Virtual Coaches in Healthcare: A Vision of the Future

CISE Distinguished Lecture

September 20, 2012 10:00 AM  to

September 20, 2012 11:00 AM

NSF Room 110

Abstract:

With health care costs raising astronomically and the number of aging increasing, there are not enough economic or human resources in the way of care givers to meet society's needs. A confluence of technologies including miniature electronics, digital communications, human-computer interaction, robotics, and machine learning makes possible the creation of intelligent assistants that monitor and communicate with users, understand their needs and goals, and compensate for diminished capabilities as we age or suffer a disability. This talk will highlight the research challenges in creating virtual coaches that monitor user activities providing reminders and advice to reach personal and caregiver goals.

Daniel P. Siewiorek is the Buhl University Professor of Electrical and Computer Engineering and Computer Science at Carnegie Mellon University.  He is the Director of the Quality of Life Technology Center, an NSF ERC in collaboration with the University of Pittsburgh. Previously he served as head of CMU's Human Computer Interaction Institute.  His research interests span human interaction with intelligent systems, mobile and ubiquitous computing, and system reliability. He has designed or been involved with the design of nine multiprocessors, over two-dozen commercial computers, and over 20 generations of mobile systems.  He has written nine textbooks and is a recipient of major awards from AAEE, IEEE, and ACM. He is a Fellow of IEEE, ACM, and AAAS, and a member of the National Academy of Engineering.

To Join the Webinar:

The Webinar will be held from 10:00-11:00am EST on September 20, 2012 in Room 110.

To attend virtually, please register by August 15, 23:59 PDT at: https://mmancusa.webex.com/mmancusa/j.php?ED=190362862&RG=1&UID=0&RT=MiMxMQ%3D%3D

After your registration is accepted, you will get an email with a URL to join the meeting. Please be sure to join a few minutes before the start of the webinar. This system does not establish a voice connection on your computer; instead, your acceptance message will have a toll-free phone number that you will be prompted to call after joining.  Please note that this registration is a manual process; therefore, do not expect an immediate acceptance.  In the event the number of requests exceeds the capacity, some requests may have to be denied.

Latest Face Transplant Surgeries Restore Form and Function

By Jeffrey Soares, USAMRMC Public Affairs

At the 2012 Medical Health System Research Symposium in Fort Lauderdale, Fla., high-tech programs and products are being discussed by researchers focused on translating futuristic technology into modern-day practice.

In the 1990 sci-fi film “Total Recall,” Arnold Schwarzenegger’s character receives a new face via high-tech methods, so that he can elude pursuers.  The image causes viewers to imagine a world where this is not only possible, but typical.  Today, providing a new face to someone in need is on its way to becoming typical thanks to the work of researchers such as Dr. Eduardo Rodriquez, who is the chief plastic surgeon at the R Adams Cowley Shock Trauma Center at the University of Maryland.

In his Aug. 14 presentation, “Comprehensive Facial Transplantation,” Rodriquez conveyed how he and his surgical team at Maryland used every resource available during a 36-hour surgery to attach a healthy donor face to a 37-year-old gunshot victim whose own face was disfigured.  The procedure is considered to be the most extensive operation of its kind ever performed.

Although the patient, Richard Lee Norris, is a civilian from rural Virginia, Rodriquez described the implications for warfighters.

“The ultimate goal of this project was to treat the wounded warrior,” Rodriquez said.  “We wanted to develop a strategy that would essentially reconstruct the massive disfigurement of the face of soldiers [wounded in battle].”  He added that beyond appearance the goal is to restore function.

“As injuries between the lower face and upper face are considered very difficult injuries to treat, the operation to repair these injuries must be proportionate to the problem in order to take these patients to the next level,” Rodriquez explained.

Rodriquez and his team -- specialists in craniofacial surgery and microsurgery -- spent hundreds of hours in rigorous training and rehearsal before the patient ever entered the operating room.  In a procedure of this magnitude, no margin of error could be tolerated by the surgical team.  They studied the underlying relevant clinical anatomy to ensure proper transplantation, and they also considered the procedure from an aesthetic perspective, to see where incisions could be placed in order to go undetected.

