Transcript Orthometrics - Columbia University

Design Problem
Knee related injuries:
• Most common sports-career ending injury
Post-ACL Surgery:
• Pain, scar tissue, muscle atrophy,
decreased proprioception
Physical therapy:
• Important for full recovery
Problem
Difficult and expensive to restore injured
knee to pre-injury functionality.
http://www.leefalin.com/wp-images/acl.jpg
Background & Demographics
Rice's 2nd Knee Injury
Ends a Lost Season
Background
The New York Times
• The average cost of ACL reconstruction ~$11,500
• Total cost of recovery ~ $30,000
• Recovery time can be up to 6 months
• Out-patient physical therapy 1-2 visits/week
• Check progress, review and modify program
• Patient Overexertion/Non-Compliance
• Poor results
• Re-injury
Jerry Rice
http://tinyurl.com/3dzgqt
Design Brief
Solution
Develop an integrated exercise
device for a more autonomous rehabilitation.
Method
Provide an suitable exercise regimen coupled with sensors to:
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Display physiological measurements for real-time biofeedback
Record these signals for later evaluation by health care providers
Basic Principles
General Rehab Process
Phase 1
Phase 2
Phase 3
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•
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• 2-4 months
• Stability and balance training
• Less frequent PT sessions
• Weight machines, exercise
bicycles or treadmills
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6-8 weeks
Control swelling
Regain R.O.M., muscle strength
PT visits few times per week
Exercise 30-60 minutes per day
Target Muscle Groups
Several months
Full R.O.M.
Normal muscle strength, no swelling
Continue stability, balance and
strength training
Rehabilitation Metrics
• Qualitative assessment
• Cincinnati Knee Rating System
• QOL Questionnaire for ACL Deficiency
• Manual manipulation
• Quantitative assessment
• Surface/Needle EMG
• Range of Motion
• Volume of exercise
http://tinyurl.com/2gxw2l
http://www.orthoassociates.com/ACL_Rehab_protocol.htm
Competing Products
Delsys Myomonitor®
Biodex System 4®
Constraints & Specifications
Reliability & Accuracy
• Must collect EMG data reliably and accurately enough to distinguish between a
functioning knee and a sub-functioning knee
Usability
• Must be intuitive, accessible, and attractive to use
Simple User Interface
• User interface/data output must be easy to understand and analyze by both the
user and the professional
Cost
• Must not be prohibitively expensive - $5000 or less to build / $10,000 or less to
purchase (to be subsidized by insurance company)
Business Model
• Initially sold to physical therapy facilities or doctor’s offices, possibly rented out for
home use
• Potential for partnership with an exercise equipment company
• Disposables - Electrodes
Components
Bike
Leg press
Elliptical
Goniometer
Knee cuff
Exercise
equipment
Surface EMG
Sensors
Exercise data
Muscle firing (EMG)
Display
Bluetooth
Data transfer
Waist pack
Idea 1
ORTHOMETRICS
Smart Elliptical Trainer 2007®
Components
• Elliptical trainer
• Surface EMG
• Bluetooth
Targeted Muscles
• Calves
• Gluteal
• Hamstrings
• Quadriceps
Partial-weight bearing
• Lower joint loading
Drawbacks
• Less common
Idea 2
ORTHOMETRICS
Leg Press Trainer 2007®
Components
• Leg press
• Surface EMG
• Goniometry
• Bluetooth/Wifi
Targeted Muscles
• Quadriceps
• Gluteus Maximus
• Hamstrings
Physical Therapy
• Phase II and later
• Drawbacks*
*Serrão F, et al. “Effect of tibia rotation on the electromyographical activity of the vastus medialis oblique and vastus lateralis longus
muscles during isometric leg press.” Physical Therapy in Sport. 6(1) 15-23 (2005).
Idea 3
ORTHOMETRICS
Bike Trainer 2007®
Idea 3
ORTHOMETRICS
Bike Trainer 2007®
bluetooth/wifi antenna
surface EMG electrode
user interface
Summary
Exercise equipment
Biosensors
Data processing
User friendly
efficient
guided
rehab program
Thank You
Dr. William Macaulay
Orthopedic Surgeon, Columbia University Medical Center
Director of Center for Hip and Knee Replacement
Dr. Ranjan Gupta
Department Chair of Orthopaedic Surgery, UC Irvine
Professor of Orthopaedics, Anatomy & Neurobiology, and BME
James Gossett
Associate Athletic Director, Columbia University
Dr. Evan Johnson
Director of Physical Therapy at the Spine Center
Administrative Director of the Spine Center
Julianne Costa
Occupational Therapist Registered
Physical Therapist
Dr. Tim Wright
Orthopaedic Biomechanics and Biomaterials
Hospital of Special Surgery
Dr. Clark Hung
Associate Professor of Biomedical Engineering
Dr. Elizabeth Hillman
Assistant Professor of Biomedical Engineering
Keith Yeager
Senior Staff Associate, Laboratory Manager