Stories about: Devices

Smart pad would provide biofeedback for Kegel incontinence exercises

biofeedback Kegel exercises urinary incontinence

If you’ve ever been given Kegel exercises to strengthen your pelvic floor, you may have wondered if you’re doing them right or if you’re getting better. Two physicians at Boston Children’s Hospital have developed a stick-on pad that could someday tell you.

Carlos Estrada, MD, director of the Spina Bifida Center and co-director of Urodynamics and Neurourology, and Jeanne (Mei Mei) Chow, MD, director of Uroradiology at Boston Children’s both work with children who have urinary incontinence. In the clinic, Estrada has equipment that provides biofeedback as kids practice squeezing their pelvic floor muscles. But parents had been asking for a home solution. “They say, ‘it’s hard to do it at home without getting any feedback,’” says Estrada.

Done right, Kegels can have an 85 percent success rate, he says. But lacking feedback, most people give up on them, including adults. “Adults can get monitoring, but it’s done in specialized clinics with intrarectal and intravaginal probes,” Estrada says.

Most people take a pass on that.

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Topical antibiotics for otitis media: A one-squirt cure?

otitis media transtympanic gel
A single-application gel could revolutionize treatment of ear infections, reducing side effects and drug resistance. (Click to play animation.) Credit:Kohane group

Otitis media, or middle-ear infection, affects 95 percent of children and is the number one reason for antibiotic prescriptions in pediatrics. Typically, antibiotic treatment involves 7 to 10 days of oral medication — several times a day — a formidable task for parents of little kids.

“Force-feeding antibiotics to a toddler by mouth is like a full-contact martial art,” says Daniel Kohane, MD, PhD, a pediatrician and director of the Laboratory for Biomaterials and Drug Delivery at Boston Children’s Hospital.

A single-application bioengineered gel could be the answer to parents’ and pediatricians’ prayers. Described in a paper published today in Science Translational Medicine, the gel would provide an entire course of therapy through a single squirt into the ear canal. It was developed by Kohane’s team in collaboration with investigators at Boston Medical Center and Massachusetts Eye and Ear.

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Drug-eluting contact lens offers hope in glaucoma

Daniel Kohane drug-eluting contact lens
Contact lenses ringed with a drug-bearing polymer film provided gradual, sustained drug release in this preclinical study, potentially offering an alternative to eye drops.

Daily medicated eye drops are the first line of treatment for glaucoma, the leading cause of irreversible blindness. The drops relieve pressure in the eye, a significant risk factor for glaucoma. But they’re not ideal: their delivery is imprecise, they can cause stinging and burning and patients often struggle to administer them. Adherence is poor: in one study based on insurance claims data, nearly half of patients who had filled a glaucoma prescription stopped topical glaucoma therapy within six months.

Engineered contact lenses dispensing glaucoma medication gradually could vastly improve adherence, helping hang onto their eyesight longer. In a pre-clinical study of glaucoma published online this week in the journal Ophthalmology, slow-release lenses lowered eye pressure at least as well as daily eye drops containing the drug latanoprost — and, in a higher-dose form, possibly more so.

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Amblyopia detection: A long climb to market for the Pediatric Vision Scanner

David Hunter Pediatric Vision Scanner
(Photo: Bruce Hunter)

David Hunter, MD, PhD, ophthalmologist-in-chief at Boston Children’s Hospital, is also developer of StrabisPix and BabySee. The Pediatric Vision Scanner received FDA marketing clearance last month.

As a pediatric ophthalmologist, I do my best to assure that every young patient I examine will have a lifetime of perfect sight. The condition that I battle most commonly is amblyopia, or “lazy eye,” in which the eye is healthy but does not develop vision — simply because the brain doesn’t receive proper input when a child’s visual system is “learning” how to see.

When I can diagnose amblyopia early enough, I can treat it with an eye patch or eye drops to block the “good” eye, giving the eye with amblyopia time to catch up. But amblyopia does not fight fairly: about half of affected kids have no visible signs of the condition. As a result, amblyopia silently steals the sight of hundreds of thousands of children — many of whom will never get their vision back because treatment started too late.

It is this problem that inspired me to develop the Pediatric Vision Scanner (PVS).

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3D-printed models assist complex brain surgery for encephalocele

Encephalocele 3D printing

At five months’ gestation, Bentley Yoder was given little chance to live. A routine 20-week “gender reveal” ultrasound showed that a large portion of his brain was growing outside of his skull, a malformation known as an encephalocele. But he was moving and kicking and had a strong heartbeat, so his parents, Sierra and Dustin, carried on with the pregnancy.