The team used computerized surgical planning to ensure the exact transfer of the donor face to the patient, and they were extremely thorough in aligning the oral/dental/tongue configuration during the transfer to ensure that the patient could chew and speak correctly.

Considering the magnitude of this procedure, it is nothing short of amazing that the patient is recovering on schedule at this time.  Upon showing a comparison photo of Norris prior to and following the extensive surgery, Rodriquez himself appeared a bit surprised -- and pleased -- about the recovery.

“You can appreciate the dramatic change in this individual’s not only appearance but also function,” Rodriquez said.  “This would not have been possible with conventional measures.”

The doctor and his team plan to continue performing state-of-the-art craniofacial reconstructions, with a goal of 3-5 facial transplantation surgeries per year.

A Hilltop in Foggy Bottom – Brother Against Brother & A New Mission

The home of the Old Naval Observatory (1844-1893) and the Navy Medical Department (1894-2012) is where many firsts in science and technology took place.

This is where the science of oceanography was born, where the moons of Mars were discovered, where the underwater path of the first transatlantic cable was plotted. This location played a key role in the Civil War, our first westward expansion, and in the development of military medicine.

In 1902, the Naval Observatory was renamed the Naval Medical School, and later became home to the Bureau of Medicine and Surgery until it was closed through the Department of Defense’s Base Realignment and Closure (BRAC).

Videos courtesy of the Office of Medical History, U.S. Navy Bureau of Medicine and Surgery.

A Hilltop in Foggy Bottom: Light House In The Sky And Pathfinder Of The Seas

The home of the Old Naval Observatory (1844-1893) and the Navy Medical Department (1894-2012) is where many firsts in science and technology took place.

This is where the science of oceanography was born, where the moons of Mars were discovered, where the underwater path of the first transatlantic cable was plotted. This location played a key role in the Civil War, our first westward expansion, and in the development of military medicine.

In 1902, the Naval Observatory was renamed the Naval Medical School, and later became home to the Bureau of Medicine and Surgery until it was closed through the Department of Defense’s Base Realignment and Closure (BRAC).

Videos courtesy of the Office of Medical History, U.S. Navy Bureau of Medicine and Surgery

"Movement Retraining" Can Reduce Knee Pain

Sensors, custom software and real-time feedback help people change their walk and possibly delay, eliminate knee surgery

Aches and pains got you down? The way you walk could be wearing out parts of your body.

"All of a sudden, I developed pain in my knee and it progressively got worse. I didn't want to walk anymore," recalls Lloyd Manson, a retired contractor and developer who has osteoarthritis in his knee. Manson's pain became so severe he was seriously considering knee surgery, but just before he was about to set a date for the operation, he learned about a study at Stanford University. And, Stanford mechanical engineer Mark Cutkosky and his team were looking for test subjects.

With support from the National Science Foundation's (NSF) Human-Centered Computing Program (HCC), the research, known as Movement Retraining, focuses on alleviating pain by analyzing and possibly changing a person's stride. One of the major problems at the root of knee pain is uneven wear and tear on the knee cartilage, which leads to arthritis. "We're trying to slow the rate at which arthritis progresses, and thereby delay the time that you would need a much more expensive, invasive procedure like surgery," says Cutkosky.

Sounded too good to be true, but Manson decided to give it try. "I didn't know what to think, but I said, 'You know, what the heck.'"

Suzanne Dancer also agreed to participate in the study. "I've had knee pain on and off for a couple of years. I'm not getting younger and it was becoming more and more noticeable."

Suzanne and Lloyd are not alone. "Roughly 50 percent of people as they get older start to show some evidence of osteoarthritis of the knee," notes Cutkosky.

The research team first outfitted test subjects with sensors and then directed them to walk on a treadmill. When Manson took a step, custom software precisely calculated the forces on his joints. That data helped the team determine if a gait change might help reduce his pain.

