CleveMed Blogs

I remember the story of a biomedical engineer I know. As an undergrad, he planned to graduate, leave school and enter the industry. In the last weeks of class, a professor brought in a patient with a high level spinal cord injury. He demonstrated how FES (functional electrical stimulation) could be used to control weak or paralyzed muscles. When he saw this paralyzed patient move his arms, he was hooked. He went on to graduate with a PhD in biomedical engineering with a focus on rehab engineering.

Biomedical Instrumentation 101: students learn circuit design, how to build an amplifier, data acquisition, signal processing, etc. The concepts are taught; but is there enough emphasis on how this information can be used in applications outside of the classroom? Education in these areas of engineering and physiology is important, but how it can be used in real world applications is just as critical.

CleveLabs is a lab course system that uses wireless data acquisition hardware and interactive software to teach engineering, data acquisition, digital signal processing and basic and advanced physiology. In addition to these customary topics, we also include a section of clinical applications: labs that demonstrate to students where they can apply all that they’ve learned. How about using electro-oculography (movement of the eye) to control the position of a dot on the screen, and control the color of the dot just by blinking? This shows how EOG can be used for computer cursor control, where blinking represents a click, for persons with high level spinal cord injuries. Or what about using electromyography (electrical muscle activity) from the biceps and wrist extensor muscles to control the elbow angle and hand grasp of a virtual robotic arm? This explains how the use of existing muscles can control a prosthetic limb. In addition, heart rate detectors are created, gait and stride time are measured, EEG is used to detect different states of alertness. CleveLabs goes beyond the traditional topics using clinical examples of biomedical engineering applications.

Where can real world examples, such as the story of my friend, take your students?

CleveMed’s SleepScout is a compact, portable sleep monitor used to aid in assessment of sleep disordered breathing outside the traditional sleep lab: in a hospital setting (with iPSG™), or typically perfect for self-administered home sleep testing (even remotely attended with DreamPort™) right in the patient’s home. But here is another way to use the SleepScout: Dentists with an interest in sleep, snoring (sleep disordered breathing), and remedies for snoring through oral appliances and surgeries can use SleepScout to perform take-home sleep tests for their patients.

Here’s why the SleepScout is a great option when considering a sleep recorder for the dental office:
• SleepScout uses AASM recommended Type 3 channel set
• SleepScout’s accessories are very cost-effective
• SleepScout can monitor effectiveness of treatment with CPAP and oral appliances
• SleepScout gives an easy-to-read report with auto-scoring of respiratory events
• SleepScout records EMG to monitor Bruxism
• With SleepScout you have next day results

These are just a few reasons to consider the SleepScout, and you can read more details here. Also, see a sample report from the SleepScout portable sleep monitor at www.CleveMed.com/DentalSleep. And if you haven’t seen the SleepScout overview video, check it out!

The SleepView™ is the smallest, lightest home sleep monitor following AASM guidelines for portable monitoring. The SleepView is ergonomically designed for patients to perform a self test at home. SleepView works hand in hand with the e-Crystal PSG Web Portal, where sleep studies are uploaded for review and scoring by sleep technologists and interpreted by a board certified sleep physician. This practical and efficient patient monitoring system, allows physicians to provide a continuum of care. (For more information on the SleepView call 216-791-6720)

Significant strides have been made in the management of Parkinson’s disease (PD) motor symptoms such as tremor, slowness of movement, and rigidity; however, treatment side effects pose a key therapeutic challenge. Upon initial onset of the disease, patients are typically prescribed levodopa, a drug taken orally several times a day to increase dopamine levels in the brain to alleviate motor symptoms.

As the disease progresses, changes in the body’s response to levodopa give rise to therapy complications such as delayed onset and decreased duration of motor symptom relief per dose. Chronic treatment can also lead to side effects such as dyskinesias, which can take on various debilitating forms: irregular brief rapid movements (chorea) during the “On” state at peak dose and sustained twisting movements (dystonia) during the “Off” state when the medication has worn off. Approximately 30% of patients diagnosed with PD exhibit levodopa-induced dyskinesia within 5 years of treatment^[1] and 59-100% by 10 years^[1-3]. Quality of life has been shown to be negatively impacted by dyskinesias^[4], specifically mobility^[5], activities of daily living^{[5, 6]}, communication^{[5, 6]}, and bodily discomfort^[6].

Figure 1: Blood Levodopa Concentration

Adjustments in medication to reduce drug side effects often sacrifice control of motor symptoms, and balancing this tradeoff poses a significant challenge for management of advanced PD. Alternate strategies to better control motor fluctuations have aimed efforts at developing drug administration methods to minimize swings in blood levodopa concentration. Figure 1 highlights the typical drug cycles that patients may experience throughout the day when taking levodopa in discrete intervals^[7]. Over time this approach shrinks the size of the “On” state window requiring higher doses to achieve the same effect and increasing the frequency and severity of dyskinesia. The ideal scenario would be to maintain levodopa concentration in the “On” state where levodopa is effective at alleviating motor symptoms without inducing dyskinesia. Studies have suggested that continuous drug administration may better mimic the normal physiological release of dopamine in the brain in order to attain more stable therapy benefits^{[8, 9].}