CleveMed Blogs

Hello! My name is Danielle Madere, a recent graduate from Illinois Institute of Technology with a bachelor’s degree in biomedical engineering. In the past month, I was lucky to join the CleveMed family as their newest biomedical engineer.

My first two weeks on the job consisted of gaining familiarity with some of our devices: Kinesia, KinetiSense, and the BioRadio. There was also much training, many meetings, and assisting with grant writing.

In the coming months, I will be focusing a lot of my time on clinical studies for several movement disorder monitoring products that we are currently focusing on, specifically ETSense, ParkinStep, and PDRemote. I will be organizing meetings with patients, collecting symptom data, and performing some preliminary analysis to ensure the data we are collecting is valid.

I am very excited to work with CleveMed’s Movement team because I truly believe that our devices, such as Kinesia HomeView, will revolutionize the way clinicians treat movement disorders such as Parkinson’s disease. Presently, Parkinson’s disease symptoms are rated by the clinician, based solely on the clinician’s subjective opinion of the severity (UPDRS). Additionally, clinicians only see the patient for a very limited window of time in their office, which does not provide significant insight into the symptoms a patient faces at home, where treatment really matters. Kinesia HomeView will allow clinicians to observe the quality of life of a patient throughout the course of a day in the comfort of their own home, and adjust medication doses and frequency accordingly.

The more closely I interact with Parkinson’s disease and essential tremor patients, the more desperately I want to help improve their quality of life, and CleveMed gives me that opportunity, which I am eternally grateful for.

Just in case you did not know: In CleveMed’s Movement Disorders Division we design and manufacture medical devices to help study movement disorders such as Parkinson’s disease. As an ongoing process in development, we’re always interested in receiving feedback to gain additional insight in movement disorders, especially from those using our devices. Some of you have participated in some of our research projects in the past (like one of our medical devices being currently developed with local hospitals, which uses a small wireless motion sensor placed on the finger to record symptoms of Parkinson’s disease).

CleveMed has established a Movement Disorder Focus Group for individuals diagnosed with Parkinson’s disease, and we are inviting you to join. As a participant, you’ll be in the know about future opportunities to get hands-on experience with our medical devices, test them out, and provide valuable feedback. Sessions are about an hour long, and allow you to learn more about how we are working to improve patient therapies. Lunch is always on us!

If you are interested in joining our Movement Disorder Focus Group call us at 216-361-5423 and ask for the focus group coordinator.

PS: CleveMed is located at 4415 Euclid Ave Cleveland, OH 44103. We look forward to seeing you at the CleveMed Movement Disorder Focus Group!

Sincerely,
Thomas Mera
Senior Biomedical Research Engineer

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?

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].}