Training a Damaged Brain

One of my medically related interests is a neurological disorder know as CTE, Chronic Traumatic Encephalopathy. I became aware of this disorder largely through an exceptional documentary on PBS Frontline, League of Denial. It's a history of the discovery of this disorder as found in NFL players and the lengths the NFL had gone to deny that this disorder is common among those in NFL and football players in general. If you're not familiar with CTE and its connection to playing tackle football, I strongly suggest that you see this documentary. And consider reading and watching much of the source material. The work in this area continues to progress with more and more sufferers of CTE being discovered among those who were NFL players. Many of the changes in the rules and football equipment has been driven by research on CTE and the accumulating findings.

CTE is not the only type of brain damage that afflicts older NFL players. CTE is particularly troubling because its severity on suffer's cognitive and emotional functioning. There are brain damage related disorders are not at the level of severity as CTE that plague older football players.

A few days ago I ran across a treatment system that trains damaged brains. Many of the former football players, particularly those from the hard-hitting NFL, live in a kind mental haze, as if they were living in a dream state. They're unable to concentrate or focus for even a short period of time on anything without mentally drifting from the task at hand. This training system has been shown to significantly increase lift patient's emotions and apparently, lift them out of the mental hazy they have been living with for years. Here's a link to video and the article: https://denver.cbslocal.com/2016/02/08/former-broncos-seek-concussion-relief-through-neurofeedback/

The treatment system is called neuro-feedback. Because it appears to run on a computer, it would seem that it would be something that a patient could use on their own home computer.

Now, one of the reason's I mention this is because one of the people mentioned in the article and who is in the video is Jon Keyworth (and his wife). I mention that because Jon and I were childhood friends. He and I grew up in the same neighborhood. Jon is a few years older than I am. And we went to different high schools and different universities. Our paths diverged, but I haven't forgotten Jon. I followed his career from a distance and I've been in contact with people who have known him over the years.

Jon was an exceptional athlete. (Interestingly enough, the only person I've ever know who had athletic skills at Jon's level is my younger brother.) Me? I'm no athlete. I kept trying and continue to ride a road racing bicycle at respectable speeds, low to mid 20s MPH over reasonable distances, but in truth my athletic skills are at the opposite end of the bell curve from Jon. I'm not ashamed to say that I'm jealous. I always wondered what it would be like to have athletic skills at his level. (I bet there are others out there who have wondered the same thing.)

Let me go through Jon's success as a football player. Jon played for the Denver Broncos as number 32 for his entire NFL career from 1974 to 1980. (Seven seasons.) He was fullback meaning that his primary job was as a blocking back, nevertheless Jon is listed the 10th best all time rusher for the Broncos. He played in Super Bowl 12. (Not only can I not imagine what it's like to play in an NFL game, I certainly can't imagine what it would be like to play in the Super Bowl. I haven't had anything close to that kind of an experience. I guess it must have been nice, but that's something I'll never know.)

One more thing I want emphasize. Jon was, is and will be a much nicer, kinder person than I ever have been or will be. Forget about any stereotypes that you might hold about NFL players, particularly the stars of the game. At least as it applies to Jon. Jon is someone filled with warmth, kindness and generosity. And when I ran across the article and video above that talked about Jon's plight and his way back, I felt that I needed to share this treatment as well a little bit of Jon's story. It could be that these players and the treatment they're undergoing may have an impact on a much wider group, maybe people suffering from dementia, especially early dementia. Maybe it can be slowed or possibly reversed. But these former players may be blazing a trail for the rest of us.

So, thank you, Jon. And your wife. And thanks to the people who have developed the treatment and continue to refine it. 

Reprise: Everyone -- Stop Playing Bingo and Get into the Gym!

Here's another article that demonstrates the benefits of weight training ... this time for everyone!

https://www.nytimes.com/2018/12/04/well/move/even-a-little-weight-training-may-cut-the-risk-of-heart-attack-and-stroke.html?em_pos=small&emc=edit_hh_20181205&nl=well&nl_art=3&nlid=67594383emc%3Dedit_hh_20181205&ref=headline&te=1

Here are a few quotes from the article ...

