Good Vibrations: Epureanu and Ward win 2018 Coulter Award

The journey for intensive care unit (ICU) patients is immensely difficult. Not only do they have to survive their initial injuries or illnesses, they have to overcome surgeries, drug therapies and the risk of infection. During this time, patients are immobilized in bed for prolonged periods and many are attached to mechanical ventilators which assist in their breathing. This immobilization can last for weeks.

MCIRCC’s Executive Director, Kevin Ward, MD, saw the consequences of immobility in the ICU. Long periods of immobility create a cascade of consequences including muscle atrophy, neuropathy, and worsening circulation and blood flow.  This is part of what is known as the post-intensive care syndrome (PICS) and can result in the need for patients to undergo months of physical therapy, learning how to walk and function again

Originally, Ward hoped to solve this problem using sound. His theory was that acoustics would vibrate the tissue and stimulate the muscle, thus alleviating the effects of muscle and nerve atrophy. However, after discussing the problem with mechanical engineering professor and MCIRCC member Bogdan Epureanu, PhD, this idea was quickly nixed. Not only would the acoustic sound waves not be strong enough to activate the muscles, the noise would be overwhelming in the ICU.

“The key word in MCIRCC is ‘integrative.’ One discipline alone cannot answer these kinds of questions. You need a team with diverse backgrounds to solve these challenging problems,” said Epureanu.

The device is placed at the shoulders and feet of the patient, emitting vibration throughout the skeletal system.

The device is placed at the shoulders and feet of the patient, emitting vibration throughout the skeletal system.

As an expert in vibration and interdynamics, Epureanu suggested they develop a system that would apply vibration to muscle tissue in order to spontaneously activate the muscle. After several iterations, the team developed a device with four entry points—two at the shoulders and two at the feet. Not only does the system apply vibrations at both ends of the skeletal system, it also compresses the body and tightens the joints so the vibration goes all the way through the body.

“If you take a sedated patient and apply vibration just at the feet or just at the shoulders, the vibration will not travel very far. The first joint it reaches will act as an isolator. However, when you compress the joint, the vibration is able to travel through the body,” Epureanu explained.

Their product will be user-friendly, mobile, and modular. Ideally, their solution will only require 5-10 minutes of treatment one to two times a day to see the desired effects.  The effects are equivalent to moderate exercise and be performed even when the patient is totally sedated and unconscious.  Current approaches require teams of nurses and physical therapist to mobilize the patient to achieve some form or rehabilitation.  If successful, the team anticipates that it will not only reduce recovery time and improve patient outcomes, but it will also shorten the average length of stay which will be cost-saving for hospitals.

“This device really has a ripple effect. You speed up the recovery process by improving blood flow and muscle function, which may get people out of bed quicker and off the ventilator sooner. It goes to show that we as humans are made to exercise. Our bodies are optimized when our muscles are activated.  The implications could greatly reduce the length of stay in the ICU and readmissions to the hospital as a result of being critically ill or injured” said Epureanu.

The team, which includes the Department of Physical Medicine and Rehabilitation’s Chandramouli Krishnan, PT, PhD and Mark Peterson, PhD, received $130,000 in funding from the Coulter Translational Research Partnership Program. With the funding, they plan to develop the system and trial is on patients in the intensive care unit to the point where it could be licensed as a commercial product.

Although initially designed with critical care patients in mind, Ward and Epureanu envision the product being essential to any population who might not be able to exercise including rehabilitation or elderly patients.