"We use a biomechanics model and say, 'Aha! If you were, for example, to turn your toes in just a little bit or maybe your knees out, you could reduce the peak loads, the adverse loads on the knee joint,'" explains Cutkosky. The idea is to shift weight away from the more worn-out area to the more cushioned area of the knee cartilage.

So, instead of Dancer walking with one foot slightly pointed out, the researchers suggested that she turn her foot in slightly. "It was a very strange feeling," she says. "You feel like you're walking pigeon-toed, but you're not. What I couldn't argue with was the fact I did not have as much knee pain. Just recently I walked four miles. It took me 60 minutes and I had no knee pain when I was done!"

Researchers recommended a similar fix for Manson. "I had to work at it to retrain myself. It took weeks, but then it just progressively kept getting better and better. The pain is almost nonexistent. It's amazing. It's truly amazing!" says Lloyd.

But, Cutkosky cautions not to try changing your stride on your own. You could do more harm than good. To help test subjects learn their new gaits, Cutkosky and his team developed a biofeedback device for treadmill walking. One misstep and the device vibrates. They're working on a portable version to reinforce the modified gait outside the lab.

"We've seen amazing changes in the lab. People are able to change the way they walk and they have less pain and greater function," says Pete Shull, a doctoral candidate in mechanical engineering and a key member of Cutkosky's research team.

Movement retraining isn't just for people in pain. Cutkosky says athletes could improve their moves with this biofeedback technique--everything from golf swings to jump shots. "The next step is a wearable, wireless system that measures peoples' movements, provides haptic feedback, and then transmits the results to a cell phone so that people can use haptic movement training anywhere they go, at home or outdoors," he says.

This research was funded by NSF's Division of Information and Intelligent Systems (IIS) under the NSF's Directorate for Computer & Information Science & Engineering (CISE).

Miles O'Brien, Science Nation Correspondent

Ann Kellan, Science Nation Producer

The Dr. Is In - Take as Directed

An enduring problem in modern medicine is that many patients do not take their medications as directed by their doctor. This is known as poor “medication adherence.”

If you are taking medication for a serious chronic condition, missing a dose can cause your symptoms to flare up. With multiple medications, not following your doctor’s instructions could lead to dangerous drug interactions or side effects. Even over-the-counter medicines have risk as taking too much can be life threatening.

According to the National Consumer League (NCL), poor medication adherence contributes to an estimated 125,000 preventable deaths a year and billions of dollars in avoidable medical costs. The NCL reports one in three Americans never fills their prescriptions, and poor adherence contributes to a third of hospital admissions.

Poor medication adherence can be an especially acute problem for members of the military who bear an added responsibility for staying healthy as a matter of national defense.

There are many reasons people don’t follow their doctor’s orders about medication. It can be as simple as not understanding the directions or forgetting to take a pill, or as serious as intentionally over-medicating. Additionally, patients may not understand the consequences of not following their doctor’s instructions. Some of the most common types of poor medication adherence are:

 •Not filling a new prescription or failing to refill an existing prescription

•Stopping a medication before directed by your doctor

•Taking too much or too little of a prescribed medication

•Taking your medication at the wrong time

There are simple ways to practice good medication adherence. It starts with personal responsibility. Talk to your doctor and pharmacist to understand the medications prescribed. Write down their instructions and ask questions if you don’t totally understand them. If your physician prescribes a brand name medication, ask about a less expensive generic alternative and consider using low-cost TRICARE Pharmacy Home Delivery for your maintenance medications (www.tricare.mil/homedelivery).

TRICARE is a partner with the NCL in the “Script Your Future” campaign, whose goal is patient education and awareness. You can learn about the “Script Your Future” campaign and find tools to improve your medication adherence and start conversations with your doctor at www.scriptyourfuture.org.

Put yourself in the best position to be healthy by practicing good medication adherence. Find more information about managing your medications by visiting www.tricare.mil/manageyourmeds.