My Current Projects
As of this writing, I am working on 25 research projects. It is a challenge to pick just a few to highlight, but I will select a range of projects to share that focus on maintaining patient quality of life, protection from injury, or improving patient healing.
Quality of Life
The Woven Warrior project was inspired by my own personal life. My late husband John suffered from chronic lymphedema as a result of radiation treatment for cancer. Lymphedema is pathological ailment, normally displayed as swelling (edema) due to a chemical imbalance, or an imbalance in the “demand for lymphatic flow and the capacity of the lymphatic circulation.” Lymphedema is also referred to as “lymphatic obstruction” as it is a permanent condition in which a superfluous amount of fluid is retained in the tissues, leading to swelling. This kind of edema is commonly found in the arms and legs of affected individuals but can be found in other parts of the body as well.
His right leg was swollen to twice its size due to lymph node damage causing chronic swelling of the extremities. John was prescribed a compression stocking to wear every day. The purpose of the garment was to compress his leg to move the fluid retention to his torso. He hated wearing the stocking – it was very hard to put on and take off. He needed my help and even I struggled to have the strength to get it on his leg. He was also embarrassed that he had to wear it – it meant that he couldn’t wear shorts or other people would see he was wearing a stocking.
Lymphedema symptoms range from mild to severe, to disfiguring. Mild lymphedema may feel like heaviness, tingling, tightness, warmth, or radiation/shooting pains. Other associated symptoms include asymmetrical appearances of the extremities, abnormal tightness of jewelry or clothing, unusual tightness of joints, skin irritation and redness, and moderate skin puffiness. There is no cure for lymphedema, however there are treatments. Current treatment methods for lymphedema include bandaging the extremities, massages, pneumatic compression, and compression garments.
The compression garments work by creating a pressure gradient in the affected limb. This causes a flow of fluids from high concentration in the area of which they are accumulating, to an area of low concentration, with little to no fluid acclimation. This gradient movement helps to reduce the pain and swelling.
Traditional compression garments can be very uncomfortable due to the need for an extremely tight fit. Users/patients often have weakness, making getting the garment on and off difficult, even with caregiver assistance. The fabric is described as hot and itchy and only available in one flesh tone color.
The Woven Warrior Project is the design, development, and testing of a garment that reflects the 5Fs™:
- Made from comfortable fabric
- Featuring an easy closure system
- Able to be custom fit to the patient
- Sufficiently reduces swelling
- Aligns with the patient’s style/identity
This project is particularly meaningful to me and through this framework we are making significant progress in mitigating discomfort and difficulty in treating this condition.
One growing population that tends to be overlooked when it comes to technological products and innovations is the population of people with Alzheimer’s disease/Dementia. When developing wearable technology for this population, we need to consider its usability and feasibility specific to people with Dementia, so it is crucial to keep the bells and whistles to a minimum. Since the technology is likely to be out of the user/patient’s comfort zone, keeping it user friendly and overly simple to use is of upmost importance.
CueMinder is a wearable for one’s wrist and has a look similar to that of a smartwatch-type device. Paired with a uniquely tailored alerting system, the desired product would assist in cueing and reminding people within this population of certain Activities of Daily Living (ADLs) with hopes of increasing user independence, which would ultimately aid in relieving caregiver burden.
Through preventative cueing, the central goal is to create a device that improves quality of life not only for its users/wearers, but also for those people who work tirelessly to care for this growing population. What separates this device is its specificity to target problems of the user directly, and not have added features that drive up cost and complication. The device’s code can be altered and tailored so that schedules can be uploaded and changed to suit the user of each individual device. These schedules can be personalized to correspond with the user’s schedule and synchronized with moments of greatest lucidity.
This personalization aspect will not only make it more user friendly, but allow for greater user acceptance and compliance, while continuing to maintain high accuracy and efficiency. Problems that consistently arise from communication are frustration, combativeness, aggression, and a whole slew of other issues that lead to increased caregiver burden, as well as accidents, in many care units. This device was designed to take proactive measures rather than reactive ones. This not only aids in the prevention of accidents, but also aims to increase user independence in hopes of increasing overall life quality and longevity.
Currently, the standard of care for facial trauma for athletes is to wear a protective mask. The mask allows players to return to play with added protection to the injured area, either skeletal or soft tissue. While standard facial masks are commercially available and relatively inexpensive, the lack of individual customization combined with the limitations of the standard mask material can cause dangerous visibility issues and player discomfort.
Standard masks reduce player visibility due to fogging from perspiration and peripheral blocking. Lack of custom fit and hard molded materials are uncomfortable and can distract injured athletes during play.
Custom fit masks made with improved materials would be preferred by athletic trainers for both collegiate and professional teams. However, accessibility, cost, and lack of evidence-based research has created a barrier to improving the current standard of care.
We were able to collaborate with John Horne from Independence Prosthetics and Orthotics in Delaware to create prototype masks for Philadelphia 76er Joel Embiid, who fractured his occipital bone during a competition. The mask was custom fitted and carbon fiber material was integrated into the protective plastic. We achieved a custom fit through the use of a body scanner.
Body scanners can produce more accurate body measurements when compared to older, traditional human measurement techniques. The carbon fiber hybrid material was used with the purpose of strengthening the protective material, while preventing any chance of shattering the mask.
Our next step was to create a rate activating tether strap mechanism to secure the mask in place during wear. The rate activating tether is elastomeric tubing with an enclosed shear thickening fluid. The fluid varies in viscosity at different shearing rates, essentially allowing the strap to easily elongate at a slow rate and constrict at a high rate.
