Team 11: Device to Monitor and Control IHD for Painful Stiff Shoulder Treatment

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1 Team 11: Device to Monitor and Control IHD for Painful Stiff Shoulder Treatment Kyle Bagshaw (Fluid Biomechanics) Vesko Zlatev (Biomaterials) University of Connecticut, Biomedical Engineering Client, Faculty Advisor: Dr. Krystyna Gielo-Perczak TA: Sarah Brittain 1

2 2 Introduction, Background, and Previous Work

Background Adhesive Capsulitis ( Stiff Shoulder or Frozen Shoulder ): Painful chronic condition characterized by fibrous tissue formation in the shoulder joint [1] Affects 3% of people at some point

3 Background Adhesive Capsulitis ( Stiff Shoulder or Frozen Shoulder ): Painful chronic condition characterized by fibrous tissue formation in the shoulder joint [1] Affects 3% of people at some point [2] Symptoms Reduced ROM Pain (chronic & acute) Risk Factors 20% have diabetes Common Treatments Painkillers, steroids Physical therapy Surgical procedures Very long recovery [1] 3 [1] [2]

4 Background Novel treatment: Intra-articular hydraulic distension (IHD) Injection of fluid into articular capsule Distends joint, stretches stiff/fibrous tissue out Local anesthetic, corticosteroids, anti-inflammatories usually incorporated Optimal conditions for treatment still unknown 4

Previous Work IHD typically performed by manual bulk infusion using a syringe Lee et al (2008) and Chung et al (2009) used a syringe pump to infuse at a fixed flow rate, and a pressure sensor to

5 Previous Work IHD typically performed by manual bulk infusion using a syringe Lee et al (2008) and Chung et al (2009) used a syringe pump to infuse at a fixed flow rate, and a pressure sensor to monitor intra-articular pressure Lee et al 2008 Chung et al Lee, et al., Real-Time Pressure Monitoring of Intraarticular Hydraulic Distension for Painful Stiff Shoulders, Journal of Orthopaedic Research [online], Volume 26 (Issue 7), p , (2008, August) Chung, et al., Intra-articular Pressure Profiles of Painful Stiff Shoulders Compared With Those of Other Conditions, American Academy of Physical Medicine and Rehabilitation [online], Volume 1 (Issue 4), p , (2009, April)

6 Introduction & Objective Project description from client: A device to monitor intra-articular pressure and control IHD in real-time, and record and analyze data to improve diagnosis, treatment, and rehabilitation options Specifications Control by PC User interface Portable Procedure for use Key Innovations Feedback control of pump system Analysis of measurement errors Assembly of components into a single package 6

7 7 Project Design: Subsytem Approach

8 Project Design Emergency Stop Biohazard Waste Disposal Patient Spinal Needle 1 st Tubing Pressure Sensor 2 nd Tubing Syringe DAQ Syringe Pump Sanitization & Preparation Ultrasound PC (LabVIEW) Positioning P vs. t Curve Patient Instruction Operator Data Display, User Interface P vs. Volume Curve Export Data Patient subsystem: Patient positioning, preparation, feedback 8

9 Project Design Emergency Stop Biohazard Waste Disposal Patient Spinal Needle 1 st Tubing Pressure Sensor 2 nd Tubing Syringe DAQ Syringe Pump Sanitization & Preparation Ultrasound PC (LabVIEW) Positioning P vs. t Curve Patient Instruction Operator Data Display, User Interface P vs. Volume Curve Export Data Operator subsystem: Operator functions, device interface, interactions with the patient 9

10 Project Design Emergency Stop Biohazard Waste Disposal Patient Spinal Needle 1 st Tubing Pressure Sensor 2 nd Tubing Syringe DAQ Syringe Pump Sanitization & Preparation Ultrasound PC (LabVIEW) Positioning P vs. t Curve Patient Instruction Operator Data Display, User Interface P vs. Volume Curve Export Data 10 Fluid subsystem: Involves all parts of the mechanical system as the fluid is injected

11 Project Design Emergency Stop Biohazard Waste Disposal Patient Spinal Needle 1 st Tubing Pressure Sensor 2 nd Tubing Syringe DAQ Syringe Pump Sanitization & Preparation Ultrasound PC (LabVIEW) Positioning P vs. t Curve Patient Instruction Operator Data Display, User Interface P vs. Volume Curve Export Data 11 Computational subsystem: Involves the user interface, device control, feedback, and data acquisition and processing

12 12 Components and Prototype

13 Syringe Pump NE-500 OEM Programmable LabVIEW compatible RS-232 pump-to-pc port w/ cable; adaptor to USB Power supply (120V A/C) Error Analysis Data from manufacturer Future testing for analysis & calibration 13

14 Subunit: Pressure Sensor PendoTECH Disposable Pressure Sensor Polycarbonate Reusable Fluid fittings: Luer-lock Wiring & specifications online 4 analog pins: +/- excitation voltage & +/- signal voltage Error Analysis Noise 14

15 Subunit: Amplifier Pressure sensor signal too weak to be detected directly by DAQ Constructed differential amplifier circuit (gain=85) Added screw-in pins for sensor, DAQ leads Added barrel jack adaptor for DC power source 15

16 Subunit: DAQ NI USB-6008 Focused on analog I/O A/D conversion LabVIEW ready USB-compatible Error analysis Design concern Noise Resolution limits 16

Luer-Lock adaptors Needle Ideal: 22 gauge, 3.

