1. Programmable Biofeedback Chest Exerciser Group 23: Eileen Bock, Lauren Cassell, Margaret Gipson, Laurie McAlexander Advisors: Douglas Sawyer, M.D., Ph.D. Paul King, Ph.D.

2. What is Heart Failure? Statistics Statistics Affects 5 million Americans Affects 5 million Americans 550,000 new cases/year 550,000 new cases/year 50% mortality rate within 4 years of diagnosis 50% mortality rate within 4 years of diagnosis Pathology Pathology Heart doesn’t pump nutrients to tissues efficiently Heart doesn’t pump nutrients to tissues efficiently Heart can’t develop pressure to eject needed stroke volume Heart can’t develop pressure to eject needed stroke volume Symptoms Symptoms Shortness of breath Shortness of breath Fatigue Fatigue Chest pain Chest pain Irregular heartbeat Irregular heartbeat

3. Treatments for Heart Failure Medications Medications Diuretics: decrease blood volume Diuretics: decrease blood volume Vasodilators: dilate blood vessels Vasodilators: dilate blood vessels Nitrates: dilate blood vessels Nitrates: dilate blood vessels Surgery Surgery LVAD: acts as a pump LVAD: acts as a pump Heart transplant Heart transplant Pacemaker: restores regular heartbeat Pacemaker: restores regular heartbeat Exercise Exercise

4. Using Exercise to Improve Symptoms Benefits of exercise Benefits of exercise Improves vascular function Improves vascular function Improves heart’s ability to contract Improves heart’s ability to contract Reduces adrenaline levels Reduces adrenaline levels Improves muscle function Improves muscle function Reduces arrythmia risk Reduces arrythmia risk Benefits of deep breathing Benefits of deep breathing Targets muscles of chest wall Targets muscles of chest wall As effective as other forms of exercise As effective as other forms of exercise Not as difficult Not as difficult

5. Current Devices Incentive Spirometer Incentive Spirometer Patient breathes in through mouthpiece to move piston. Patient breathes in through mouthpiece to move piston. Inconveniences: Inconveniences: Must be stationary during use Must be stationary during use Large, awkward shape Large, awkward shape Regimen: 10 times every hour while awake Regimen: 10 times every hour while awake

6. Current Devices Pneumotrace Pneumotrace Measures respiration changes Measures respiration changes Strain gauge transducer attached to belts Strain gauge transducer attached to belts Inconveniences: Inconveniences: Must be lying down to use Must be lying down to use Multiple belts and large Multiple belts and large measurement device

7. Current Devices RESPeRATE RESPeRATE Main purpose is to lower blood pressure Main purpose is to lower blood pressure Inconveniences: Inconveniences: Must wear headphones Must wear headphones Must carry additional device Must carry additional device Regimen: No more than 15 minutes, 3 to 4 times a week Regimen: No more than 15 minutes, 3 to 4 times a week

8. Current Devices VivoMetrics LifeShirt VivoMetrics LifeShirt Garment worn continuously Garment worn continuously Constantly records respiration data Constantly records respiration data Inconveniences: Inconveniences: Large device Large device Uncomfortable to wear Uncomfortable to wear Conspicuous Conspicuous

9. Approach Bridge Bridge Differential amplifier Differential amplifier Strain gage Strain gage Voltage threshold detector Voltage threshold detector

10. Innovative Features Portable – PDA Portable – PDA Discrete Discrete Biofeedback system Biofeedback system Alerts patient when regimen is not being followed Alerts patient when regimen is not being followed Can be turned off for privacy Can be turned off for privacy Allows physician to monitor progress Allows physician to monitor progress

11. Design January 15, 2007 Adjustable inelastic band Adjustable inelastic band Elastic section Elastic section Strain gauge Strain gauge Voltage source Voltage source DAQ system DAQ system Motor for vibration Motor for vibration January 29, 2007 Portable power source Portable power source PDA for digital output PDA for digital output

12. Testing Part 1 10 subjects wear the device for 1 hour each 10 subjects wear the device for 1 hour each Subject will perform breathing exercises and various common activities Subject will perform breathing exercises and various common activities Subject survey Subject survey Part 2 Previous 10 subjects will return and wear device for 3 hours Previous 10 subjects will return and wear device for 3 hours Subject survey Subject survey

13. Testing Part 3 Clinical testing: requires another IRB protocol submission Clinical testing: requires another IRB protocol submission 2 control groups, 1 experimental group 2 control groups, 1 experimental group Measure improvement of negative inspiratory force with incentive spirometer Measure improvement of negative inspiratory force with incentive spirometer

14. Resources REST1 Impedance Pmeumograph by UFI. http://www.ufiservingscience.com/ DSRsp11.html REST1 Impedance Pmeumograph by UFI. http://www.ufiservingscience.com/ DSRsp11.html "How to Use an Incentive Spirometer". The Cleveland Clinic Foundation.. "How to Use an Incentive Spirometer". The Cleveland Clinic Foundation.. "Anaesthesia Products," Lifeline Systems Pvt. Ltd. "Anaesthesia Products," Lifeline Systems Pvt. Ltd. "RESPeRATE High Blood Pressure and Hypertension." Buyamag.. "RESPeRATE High Blood Pressure and Hypertension." Buyamag.. "Smart textiles at Hightex 2005". Hightex 2005.. "Smart textiles at Hightex 2005". Hightex 2005.. “Learning to Whistle”. November 2005.. “Learning to Whistle”. November 2005..