Harvard Developing Pants With “Muscles” That Walk! // One Hip Surgery Saves $160, 000 in Future Medical Costs! // and More!

Harvard Developing Pants With “Muscles” That Walk!

“Put on your smartest suit, ” means something different in this day and age. And according to the federal government, it is worth investing in. The Defense Advanced Research Projects Agency (DARPA) is entrusting $2.9 million so that the geniuses at The Wyss Institute for Biologically Inspired Engineering at Harvard University can create a biologically inspired “smart suit.” Conor Walsh, Ph.D. is the founder of the Harvard Biodesign Lab and assistant professor of Mechanical and Biomedical Engineering at the School of Engineering and Applied Sciences at Harvard. He tells OTW, “Many of us engineers have worked on some form of rigid exoskeleton, some of which can enable paralyzed people to walk. Our new approach was to ask, ‘What if people who have some mobility could move around better?’ A traditional exoskeleton may not be suitable for these situations because they are relatively slow, heavy, and they can interfere with a person’s natural motion.”

“Our first proof of concept was a pair of pants with embedded webbing to which we attached artificial muscles. And while we showed that one could apply large enough forces to have a positive impact on mobility, the device wasn’t portable. We then set to work on trying to make the device battery powered and, lighter. The key innovation was related to making the actual textile lighter; then we embedded actuators in the textile and generated forces that were in parallel with the underlying muscles. We applied the low-power microprocessors to the ankle and hip and they replicated the actions of the muscles. Then we used a variety of sensors to send signals to a microprocessor to detect how the wearer is moving (walking, crouched, etc.) so the user could apply the right amount of assistance.”

“The Soft Exosuit is easily pulled on like a pair of pants and is meant to be worn under one’s daily clothing. For those in the military, it means that they can walk longer distances without getting as fatigued. Wearing the Exosuit would also help reduce the risk of injury when carrying the typical heavy loads that soldiers have to contend with.”

“This is a platform technology for a wide variety of people who suffer from immobility due to muscle weakness after neurological or orthopedic injury. For these patients the current care results in them being relegated to a bed for a long period of time or put in rigid braces, each of which can lead to further muscle atrophy. An exosuit could allow patients to get walking sooner because they are unloading soft tissue and tendons while they are in the process of repairing; the suit also provides combined assistance and rehabilitation. The medical possibilities are huge, from those who experience a stroke to patients with multiple sclerosis and cerebral palsy…essentially any case involving an abnormal gait pattern.”

“Over the next year months we will be evaluating the Exosuit with the Army, putting prototypes on soldiers as they undergo a training course. The Army representatives will quantify the soldiers’ performance and then we will go forward and optimize the system (perhaps making it even lighter or easier to put on and remove). Our ultimate goal is to have a system that is affordable for the millions of people who need assistance with mobility. In order to achieve that goal, the price of the Exosuit may need to cost less than the current rigid exoskeletons that sell for approximately $70, 000.”

One Hip Surgery Saves $160, 000 in Future Medical Costs!

While most talk of the cost of orthopedic surgery, few point out the societal benefits. John Tongue, M.D., former head of the American Academy of Orthopaedic Surgeons, thought it was time to do something about that. Along with colleagues Dr. Tongue, who practices at Cascade Orthopaedic Group in Oregon, worked with health economists to determine the lifetime societal benefit of hip fracture surgery. Dr. Tongue tells OTW, “Orthopedic surgeons are heavily criticized for the cost of procedures at a time when we are searching for value in healthcare. We know the projections and we understand that we as a nation cannot afford to sustain the present costs. Well educated people tell me that they are concerned about the cost of orthopedic care, but no one is aware of the societal benefits. We undertook five studies, one on total hip replacements, another on anterior cruciate ligament reconstruction, one of rotator cuff surgery, another on discectomy, and this latest one on hip fracture…all revealed a cost savings to society.”

“Our new study, published in Clinical Orthopaedics and Related Research, clearly demonstrates that the societal benefits outweigh the direct costs of hip fracture surgery. We found that the average lifetime societal benefits exceeded the direct medical costs of hip fracture surgery by $65, 000 to $68, 000 per patient; the lifetime societal savings exceeded $16 billion for older patients in 2009. We estimated the lifetime cost of a hip fracture to be $81, 300, of which approximately 44% of the costs were associated with nursing facility expenses. On a per-patient basis, the lifetime societal savings of undergoing hip fracture surgery was estimated at $160, 000.”

“Our team conducted a literature review and analyzed Medicare claims data. We also worked with health economists who cross-correlated data sets, used economic models, added insights from a panel of clinical experts, and performed sensitivity analysis (a way of estimating whether or not the assumptions you made are in the ballpark). The results also projected that hip fracture surgery produced an average increase of 2.5 quality adjusted life years based on a patient’s life expectancy and level of physical function for patients with intracapsular fractures, and 1.9 years for patients with extracapsular fractures.”

“These studies on five different orthopedic conditions provide vital information that has heretofore not been estimated. And it is good news for orthopedic surgery in terms of maintaining access to musculoskeletal care for patients going forward. There are now other medical societies looking into doing similar studies with the same team of healthcare economists.”

Don’t Know Your Patient’s Global Sagittal Angle? You Should

Many people look for a new angle when searching for answers. Bassel Diebo, M.D. a spine research fellow in the spine lab at NYU Langone Medical Center, has found one. Dr. Diebo tells OTW, “In my quest to study the impact of spinal alignment on the musculoskeletal system, I was inspired by the work of Jean Dubousset about the ‘conus of economy, ’ defined as the cone in which the body can stay balanced within a narrow range (polygon of sustentation) without energy expenditure. When I looked at the EOS imaging of a number of patients I noticed that we were missing an opportunity to capture information on what was happening with the lower body when it comes to spinal malalignment.”

“If there is sagittal malalignment or deterioration in the sagittal plane then the body recruits compensatory mechanisms. This begins with the pelvis as it tilts backwards, and knee flexion is also recruited as a way to maintain erect posture. These mechanisms are energy draining, compromise walking and debilitate the quality of life.”

“The angle I developed, the Global Sagittal Angle, goes as a fan from the knee to C7 and from the knee to S1. This angle can give the surgeon an idea if the patient is standing in the conus of economy or has truncal inclination or forward alteration. In the lateral view the angle gets bigger when the patient tilts forward, retroverts the pelvis or flexes the knee. Clinically, this angle unmasks the compensatory mechanism in the lower limbs, and connects orthopedic fields (spine, hip and knee). Although a study on normative population remains to be done, but we hypothesize that the ideal postural alignment is a zero angle after treatment—that means there is no malalignment and no compensatory mechanism. I’m pleased that this work has received some recognition, and that I will have the opportunity to present it at the American Academy of Orthopaedic Surgeons annual meeting in Las Vegas, Nevada, 2015.”

“Additionally, I am working on a prospective study where we are trying to assess the clinical outcome of spine treatment—operative or non-operative—by using more dynamic methods than what is traditionally used, such as the Fitbit. We give patients a Fitbit six weeks before surgery and thus we record their daily functionality. Then, after treatment (surgical or other), we give the Fitbit back to the patient for another six months of data to see if there is a benefit or not. Traditionally, we would give patients questionnaires in separate time points post-op and that’s pretty much it. Using the Fitbit, along with our questionnaire, is a step forward towards a more patient centered approach and daily evaluation for the treatment outcome. Moreover, we will be giving patients the ability to specify what they want in terms of outcomes…to say, for example, ‘My goal is that I can play with my grandchildren, and I want the treatment to accomplish this aspect’ This is new.”