Jaimee Holbrook

The Tongue Enables Computer and Wheelchair Control for People with Spinal Cord Injury

Individuals with severe spinal cord injury control a computer and powered wheelchair by using a wireless tongue-operated assistive technology called the Tongue Drive System. Tying the Tongue to Motor Control Voluntary tongue motion may help people with limited upper limb mobility, such as those with high-level spinal cord injury, to access computers and to drive wheelchairs. The Tongue Drive System (TDS) is a wireless and wearable assistive technology that allows individuals with severe motor impairments to access their environments using voluntary tongue motion. Kim et al. report on a new study of TDS efficacy in patients with severe spinal cord injury. Two groups of able-bodied participants and a group of patients with spinal cord injury received a magnetic tongue barbell. Participants used the TDS during five to six testing sessions. Comparisons between the TDS and the keypad for the able-bodied groups and a sip-and-puff device (a traditional assistive technology) for those with tetraplegia were based on widely accepted measures of speed and accuracy. A combination of TDS flexibility and inherent human tongue abilities enabled individuals with severe motor impairments to access computers and drive wheelchairs more quickly but just as accurately as when using traditional assistive technologies. The Tongue Drive System (TDS) is a wireless and wearable assistive technology, designed to allow individuals with severe motor impairments such as tetraplegia to access their environment using voluntary tongue motion. Previous TDS trials used a magnetic tracer temporarily attached to the top surface of the tongue with tissue adhesive. We investigated TDS efficacy for controlling a computer and driving a powered wheelchair in two groups of able-bodied subjects and a group of volunteers with spinal cord injury (SCI) at C6 or above. All participants received a magnetic tongue barbell and used the TDS for five to six consecutive sessions. The performance of the group was compared for TDS versus keypad and TDS versus a sip-and-puff device (SnP) using accepted measures of speed and accuracy. All performance measures improved over the course of the trial. The gap between keypad and TDS performance narrowed for able-bodied subjects. Despite participants with SCI already having familiarity with the SnP, their performance measures were up to three times better with the TDS than with the SnP and continued to improve. TDS flexibility and the inherent characteristics of the human tongue enabled individuals with high-level motor impairments to access computers and drive wheelchairs at speeds that were faster than traditional assistive technologies but with comparable accuracy.

Evaluation of a Smartphone Platform as a Wireless Interface Between Tongue Drive System and Electric-Powered Wheelchairs

Tongue drive system (TDS) is a new wireless assistive technology (AT) for the mobility impaired population. It provides users with the ability to drive powered wheelchairs (PWC) and access computers using their unconstrained tongue motion. Migration of the TDS processing unit and user interface platform from a bulky personal computer to a smartphone (iPhone) has significantly facilitated its usage by turning it into a true wireless and wearable AT. After implementation of the necessary interfacing hardware and software to allow the smartphone to act as a bridge between the TDS and PWC, the wheelchair navigation performance and associated learning was evaluated in nine able-bodied subjects in five sessions over a 5-week period. Subjects wore magnetic tongue studs over the duration of the study and drove the PWC in an obstacle course with their tongue using three different navigation strategies; namely unlatched, latched, and semiproportional. Qualitative aspects of using the TDS-iPhone-PWC interface were also evaluated via a five-point Likert scale questionnaire. Subjects showed more than 20% improvement in the overall completion time between the first and second sessions, and maintained a modest improvement of ~9% per session over the following three sessions.

Body piercing: complications and prevention of health risks.

Body and earlobe piercing are common practices in the USA today. Minor complications including infection and bleeding occur frequently and, although rare, major complications have been reported. Healthcare professionals should be cognizant of the medical consequences of body piercing.Complications vary depending on the body-piercing site, materials used, experience of the practitioner, hygiene regimens, and aftercare by the recipient. Localized infections are common. Systemic infections such as viral hepatitis and toxic shock syndrome and distant infections such as endocarditis and brain abscesses have been reported. Other general complications include allergic contact dermatitis (e.g. from nickel or latex), bleeding, scarring and keloid formation, nerve damage, and interference with medical procedures such as intubation and blood/organ donation.Site-specific complications have been reported. Oral piercings may lead to difficulty speaking and eating, excessive salivation, and dental problems. Oral and nasal piercings may be aspirated or become embedded, requiring surgical removal. Piercing tracts in the ear, nipple, and navel are prone to tearing. Galactorrhea may be caused by stimulation from a nipple piercing. Genital piercings may lead to infertility secondary to infection, and obstruction of the urethra secondary to scar formation. In men, priapism and fistula formation may occur. Women who are pregnant or breastfeeding and have a piercing or are considering obtaining one need to be aware of the rare complications that may affect them or their child. Though not a ‘complication’ per se, many studies have reported body piercing as a marker for high-risk behavior, psychopathologic symptoms, and anti-social personality traits.When it comes to piercing complications, prevention is the key. Body piercers should take a complete medical and social history to identify conditions that may predispose an individual to complications, and candidates should choose a qualified practitioner to perform their piercing.As body piercing continues to be popular, understanding the risks of the procedures as well as the medical and psychosocial implications of wearing piercing jewelry is important for the medical practitioner.

