Progress 09/01/10 to 08/31/15
Outputs
Target Audience:The target audience served during this project initially was designed for two population groups, but by the end of the project had grown to four distinct groups. First, we selected a population of stroke patients (men and women who had experienced a stroke on one side of the head) who were undergoing rehabilitation at Madonna Rehabilitation Hospital. Second, infants who were scheduled for surgery to correct certain congenital heart diseases were chosen to test hypotheses regarding correlation of cerebral damage and surgical maneuvers. These first two groups were originally proposed for this Hatch project. The new groups include: Third, a population of elderly patients with heart disease who were prone to falling (and thus had balance problems) were targeted for testing. Fourth and most recently, astronauts suffering from vision problems upon returning from space missions. Although these four subject populations were used for experiments in the Hatch project, the true general target audience is any person with brain injury or cerebrovascular disease. Efforts also included an international focus; namely, education of transcranial Doppler principles to a foreign country (Saudi Arabia) as a possible means to ameliorate the growing problem of head trauma due to automobile accidents in the larger cities. Changes/Problems:The main change during the project lifetime is described above in the 'Accomplishments' section; namely, the shift in direction in Objective #3 from a coded excitation focus to a hemodynamic parameter measurement focus. Although representing different areas and thus different activities, the shift was chosen because as the project progressed, it became clear that there was a distinct need for studying the new parameters and their potential improvement of the signal analysis. The reason the objective was modified (instead of deleted and adding a new objective) was that the overall goal of the objective was the same - to improve the clarity of the information in the signal that is measured. What opportunities for training and professional development has the project provided?
Nothing Reported
How have the results been disseminated to communities of interest?
Nothing Reported
What do you plan to do during the next reporting period to accomplish the goals?
Nothing Reported
Impacts
What was accomplished under these goals?
Impact: The long-term goal of this Hatch project was to examine blood flow in the brain while either 1) the brain is injured, or 2) the brain is involved in different activities. The initial population targeted was children undergoing surgery to repair congenital heart defects; our goal was to develop an algorithm to guide clinicians to prevent dangerous situations from occurring by using ultrasound monitoring. The long-term impact will be a new care standard (meaning doctors and surgeons will change the way they practice surgery), that utilizes easy-to-use technology to predict when dangerous health situations are about to be encountered. Most importantly, if successful in our long-term goals, the technology developed by findings from this proposal may be applied immediately for the benefit of infant health. With the long-term impact in mind, the impact of the five-year project can be reported. The major impact has been to verify that transcranial Doppler was indeed a reliable substitute for other much more expensive tools that measure brain activity (such as fMRI). The reason this is important is that many applications (such as surgery, brain injury, diseases, and psychological evaluations) may become much more inexpensive. At present, transcranial Doppler (the major tool used in this study) is underutilized. The impact of the project can be to lower the cost of health care for many people. Objective #1: Construct an infant-sized transcranial Doppler ultrasound (TCD) fixation headset. An innovative ultrasound scanning system has been developed that will fit on an infant's head and permit monitoring of cerebral blood flow for several hours without disruption. This headset has begun to be tested at Children's Hospital in Omaha. The headset project was featured in 2015 on a media outlet (KETV in Omaha), and linked to a fundraiser that to date has raised over $40,000 for our research. A separate study combining the technologies of cerebrovascular assessment and vestibular (balance) assessment has been tested on healthy subjects. This study was the first to combine the blood flow detection capabilities of TCD with the balance sensors of mechanical force plates. It was found that the two measurements have interesting correlation measures (both positive and negative), and thus can provide more information together than those taken separately. To date, one peer-reviewed journal article has been submitted, one more will be submitted by the end of calendar year 2015, three conference papers have been published, and four conference papers have been given. Objective #2: Determine the impact of rest, exercise and cognitive challenge on blood flow velocity in adult stroke subjects. This objective has been expanded to include the evaluation of adults experiencing cardiac failure and the effects of intracranial pressure on blood flow velocities at the back of the eye. Our group has successfully shown that blood flow velocity changes are significantly changed by the effects of intracranial pressure, stroke, and heart disease. To date, two peer-reviewed journal articles have been published, one invited book chapter has been accepted and is in press, 12 conference papers have been published, and 18 conference presentations have been given over the five-year project. Objective #3: Determine an optimal coding and decoding pattern for ultrasonic coded excitation used for characterizing and sizing artificial emboli. This objective was modified in late 2014 to look at different hemodynamic parameters (mean time-averaged maximum spectral velocity, peak systolic velocity, maximum end-diastolic velocity) in addition to the conventional parameters used today. The reason for the modification was a growing realization by the team that this was more important and had more potential impact than implementing coded excitation. Although studied for only one year, the output has been strong, with these parameters being integral to several of the papers and presentations described in objectives #1 and #2. Objective #4: Acquire preliminary data using an automated analysis system on pediatric subjects with various cardiac defects that require surgical repair, cardiac catheterization and post-operative recovery in the pediatric intensive care unit. In late 2014, we were notified of the awarding of a nearly $300,000 three-year grant from the Gerber Foundation which greatly accelerated this objective and will make it possible to continue this work for the foreseeable future. The main accomplishments during the project lifetime include acquisition of preliminary data on about 30 infants less than one year of age who were in the pediatric intensive care unit for cerebrovascular disease. This is the largest known study of transcranial Doppler flow patterns in infants with known pathological conditions. Currently a journal article and conference presentation are in preparation, and several more are planned.
