IBEHS 3P04: Health Solutions Design Project III

Introduction and Design Project Overview

J Wilson and Q Fang, Winter 2020

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Who are we?
Janie Wilson, PhD
Professor, Department of Surgery, School of Biomedical
Engineering, Department of Mechanical Engineering
• Engineer with expertise in human movement
biomechanics, modeling, gait analysis, and orthopaedic
biomechanics
• Engineering Mathematics and Mechanical Engineering,
Queen’s
• Biomedical Engineering, MASc, Dalhousie
• Biomedical Engineering, PhD, Dalhousie
• Postdoctoral Fellow at Sport Science Institute of South
Africa in barefoot running biomechanics
• Biomedical Engineer, Institute for Surgical Design and
Biomechanics, Bern, Switzerland
• Had my own statistical and orthopaedic consulting
company for 4 years
• Past president Canadian Orthopaedic Research
Society
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Who are we?
Qiyin Fang, PhD, FSPIE, PEng (LEL, Ontario)
Professor, Department of Engineering Physics & Biomedical Engineering
Canada Research Chair in Biophotonics
• Optical Engineer with expertise in optical sensing/imaging technologies
and their biomedical applications
• BSc. Physics, Nankai
• MASc. Applied Physics, East Carolina University
• PhD. Biomedical Physics, East Carolina University
• Postdoctoral Fellow and Research Scientist at Minimally Invasive
Surgical Technology Institute of Cedars Sinai Medical Center, Los
Angeles
• Had my own Optical Microscopy company for 3 years
• Fellow of SPIE, the International Society for Optical Engineering
• Faculty Mentor for iBEHS 1P10
• EP 2W03 (Applied Statistics: Data acquisition and analysis)
• EP/MP 4I03 (EP/MP/BME 6I03): Introduction to Biophotonics
• EP 4US2: Smart Systems
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3P04 Health Solutions Focus
Remote Technologies for Post-Orthopaedic Surgery Rehabilitation
Biomechanics

Why?
Continued disability after surgery is very costly on a human and societal
level. Our ability to develop solutions in this space that are affordable,
translatable and can be used remotely either in clinics or in people’s
homes, can significantly change how we monitor, evaluate and intervene
in post-surgery recovery with appropriate rehabilitation strategies.

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3P04 Schematic

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Engineering Design from ABET
• Engineering design is a process of devising a system,
component, or process to meet desired needs and
specifications within constraints.
• It is an iterative, creative, decision-making process in which the
basic sciences, mathematics, and engineering sciences are applied
to convert resources into solutions.
• identifying opportunities, developing requirements, performing
analysis and synthesis, generating multiple solutions, evaluating
solutions against requirements, considering risks, and making
trade- offs, for the purpose of obtaining a high-quality solution
under the given circumstances.
• examples of possible constraints include accessibility, aesthetics,
codes, constructability, cost, ergonomics, extensibility, functionality,
interoperability, legal considerations, maintainability,
manufacturability, marketability, policy, regulations, schedule,
standards, sustainability, or usability.

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Biomedical Engineering Design
• Analyze the problem;
• Anatomy, physiology, current standard of the care (process, devices), prognosis, side
effects, risks, outcome statistics, regulatory requirements
• What is the specific problem
• Initial design
• Device or process? Or policy?
• Improve/customize existing instruments/processes
• Using acquired knowledge (e.g. your 2nd/3rd year domain specific courses) to solve
problems, invent new technologies
• Available resources (e.g. existing instruments/components/materials/tools)
• Feasibility
• First principle evaluation, theoretical calculations
• Proof-of-principle setup and validation
• Improved design and prototype building
• Validation and performance characterization

• It is a system! optics is not everything!

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3P04 Structure
Lectures: 2 x 1 hour per week (Tues 1:30 pm; Thurs 9:30 am)

Weekly Design Studio: 10:30 – 12:20 pm (Monday through Friday)

Project Zero (first 2 weeks)

Design Project (9 weeks; team-based)

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 Project Zero

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Project Zero Overview
• Goal
• inform a coffee drinker the temperature of the coffee in a
cup. This system will be a portable device that one can
add to the coffee cup while drinking.
• Tasks:
• Design the housing of the components
• Build a data acquisition solution w/ thermo sensors &
ESP32
• Demonstrate the full functionality and utility.
• Learning objectives:
• Review basic design processes learned in IBEHS 1P10
• Review AutoCAD design and 3D printing
• Practice full sensing data acquisition w/ a microcontroller

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Design
Project

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Design Project
5 Challenge Choices: A through E

Pre-assigned Team

Progressively walk through a series of 9 Milestones and

Deliverables (some Team, some Individual)

Final Report and Expo Presentation

Design Studio, week 3 – 11

Self-managed time outside of DS

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Orthopaedic Surgery
Orthopaedics is a branch of medicine concerned with the correction or
prevention of deformities, disorders, or injuries of the skeleton and
associated structures.

Orthopaedics: ‘ortho’ = ‘upright’ ‘correct’ and ‘paedic comes in part from the
Greek word for ‘child’

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Orthopaedic Surgery
Orthopaedics focusses on the diagnosis, treatment, rehabilitation and
prevention of diseases of the musculoskeletal system including those of
bones, joints, ligaments, muscles, tendons and nerves.