The findings were dramatic: The risk of experiencing these events (stroke & heart attacks) was roughly 50 percent lower for those who lifted weights occasionally, compared with those who never did — even when they were not doing the recommended endurance exercise. People who lifted twice a week, for about an hour or so in total, had the greatest declines in risk.

As an associational study, the results show only that people who occasionally lift weights happen to have healthier hearts ...

Commentary: HE-75 and IEC 62366 and Cleaning Up the Messes

I received a reminder recently when I was made aware of the International
Consortium of Investigative Journalists' database of medical device recalls of what human factors professionals working in the area of human engineering for medical devices are often called on to do: clean up the mess created by a failed design process that somehow failed to incorporate research. (Note that medical device development isn't the only domain where this kind of failure occurs, however, the impact of medical device failures can often result in fatalities.) The persons responsible for designing an awful, unusable and in some case, useless user interface expect the usability expert to come in, take one look and create a beautiful user interface. This is absurd!

Writing from my own perspective, there is nothing that a usability professional likes to do less than to correct a failed design that resulted from a failed design process. This week I was asked to save a group of programmers and user interfaced designers from the monstrosities that they had created. What was particularly strange was that the leader of the project thought that I could just redesign something by looking at what they had created. It was bizarre. Unfortunately, I had to deliver several harsh messages regarding the design process and the design, that were not well received. (Nevertheless, that is my job.)

Here is the point I want to make clear to anyone who reads this: Process and the resulting design should be considered as two sides of the same coin. The outcome of a good design process generally results in a good design. A nonexistent or poor design process often times leads to a poor design and a design that gets worse with each design iteration when attempts are made to fix problems or incorporate enhancements.

The processes and design direction provided by HE-75 and IEC 62366 can serve as a foundations for research and designing systems with user impacts within nearly any industry, particularly in those industries where the potential for harm is likely.

Careband: Keeping track of those with dementia

I was at an evening venture capitalist meeting on 13 November 2018. I'm not a venture capitalist but I have a few connections to this community and I periodically receive invitations to their meetings. Most of the time I pass on attending. I'm interested in science, mathematics and technology. VCs are interested in ways to make money. Nothing against them. We just live on different planes of existence.

However, I attended this meeting because I read the description of one of the companies doing a presentation, careband (http:www.careband.co).

careband

Careband provides a capability to track the location of people with dementia. This is a more difficult problem than you might imagine. In institutions, patients with dementia are known to wander away: from the institution, from their homes, from family members. The patients do not know where they are or how to return. Institutions who care for dementia patients frequently need to find their patients who have wandered away from the institution's grounds or to areas of the institution that caregivers do not expect that they would be able to wander. 

Thus there's a clear need to be able to keep contact track of dementia patients. To know where their location at all times and be notified when they've wandered off the grounds of the institution.  Here's a page from the careband.co website that summarizes the capabilities of their system.

The diagram above shows the elements of system for patients and customers/caregivers -- those responsible for caring for the dementia patient(s). Caregivers can see at a glance the current location of each patient. Each dementia patient wears a band about the size of a large wristwatch on the wrist that periodically sends a location related message to the network. All data is sent to careband's cloud server system. Patient location data is made accessible to the caregiver systems that are connected to the cloud server system.

The wrist bands connect to the Internet to the low-power communications system: LoraWAN. More information about this wireless data communications network is available here: https://lora-alliance.org/about-lorawan The LoraWAN network is a low-power, low-speed (0.3 kbps to 50 kbps) but long distance (up to 3 miles from an access point outside) and robust wireless communications system. 

The wristband also includes Bluetooth that is used to provide indoor location data. And an accelerometer has been included to provide information regarding whether the patient has moved his or her body during the reporting period. 

I am not familiar with all of the current capabilities of the careband.co system. However, I know that the wristband continually transmits to the cloud the following data:

• Patient ID data
• Transmission time 
• Location data
• Movement (whether or not the person has moved from the time of the last data transmission and the time of the current data transmission)
• Battery charge level

How careband.co is currently analyzing is something of which I am presently unsure, but there are a number of pieces of information that can be derived from this relatively small amount of data. Here's what's possible:

1. Current patient location
2. Map of patient's activity and the distance covered over time
3. Amount of time that the patient was moving
4. Alarm initiation: should the patient stray away from the institution, the system can automatically notify the caregivers. (Boundaries should be able to be drawn on the display.)
5. Trend and trend line analysis for patient activity time and distance covered. These could be indicators of the patient's cognitive health. Significant deviations from calculated trend lines could be indicators of a slip or improvement in a patient's cognitive and/or physical health.
6. Suggest that the patient has removed the band from his or her wrist (when the patient appears not to have moved during normal activity time) or that the patient maybe in distress or died.