Publications
- Type:
Journal Articles
Status:
Published
Year Published:
2015
Citation:
Ketcham, T., Twedt, M., Lim, D., Bashford, G. R., and Hawks, J., "Proof-of-Concept Prototype for Noninvasive Intracranial Pressure Monitoring using Ocular Hemodynamics under Applied Force," Journal of Medical Devices, vol. 9, no. 2, pp. 21-24 (2015)
- Type:
Journal Articles
Status:
Published
Year Published:
2015
Citation:
Hawks, J., Twedt, M., Pfeifer, C., Spilinek, M., Ahlquist, E., Burger, M., Thorell, W., Gigantelli, J., and Bashford, G. R., "Ocular Blood Flow Response to Applied Force: In Vivo Tests Toward Noninvasive Intracranial Pressure Monitoring," Journal of Medical Devices, vol. 9, no. 2, pp. 111-113 (2015).
- Type:
Book Chapters
Status:
Awaiting Publication
Year Published:
2015
Citation:
(Invited) Truemper, E. and Bashford, G. R., "Cerebral Blood Flow Measurement for Neurological Assessments: Functional Transcranial Doppler Ultrasound," to appear in: Preedy, V editor, Biomarkers in Disease: Methods, Discoveries, and Applications. Diseases of the Cardiovascular System, Elsevier Press (2015).
- Type:
Conference Papers and Presentations
Status:
Published
Year Published:
2015
Citation:
Hage, B., Alwatban, M., Barney, E., Mills, M., Dodd, M., Truemper, E., and Bashford, G. R., "Functional Transcranial Doppler and Cerebral Lateralization during Two Visuospatial Tasks," Proceedings of the IEEE International Ultrasonics Symposium (2015).
- Type:
Conference Papers and Presentations
Status:
Published
Year Published:
2015
Citation:
Hawks, J., Twedt, M., Thorell, M., and Bashford, G. R., "Using Resistivity Index Changes in the Ophthalmic Artery during Applied Force for Noninvasive ICP Monitoring: In Vivo Test Results," Proceedings of the Military Health System Research Symposium (2015).
- Type:
Conference Papers and Presentations
Status:
Published
Year Published:
2015
Citation:
Hawks, J., Twedt, M., Pfeifer, C., Spilinek, M., Burger, M., Thorell, W., Gigantelli, J., and Bashford, G. R., "Using Ophthalmic Resistivity Index Response to Applied Force for Noninvasive ICP Monitoring: in Vivo Animal and Human Testing," Proceedings of the Fourth International Space Station Research & Development Conference (2015).
- Type:
Conference Papers and Presentations
Status:
Published
Year Published:
2015
Citation:
Honaker, J., Patterson, J., Twedt, M., Truemper, E., and Bashford, G. R., "Exploring Cerebral Hemodynamics with Transcranial Doppler during Computerized Dynamic Posturography," Proceedings of the 38th Annual Meeting of the Association for Research in Otolaryngology (2015).
