Can we design a DIY neuro examination? If not, why not? #ClinicSpeak #MSBlog #MSResearch
“I have a vision of an automated quantitative neurological examination, done by yourself with the help of devices and apps with no input from a neurologist to mess up the metrics. My colleagues tell me I am mad; they tell me repeatedly that there is very little chance of a machine taking over what took us the better part of 15 years to learn how to do. They are wrong. It all depends on why you want to automate the neurological examination. For diagnosis or monitoring? I need the automated neuro exam to be able to measure the impact of MS on your neurological system so that we can document and assess relapses and disease progression. We could potentially use the automated neurological examination as an outcome measure in clinical trials. The sky’s the limit in terms of what we can do with modern technology, the questions is whether or not neurologists and the community are prepared to concede that technology is better at doing things than we are? Why shouldn’t a computer algorithm look at, analyse and interpret retinal images taken with a smart phone? Why shouldn’t an algorithm assess upper limb and hand function? Why shouldn’t a device detect unsteadiness of gait and predict and help prevent falls? We are entering an era of technological evolution that is happening at such a fast pace that some of us in the medical profession are simply being left behind. I think we need to embrace technology and adapt; by using technology we will become better neurologists. The time saved will allow us more time to communicate with our patients.”
Jeremy Greene. HISTORY OF MEDICINE: Do-It-Yourself Medical Devices — Technology and Empowerment in American Health Care. N Engl J Med 2016; 374:305-308.
Excerpts:
….. Yet “do-it-yourself” is rarely defined, and novelty claims in this arena require a decidedly short-sighted view of history. An examination of past and current DIY medical technologies suggests that over time, different approaches to these devices have been linked to different concepts of empowerment, with very different implications for benefit, cost, and risk for consumers…..
….. On the one hand, there are some deep continuities between today’s disruptive DIY medical technologies and those that came before. One proposed application of DIY health care, for example, is the digitally mediated remote physical exam, illustrated by CliniCloud, a thermometer–stethoscope accessory and smartphone app that can send a 15-second recording of a child’s breathing to a physician’s office for an assessment of whether a cough requires a clinic visit or just reassurance….
“I have a vision of an automated quantitative neurological examination, done by yourself with the help of devices and apps with no input from a neurologist to mess up the metrics. My colleagues tell me I am mad; they tell me repeatedly that there is very little chance of a machine taking over what took us the better part of 15 years to learn how to do. They are wrong. It all depends on why you want to automate the neurological examination. For diagnosis or monitoring? I need the automated neuro exam to be able to measure the impact of MS on your neurological system so that we can document and assess relapses and disease progression. We could potentially use the automated neurological examination as an outcome measure in clinical trials. The sky’s the limit in terms of what we can do with modern technology, the questions is whether or not neurologists and the community are prepared to concede that technology is better at doing things than we are? Why shouldn’t a computer algorithm look at, analyse and interpret retinal images taken with a smart phone? Why shouldn’t an algorithm assess upper limb and hand function? Why shouldn’t a device detect unsteadiness of gait and predict and help prevent falls? We are entering an era of technological evolution that is happening at such a fast pace that some of us in the medical profession are simply being left behind. I think we need to embrace technology and adapt; by using technology we will become better neurologists. The time saved will allow us more time to communicate with our patients.”
“The perspective article below discusses DIY medical devices. It is interesting that the history of DIY medical devices goes back several decades. Are you prepared for DIY diagnostics and self-management of your MS? It may be just around the corner.”
“I wonder if our new online web-EDSS calculator will be viewed in the future as a disruptive technology? In reality it gives you a surrogate measure of the physician EDSS. Wouldn’t it be amazing if the web-EDSS, or some future version of it, replaced the physician EDSS? I wonder if we could use it to detect and document relapses? Is this the beginning of a brave new world?”
“Are any of you interested in getting involved in designing and validated the DIY neurological examination?”
Jeremy Greene. HISTORY OF MEDICINE: Do-It-Yourself Medical Devices — Technology and Empowerment in American Health Care. N Engl J Med 2016; 374:305-308.
Excerpts:
….. The auditing and consulting firm PricewaterhouseCoopers ranked DIY health care number 1 in its top 10 health industry developments of 2015…..
….. Yet “do-it-yourself” is rarely defined, and novelty claims in this arena require a decidedly short-sighted view of history. An examination of past and current DIY medical technologies suggests that over time, different approaches to these devices have been linked to different concepts of empowerment, with very different implications for benefit, cost, and risk for consumers…..
….. On the one hand, there are some deep continuities between today’s disruptive DIY medical technologies and those that came before. One proposed application of DIY health care, for example, is the digitally mediated remote physical exam, illustrated by CliniCloud, a thermometer–stethoscope accessory and smartphone app that can send a 15-second recording of a child’s breathing to a physician’s office for an assessment of whether a cough requires a clinic visit or just reassurance….
…… the DIY in the modern health care technologies now celebrated by venture capitalists suggests not the productive act of building but the consumptive act of buying a proprietary communications platform (i.e., a smartphone, which can easily cost $600) along with a proprietary application and a set of peripherals…..
