ekta grewal
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PowerPoint Presentation
Patient Centric ResearchEkta Grewal, M.Sc.interdisciplinary Consortium on Advanced Motion Performance (iCAMP)University of Arizona, Tucson, AZ
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OverviewPhantom pain and sensationPhantom limb SyndromePhantom Bladder SyndromeObjective outcome evaluation Quality of life Postural balanceGait Physical activity 2
Phantom Pain & SensationsContinued sensations following amputation of a body part
Common phantom pain/sensations Phantom limb syndromePhantom bladder syndrome 3
Management of Phantom PainMirror TherapyVirtual training
Not ideal for PBS What alternatives do we have ? 4
Alternative MedicineGuided imagery a therapeutic and stress relaxation techniqueEndorphinsChronic pain conditions, anxiety, cancer pain, interstitial cystitis5
https://www.youtube.com/watch?v=W0i0KvHoSiM
Study DesignA randomized, double blind, parallel group controlled trialSample size= 30Control- relaxation CD, Intervention- Guided Imagery twice a day for 8 weeksPrimary outcomePain (VAS)
Secondary outcomeQuality of life (SF-36)
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Skills AcquiredConducting comprehensive literature reviewHES database/ICD-10 and OPCS-4 codingResearch DesignIRB protocolPatient recruitment
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Objective Outcome EvaluationOutcome evaluation of an intervention Outcomes related to quality of life and day to day mobility are most evaluated through subjective measures Standard questionnairesSelf-reports No objective measures under most scenarios 8
Why Go ObjectiveExampleOrthopedic surgeryKnee/Hip joint replacement
What impact does these interventions have on everyday living and quality of lifePostural balance, walking, everyday living activitiesHas the above been improved or at least regained9
Postural BalanceBody swayPreviously assessed subjectivelyImproved technology led to objective measures However, still not feasible for busy clinicsAdvent of Body-worn sensors10
ML Sway, cmAP Sway, cmCenter of massSway, cm2
Walking PatternsMotion Capture/ Mat SystemsTedious Confined to in lab measurements
Body-worn sensors Out of labIn clinic/homeEasy
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Daily Spontaneous ActivitiesGenerally Pedometers Very basic measures (steps, calories, distance)
Body worn sensorsAccurateEasyValuable measures (steps, speed, postural transitions, standing time, walking time)
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Stress Assessment 20 Diabetic patients with active foot ulcers (57 12 years)Stress assessed during clinical visit for wound dressing Body worn sensor (Zephyr BioHarness) Stress quantified by HRV
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18%35%47%Typical example of patient with low stress (a) and high stress (b) during would dressingabDuration of different levels of stress experienced by patients during wound dressing
Skills AcquiredIRB Protocols: CITI, HIPPAResearch Design and coordinationSCM/All scriptsPatient recruitmentData collectionBody worn sensorsGrants writingSPSS
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Patient population
Diabetes/Peripheral neuropathy
Chronic pancreatitis
Phantom urinary bladder syndrome
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AccomplishmentsGrants ContributionsUrostomy Association: Grant awarded during research at Bournemouth, EnglandNIH R21: A Tailored Stress-Management intervention to accelerate wound healing in diabetes(Submitted)Diabetes Research and Wellness Foundation Grant: Multifaceted Patient Centric Approach to ImproveManagementof Diabetic Foot Wounds (Submitted)American Diabetes Association: An Innovative Game-Based Exercise to Accelerate Diabetic Foot Wound Healing (Submitted)PublicationsParvaneh S, Grewal GS, Grewal E, Menzies RA. Talal TK, Armstrong DG, Sternberg E, and Najafi B. 2014 Stressing the Dressing: Assessing Stress during Wound Care in Real-Time Using Wearable Sensors. Wound Medicine, 4: 21-26.Parvaneh S, Grewal GS, Grewal E, Talal TK, Armstrong DG and Najafi B. 2014 Heart Rate Variability for assessment of physiological stress response: validation of a personalized algorithm. (Submitted).Grewal E et al. Phantom Urinary Bladder Syndrome: A Systematic Review (Drafting)
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