- Type:
Conference Papers and Presentations
Status:
Published
Year Published:
2014
Citation:
Twedt M., Hawks J., Pfeifer, C., Rackerby, R. Gigantelli, J., Thorell, W., and Bashford, G. R., "In Vivo Testing to Validate Methodology of Detecting a Change in ICP in a Porcine Model, Proceedings of the 30th Annual Meeting of the American Society for Gravitational and Space Research (2014).
- Type:
Conference Papers and Presentations
Status:
Published
Year Published:
2014
Citation:
(Invited) Hawks J., Twedt M., Pfeifer C., Gigantelli J., Thorell W., and Bashford, G. R., "In Vivo Testing of Noninvasive ICP Monitoring Methodology," Proceedings of the ASME International Design Engineering Technical Conference (2014)
- Type:
Conference Papers and Presentations
Status:
Published
Year Published:
2014
Citation:
Twedt, M., Hawks, J., Yule, J., Pfeifer, C., Ozanne, K., Gigantelli, J., Thorell, W., and Bashford, G. R., "In Vivo Testing to Determine Correlation between Ocular Blood Flow Velocity and Intracranial Pressure in a Porcine Model," Proceedings of the Annual International Space Station Research & Development Conference (2014)
|
Progress 10/01/13 to 09/30/14
Outputs
Target Audience:
Nothing Reported
Changes/Problems:
Nothing Reported
What opportunities for training and professional development has the project provided?
Nothing Reported
How have the results been disseminated to communities of interest?
Nothing Reported
What do you plan to do during the next reporting period to accomplish the goals?
Nothing Reported
Impacts
What was accomplished under these goals?
Impact: The major impact made during this reporting period pertains to awareness. To adequately describe last year’s impact, it is helpful to reexamine our overall goals. Our long-term goal is to examine blood flow in the brain while children undergo surgery to repair congenital heart defects, and develop an algorithm to guide clinicians to dangerous situations from occurring by using ultrasound monitoring. The long-term impact will be a new care standard (meaning doctors and surgeons will change the way they practice surgery), that utilizes easy-to-use technology to predict when dangerous health situations are about to be encountered. Most importantly, if successful in our long-term goals, the technology developed by findings from this proposal may be applied immediately for the benefit of infant health. With the long-term impact in mind, we can describe last year’s contribution. As our team has visited target audiences (clinicians, parents of children with congenital heart disease), we have explained the potential long-term impact of this project. Most parents (and even many doctors) did not know the potential secondary dangers of heart surgery. We found many doctors changing their normal procedures by letting us in the operating room, letting us monitor their equipment, and giving them a mental framework for experiments to come. Specifically, we recruited nine cardiologists, three cardiovascular surgeons, five cardiac anesthesiologists, and nine pediatric intensivists who are excited to take part in our studies. In addition, we found many parents who wanted to take part in our research and were willing to allow us to start (safe, non-invasive) experiments with their children. Objective #1: Construct an infant-sized transcranial Doppler ultrasound (TCD) fixation headset. An innovative ultrasound scanning system has been developed that will fit on an infant’s head and permit monitoring of cerebral blood flow for several hours without disruption. This headset has begun to be tested at Children’s Hospital in Omaha. The major activity has been refinement; by taking key anatomical measurements of the head sizes of neonates, we have made progressive improvements to several versions of the ultrasound system. Also, a separate study combining the technologies of cerebrovascular assessment and vestibular (balance) assessment has been tested on healthy subjects. This study was the first to combine the blood flow detection capabilities of TCD with the balance sensors of mechanical force plates. It was found that the joint results more accurately predict brain activity in the vestibular system in a response to balance challenges. Two presentations at national meetings were given from this data, and a manuscript is currently in preparation showing the new method and results. Objective #2: Determine the impact of rest, exercise and cognitive challenge on blood flow velocity in adult stroke subjects. This objective has been slowed by the lack of available stroke patients from Madonna. This year, two patients less than three months post unilateral stroke within the middle cerebral artery were recruited for inclusion in the study. After being fully informed regarding the nature of the study, written informed consent and HIPAA authorization was obtained from each patient. Then each participant underwent a series of clinical assessments which included the NIH Stroke Scale, Berg Balance Scale, a self-paced free and fast walking test, an