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Small Wonders - Big advances in medicine are coming to the smallest patients.  See how Georgia Tech and its partner organizations are improving the lives of children, from home health care to  medical devices designed for kids.  Story by Brett Israel, Photos by Rob Felt, Photo illustration by Melanie Goux

Small Wonders

Soon after turning 12 months old, Hudson Day stopped eating and drinking.

At the age of 10 months, he had been diagnosed with an interstitial lung disease, which required him to take supplemental oxygen full time. The disease, called NEHI (Neuroendocrine Hyperplasia of Infancy), was affecting his ability to eat. Hudson became anemic and lost so much weight in four days that an emergency medical airplane was called to fly him from his home in Jackson Hole, Wyoming, to Children’s Hospital Colorado. During his month-long stay in Denver, doctors inserted a feeding tube into Hudson’s stomach to keep him alive.

Hudson’s parents then enrolled him in feeding therapy programs at local medical centers, but progress was elusive.

“Nothing was really working for him,” said Melinda Day, Hudson’s mother. “The further away I was from getting food into his mouth, the more concerned I became.”

Melinda, an Atlanta native, learned about the Atlanta-based Marcus Autism Center’s Feeding Disorder Program. Hoping it might help her son eat food again, she contacted Marcus and enrolled Hudson in a feeding therapy program. Hudson’s treatment at Marcus involved the use of a new app called iEAT, developed through a collaboration between the Georgia Institute of Technology and Marcus. Hudson’s feeding therapy was the first use of iEAT after clinical trials on the technology had been completed.

Video: iEAT app extends feeding therapy for children

video iEat app - click to play


The feeding program was eight weeks long, during which time a multidisciplinary team used the app to track Hudson’s progress toward eating food and reducing his reliance on the feeding tube. The app suggested the next steps for Hudson’s feeding therapy based on positive or negative reactions to food in previous sessions.

Hudson finished the program by the time he turned 2. He has not needed the feeding tube since returning to Wyoming, and he is now eating 1,400 calories a day from a spoon.

Hudson also had a major breakthrough during the program: He ate a peanut butter and jelly sandwich. It was the first time he had chewed food.

“This program has been a complete life-changer,” Day said.

Photo of Day family.

The Day family, parents Clint and Melinda and children Hudson and Austin, in their hometown of Jackson Hole, Wyoming.
Melinda is originally from Atlanta and enrolled Hudson in a feeding program at the Marcus Autism Center.
After therapy that included the iEAT application, he’s now able to eat solid food.
Photo: Morris Weintraub.

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Georgia Tech scientists and engineers, in collaboration with Emory University, Children’s Healthcare of Atlanta, and Marcus Autism Center, are tackling one of the biggest challenges in pediatric medicine — the lack of medical devices and technologies designed specifically for children. Many medical devices used on children were designed for adults. And because the market for children’s medical devices is small, many companies shy away from building medical technologies for children.

Georgia Tech is helping to fill that gap in the market. From an app that allows parents to send pictures of their child’s potential ear infection to a doctor, to surgical tools tailored to a child’s physiology, the Institute is leading the push toward improving and saving children’s lives through technology.

“Children are not young adults,” said Ajit Yoganathan, a Georgia Tech Regents Professor and the Wallace H. Coulter Distinguished Faculty Chair in Biomedical Engineering, who is developing a device to treat pediatric kidney disease. “The physiology is different; the anatomy is different,” he added. “In many cases you need to design the device for the pediatric application because otherwise it’s tough to downsize adult devices for children. You must design devices for kids.”

Photo of little girl with the CellScope Oto device placed close to her ear.

CellScope Oto is a smartphone attachment that allows parents to send an image of a child’s eardrum to an on-call physician for diagnosis. By allowing examination remotely, the device could reduce the number of late-night emergency room visits for suspected ear infections. Photo: Rob Felt.

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Georgia Tech hosts important centers for pediatric research, including the nation’s first Center for Pediatric Nanomedicine, led by M.G. Finn, professor and chair of the School of Chemistry and Biochemistry at Georgia Tech; the Center for Transforming Pediatric Healthcare Delivery, led by College of Computing Professor Elizabeth Mynatt; and the Center for Pediatric Innovation, co-led by Robert Guldberg, Parker H. Petit Director’s Chair in Bioengineering and Bioscience at Georgia Tech, and Dr. Kevin Maher, associate professor of pediatrics at Emory and a pediatric cardiologist at Children’s.

