. CE approval for Europe is expected soon.

VRHealth plans to launch additional products within a year: VRCoordi, which will work with VRPhysio to improve coordination skills, initially of children with developmental coordination disorder and various levels of autism; VRCogni to improve cognitive function in stroke, Alzheimer’s, concussion, Parkinson’s and dementia patients; VRReliever to manages chronic and severe pain through distraction; VRPsyc to enhances treatment for diagnosable mental disorders including general stress, phobias and anxieties, eating disorders, and PTSD.

“I hope our company will make a difference in the entire healthcare sector — every hospital, nursing home and assisted living — because VR can make a huge difference in many fields,” says Orr.

“I think Israel has a lot of potential in this technology because of the quality of engineers and developers able to develop products at a rapid pace and to be first to market and expand from there. That’s why we maintain our R&D in Israel.”

via 8 ways augmented and virtual reality are changing medicine | ISRAEL21c

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[WEB SITE] New wearable electronic device could revolutionise treatment for stroke patients

Stroke patients are starting a trial of a new electronic device to recover movement and control of their hand.

Neuroscientists at Newcastle University have developed the device, the size of a mobile phone, which delivers a series of small electrical shocks followed by an audible click to strengthen brain and spinal connections.

The experts believe this could revolutionise treatment for patients, providing a wearable solution to the effects of stroke.

Following successful work in primates and healthy human subjects, the Newcastle University team are now working with colleagues at the prestigious Institute of Neurosciences, Kolkata, India, to start the clinical trial. Involving 150 stroke patients, the aim of the study is to see whether it leads to improved hand and arm control.

Stuart Baker, Professor of Movement Neuroscience at Newcastle University who has led the work said: “We were astonished to find that a small electric shock and the sound of a click had the potential to change the brain’s connections. However, our previous research in primates changed our thinking about how we could activate these pathways, leading to our study in humans.”

Recovering hand control

Publishing today in the Journal of Neuroscience, the team report on the development of the miniaturised device and its success in healthy patients at strengthening connections in the reticulospinal tract, one of the signal pathways between the brain and spinal cord.

This is important for patients as when people have a stroke they often lose the major pathway found in all mammals connecting the brain to spinal cord. The team’s previous work in primates showed that after a stroke they can adapt and use a different, more primitive pathway, the reticulospinal tract, to recover.

However, their recovery tends to be imbalanced with more connections made to flexors, the muscles that close the hand, than extensors, those that open the hand. This imbalance is also seen in stroke patients as typically, even after a period of recuperation, they find that they still have weakness of the extensor muscles preventing them opening their fist which leads to the distinctive curled hand.

Partial paralysis of the arms, typically on just one side, is common after stroke, and can affect someone’s ability to wash, dress or feed themselves. Only about 15% of stroke patients spontaneously recover the use of their hand and arm, with many people left facing the rest of their lives with a severe level of disability.

Senior author of the paper, Professor Baker added: “We have developed a miniaturised device which delivers an audible click followed by a weak electric shock to the arm muscle to strengthen the brain’s connections. This means the stroke patients in the trial are wearing an earpiece and a pad on the arm, each linked by wires to the device so that the click and shock can be continually delivered to them.

“We think that if they wear this for 4 hours a day we will be able to see a permanent improvement in their extensor muscle connections which will help them gain control on their hand.”

Improving connections

The techniques to strengthen brain connections using paired stimuli are well documented, but until now this has needed bulky equipment, with a mains electric supply.

The research published today is a proof of concept in human subjects and comes directly out of the team’s work on primates. In the paper they report how they pair a click in a headphone with an electric shock to a muscle to induce the changes in connections either strengthening or weakening reflexes depending on the sequence selected. They demonstrated that wearing the portable electronic device for seven hours strengthened the signal pathway in more than half of the subjects (15 out of 25).

Professor Stuart Baker added: “We would never have thought of using audible clicks unless we had the recordings from primates to show us that this might work. Furthermore, it is our earlier work in primates which shows that the connections we are changing are definitely involved in stroke recovery.”

The work has been funded through a Milstein Award from the Medical Research Council and the Wellcome Trust.

The clinical trial is just starting at the Institute of Neurosciences, Kolkata, India. The country has a higher rate of stroke than Western countries which can affect people at a younger age meaning there is a large number of patients. The Institute has strong collaborative links with Newcastle University enabling a carefully controlled clinical trial with results expected at the end of this year.

A patient’s perspective

Chris Blower, 30, is a third year Biomedical Sciences student at Newcastle University and he had a stroke when he was a child after open heart surgery. He describes his thoughts on the research:

I had a stroke at the age of seven. The immediate effect was paralysis of the right-hand side of my body, which caused slurred speech, loss of bowel control and an inability to move unaided. Though I have recovered from these immediate effects, I am now feeling the longer term effects of stroke; slow, limited and difficult movement of my right arm and leg.

My situation is not unique and many stroke survivors have similar long-term effects to mine. Professor Baker’s work may be able to help people in my position regain some, if not all, motor control of their arm and hand. His research shows that, in stroke, the brains motor pathway to the spinal cord is damaged and that an evolutionarily older signal pathway could be ‘piggybacked’ and used instead. With electrical stimulation, exercise and an audible cue the brain can be taught to use this older pathway instead.

This gives me a lot of hope for stroke survivors. My wrist and fingers pull in, closing my hand into a fist, but with the device Professor Baker is proposing my brain could be re-taught to use my muscles and pull back, opening my hand out. The options presented to me so far, by doctors, have been Botox injections and surgery; Botox in my arm would weaken the muscles closing my hand and allow my fingers to spread, surgery would do the same thing by moving the tendons in my arm. Professor Baker’s electrical stimulations is certainly a more appealing option, to me, as it seems to be a permanent solution that would not require an operation on my arm.

I was invited to look around the animal house and observe a macaque monkey undergoing a test and this has made me think about my own stroke and the effect it has had on my life.

I have never seen anything like this before and I didn’t know what to expect. The macaque monkey that I observed was calmly carrying out finger manipulation tests while electrodes monitored the cells of her spinal cord.

Although this procedure requires electrodes to be placed into the brain and spine of the animal, Professor Baker explained how the monkey had been practicing and learning this test for two years before the monitoring equipment was attached. In this way the testing has become routine before it had even started and the animal was in no pain or distress, even at the sight of a stranger (me).

The animals’ calm, placid temperaments carry over to their living spaces; with lots of windows, natural light and high up spaces the macaques are able to see all around them and along the corridors. This means that they aren’t feeling threatened when people approach and are comfortable enough that even a stranger (me, again) can approach and say ‘hello’.

From my tour of the animal house at the Institute of Neuroscience I saw animals in calm, healthy conditions, to which the tests were just a part of their daily routine. Animal testing is controversial but I think that the work of Professor Baker and his team is important in helping people who have suffered stroke and other life-changing trauma to regain their independence and, often, their lives.

Source: Newcastle University

Source: New wearable electronic device could revolutionise treatment for stroke patients

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