2014 continued to see massive evolution in health care—from digital health innovations to the maturation of technologies in genomics, genome editing and regenerative medicine to the configuration of the health care system itself. We asked leaders from the clinical, research and business corners of Boston Children’s Hospital to weigh in with their forecasts for 2015. Click “Full story” for them all, or jump to:
The consumer movement in health care
Evolving care models
Genomics in medicine
Stem cell therapeutics
Our ability to use the thumb as an opposable digit is a critical part of what sets us apart as a species. “That’s how you’re holding a pen,” Leia Stirling, PhD, a senior staff engineer at the Wyss Institute for Biologically Inspired Engineering told me recently as we talked about the Wyss’ latest collaboration with Boston Children’s Hospital. “That’s how you hold your phone; that’s how you open a door; that’s what makes us unique.”
It’s also an ability that children who have suffered a stroke or have cerebral palsy or hemiplegia (paralysis on one side of the body) can lose or fail to develop in the first place.
Stirling, along with Hani Sallum, MS, and Annette Correia, OT, in Boston Children’s departments of Physical and Occupational Therapy, are the architects of a robotic device that may improve functional hand use. The device assists children with muscle movements, using small motors called “actuators” placed over the hand joints, while giving them sensory and visual feedback. It’s called the Isolated Orthosis for Thumb Actuation, or IOTA.
When Patrick Codd, MD, removed a toddler’s deep brain tumor not long ago at Massachusetts General Hospital, he first put a catheter inside the boy’s head to drain the excess fluid that had built up. He and the neurosurgery team then removed a large portion of the child’s skull, exposed the brain and dissected through the brain tissue, using a microscope, until he could reach the tumor, which the team then removed.
The boy is doing fine, but Codd and his mentors at Boston Children’s Hospital—Joseph Madsen, MD, and Pierre Dupont, PhD, chief of Pediatric Cardiac Bioengineering—had a vision: Could the tumor have been removed via the same catheter that he used to drain the fluid, leaving the rest of the brain intact?
Standard surgical techniques—and even newer ones that use lasers or go into the brain through the nose—require surgeons to bore through brain tissue to get to their destination. This carries a risk of injuring sensitive areas as they pass through, like the structures involved in language, as well as a risk for wound infections and complications from extended anesthesia times.
Hospital innovators are beginning to turn to robotic systems – some as simple as a cell phone that enables video conferencing between doctor and patient – to enhance patient care and lower costs (see yesterday’s post). The Child Life department at Children’s Hospital Boston asked kids staying at the hospital to share their ideas for robots that could help them and assist their doctors and nurses. A few hospital staff got in the spirit, too. At left and below are a few of their submissions. Click to enlarge them.
Countless scientific epiphanies never leave the bench – unless there’s the kind of serendipitous encounter that set Children’s Hospital Boston psychologist Gene Goldfield on a path he never expected to follow.
One in eight babies are born prematurely, putting them at greater risk for cerebral palsy, an inability to fully control their muscles. Goldfield saw these children being wheeled around the hospital, and was convinced that they did not have to be wheelchair-bound.
During early infancy, he knew, the developing brain naturally undergoes a rewiring of its circuits, including those that control the muscles. Could some type of early intervention encourage more typical motor development by replacing damaged circuits with more functional connections?
At Children’s Innovators’ Forum last week, Goldfield discussed his envisioned solution: the use of programmable robots
It began as a proof-of-principle demonstrated with LEGOs – a surgical biopsy needle whose motor is driven solely by a clinical MRI scanner:
The above demo shows that an MRI machine’s magnetic field can be programmed to produce enough force to control a robotic instrument — an accomplishment with broad potential in medicine. In the demo, the scanner’s magnetic field swings a rotating arm, and a set of gears convert that motion into the motion of a biopsy needle, strong enough to puncture the tough outer tissue of an animal heart and then withdraw. All parts exposed to the magnetic field are metal-free and MRI-compatible.
While MRI-compatible robots have been built before, this was the first demo of a motor powered by MRI, says Pierre Dupont, chief of Pediatric Cardiac Bioengineering at Children’s Hospital Boston. His engineering team was one of five finalists for Best Paper Award — out of 790 papers presented — at last week’s International Conference on Intelligent Robots and Systems (IROS 2011).
Inventors and engineers tend to come up with ideas and technologies first, then say, “This is cool, what’s it good for?” Clinicians tend to say, “Here’s my clinical problem, how can I solve it?”
This was roughly the thinking that brought together Boston University engineer Pierre Dupont and Pedro del Nido, chief of Cardiac Surgery at Children’s Hospital Boston.
Dupont had a vision for a next-generation surgical robot. del Nido had a vision of doing complex cardiac repairs in children while their hearts are still beating. Could they create a viable technology?
During breaks at TEDMED, Children’s Hospital Boston is demonstrating a sampling of its technologies. Medgadget, the Internet Journal of Emerging Medical Technologies, came by to watch and posted these videos.
Above, Children’s engineer Pierre Dupont describes a new way of fixing children’s hearts — with enhanced, robot-guided catheters and tiny surgical tools that he’s developing with Pedro del Nido, chief of Cardiac Surgery. We hope these tools (shown at their true miniscule size and in large models) and the robotic system driving them will allow children, especially babies, avoid the rigors of open-heart surgery. Instead, a short-stay catheterization procedure could be performed while their hearts are still beating.
Here, Children’s epidemiologist-informatician John Brownstein explains some of the new features of HealthMap, an Internet-based infectious-disease tracking system. He zeroes in on Haiti’s emerging cholera outbreak, in which a “crisis mappers” community on the ground is sending real-time data to HealthMap via iPhone and iPad.
Read more about innovations at Children’s on our website, and stay with Vectorblog and our Twitter feed (@science4care) for continuing TEDMED coverage.
Move over, Ozzy Ozbourne. Next Wednesday, October 27th, Children’s neurologist-neuroscientist and TEDMED speaker Frances Jensen will compare and contrast the developing infant brain with the highly paradoxical teen brain – which is also developing rapidly, all the way to age 25 or so. Infant and teen brains are at opposite ends of the developmental spectrum — almost different species, Jensen says – but they’re both extremely dynamic and exquisitely sensitive to environmental factors (drugs and alcohol in teens and brain injury and seizures in infants).
The seemingly random flailing of a newborn’s arms and legs is more important than it looks – it’s how babies begin to explore the physical world and their place in it. This motion-capture movie shows the normal kicking of a 5-month-old, but when a baby’s muscles are weakened by brain injury, this exploration is curtailed. It becomes a vicious cycle: the motor parts of the brain can’t develop properly, impairing mobility even further. Psychologist Eugene Goldfield, PhD, of the Center for Behavioral Science at Children’s Hospital Boston, with a team of engineers and scientists at the Wyss Institute, is in the early stages of a project that could help break this cycle for babies with cerebral palsy.
Goldfield calls it the “second skin” – smart clothing whose fabric, studded with tiny sensors, would pick up attempts at motion.