evaluation of lower extremity strength and range of motion and the FIM (locomotor and transfer scores). The purpose of these assessments was to quantify each participant’s impairments and functional limitations. Subjects were then be instructed in the use of a modified elliptical trainer (modified to allow easier access by stroke patients) and had an opportunity to practice briefly on the device to ensure familiarization. During this initial session, a schedule was developed for subsequent cardiovascular training sessions, 3 days/week, 60 minutes per session (including rests). TCD assessment occurred during the first, third and sixth training sessions. Specifically, during each session, TCD (Multi-Dop X2, Compumedics DWL, Singem, Germany) spectral waveforms of the bilateral MCAs were acquired while the subject was: 1) at rest for a period of at least 10 minutes to achieve baseline stabilty; 2) physically at rest, but performing cognitively challenging activities (e.g., numeric calculations); 3) performing cardiovascular exercise on the elliptical; and 4) performing cardiovascular exercise on the elliptical and concurrently performing a cognitively challenging task (i.e., dual-tasking). It is too early to identify any clear patterns with so few stroke patients, but there are clear indications that the Doppler spectra waveforms are different between stroke patients and healthy subjects. In particular, stroke patients (who have recovered for three months) tend to have slower velocity profiles than healthy subjects. The data from the first three patients were treated as a case study, and presented to the American Institute of Ultrasound in Medicine in March 2014. Objective #3: Determine an optimal coding and decoding pattern for ultrasonic coded excitation used for characterizing and sizing artificial emboli. This objective requires the completion of the system described in Objective #1. This system is undergoing the final revisions and is expected to be complete by this spring. Thus, there were no significant activities carried out this reporting year. Objective #4: Acquire preliminary data using an automated analysis system on pediatric subjects with various cardiac defects that require surgical repair, cardiac catheterization and post-operative recovery in the pediatric intensive care unit. As in Objective #3, progress on this step requires the completion of the TCD system described in Objective #1. The major activities carried out were planning for upcoming experiments in 2015, recruiting of clinical help, and recruiting of multi-site support (other pediatric surgery centers who will follow our research and eventually take part).
Publications
- Type:
Conference Papers and Presentations
Status:
Published
Year Published:
2014
Citation:
Watt, B., Alwatban, M., Truemper, E., and Bashford, G. R., Stability Testing of a Novel Transcranial Doppler Fixation Headset During Exercise, Journal of Ultrasound in Medicine, vol 33, p. 72 (2014).
- Type:
Conference Papers and Presentations
Status:
Published
Year Published:
2014
Citation:
1. Twedt, M., Patterson, J., Criter, R., Honaker, J., Truemper, E., and Bashford, G. R., Pilot Study to Determine the Feasibility of Simultaneous Cerebral Blood Flow Monitoring and Postural Control Measurements, Journal of Ultrasound in Medicine, vol 33, p. 72 (2014).
|
Progress 10/01/11 to 09/30/12
Outputs
OUTPUTS: A new, novel fixation device was designed and constructed for transcranial Doppler on infants and neonates. This device is currently being tested at three separate clinical laboratories/hospitals - Children's Hospital in Omaha, Madonna Rehabilitation Hospital in Lincoln, and the Dizziness/Vestibular Balance lab at the Barkley Center on East Campus. PARTICIPANTS: Brian Watt, graduate student, has helped with design of the fixation device. Collaborators and their organizations include Edward Truemper, M.D. (Children's Hospital and Medical Center, Omaha, NE) and Judith Burnfield (Madonna Rehabilitation Center). TARGET AUDIENCES: Nothing significant to report during this reporting period. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.
Impacts
A pilot study completed at Madonna Rehabilitation Hospital shows the potential of a change in the way clinical investigators can study cerebral blood flow. Specifically, the novel device created allows investigators to watch cerebral blood flow velocity in real-time as particular activities or challenges are being performed by a subject, such as exercise or surgery.
Publications
- Watt, B., Jones, D., Burnfield, J., Truemper., E., and Bashford, G., "Classifying cerebral blood flow by fuzzy clustering in healthy individuals," Proceedings of the Institute of Biological Engineering (2012)
- (invited) Watt, B., Burnfield, J., Truemper, E., Buster, T., and Bashford, G., "Monitoring Cerebral Hemodynamics with Transcranial Doppler Ultrasound During Cognitive and Exercise Testing in Adults Following Unilateral Stroke," Proceedings of the International Engineering in Medicine and Biology Conference (2012)
|