Born through a normal vaginal delivery (the doctors felt that a C-section would interfere with Sierra’s grieving process), Bentley surprised everyone by thriving and meeting most of his baby milestones.

But the large protuberance on his head was holding him back. It steadily got larger, filling with cerebrospinal fluid. Bentley couldn’t hold his head up for more than a few seconds.

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Bringing voice technology to healthcare: Hacking with Amazon’s Alexa

voice technology healthcare
Kate Donovan, clinical advisor to IDHA, conducts a simulated inpatient demo of Alexa.

Earlier this spring, Boston Children’s Hospital’s Innovation and Digital Health Accelerator (IDHA) released KidsMD for Amazon’s Alexa, the voice technology system’s first healthcare “skill.” It offers simple health advice for parents inquiring about their child’s fever and medication doses at home. But fever is just the beginning. Where else in a patient’s journey could voice be leveraged?

In collaboration with Boston Children’s Hospital’s Simulator Program (SIMPeds), IDHA brought Alexa to a two-part mini-hackathon on May 25. Patients and their families, clinicians, developers and researchers were invited to watch and join demonstrations of voice technology across the hospital. In the breakout hack sessions that followed, participants brainstormed future applications for voice at Boston Children’s.

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Detecting shunt failure in hydrocephalus without imaging or surgery: ShuntCheck

shunts hydrocephalus
Antonio helped test a device that can tell whether a shunt is still working. (Photos: Katherine Cohen)

Antonio Venus-Reeve, 14, had his first shunt surgery for hydrocephalus when he was 2½ months old. Born at 25 weeks’ gestation, weighing less than two pounds, he had a serious brain bleed seven days later.

As Antonio’s head began to swell with excess fluid, neurologists at Boston Children’s Hospital told his mother, Joanne Venus-Williams, that Antonio probably would not be able to walk, talk or develop major motor skills. “Neurosurgery got involved and the team did daily spinal taps to draw out the fluid in his brain,” says Venus-Williams. “They were hoping he wouldn’t need a shunt, but we got to the point where we knew it was the way to go.”

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Why can’t a walker be more like an all-terrain vehicle?

Child innovator Sadie with Amazing Curb Climber
Photo: Patrick McCallum

Sadie McCallum’s own life led her to become an inventor. She’s 9, has cerebral palsy, for which she’s seen at Boston Children’s Hospital, and relies on a walker to get around. “It would be SO much easier if my walker was more like an all-terrain vehicle and could go over curbs or stairs,” she says.

This year, in third grade, Sadie took part in her school’s annual Invention Convention and designed and built the Amazing Curb Climber. She sketched the design, and her family helped her with the planning, drilling, sawing and assembly. The end product combined two of Sadie’s old walkers and six lawn mower wheels (three on either side) to create an all-terrain design, plus two smaller wheels in back. Her dad helped build a portable curb for testing and demo purposes.

The invention won first place for Best Use of a Wheel and second place for Kids’ Choice. Sadie went on to the regional Invention Convention, where she took the first place for the Special Needs Award as well as the Microsoft Technology Award.

Read Sadie’s post on our sister blog, Thriving.

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StrabisPIX: Assessing strabismus from patients’ smartphone photos

strabismus smartphone

New smartphone-based diagnostic tools are enabling consumers to take their temperatures, diagnose simple skin conditions and much more. As advanced smartphone imaging puts more and more capabilities in patients’ hands, it’s no surprise that clinicians and numerous digital health startups are leveraging them.

As a case in point, the Department of Ophthalmology and the Innovation & Digital Health Accelerator (IDHA) at Boston Children’s Hospital have co-developed a smartphone application for patients with strabismus, or misalignment of the eyes, to securely capture and transmit photos of their eyes to their providers.

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Medicine meets theater: Pediatrics training, parent practice, device innovation ‘on location’

medical simulation

Pediatric medicine just took a step for the better in Boston’s Longwood Medical Area with a new, expanded pediatric Simulation (SIM) Center — a dedicated space where doctors, nurses and other staff can rehearse tough medical situations or practice tricky or rare procedures in a clinical setting that looks and feels real.

But clinicians aren’t the only ones who will be using the new 4,000-square-foot facility, which incorporates real medical equipment, set design and special effects.

Families can get hands-on practice with medical equipment they’ll be using at home. Inventors and “hackers” can develop and test new devices or software platforms and see how they perform in a life-like clinical environment. Planned hacks, for example, will explore different medical and surgical applications for voice-activated and gesture-controlled devices.

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