17 Subunits: Syringe, Tubing, Adapters, Needles Terumo 30mL plastic syringes Tubing: 50 bulk length, 1/16 inner diameter, vinyl Luer-Lock adaptors Needle Ideal: 22 gauge, 3.5 spinal needle Error analysis Leak-free Effect of fittings 17 *Styrene-acrylonitrile resin

holes to pass tubing, cables through Attached components to case

18 Subunit: Casing Received recycled Plexiglas box from Dr. Gielo-Perczak Added handles, plastic feet, lids with hinges Cut holes to pass tubing, cables through Attached components to case Syringe pump: Bolted to case & secured with nuts Others: High-strength Velcro 18

19 PC and User Interface LabVIEW driver Front Panel User input/output Real-time displays Controls Parameters affecting error Background Operations Negative feedback Data processing Data I/O Pump communication 19

Patient Positioning System Procedure to stabilize the patient s arm Error associated with different patient positions Intra-articular pressure changes with arm position [3] Identification of optimal

20 Patient Positioning System Procedure to stabilize the patient s arm Error associated with different patient positions Intra-articular pressure changes with arm position [3] Identification of optimal position Review of literature Risk Factors Potential injury Pressure vs. arm position Inokuchi et al 1997 [3] 20 [3] Inokuchi et al, The relationship between the position of the glenohumeral joint and the intraarticular pressure: An experimental study, J. Shoulder Elbow Surg. 6:2 1997,

21 Complete System AMPLIFICATION Feedback Loop 21

22 Complete System Lee et al 2008 Patient with shoulder pain, reduced motion IHD Device User Interface Ultrasonography imaging to confirm needle placement 22 Microsoft stock image Operator (Researcher or health care provider)

23 Complete Device & Testing with Porcine Shoulder, Ultrasonography USG expertise provided by Dr. Patrick Kumavor 23

24 Budget ($1000) Part Cost Syringe Pump $ DAQ (NI USB-6008) $ Syringes $7.45 Pressure Sensor, 1-way check valves $35.21 Vinyl tubing, male & female luer fittings with barb hose adaptors (1/16 inner diameter) $37.52 Circuit components/cables/electronics $79.81 Hardware for case (handles, hinges, bolts, Velcro, Plexiglas for lid) (Mansfield supply) $35 Porcine shoulder (Animal Technologies Inc.) $150 TOTAL COST $1,043 REMAINING BUDGET -$43 24

25 25 Conclusions

26 Design Conclusions: Spring 2013 Assembled complete device into a case Implemented user interface/controls in LabVIEW Studied & implemented calibration & error analysis Implemented feedback loop Noise & small rate of change of signal of interest limiting Performed preliminary validation using porcine shoulder sample 26

27 Future Directions Optimize patient positioning system and incorporate immobilization device Programming Recognize characteristic pressure profiles Improve filtering of signal to optimize control Upgrade case construction Further in vitro testing for error analysis purposes (porcine shoulders) Continued testing, error analysis, modification 27

28 Device Impact Improved therapy and patient rehabilitation Optimized effectiveness of treatment Accurate measurements Significant reduction of measurement error Increased understanding of technique Economic treatment option Alternative diagnostic method (compared to MRI imaging) 28

29 Acknowledgements Client, Faculty Advisor: Dr. Krystyna Gielo-Perczak* Dr. John Enderle TA: Sarah Brittain Mr. David Kaputa Mr. Orlando Echevarria, Mr. George Assard Dr. Patrick Kumavor Mr. David Cavallaro Ms. Jen Desrosiers Mr. Serge Doyon, Mr. Peter Glaude *Biomedical Engineering, University of Connecticut, Storrs, CT 29

Thank you! Questions? http://static.stuff.

30 Thank you! Questions? 30

31 31 Thank you!

32 Backup info: Error Analysis Mathematical relationships between physical variables must be established E.g., fluid subsystem: relationship between intra-articular pressure & pressure sensor reading depends on system Bernoulli s Equation: 32

Team 11: Device to Monitor and Control IHD for Painful Stiff Shoulder Treatment

Team 11: Device to Monitor and Control IHD for Painful Stiff Shoulder Treatment Kyle Bagshaw (Fluid Biomechanics) Vesko Zlatev (Biomaterials) University of Connecticut, Biomedical Engineering Client, Advisor: