Integration of New Technology for Research in the Emergency Department: Feasibility of Deploying a Robotic Assessment Tool for Mild Traumatic Brain Injury Evaluation

Abstract

The objective of this paper is to demonstrate the effective deployment of a robotic assessment tool for the evaluation of mild traumatic brain injury (mTBI) patients in a busy, resource-constrained, urban emergency department (ED). Methods: Functional integration of new robotic technology for research in the ED presented several obstacles that required a multidisciplinary approach, including participation from electrical and computer engineers, emergency medicine clinicians, and clinical operations staff of the hospital. Our team addressed many challenges in deployment of this advanced technology including: 1) adapting the investigational device for the unique clinical environment; 2) acquisition and maintenance of appropriate testing space for point-of-care assessment; and 3) dedicated technical support and upkeep of the device. Upon successful placement of the robotic device in the ED, the clinical study required screening of all patients presenting to the ED with complaints of head injury. Eligible patients were enrolled and tested using a robot-assisted test battery. Three weeks after the injury, patients were contacted to complete follow-up assessments. Results: Adapting the existing technology to meet anticipated physical constraints of the ED was performed by engineering a mobile platform. Due to the large footprint of the device, it was frequently moved before ultimately being fully integrated into the ED. Over 14 months, 1423 patients were screened. Twenty-eight patients could not be enrolled because the device was unavailable due to operations limitations. Technical problems with the device resulted in failure to include 20 patients. A total of 66 mTBI patients were enrolled and 42 of them completed both robot-assisted testing and follow-up assessment. Successful completion of screening and enrollment demonstrated that the challenges associated with integration of investigational devices into the ED can be effectively addressed through a collaborative patient-oriented research model. Conclusion: Effective deployment and use of new robotic technology for research in an urban academic ED required significant planning, coordination, and collaboration with key personnel from multiple disciplines. Clinical Impact: A pilot clinical study on mTBI patients using the robotic device provided useful data without disrupting the ED workflow. Integration of this technology into the ED serves as an important step toward pursing active clinical research in an acute care setting.

Test-retest reliability of the KINARM end-point robot for assessment of sensory, motor and neurocognitive function in young adult athletes

“…Given the end goal of utilizing this technology for assessment of acute SRC and recovery, the feasibility of using the KINARM to this end should also be addressed. Prior work examined the feasibility of integrating the KINARM into an emergency department setting for neurologic assessment of mTBI [ 47 ]. The primary challenges faced in this emergency department study related to technological maintenance and the implementation of the large, relatively immobile KINARM device into a busy clinical environment [ 47 ].…”

“…Prior work examined the feasibility of integrating the KINARM into an emergency department setting for neurologic assessment of mTBI [ 47 ]. The primary challenges faced in this emergency department study related to technological maintenance and the implementation of the large, relatively immobile KINARM device into a busy clinical environment [ 47 ]. These same challenges are certainly applicable to the integration of the KINARM device into a sport medicine clinic for assessment of SRC.…”

“…We overcame technological challenges through continued collaboration with the support staff of the makers of the KINARM (BKin Technologies Ltd.) and involvement of researchers with skills in computer science. Rather than adapt a mobile KINARM, as done in prior work [ 47 ], we have a dedicated room in the sports medicine clinic for all KINARM testing, and a staff member whose primary tasks are to schedule, collect and compile the information obtained from the robotic assessments. Conducting truly acute assessments of SRC (i.e., sideline assessments or <24 hours) with this device is unlikely given its size (>800 lbs) and electrical requirements, but not necessarily impossible.…”

A Novel Tool for Evaluation of Mild Traumatic Brain Injury Patients in the Emergency Department: Does Robotic Assessment of Neuromotor Performance Following Injury Predict the Presence of Postconcussion Symptoms at Follow‐up?

“…This study is the first of its kind to describe the deployment of a sophisticated robotic‐assisted assessment tool to evaluate mild TBI patients in the ED for developing subsequent PCS . The analysis demonstrates that poor visuomotor and proprioceptive performance on robot‐assisted testing is associated with Rivermead positive (presence of PCS at 3 weeks postinjury).…”

A Secure Automated Elevator Management System and Pressure Sensor based Floor Estimation for Indoor Mobile Robot Transportation

“…Over the last years, mobile service robots have played critical roles in many applications, including (but not limited to) medical [2,3] and cleaning services [4,5], agriculture [6,7], operations in hazardous environments [8,9], construction and demolition [10], space [11] and military applications [12], materials transportation [13], support services for the elderly and handicapped [14], and entertainment [15]. In contrast to certain service mobile robots used for surveillance and cleaning services, which can utilize random movement in performing their tasks, the majority of mobile robot applications requires a sophisticated navigation ability in order to move in the desired manner.…”