Today was an amazing day in all ways, even the rain didn’t detract from our experiences. We were able to listen to two different presentations, including one given by Dr. Borovetz!
The first presentation we listened to was presented by Dr. Saioa Herrero, the Vice Dean of International Relations at the School of Engineering, as well as an assistant professor in the Department of Mechanical Engineering. She talked about her current research, which she was been working on for the past 7 years, with Compmech Research Group in collaboration with the local rehabilitation hospital, Hospital Gorliz, and BioBizkaia.
When Compmech was looking for a project that they could undertake, they first reached out to different hospitals to see what they needed. The hospitals they called were surprised when they called, because when companies design a device, they usually show up with a fully developed piece ready sell, and they hospital has to point out areas where it’s ineffective and why they can’t use it. They were excited to have a part to play in the development of the product itself, where they point of inefficiencies before the product has come to the market.
When the Compmech team visited Hospital Gorliz, they noticed that doctors don’t have anything to measure the improvement of their patients balance as they recover from strokes and other balance affecting disorders. The research group decided that they would design a device that would be able to measure the balance of a patient, so that doctors can get a quantitative measurement of their improvement, rather than just a qualitative one. They name this project Oreka Balance.
The device that they design uses a single platform with 3 degrees of freedom, meaning that the platform is able to move up and down, rotate side-to-side, as well as moving front to back. Using this platform, they measure the center of pressure (COP), which is the average point of force given by the the patients feet on the platform. Using this information, the are able to graph the data to see where and how the patient can improve on their balance, with the best indication being a prefect circle in the center of the graph. A problem that the group is still trying to figure out is that people have different strategies on how to keep balance, using more of the knees or their hips or other parts of their body. For example, in the graph shown below taken from Saioa’s presentation, there is a perfect circle shown, but it is above the center of the graph since he was using his toes and leaning forward more to balance himself, although the pressure between their two legs was even. They have also noticed that even in healthy patients with what seem like normal balance provide different results because of these differences in strategies. On people older than 65, the COP graph tends to be a longer ellipse. Because of these different strategies on keeping balance, the research group wants to add cameras to the device to see how the patient is keeping their balance so they can add that as part of the analysis as well.
Compmech also believe that this device can be used for more than just stroke patients and those with balancing disorders. Athletes in sports that require very precise balancing, like dancing, surfing, ice skating, etc. can utilize this device to test and improve their balance.
Now let’s talk about the device itself. Compmech decided to use a 3PRS parallel manipulator to move the platform with more precision, since they have a large area of movement. Parallel manipulators are made up of two serial manipulators joined together to improve the speed and precision of serial manipulators, although it limits the range of motion. Serial manipulators are machines that are made up of joint like parts, similar to an arm, that allows it to bend and have a large field of mobility, though it is slower and less accurate since the margin of error is being added together as the machine adjusts each “joint”.
Patients will stand on the platform as it moves, and they will work on correcting their balance, will sensors in place on the machine and the surrounding supports to test for their balance. There are handles in place, so that if needed the patients can grab onto them for extra support, and that information is also added into their report. The position and variability of the COP is what determines their measure and improvement of their balance, which doctors can use to focus and improve their rehabilitation process.
The Oreka Balance project also has a second, newer project that they are working on. It is similar to their first machine, but it utilizes 2 different platforms, one for each foot. They added in a 4th degree of freedom, introducing a back and forth movement as well. With these two platforms being separate, it allows the patient to test their balance when the platforms are moving together, or when they’re moving separately, simulating uneven floors.
Both of these devices have the possibility to be used for more than just measuring ones balance. The machine has a removable screen than can display the patients results as they are using the machine, allowing for them to adjust and improve their balance. Compmech is thinking that if they remove the screen, doctors can use the device to test the patients balance, and if they were to add the screen back, it would aid in learning and practicing how to balance since they would be able to make the corrections.
Although the presentation was mostly about their machine, Oreka Balance, it wasn’t the only thing that Saioa talked about. She also talked about challenges that went on within the team and process of getting their device from an idea to the clinical evaluation stage that they’re at now. She mentioned how because they were a group of engineers and medical professionals working together, they had some struggles with getting information. When the engineers wanted what degrees they wanted the platform to tilt and at what velocities, the doctors didn’t know what where the specific numbers, so they demonstrated using a piece of paper, in which the engineers then had to time and count to figure out the specific numbers. The doctors and nurses would also use medical and anatomy terms that the engineers didn’t know, so they had to learn each others language so that they could communicate efficiently.
Dr. Herrero also talked about the stages of developing a medical product. There is a slight difference between the process in the US and the process in Spain. In Spain they have 9 steps that they need to go through to get a device to the market. The main device that Compmech is working on is about to undergo clinical trials, in stage 7/8, and they have accomplished this in 7 years, which is considered very quick for these kind of devices. Their newer device is currently in stage 5/6, and they’re trying to work out all of the kinks of the device.
A section of the process is called the Valley of Death, and it’s where public funding from Universities and Government starts to run out, and companies haven’t invested yet. This section is around stage 4-6 where a lot of money is required since they are building and testing these devices. Companies like to see that there are positive results and no risks to be taken before they start investing in different projects. Many companies don’t start investing until after stage 8, the clinical trials, which means that a lot of ideas don’t make it past stage 4-5 as they run out of funding. Compmech’s second device is currently in the Valley of Death and they believe they should be able to get out pretty quickly. For their main device, Compmech was able to avoid the Valley of Death pretty easily because they built everything themselves. They also only needed to build 1 prototype, as the first one they built passed all of their tests and the other stages of the process without much trouble.
