By Ashkan Pakzad and Samuel Gunning

The Department of Medical Physics and Biomedical Engineering generously funded two students to attend a Neurorehabilitation Symposium organised by UCL Partners. The students were Ashkan Pakzad (MSci Medical Physics) and Samuel Gunning (iBSc in Medical Physics).

Ashkan takes up the story:

Although the conference aimed to cover neurodegenerative diseases as a whole it often revolved around support and provision for those that suffered from multiple sclerosis, a disease that encompasses most aspects of any neurodegenerative condition.

As it was my first ‘real’ conference I was already nervous about the 9 hours ahead only to find out that my experience was about to curve further; I felt like an outsider, not because I was a student amongst clinicians bound to become consultants but because I was a physicist. The speakers all had the idea that they were informing clinicians rather than intruding academics but none the less I managed to keep up with their abbreviated jargon.

A wide range of speakers from top international consultants to graphic designers with no official qualifications in science working with clinics had a slot. It all started off with a few words from a retired prestigious academic, giving his take and definition on rehabilitation for neurodegenerative disease as he urged that such cases needed to not be over simplified and not be redefined into something new and that these diseases often should not even be considered as a disease but to take them as they come and to refrain from a systemic approach.

One particular speaker that I enjoyed had highlighted the need to conduct research with care as large budgets have been wasted in the field due to indirect questionnaires that measured outcomes too broadly and thus those studies had given imprecise results to critically compare techniques therefore leading to unsustainable conclusions. In fact, he claimed that much was to be learnt from experiments in physics coupled with rigorous statistical analysis when planning medical experiments.

Stalls were set up in between speakers offering close inspection of incontinence technology and several industry representatives were presenting their technologies as fast as possible with no time to lose. Overall this opportunity has been an eye opener just presenting the great wealth of knowledge delivered intensely and often ready digested thanks to talented speakers whom all have a different perspective to offer.

Samuel continues after lunch:

The symposium was approached from a greater clinical perspective after lunch. Whereas before lunch had been focused primarily on the technology that is currently circuiting, as demonstrated in Helen Paterson’s lecture on Augmentive and Alternative Communication, or the general role rehabilitation should have in neurological diseases, after the break we started to pinpoint specific conditions or symptoms which can be overcome with rehabilitation.

We began with the management of incontinence – bladder first and then bowel – issues which are quite often left untreated due to them being regarded as “private” matters. The lectures had very different structure with the first summarising the main surgical methods which would follow the failure of conservative treatments and the second concentrating on the technological interventions used, sometimes with many being used in parallel. The reason for this is, I believe, is the far more advanced care algorithm used for bowel management.

Following this we moved onto the complicated management of pregnancy in women with Charcot-Marie-Tooth disease. To a medical student this was very interesting as CMT, a hereditary sensory and motor neuropathy with peroneal muscular atrophy as well, is a perplexing condition. To then understand the methods to overcome the disease, or at least reduce the impact of some of the many symptoms attributed to CMT, was a highlight.

Moving away from disease, the next session addressed the analysis of research, specifically research into emerging rehabilitation technologies. With doctor autonomy currently growing, the ability to differentiate a potentially hugely beneficial treatment method from a false one is hugely important. The objective of the lecture, I believe, was to emphasise how an outcome was completely reliant on the measurement process and how you must first decide the outcome you want before indentifying the measurement process, a thinking point I later applied to my own research.

To finish, two support groups were identified. The key purpose of these groups is to support and to facilitate learning of how to manage oneself when struggling with a disease or symptom.

The second half of the day was much more applicable to my own learning, with such symposiums contributing to the compulsory CPD points I will one day have to accumulate. Despite this, the technological aspect was what I had expected. Having spoken to the other attendees, the majority were practicing doctors, physiotherapists and nurses, and I think the day was perfectly focused to them. For a student it was important to see how the stuff we are learning about is applied in a clinical situation as this is the eventual goal of any studying and can help focus and encourage. Furthermore, with presentations looming at the end of next term, the symposium was a valuable opportunity to identify positive presentation methods and those to avoid as well. All in all a fantastic day, filled with a wide variety of interesting topics.

Thanks to the Centre for Neurorehabilitation who agreed to offer a student discount on the registration fee.

By Alan Cottenden

Congratulations to the victorious Biomedical Engineering team who managed to transport their pebble the length of the assault course they had designed and built – involving a catapult, a lift, numerous slides and prodigious quantities of string and sticky tape – and deposit it in a bucket at the finishing line with fewer “interventions” (that is, manual interferences to help it on its way!) per meter of travel than either of their two rival teams. The pictures show the creators of the assault course’s four sections admiring their handiwork while savouring the taste of victory!

Team Catapult

Team Vertical

Team Cup

Team Balloon

By Nishat Ahmed and Bindia Venugopal

On Wednesday the 11th of November, we were up at the crack of dawn, pumped and ready to go to the Royal National Orthopaedic Hospital in Stanmore. After missing trains due to tube closures and our taxi rides arriving a half hour late, we finally managed to reach the hospital in time to attend the Multi-Disciplinary Team meeting.