….. Whether doing it yourself is ultimately liberating or dangerous depends on our approach to risk and technological literacy. How do we decide who is competent enough to deal with risks of technological auto-experimentation and who is not? But the same questions could also be asked regarding consumers who purchase expensive wearable technologies and smartphone apps whose claims to produce healthier lives remain unvetted by the FDA…..
…… As we try to distinguish hope from hype in the promises made about smart medical devices, it’s important to remember that DIY medical technologies are neither wholly new nor wholly liberating. And in offering means for circumventing physicians, they may well expose patients to new costs and new risks……
I think in general this is a good idea. I also think a self questionnaire could be good to fill in each time an MSer has a relapse or follow up meeting with their neuro.Questions such as to name a few…Have you had a recent infection or illness in the last six weeks?Any problems with bladder and bowel?Any numbness or tingling?Any weakness?Are you sleeping ok?
Well yes… and no.Many things can be measured with smart devices such as you suggest, range of motion, tremors, gait and a ton more. The problem programmatically is assessment and interpretation. Certainly at a commercial level of smart devices targeted towards measurement and interpretation in a doctors office afford the human assessment. In the home, too much caffeine and a bad nights rest along with some stress might be misinterpreted by the device user resulting in unwarranted trip to a neurologist.Do doctors need embrace technology? Absolutely. They will simply have no choice it appears.Right now as both detection and patient assistive technologies in robotics and then some continue to evolve the landscape will indeed change. This will all go through growing pains where mishaps both big and small occur. A question is will the mishaps result in sudden death in the technologies. Media and attorneys I more than happy to exploit statistically minor incidents. At the sametime media is also more than happy to promote technology not properly vetted.Doc McCoys Tricorder is quite a ways off.A short story might suffice. Two summers back I was driving home and a young lady rear-ended my Jeep CJ with the claim some guy in another car was playing car tag with her. She hammered the back of my rigid frame Jeep at around 40 MPH.I ended up with some whiplash due to this. Her Rav-4 ended up with alot more whiplash than my Jeep. Off to physical therapy. They used a smart phone to measure my range of motion and based some therapy on it. We are talking an HMO here not an indie PT operation. The assessment based on range of motion was way wrong. Either they farted the data, farted the measurements or farted their therapy plan. Perhaps multiple farts. But in scant weeks of the therapy I was rather demolished. They said, "Its normal" which my fiance questioned. We went to an indie PT operation who re-assessed me the tradition way and examined the information my fiance acquired (under threat) from the HMO. Needless to say, the indie PT operation was in shock. It took many many months just to undo what the HMO had done. My light whiplash which should have been a done deal in 3-4 months turned out to be almost a year and a half ride.This is my fear with using technology to assess health at a "human level". The devices are only as good as the users ability to properly use them. From the aspect of interpretation, same deal.
I disagree with your final statement. Youre not taking artificial intelligence into account. Over time, assessment devices should be able to improve accuracy and account for human error. You are unfortunate in that you were assessed by a tool that is clearly in its infancy.
"You are unfortunate in that you were assessed by a tool ….."Now that's no way to speak of your neurologist 😉
hahahahahha. i was going to leave a note – something about what's the point in digitalising a tool as useless as the EDSS but these two jokes just made my night so I'll abandon my note. all jokes aside, any tool that could replace my partner's neuro would be exceptionally welcome. and my partner has one of the better neuros out there in the part of Australia we live in 😡
How would technology interpret emotional and psychological changes? Physical data is empirical but mental and cognitive may be more subjective.
This item: http://www.bbc.co.uk/news/health-35434278 was on the BBC news yesterday. A step in the same direction, seems a good idea to monitor and gather data in preparation for an examination.
On a similar note, I saw this story today – http://www.independent.co.uk/life-style/health-and-families/health-news/simple-test-could-predict-alzheimers-two-years-before-symptoms-show-a6846566.html. It's not hi-tech but demonstrates a new thinking in relation to assessing cognition.
I work for a company that is deep into the Internet of Things, and I think these smart medical tools are inevitable. You can do amazing things by putting together a well-placed sensor, the Internet, an algorithm, big data, and some artificial intelligence.Think of the money saved on doctors visits. Think of the metadata opportunities for researchers! 10 years from now, we'll marvel at how we ever got by without it.
This is something that I have done for nearly 20 years. My mother had MS so I have been regularly testing myself. Whenever I would get on the underground, DLR, metro or subway I would always test my eye sight by reading the number on the far wall of the carriage/car. Also I would regularly stand on one leg to test my balance. I still practice this after my own diagnosis. I was thinking, is there something like a VEP 2.0 we could build that could be a self service device in the OBGYN waiting room? MS affects more women and if we had a device that could test the 'wiring bundle' that would be helpful. I know the inputs, 3D headset and sound, but how could I get an output? It needs a tech to attach the head lace for the VEP.
Technology is still in its infancy. Reliability, accuracy and most important security is not viable at this time for a medical device.http://www.theverge.com/2016/1/6/10724270/fitbit-lawsuit-charge-hr-surge-incomplete-heart-rate-tracking
Could the hand held 'Infrascanner' pick up anything interesting about MS and changes in the brain? It's used in with head traumas and was on the BBC newsite. http://www.bbc.co.uk/news/health-35197197