There could be more information that can derived from the wristband data that I have yet to think of. As I come up with additional thoughts regarding this, I shall post them.

Upgrades to the wristband could include pulse oximetry and pulse rate data. Again, there are other capabilities that could be added that I have yet to think of.

Since the transmission speed is so low, careband.co will likely need to develop a data compression system to effectively communicate this data back to the cloud server system. 

Careband.co is one more interesting product for remote medical monitoring. It's not designed for remote patient management largely because most patients will normally be closely supervised. However, it could be an aid to enable people with dementia to live for a longer time in their own homes. The benefits to both the patient and to society are massive. Six months to a few years of being able to live in one's own home would improve both the quality of life for people with dementia and significantly, dramatically reduce the cost of care.

I shall continue to monitor careband.co's progress. Stay tuned.

Careband.co plans on making their products available through medical device distributors. Their products are not yet commercially available. They are about to manufacture the wristband. Their wristband has been approved by the FCC. FDA approval is not required.  If you are interested in purchasing their product, please contact them at care band.co.

I should mention that careband.co is looking for investors. If you're interested in what careband.co is selling, please contact them directly using the URL listed above.

International Medical Device Database

For anyone interested in medical device safety, you should bookmark this website: https://medicaldevices.icij.org

It has been created by the International Consortium of Investigative Journalists to:

"Explore more than 70,000 Recalls, Safety Alerts and Field Safety Notices of medical devices and their connections with their manufacturers." 

Apple Watch 4: New York Times Review

Here's an article reviewing the Apple Watch 4 that was published in the New York Times on 19 September 2018.

Here's the link: https://www.nytimes.com/2018/09/19/technology/personaltech/apple-watch-series-4-review-health.html?em_pos=large&emc=edit_ct_20180920&nl=technology&nlid=67594383edit_ct_20180920&ref=headline&te=1

As of the posting of this article, Apple has yet to release their ECG app -- the thing I guess that most of us have interest with regards to the Apple Watch 4. It's the one thing that moves the Apple Watch 4 from a consumer to a medical device and a hardware platform on which to base medical applications and services. So, until the ECG application is available, I'm holding off on reviewing the Apple Watch 4.

Apple Watch 4 -- FDA Announcement: Statement from FDA Commissioner Scott Gottlieb, M.D., and Center for Devices and Radiological Health Director Jeff Shuren, M.D., J.D., on agency efforts to work with tech industry to spur innovation in digital health

The FDA just provided what amounts to a "shout-out" to companies that design and manufacture intelligent, wearable devices that include medically-related monitoring devices and specifically, the Apple Watch 4.

Here's the link to the FDA statement: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm620246.htm

And here's an interesting quote from the announcement:

... [There have come] a new swath of companies that are investing in these new opportunities [e.g., wearable, intelligent monitoring devices measuring medically-related, physiological characteristics with analysis capabilities.] These firms may be new to health care products and may not be accustomed to navigating the regulatory landscape that has traditionally surrounded these areas. A great example is the announcement of two mobile medical apps designed by Apple to work on the Apple Watch. One app creates an electrocardiogram, similar to traditional electrocardiograms, to detect the presence of atrial fibrillation and regular heart rhythm, while the other app analyzes pulse rate data to identify irregular heart rhythms suggestive of atrial fibrillation and notify the user. The FDA worked closely with the company as they developed and tested these software products, which may help millions of users identify health concerns more quickly. Health care products on ubiquitous devices, like smart watches, may help users seek treatment earlier and will truly empower them with more information about their health.

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I find it interesting that Dr. Gottlieb states that the Apple Watch analyzes pulse rate data, not the ECG, to detect "rhythms suggestive of atrial fibrillation." Yeah, that's a way to do it, but analysis of the ECG is a much better way. When I do a deep dive on the Apple Watch 4, I'll look into this and questions like it.