We found the meeting very interesting, watching the consultant surgeons and nurses discuss real case studies of patients. They collaborated well to work out the best way to rehabilitate patients, whether this was through further surgery or simply giving them advice and support.

Later on we headed to the operation theatres, adhering to hospital dress code we threw on our scrubs, hair nets and masks beforehand! Since we were only allowed three students at a time in the theatres, we split into groups and then went off to watch various operations taking place. The first surgery we watched involved attaching a metal plate to a fractured tibia bone to aid its healing process in a way that was ingenious! It was fascinating watching the surgeon screw the bone together and then brace the join with a metal plate. The screws held the fracture under compression, this meant it was forced to combine together rather than slide apart, and the metal plate stopped it from twisting.

The second surgery we went to was an extremely rare case where the surgeons ended up dislocating the hip bone in order to remove a benign tumour from inside the bone. They sawed the hip bone in half as bone-to-bone healing worked best compared to tendon-to-bone healing. The challenge was in trying to avoid damaging the femoral head to get to the tumour.

After this we had a little tea break and then made way to our next surgery! This was a spinal surgery where the patient had a twisted spine due to being paralysed for 10 years. They operated with a diathermy machine which uses electricity to cut through the skin and muscles as this reduces blood loss. Although we only saw the surgery for 10 minutes we learnt how vital it was to keep the fluids in the patient regulated. This job was monitored by the anaesthetist, who informed us about the patient and the precautions which needed to be taken. Two neurophysiologists were monitoring electrical activity in the spinal cord to ensure that it wasn’t damaged by the surgery.

After an insane experience watching all the surgeries, we went to have lunch which was provided by the lovely team at Stanmore. In the afternoon we got a tour around the BME department at the hospital and learnt about all the weird and wonderful things they collect and experiments they run! In fact, we found out that they have over 6000 failed hip replacements from 25 different countries in their labs to study and analyse. They conduct experiments to research why implant failure happens in some patients the way it does, especially those with metal on metal implants. They use tools for metrology which measures the exact size of the ball and socket implants with crazy precision! This information is then used to work out the amount of corrosion that happened in the body when the implants were inserted.

Overall, we had an amazing and truly valuable experience. The entire team were extremely friendly and helpful! We loved that we could ask questions and interact with the staff so well. It was remarkable to see the transition from a real-life patient problem to actually seeing the solution executed in the surgeries. It was also encouraging to see how the hospital carries out their own research which can then be implemented to the surgery procedures in only a few years’ time.

On behalf of our whole BME department, we thank you for this experience Professor Hart and RNOH!

By Jenny Griffiths

Scenarios are a highlight of our new biomedical engineering programme. In a scenario, all lectures stop and students spend the whole week working on a group project where they solve a biomedical engineering problem. Last week, our second year students worked with Jenny Griffiths to build articles of smart clothing. Their brief was to design and build an item of clothing to monitor a marathon runner’s wellbeing and give an alert to inform the runner and all those around them to prevent injury. Students were encouraged to be creative and develop their own solutions as long as their device met the design brief and was safe.

Jenny provided the students with a range of components, mainly centered around the Adafruit Flora wearable arduino. We gave them sensors including temperature and pressure sensors, accelerometers, GPS, UV and light sensors and stretchy conductive rubber. Outputs included buzzers, vibration motors, Bluetooth connectivity and programmable RGB LEDs, but they were only allowed to use up to £40 for materials. The task built upon electronics modules which students took last year, and a clinical engineering module which includes lectures on transducers which the students are taking at the moment.

We put the students into random groups and let them loose!

Two groups chose to design their own sensors from scratch to monitor electrolyte concentration in sweat. They quickly learnt how challenging it is to build a robust sensor! They sewed their home-made sensors into running shirts with conductive thread and used the arduino to control LEDs based on the resisitivity of the sensor. Another group built an arm band to monitor skin temperature. They learnt that packing 10 LEDs, a microcontroller, batteries and an temperature sensor into a package the size of a iphone can lead to wiring complexities. The winning group instrumented a running shoe with pressure-sensitive pads to measure gait continuously during the running cycle. They sewed their Flora onto the shoe and daisy-chained LEDs around the shoe with conductive thread. They went shopping to find low-cost trainers which fitted a team member and also gave them something additional to write about in their sustainability analysis.

Students enjoyed the scenario, some saying this was the first time they’d ever worked as a team under pressure. They were ambitious and undaunted by such an open-ended task. Despite one team doing a complete redesign at the beginning of Day 4 out of 5, project management and budgeting were good even when students were tempted to go over budget (see  title of post!). All worked hard and Jenny had fun leading it, with great support from Eve, the lab technician. All enjoyed the occasional punctuations from smoking components and whoops of success. There’s now competing demand for the clothing, with students wanting to take them home to show family and friends and us wanting to hang onto them to entice prospective students in UCAS visits to join us next year.