High Ankle Sprain Brace
High ankle sprains (syndesmotic sprains) occur when there is stretching and damage to the proximal ankle ligaments, which hold the tibia and fibula in place and prevent separation during weight bearing activities. These sprains are prevalent in contact sports, especially football, due to the high probability of rotational injuries. Studies suggest that high ankle sprains account for 50-75% of all ankle sprains diagnosed in contact sports.
The foot and ankle devices market is anticipated to reach 3.4 billion USD by 2025 due to the rising occurrence of ankle sprains and other foot related injuries.
Patients with high ankle sprains typically experience pain focused above the ankle, accompanied by tenderness in the distal lower leg. As a result of a high ankle sprain, the anterior inferior tibiofibular ligament is weakened, causing the talus bone to wedge apart the tibia and fibula. The separation of these bones causes severe pain in the region when any sort of weight-bearing is experience.
Recovery time for high ankle sprains can be considerably longer than normal ankle sprains, with an average of six weeks before an athlete can to return to play. Due to the weakness in the proximal ankle, there is an increased likelihood of re-injury to the medial and lateral ankle ligaments.
This long recovery time and joint instability becomes problematic for student athletes and the athletic training staff, which brings us to our opportunity to help.
A high ankle brace was developed that provides a custom fit to the user without the excessive cost and casting process associated with custom orthotics. In order to achieve this, a 3D scanned image of the foot and ankle is used to design a custom and ergonomic footplate that sits on top of the insole of the shoe. The footplate is 3D printed because it offers the most customizable option where multiple iterations and sizing alterations can be made relatively quickly and at a low cost.
The footplate is hinged at the ankle joint and is secured through a circumferential orthoplast support with removable steel rivets once it is formed to the anatomy of the user’s lower leg and inserted into a neoprene pocket lining. The removable steel rivets are secured with Red 13 271 Loctite and washers are added on the outside. The orthoplast support is tightened to the lower leg with a ratcheting buckle strap and a Velcro strap. Each of these components addresses the major concerns of ankle stability and protection associated with high ankle sprains, and together offer a feasible approach to rehabilitating these injuries.
We conducted promising pilot testing with two injured UD football players with high ankle sprains, in that the players using our device were able to return to sport 25% earlier than the standard recovery time. We plan on further developing the device and continue testing with injured players.
The Walking Boot
Orthopedic boots are often used as treatment for various lower leg, ankle and foot injuries These are used to:
- Stabilize the foot/ankle in order to limit patient movement
- Control the biomechanical load on injured structures, in order to promote healing
- Minimize discomfort and pain for the patient.
For patients with acute Achilles tendon rupture, casts or orthopedic boots are used for the first 6-10 weeks after injury/surgery to keep the ankle in a specific orientation that keeps the ends of the ruptured tendon close together for healing. Patients wearing the orthopedic boot may reduce their activity level during healing and therefore may lower the amount of biomechanical load on the injured ankle; a scenario which has a negative effect on healing.
It is important to the healing process that the patient progressively bear weight on the injured ankle. Patients with acute Achilles tendon rupture also require an orthopedic boot which allows for both the angle of the patient’s foot to progressively decrease and the biomechanical load increase over time. For this reason, the standard practice is for a health professional to add varying heel lifts inside the boot to produce varying degrees of ankle plantar flexion.
The patient starts with the highest heel lift and over time, the health professional replaces the lift with smaller lifts, thus reducing the angle. However, the use of these heel lifts has been questioned: how well does the heel lift control the patient’s ankle?
Patients also reported discomfort and pain while using the standard orthopedic boot, hindering the healing process from the patient minimizing use. The standard orthopedic boot comes in only three generic sizes (S,M,L). This non-customized fit makes the patient’s leg shift and move within the orthopedic boot, increasing the risk of developing blisters and wounds. Moreover, shifting and moving of the patient’s leg within the boot may affect weight-bearing strategies.
From the patient’s perspective, there are additional concerns with the standard orthopedic boot that effect patient comfort, usability, and practicality. The boot is made from rigid plastic, a non-breathable material that, as noted, can cause wounds, but is also difficult to walk in, and must be worn continuously for 6-10 weeks straight resulting in odor and bacteria accumulation. The standard boot is intended to be worn under diverse and non-compatible conditions: walking outside, walking inside, bathing, and sleeping. For this reason, the lack of fit, limitations in the boot design, and rigid boot material make wearing the boot in these varied conditions very challenging and uncomfortable for patients.
Additionally, as is the case with many medical devices, the aesthetics of the boot design are not considered relevant nor an important design consideration, leading to potential psychosocial discomfort and ultimately patient non-compliance.
The ultimate aim of this research is to develop an orthopedic boot that is individually fitted, using material that provides for progressive loading of the healing tendon while minimizing pain and discomfort and improving the users’ physical and psychosocial comfort. Using a 3D body scanner, 3D printing, and shock absorbing textiles, we can create a boot that meets the functional needs of users. We can also meet the aesthetic and expressive needs of users by creating custom designs. For example, why not build an orthopedic boot that looks like a sexy high heel, or a cool sneaker? How might patient compliance improve if the user wanted to wear the device, rather than was forced to wear the device?
These are some of the most exciting projects I’m working on right now and I’ll be updating you as we make progress on them. There is a lot of work and a lot of innovation ahead! I’m excited to tell you about these projects and I hope you’ve enjoyed reading about them. You can subscribe here to stay updated on these and other projects.