The goal of many orthopaedic surgeries is to restore function, mobility

and quality of life.

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Orthopaedic Surgery
The Design Project highlights rehabilitation challenges from 5 orthopaedic
surgeries:

A. Knee Arthroplasty (i.e. Replacement) Surgery

B. Anterior Cruciate Ligament (ACL) Repair
C. Rotator Cuff Tear Repair
D. Cerebral Palsy Muscle/Tendon Lengthening Surgery
E. Lumbar Spinal Stenosis Surgery

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Rehabilitation
The action of restoring someone to health, particularly by therapeutic
means, to an improved condition of physical function.

Rehabilitation Biomechanics is the field of study that addresses the impact

of disability and the effectiveness of rehabilitation therapies and
interventions on human performance.

Engineering and physics principles are applied to evaluate and analyze

human body movement and forces.

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In this course…
Learn the principles of human movement biomechanics.

Learn about mobility and gait (walking) analysis.

Learn about instrumentation, data collection, processing and analysis for

applications in human biomechanics.

Undergo a team-based and directed design project providing a solution to 1

of 5 prescribed challenges in the space of post-orthopaedic surgery
rehabilitation biomechanics.

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Project A:
Walking Away with a Knee Replacement

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Total Knee Arthroplasy (TKA)
Total knee arthroplasty (TKA), also known as knee replacement surgery, is
the surgical procedure of removing the ends of the long bones that form the
knee joint and replacing, or capping, the ends of the bones with synthetic
material implants, typically metal and plastic parts.

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Osteoarthritis (OA)
Why? The most common reason for joint replacement is advanced
osteoarthritis (OA)

Osteoarthritis is a progressive disease marked by the degeneration of joint

tissues, including the cartilage and underlying bone. This causes significant
pain with movement, and a lack of mobility and joint function.

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Post-Surgery Rehabilitation
The most desired outcome of knee joint replacement surgery is the ability to
walk and resume daily activities with independence and social
connectedness.

Despite significant improvements in mobility for most people after surgery,

many continue to lag healthy age-matched adults in achieving the same
walking mechanics.

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Post-Surgery Rehabilitation
In particular, many do not achieve healthy levels of the range of motion of
the knee joint in the sagittal plane while walking even two years after
surgery.
70
Healthy Adult
60 Before Surgery
One Year After Surgery
50

Knee Flexion Angle (deg)

40

30

20

10

0 20 40 60 80 100
% Gait Cycle

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Project A Challenge:
Design a solution to remotely monitor
the range of motion of the knee joint
during walking gait for a patient after
total knee joint replacement surgery.

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Project B:
A Balancing Act After ACL Surgery

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 ACL Repair Surgery
The Anterior Cruciate Ligament (ACL) is an
important part of the structure of the knee
joint. It is a ligament that is a key stabilizer of
the knee joint during dynamic movement,
connecting the two the long bones, the femur
(thigh) and the tibia (shank).

The word ‘cruciate’ comes from cross. The

ACL and the Posterior Cruciate Ligament
(PCL) form a cross in the knee joint.

The ACL runs from the posterior (back) femur

to the anterior (front) tibia. The strong fibers
that make up the ACL and their direction
resist excessive anterior movement of the
tibia bone relative to the femur. They also
resist excessive twisting of the knee joint
(internal rotation of tibia relative to femur).
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ACL Injury
ACL tears are one of the most
common injuries to the knee joint.
They are most often caused in non-
contact scenarios, during activities
with sudden changes in direction
such as landing or running and
unanticipated cutting.

Athletes are therefore most

susceptible to ACL tears, and we
see high incidence in sports such as
soccer, basketball, volleyball,
football, and tennis.

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ACL Injury

Females are 7 times more likely to tear an ACL than males.

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ACL Injury

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ACL Repair Surgery
For some patients, surgical repair of the torn ACL is the best option for
return to function and/or sports. The most common type of surgery is an
autograph surgery. Autograft surgery involves a patient’s own tissue, an
autograft, being used for surgical reconstruction.

The two most common autograft sites are the patella tendon and the
semitendinosus (hamstrings) tendon. Screws are often used to hold bone
plugs of the graft in place.

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ACL Rehabilitation
After surgery, there is a great deal of physiotherapy and rehabilitation, with
much focus on muscle strength and knee joint stability and balance.

Despite this, there is not yet clear guidelines on return to sport (RTS). Risk
of re-injury with RTS hovers around 33%. Having biomechanical
determinants for joint stability and balance before RTS could therefore be
very important in the field.

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Project B Challenge:
Design a solution to remotely
monitor post-ACL reconstruction
surgery balance

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Project C:
Am I Rotating my Cuff Correctly?

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Rotator Cuff Tears
The rotator cuff is the group of
muscles and tendons that surround
the shoulder joint, providing stability
and mobility to the joint. The muscles
and tendons keep the humeral head
of the humerus bone into the
relatively shallow glenoid cavity
(shoulder socket).

