How two Lawson researchers are taking a digital approach to improving patient care
At first glance, it may not seem like the studies of Lawson researchers Drs. Mandar Jog and Cheryl Forchuk have much in common. A neurologist at London Health Sciences Centre (LHSC), Dr. Jog works on treatments for neurological movement disorders, including tremor and Parkinson’s disease, while Dr. Forchuk’s research at LHSC and St. Joseph’s Health Care London focuses on improving mental health care and the transition from hospital to community.
However, an underlying principle is the same: adapting technology to address symptoms where, in many cases, no successful intervention has existed.
The results are delivering individualized solutions to unsolved problems. They give us a glimpse at the future of discovery in our increasingly digital world.
A combination of existing technologies that create something entirely new
“The pen, the paper and the ink exist. But what you write with them, that comes from the mind. That’s the intelligence. Can we solve this unmet need using what is already available?”
This question, Dr. Jog explains, drove the development of TremorTek, a wearable sensor technology that has already successfully treated over a hundred research patients who suffer from tremors in their arms and hands.
These tremors, typically caused by Parkinson’s disease or essential tremor, are a common movement disorder symptom yet there is no effective treatment. Everyday actions like writing a grocery list or taking a drink from a cup can be a struggle.
“There is no oral medicine or treatment available specifically for tremors. Patients are sometimes given anti-hypertensive or anti-convulsant medication but these aren’t a great solution because they’re not individualized,” he says. “Often they aren’t used and patients go untreated.”
Dr. Mandar Jog (right) and his team use sensors to isolate independent muscle movements in patients with tremors. The data is then run through a computer program that matches the muscle activity with the correct dosage of neurotoxin.
Neurotoxin therapy has been identified as a possible treatment for tremors. Some neurotoxins reduce muscle activity and are already on the market for a variety of uses.
The catch is that it’s necessary to know which specific muscles are causing the tremor. If the injection of neurotoxin is given in the wrong place or the patient isn’t given the correct dose, it could cause negative side effects.
Another hurdle is that everyone experiences tremors in different ways. The location and strength of the movements, and how often they occur varies widely.
“It’s not uncommon to see tremor movement that is actually in three different joints and moving in six different directions, at the same time. We aren’t able to detect that with the naked eye.”
“This is an unmet need in how we treat patients in general – to measure the abnormal movements we observe and then target therapy towards that, taking into account specific symptoms and their severity.”
Dr. Jog and his research team set out to bridge the gap, taking existing systems and making them intelligent for use in the clinic.
Using commercially available sensor technology, they were able to isolate independent muscle movements. They created a system that matched the muscle activity pinpointed by the sensors with the correct amount of toxin to administer.
Through clinical trials, participants have experienced striking improvements to the severity of their tremors after receiving the assessment and tailored injections.
“This makes it easier for them to complete their regular activities, maintain careers or hobbies, and keep their independence.”
The Botulinum toxin used is commercially called Xeomin, made by Merz Pharma Canada Ltd.
The goal is for TremorTek assessments and dosing recommendations for injections to be made widely available to patients for the treatment of tremors.
Dr. Mandar Jog is developing two other sensor-based technologies based on the same smart technology principles. They will be used for both targeted and whole body assessment of movement disorders, including those caused by Parkinson’s disease and stroke.
Personalized treatment for tremors
Smart technology can extend mental health treatment beyond a clinic room
Most of the participants in Dr. Forchuk’s studies are very familiar with some of the technology involved. It’s already all around them.
Many mobile applications are on the market to help people struggling with mental health issues, but these aren’t necessarily created or used by health care providers.
Creating an entire smart mental health system is one of the strategic priorities of the Lawson Mental Health Research Group, led by Dr. Forchuk. Numerous projects have been identified as components of a plan spanning seven years.
With a smartphone pilot project called the Lawson “SMART” record, participants received an iPhone loaded with a custom-designed app. This gave them access to their personal health information and allowed them to easily stay in contact with their health care provider in a secure environment. A mood monitor was built in, but unlike other tracking apps, the information was instantly sent to the care provider.
A patient can share what kinds of text messages might be helpful for them to receive, such as a reminder to take medication or even a simple check-in, like “how is your day going?” Their care provider can then monitor the responses and engage in dialogue.
“We found that using this technology and individualized system improved patients’ quality of life and community integration, as well as reduced outpatient visits, psychiatric hospitalizations and arrests.”
In a similar pilot project funded by the Canadian Frailty Network, they created an app to help seniors with depressive symptoms, which Dr. Forchuk says are commonly seen in this age group. Having depressive symptoms means someone hasn’t necessarily been diagnosed with clinical depression but is at risk of developing it. The study looks at whether some mental health services could be done virtually, such as face-to-face visits through secure video chats and tools like mood monitoring.
Lawson researchers created an app to help seniors with depressive symptoms, allowing for some health and support services to be provided virtually.
“This would save the healthcare provider time, but really it would reduce the burden on a population for which face-to-face visits can be a huge ordeal, especially in the winter.”
Using the app is not meant to eliminate structured appointments, but to avert crises between visits.
Moving forward, they will pilot two smart home prototypes to study the benefit of technologies built in the home, including automatic medication dispensers, blood pressure monitors, smart mirrors and smart TVs.
With these smart tech treatments, the ‘dose’ of technology would vary. A lower dose could be a text, a medium dose could be something you access through an app or online, and a higher dose would be having technology set up right in the home.
“It depends on the unique needs of the individual. Someone might only need a text message, but since he has trouble remembering to take medications, an automatic medication dispenser could be installed.”
Dr. Mandar Jog leads the Neurological Disorders research program at Lawson. He is a Professor in the Schulich School of Medicine & Dentistry and the Faculty of Engineering at Western University. Dr. Cheryl Forchuk leads the Mental Health research program at Lawson. She is a Distinguished University Professor in the Schulich School of Medicine & Dentistry and the Faculty of Health Sciences at Western University.
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