Overall, I think Dr. Herrero’s presentation about Oreka Balance not only taught me about the product the she and her team are developing, but also about what it is to work in a team. You have to be able to give and take, putting in your best effort to get things as precise as you can, because at the end of the day this is going to affect the patients. You have to think with them in mind, and be able to communicate and get through hard times and problem solve to deliver the best product that you can. I am also really excited for the coming days, since we will be able to see the main device tomorrow, and the newer device we will be able to see on Monday.
We were also given the chance to listen to another presentation about Bioengineering topics, presented by one of our professors, Dr. Borovetz. After Saioa’s presentation ended, students and professors from the School of Engineering came in to watch Dr. Borovetz’s presentation. He first started presenting about the history of Pittsburgh and comparing it to Bilbao, since both cities were very industrial, and very quickly were able to re-establish themselves. He also talked about the University of Pittsburgh, focusing mainly on the School of Engineering and the School of Nursing. The Pitt Bioengineering program started back in 1998, while the University of the Basque Country only opened their Bioengineering program 2 years ago!
After discussing Pitt for a bit, he started talking about the research that he conducts regarding heart transplants different devices used to keep the heart pumping while waiting for a transplant. He first talked about different statistics related to heart diseases, such as there being 800,000 death attributed to heart disease in the United States, 10% because of heart failure and 42% because of coronary heart disease, a build up or blockage in the arteries leading to the heart.
Dr. Borovetz then went on to discuss heart transplants, and how the very first heart transplant was done in 1967 by Christian Barnad, and since 1982, the survival rate has increased from 85% to 93% in adults and from 82% to 92% after 1 year. There are 7 times more heart transplants performed on adults then there are performed on children, with Spain conducting 1 out of 14 of all pediatric transplants ever performed and 1 out of 10 of all adult transplants ever performed. A lot more funding going into research on devices and methods for transplants on adults then pediatric transplants, since companies want to invest in devices that will make them the most money, which is in adult transplants since there are so many more of them. Only 5.7% of all money invested into transplant research in the US is invested into pediatric transplants.
We then learned about the different generations in mechanical circulatory support devices. 1st generation devices mimicked the natural heart, with two large pumping chambers. These devices were very large, and around 50% of the population, mainly women, weren’t able to use because of there size. 2nd generation machines were developed by aerospace engineers, and were a lot smaller. They used a motor to move the blood so they no longer needed to use the pump. These machines hade bearings and seals, which was an issue when the body got to hot, because it would cause the bearings to fail and the motor seizing. 3rd gen devices still used the motor, but not longer used bearings and seals, getting rid of the previous issues. They used magnetic levitation to turn the motor, which also reduces wear on the device, increasing its lifespan. 4th generation devices can rotate 40,000 times per minute and are inserted directly into the heart instead of just connected like the previous iterations.
Even with all of these different generations of circulatory support devices, there still weren’t many made for children. One of the major devices used in pediatric care while waiting for a heart transplant is the Berlin heart. Over 1,800 patients have used it, with the average use time being >3.5 years. It is similar to a 1 gen device in that is has a large chamber, although it is outside the body, and blood is pumped into and out of it.
Dr. Borovetz and his research team have developed a device called the PediaFlow Pediactric VAD, which is intended for the use of children from babies 5kg and heavier to young adolescents with congenital and acquired heart failure while they wait for a heart transplant. The entire device is the size of a double A battery, and is connected directly to the heart. Children generally have to use the device for a few months only as the wait, so there isn’t as much of a need to adjust the device as the child grows since they won’t need it for long. The research group is thinking that the device can be used for rehabilitation as well, after the heart transplant in complete, in which they would have the change the design of the device since the child will continue to grow.
Before I listened to these presentations, I didn’t really know what I wanted to do within Bioengineering, and I still don’t really know. But one thing that has changes is that I am now more interested in the research side of the field. I would love to know more about both of these projects and I hope to take part in similar projects in my future.
After all of the presentations were complete, we spent the rest of the day visiting the Guggenheim, a museum that started the shift of the city of Bilbao from an industrial city to what it is today. The Guggenheim is an art museum that focuses on modern art, with many different exhibits showing artists from Rembrandt to Andy Warhol. There were a lot of very interesting exhibits, including one by Sergio Prego called YOU that felt like a horror film. It meant for the viewer to be uncomfortable as they watched 2 different projected films and 3 more shown on old style television, confronting why we feel uneasy. Another exhibit that was very interesting was one that was design specifically for Bilbao and focused on themes such as love, loss, and mourning, showing vaguely creepy messages scrolling past on multiple thin screens, such as “I forget your name”, “I am crying out”, “I will bury you”, and more.
My favorite exhibit at the Guggenheim had to be one that was on loan from the Museum of Fine Arts – Hungarian National Gallery called “Masterpieces on Paper from Budapest” which showed drawings and painting from Hungarian and European artist from the 1400’s to present day. I also really enjoyed being able to see Puppy, a giant flower sculpture of a dog that is located at the entrance of the Guggenheim and is covered in seasonal flowers.(He was designed by someone from York, PA!!!)
I had an amazing time today, and even though we walked back to the hotel in rain, I wouldn’t change a thing about today. We’ve only been in Bilbao for 3 days, and I never want to leave.