The four main muscles are the

supraspinatus (holds in place and
lifts arm in abduction), infraspinatus
(main muscle that externally rotates
and extends shoulder), teres minor
(assists in external rotation), and
subscapularis (helps internal rotation,
flexion, adduction)

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Rotator Cuff Tears
Tears of the rotator cuff are common. Tears cause pain and a feeling of
weakness in the shoulder joint, making it hard to perform common daily
activities with independence. Tears to the supraspinatus are most common, but
other parts of the cuff can also be involved, and tears can be partial or full.

Tears can also be acute (falls on outstretched arm) or degenerative (wearing

down over time from repetitive stress).

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Rotator Cuff Surgery
Diagnosis of a rotator cuff tear will most often be done with imaging (X-ray
and/or MRI). Often non-surgical management including physiotherapy will be
used first, and many will improve and not require surgery.
If pain does not improve, surgery may be recommended. Surgery will involve
reattachment of the torn tendon to the humeral head.

Healthy Shoulder Rotator Cuff Tear Rotator Cuff Tear Rotator Cuff Tear
Top View Side View Surgical Re-attachment

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Rotator Cuff Rehabilitation
Rehabilitation and physiotherapy is an important part of non-surgical and
surgical management. Strengthening and mobility exercises for the rotator cuff
muscles is important.
The movements of key interest for healing from surgeons and therapists
include abduction, internal rotation and external rotation. Doing exercises
‘properly’ by isolating these muscles and movements is important to build
strength and avoid injury.

2020-01-07 Abduction External Rotation

iBEHS 3P04 Internal Rotation 36
Project C Challenge:
Design a system to remotely monitor
improvements in recovery of rotator
cuff injury and/or surgery.

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Project D:
A Mobile Lab for Cerebral Palsy

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 Cerebral Palsy
Cerebral palsy (CP) is a motor control disorder that appears in early childhood.
It is the most common motor disability in childhood. Musculoskeletal symptoms
can include poor coordination, muscle weakness, muscle spasticity, and
stiffness. There is no known cure for CP, however treatments and therapies can
be used to improve motor function in people with CP.

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 Cerebral Palsy Treatment
While the primary cause of CP is neurological lesion, the orthopaedic
considerations are progressive and often the focus of treatment. Joint
contractures (limiting range of motion) are common and can cause increasing
difficulties for mobility and walking. Spastic CP (muscle tightness) is the most
common manifestation. Tightness of the calf (gastrocnemius, soleus) muscles
and the Achilles tendon causes a characteristic equinas (‘toe-walking’) gait
pattern.

Much of childhood therapy for spastic CP is aimed at improving walking and

gait. At times, orthopaedic surgery is used to treat tight muscles and spasticity.
Cuts are made to the muscle and/or tendons to release the tightness.

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 CP Gait Analysis
Equinas gait refers to a walking pattern characterized by plantarflexion (or
pointed toe) of the foot relative to the leg, which is usually accompanied by
extended knee and hip joints while walking. Treatment or therapy (including
surgery) aims to remove spasticity and improve gait function, at times in an
effort to reduce this toe walking feature of gait.

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Project D:
Design a ‘remote gait lab’ for
monitoring improvement in walking
gait patterns (equinas gait or other) of
children with CP after surgery.

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Project E:
Fixing this Pain in my Back

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Lumbar Spinal Stenosis
The Lumbar spine consists of the 5
vertebrae (bones) of the lower back.
Lumbar spinal stenosis is a condition
that is characterized by narrowing and
degenerative changes of the lower
back. The changes squeeze and
irritate the nerves that branch out of
the spinal cord between the vertebrae
of the spinal column. This causes
pain, numbness and dysfunction in
the muscles innervated by these
nerves.

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 Lumbar Spinal Stenosis
Conservative therapy for lumbar
spinal stenosis includes anti-
inflammatory medication and
analgesics, and physical therapy and
exercise to help stabilize and protect
the spine.

If conservative management does not

improve symptoms, surgery may be
recommended.

Depending on the presentation,

surgery may involve spinal fusion to
stabilize the spine and alleviate pain,
and/or a laminectomy which removes
the roof of the vertebrae to make
more space for the nerves.
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LSS Rehabilitation
Conservative or surgical management
will involve rehabilitation to strengthen
the spine and improve mobility.

One of the key desired changes

patient’s want from treatment is
improved mobility and walking ability.

LSS gait can be characterized by

excessive forward lean gait (posture
extends spine relieving pressure on
nerves), as well as Trendelenburg gait,
which can occur from with weak hip
abductor muscles from strained spinal
nerves.

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Project E:
Design a remote system to monitor
improvements in gait mechanics after
surgery for spinal stenosis.

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Milestone 1
Type: Individual

Weight: 3%

Time: own time, due beginning of DS-3 (Jan 20-24)

Objective: Individually review the 5 projects and come up with a plan for 3/5
of the project challenges. The design plan should demonstrate a clear
understanding of the challenge, a preliminary design with sketches and
descriptions. Some self-directed background reading is encouraged.

Submit: 1 page per design (3 pages total), submission through Avenue to

Learn.

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