Seniors: Stop Playing Bingo and Get into the Gym!

I've included an article from the New York Times that's not only worth reading, but passing around no matter what their age, but especially to those who are 50 years old and older. Here's the bottomline: resistance/strength training using weights and/or bands may be the key to staying out of (or at least postponing as long as possible a stay in) a nursing home when you grow older.

A relative of mine told me that once he reached 80 years old that was when he felt himself truly growing old: loosing his strength and stamina. I had always assume that 80 was a point in life when the body reached a point where no matter what you did, everything would decline ending in death. 

Well ... that may not necessarily be the case. My relative never engaged in any resistance training ... at all, ever. Certainly not when I knew him. He was active, but never when into a gym to lift weights or engage in any resistance training. Turned out that was a significant mistake. 

Here's the link to the article: https://www.nytimes.com/2018/09/03/well/live/preventing-muscle-loss-among-the-elderly.html

Here's an interesting quotes from the article:

...  many people past 50, have a condition called sarcopenia (my emphasis) — a decline in skeletal muscle with age. It begins as early as age 40 and, without intervention, gets increasingly worse, with as much as half of muscle mass lost by age 70. (If you’re wondering, it’s replaced by fat and fibrous tissue, making muscles resemble a well-marbled steak.)

“Sarcopenia can be considered for muscle what osteoporosis is to bone,” Dr. John E. Morley, geriatrician at Saint Louis University School of Medicine ... he pointed out that up to 13 percent of people in their 60s and as many as half of those in their 80s have sarcopenia.

But — and this is a critically important “but” — no matter how old or out of shape you are, you can restore much of the strength you already lost. 

So, what are you waiting for? If you’re currently sedentary or have a serious chronic illness, check first with your doctor. But as soon as you get the go-ahead, start a strength-training program using free weights, resistance bands or machines, preferably after taking a few lessons from a physical therapist or certified trainer.

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And by the way, you'll need to increase your protein intake as well. Read the article. I think you'll find it to be of value and something to place in your personal archive.

Apple Watch 4, Preview of Medical-Monitoring Features

Here's an article regarding the Apple Watch 4 and what are suppose to be built in medical monitoring features.

Here's the link: https://www.mobihealthnews.com/content/apple-watch-series-4-will-have-fda-cleared-ecg-fall-detection?mkt_tok=eyJpIjoiTkRVMk0yVmxNamsyWkRneiIsInQiOiJjWXRoaVpENmhJYlBRNFlzVVBYZ3hrc0VEVFdsYmNLUG1FQUIrQmcyMnVHMTRwSnBORDh6cW1Da1kzbjJqS2JxbHcydjRuTk0zaG5qRzBvMFR1MmdiMmZyNGhyXC9SZmYyYkduaSs5R0tyRG85TXkrMHVxTnFFYXFrVE5jWHpIRWwifQ%3D%3D

Here's the list of new medically-related features:

1. ECG (30 second rhythm "strip")
2. A-Fib detection (of course, if you're paying attention and you know the symptoms, you'll probably know sooner than the watch.)
3. Fall detection (as in when the person falls, the watch detects that it has occurred)

All information is sent back to Apple Health Records where all this information be accessible to a physician/cardiologist.

Apple has received FDA approval, according to the article. 

I'm not going to comment until I've had a little more time to study the Apple Watch 4 except to say, if you can detect A-Fib, then why not V-Fib? V-Fib is much more life threatening. Also too, if you've got a 30 second rhythm snap shot, you can do a lot with that. 

I'll touch on these and other questions regarding the Apple Watch 4 and Apple's effort to product a remote medical monitoring device and medical monitoring system later. 

Public Health Crisis: Suicides

This is a public health related piece. I produced a video about suicides. The data that I analyzed was from the Centers for Disease Control.

Suicide has been on the public radar recently because of the scrutiny it has received in the press. And the concerns expressed in the press about the rising numbers and rate of suicide.

When I was in college, I was taught that suicide was a largely based on the victim's emotional state. That the answers of how to address it were to be found in psychology and psychiatry. That may have been true then, but the data that I analyzed, that you will see in this movie, says that suicide may now be more of a socio-economic problem.

Here is the link to the video:

Let us know what you think.