“Because the relationship between Children’s and Georgia Tech exists, I can pick up the phone, talk to engineers and actually bring them into the hospital to see the clinical problems that we’re dealing with,” Maher said.

Georgia Tech engineers, led by Dr. David Ku, a mechanical engineering professor, worked with Maher to design a new fluid mechanical geometry for the inside of tubes used in Extracorporeal Membrane Oxygenation (ECMO) life-support machines. The redesigned fluid mechanics minimizes the development of blood clots in patients using the machines.

ECMO machines were designed for adults but are used with children. The most common problem for patients on ECMO is the risk of clot formation. These clots can be severe, causing strokes and even death, despite aggressive use of anticoagulation (non-clotting) medicines.

“Without the three of us working together, we wouldn’t have gotten anywhere,” said Ku, a Regents Professor of Mechanical Engineering and Lawrence P. Huang Chair Professor of Engineering Entrepreneurship. “The partnership brings the clinicians in touch with the engineers. We weren’t talking to each other about this project at all before.”

Development and testing of the ECMO technology continues, but this type of fluid mechanical design could also apply to several other types of technology used in pediatric cardiology, including cardiac pumps and in-dwelling catheters.

The ECMO project was funded by the Center for Pediatric Innovation and the Atlantic Pediatric Device Consortium. Other collaborative projects are funded by the Quick Wins program, which spun out of a partnership between Georgia Tech and Children’s (iEAT was also part of the Quick Wins program). The collaboration involves existing Children’s research centers, the Department of Pediatrics at Emory University, and faculty and researchers from academic and research units throughout Georgia Tech. The goal is to bring together physicians and engineers to solve pediatric medical problems.

Photo of device on table in lab - Extracorporeal Membrane Oxygenation (ECMO) life-support equipment.

Georgia Tech engineers, collaborating with a physician at Children’s Healthcare of Atlanta, designed a new connector for the inside of the tubes used in Extracorporeal Membrane Oxygenation (ECMO) life-support equipment.
The improved fluid mechanics minimizes the development of blood clots in patients using the machines.
Photo: Rob Felt.

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Projects funded through Quick Wins focus on solving day-to-day issues that clinicians face in the care of their patients. That can be anything from process improvement to sensor technologies to mobile health solutions. The goal of Quick Wins is to develop a solution to a given challenge within 18 months.

“With this partnership, we are helping kids through innovative technology,” said Leanne West, the partnership’s chief engineer for pediatric technologies. “Our hope is to continue to strengthen the relationship between Georgia Tech and Children’s Healthcare of Atlanta and develop solutions to better serve patients. The partnership has already resulted in several ideas, and by working together things are starting to happen.”

Another device under development by Georgia Tech is for bedside dialysis for children. When critically ill children need kidney dialysis, doctors are forced to use adult-size dialysis equipment, which can withdraw too much fluid from a pediatric patient, leading to dehydration, shock, and loss of blood pressure.

Yoganathan’s group, with funding from the National Institutes of Health, is working on a kidney dialysis prototype device that is much smaller than existing dialysis equipment and works in tandem with equipment that supplements the function of the heart and lungs for severely ill patients. The device can be used either for pure dialysis or for dialysis plus oxygenation as a part of continuous veno-venous hemofiltration (CVVH), which is a short-term treatment used in ICU patients with acute or chronic renal failure.

“What doctors are using right now for CVVH are adult devices that are not FDA-approved for use in children, but clinicians have no choice but to use the adult devices,” Yoganathan said.

The team is currently working on a more robust prototype that can be used in the clinic, and they are hopeful for additional funding and the start of clinical trials soon. The Wallace H. Coulter Foundation is funding the next phase of development through the Emory/Georgia Tech Coulter Translational Partnership.

Photo of young boy being fed by technician.

Technician Stefanie Jaskot uses the iEat app as part of the Marcus Autism Center’s Feeding Disorder Program.
The app was part of the Quick Wins program, a project that came out of a collaboration with Children’s Healthcare of Atlanta.
Photo: Rob Felt.

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Georgia Tech engineers are looking beyond redesigning medical devices that are used in hospitals and toward developing innovative ways to bring doctors and therapists into the home. Apps like iEAT, which helped Hudson Day transition from a feeding tube to real food, were designed for the clinic, but researchers hope to have a second phase of development for a version that can be used in the home.