Safety and efficacy of medically performed tongue piercing in people with tetraplegia for use with tongue-operated assistive technology

BACKGROUND Individuals with high-level spinal cord injuries need effective ways to perform activities. OBJECTIVES To develop and test a medically supervised tongue-piercing protocol and the wearing of a magnet-containing tongue barbell for use with the Tongue Drive System (TDS) in persons with tetraplegia. METHODS Volunteers with tetraplegia underwent initial screening sessions using a magnet glued on the tongue to activate and use the TDS. This was followed by tongue piercing, insertion of a standard barbell, a 4-week healing period, and an exchange of the standard barbell for a magnet-containing barbell. This was then used twice weekly for 6 to 8 weeks to perform computer tasks, drive a powered wheelchair, accomplish in-chair weight shifts, and dial a phone. Symptoms of intraoral dysfunction, change in tongue size following piercing, and subjective assessment of receiving and wearing a magnet-containing tongue barbell and its usability with the TDS were evaluated. RESULTS Twenty-one volunteers underwent initial trial sessions. Thirteen had their tongues pierced. One individuals barbell dislodged during healing resulting in tongue-tract closure. Twelve had the barbell exchanged for a magnet-containing barbell. One subject withdrew for unrelated issues. Eleven completed the TDS testing sessions and were able to complete the assigned tasks. No serious adverse events occurred related to wearing or using a tongue barbell to operate the TDS. CONCLUSIONS Using careful selection criteria and a medically supervised piercing protocol, no excess risk was associated with tongue piercing and wearing a tongue barbell in people with tetraplegia. Participants were able to operate the TDS.

Development of a Tongue-Piercing Method for Use With Assistive Technology

Piercing the tongue for wearing jewelry is not infrequent among young adults.1,2 The procedure is not usually performed by medical personnel. A new assistive technology for people with tetraplegia, the Tongue Drive System (TDS), utilizes voluntary tongue movements for control.3 The operator uses a magnet attached to the tongue together with an externally mounted sensor array that detects changes in the magnetic field to drive powered wheelchairs and access computers.4 We hypothesized that a magnet-containing barbell would provide a semipermanent means of attaching the magnet to the tongue. Our aims were to design a medically appropriate tongue-piercing method and to confirm that using a magnet-containing tongue barbell works to control the TDS.

Bone mineral density and FRAX as predictors of fracture risk in women with breast cancer.

121 Background: The number of cancer survivors is rising in the USA, the 2007 CDC analysis of the SEER database estimated 11 million cancer survivors, with 90% being over the age of 65 years. Of these, 70% are women, and the most common cancer in survivors is breast cancer. Cancer therapy induced bone loss (CTIBL) contributes to an increase in fracture risk in women with breast cancer. Fractures are responsible for considerable morbidity, disability, hopitalizations and mortality in older adults. Fractures are often the cause for nursing home placement in seniors. Our objective was to analyze the prevalence of fractures after breast cancer therapy and to assess the effect of cancer therapy, clinical risk factors, bone density and the World Health Oragnization (WHO) fracture risk assessment [FRAX] as predictors of fracture occurrence. METHODS The study population consisted of breast cancer patients with invasive breast cancer who participated in a genetic databank within a NCI-Comprehensive Cancer Center. Demographic and clinical characteristics were abstracted from the EMR. Participants were followed for 6-12 years. RESULTS A total of 439 women with breast cancer were assessed; 79 had sustained fractures during the observation period (116 fractures), fractures occurred at multiple skeletal sites in 27 cases. The prevalence of fractures was 18%. Baseline characteristics revealed that women who sustained fractures were mostly Caucasian (91%, p=0.08), and had a family history of osteoporosis (36.9%, p=0.03). The time to fracture was 4.0 years (range 0-12 years) from diagnosis. Fracture cases had lower BMD at the femoral neck 0.86 ± 0.13 gm/cm2 (T-score= -1.0, p=0.04) than non- fracture cases, although BMD was in the low normal range. Eight cases of hip fractures were identified with a median age of 55 years (32-67 years) Median T-score -0.75. Cox proportional hazard analysis failed to identify any specific risk factors for fractures. CONCLUSIONS Fractures occur shortly after commencing cancer therapy. BMD and FRAX risk calculation were not able to identify women who fractured. Occurrence of fractures in breast cancer raises the possibility of cancer-induced impairment in bone quality.

The Tongue Drive System: Testing Novel Assistive Technology that Uses Magnetic Signals Derived from Tongue Movements

A Randomized Controlled Trial on the Efficacy of Body Weight Support Overground Ambulation Versus Body Weight Support Treadmill Training Among Post-stroke Patients of a Tertiary Hospital. Sherwin W. Gan, MD (Veterans Memorial Medical Center, Quezon City, Philippines); Alfredo C. Azarcon, MD; Ma Jullita J. Cadiao, MD; Ma. Antonette M. Gabua, MD; Rafaelita S. Javier, MD; Edwin M. Orayle, MD; Edgardo D. Uyehara, MD.