“I was extremely lucky in that I had family in the Atlanta area to help with travel, but not everyone can afford to travel and take the time off of work,” said Melinda Day, Hudson’s mother. “To have an app like iEAT and to able to do the feeding program in your home is incredible.”

To help create and commercialize new pediatric devices, Georgia Tech, Emory University, Children’s Healthcare of Atlanta, and Virginia Commonwealth University have formed the Atlantic Pediatric Device Consortium (APDC). Funded by the FDA, APDC provides a national platform to translate ideas through its product development pathway all the way to commercialization.

One of the first projects from the Atlantic Pediatric Device Consortium is helping parents take the guesswork out of a common nighttime emergency — the ear infection. The device, called CellScope Oto, combines an app with a smartphone attachment that uses the phone’s light source and camera as an otoscope, which is a medical device used to look into the ears.

Children are not young adults. The physiology is different; the anatomy is different. You must design devices for kids.

CellScope Oto is now available to parents in California, with plans to expand to other markets soon. Parents who have the CellScope Oto can call the CellScope Oto service to alert a physician if they suspect their child has an ear infection. The app will then guide them through an actual ear exam in the home, after which the on-call physician will contact the parent with a diagnosis. The goal for CellScope Oto’s developers is to improve quality of life for families while reducing health care expenditures.

“Ear infections are often really bad at night. What we’re trying to do with this system is to prevent unneeded emergency room visits,” said Dr. Wilbur Lam, an assistant professor in the Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University, who is leading the development of the project.

One important issue in a child’s social and communication development is the need for parents and caregivers to talk to children from birth, said Dr. Jennifer Stapel-Wax, an associate professor of pediatrics at the Emory University School of Medicine.

The national Talk With Me Baby campaign is designed to train nurses to coach parents to talk to their babies in the first year of life because language builds brain development. To extend the reach of the program, Stapel-Wax and her partners teamed up with Georgia Tech engineers to create an app that encourages parents to talk to their children.

The app is meant to bridge the gap between pediatric visits for parents. The app will push notifications to parents about their baby’s development, such as milestones to watch for between birth and 12 months, activities to encourage language development, and videos to model language nutrition for babies.

“The app will give families easy access to this information, because it’s not always easy to find,” said Stapel-Wax. “The app will push it to them.”

The Talk With Me Baby app is expected to be available this summer for both iPhone and Android devices.

As children get older, they need to be able to use apps themselves, but kids with disabilities often have difficulty using popular tablet devices. When electrical and computer engineering professor Ayanna Howard saw this problem, she launched Zyrobotics, which develops mobile-accessible technologies for children with cerebral palsy, autism, and other challenges.

“We focus on designing technology that all kids enjoy, and that happens to be accessible, so children with special needs don’t feel excluded,” Howard said.

At the beginning of 2015, Zyrobotics began distribution of TabAccess, a Bluetooth switch interface that enables wireless access to iPad and Android tablets for children with special needs. The technology has been distributed to clinics and special education classrooms. TabAccess has a universal interface with three inputs so users can plug and play any sensor device — such as a button, joystick, or a force sensor — which allows for simulation of the swiping, touching, and pinching commonly used to control tablets.

“TabAccess is the interface to any device that a child might already be using,” said Howard. “It’s more universal to the wider needs of the target demographic.”

Photo of young, female patient walking with doctor down hall of medical facility. She is wearing mask and hospital cap, and her eyes are smiling.

Dr. Wilbur Lam talks with Tram Cao, a patient at Children’s Healthcare of Atlanta.
In addition to his research responsibilities at Georgia Tech and Emory University, Lam is a hematology/oncology specialist treating patients at Children’s. Photo: Rob Felt.

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To get the best care for her three autistic children, Mandi Larkin used to drive three hours from her family’s home in Tifton, Georgia, to Marcus Autism Center in Atlanta. Today, Larkin’s children receive world-class medical care at her local hospital via a state-of-the-art telemedicine link to Marcus.

The recently improved telemedicine system was optimized by scientists at the Georgia Tech Research Institute (GTRI) and Cisco Systems, Inc., and now Marcus Autism Center’s telemedicine room is a showcase for providers of telemedicine. Improved video capabilities, an iPad control panel, and an ergonomic suite allow patients in rural Georgia to meet face-to-face with medical specialists in Atlanta.

“The accessibility to the doctors in Atlanta is the big thing,” Larkin said. “Not everyone has the means to make that kind of a drive. Telemedicine gives us access to the doctors that we normally wouldn’t have access to.”

GTRI’s telemedicine efforts are supported by a donation from Allen Ecker, a Georgia Tech alumnus and former executive vice president of Scientific Atlanta. Cisco, as a provider of telemedicine equipment at Children’s Healthcare of Atlanta, also donated equipment and software toward telemedicine enhancements at both Marcus Autism Center and Children’s.

“We wanted to ensure that the telepresence is at least as good as when you’re sitting in the office with a provider,” said Courtney Crooks, a senior research scientist at GTRI, who is involved in human systems integration for the project.

Dr. Felissa Goldstein, the primary doctor using the improved telemedicine system at Marcus, uses the system for providing early screening and continuing care for children with autism spectrum disorders. Goldstein had been using a telemedicine system in her office that had poor lighting, muffled sound, and poorly placed monitors that reduced eye contact. The new telemedicine system is now in a soundproof room with lighting designed to make Goldstein appear more natural.

An iPad now acts as the central control station for the telemedicine system. Goldstein can tap the iPad to control the camera. She can pan and zoom to follow children around the room as they play with toys, or tightly focus on the parents as they praise or discipline their children. The iPad is also enabled for touchpad tagging of behavioral events of interest that may occur during a session. If Goldstein needs to note a significant event, she can flag it in the system. Later, she analyzes the data to look for trends, such as how a symptom develops over time.

The research team is also involved in developing ways to use the system for other needs, such as tele-training, parent education, and dependent care in the military. Those applications are still under development, but the system’s value to families with children is already changing their lives.

“I think the doctor gets a little bit more interaction from the kids through the screen because they more or less shut down around new people,” Larkin said. “With telemedicine, to the kids, it’s just somebody on a TV screen talking to them. The doctor can see a little bit more and get a little bit more from them than if she was in the room in front of them.”

END

Brett Israel is a former communications officer with Georgia Tech’s Institute Communications, where he covered life sciences and the environment. He now lives and works in Nashville, Tennessee.

Physician meets engineer

Photo - Dr. Lam with young female patient in hospital playroom.

Dr. Wilbur Lam talks with Tram Cao, a patient at Children’s Healthcare of Atlanta.

When his laboratory works on challenging research problems, Dr. Wilbur Lam can easily envision how the solutions will help children with cancer or blood disorders. That’s because the issues he studies spring from patients he sees as a physician specializing in pediatric hematology and oncology at Children’s Healthcare of Atlanta.

Lam holds both an M.D. and a Ph.D. and splits his time between the Emory University campus and Georgia Tech, where he’s an assistant professor in the Wallace H. Coulter Department of Biomedical Engineering, operated jointly by the two institutions. His lab is in the Marcus Nanotechnology Building – an ideal place for studying blood flow at the microscale and developing medical devices based on microelectronics technology.

“We’re interested in the cellular biophysics of blood, and we often need to make our own devices to study blood cells and the diseases that alter them,” Lam said. “We do basic science as well as translational research, but it all begins and ends in the clinic with patients.”

Lam has many research interests, but some of his lab’s biggest successes have been medical devices. One, called AnemoCheck, was invented by Erika Tyburski when she was an undergraduate at Georgia Tech; however, its ability to measure anemia was evaluated in clinical trials at Emory. The other, Cellscope Oto, attaches to smartphones and allows parents to send snapshots of their child’s eardrums to an on-call physician who can determine whether a midnight earache merits immediate attention.

Beyond his own research, Lam sees his role as building bridges between physicians and engineers. The two disciplines can be complementary, but they speak different languages and have different cultures and expectations.

“We are working on this bridge, trying to widen it and make it stronger,” he said. “We are constantly trying to connect people on the clinical side to the engineering side, and vice-versa. I play matchmaker.”

But bringing engineering and medicine together isn’t Lam’s only goal. He also represents biomedical engineering in CREATE-X, Georgia Tech’s initiative to build entrepreneurial confidence in its students.

“We have the raw material here to really establish a culture that helps undergraduates form their own startups, and we’re beginning to see that transformation,” he added. — John Toon

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