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. John Newman, M.D.

2. Heart Failure and Its Treatment Statistics Statistics Affects 5 million Americans Affects 5 million Americans 50% mortality rate within 4 years of diagnosis 50% mortality rate within 4 years of diagnosis  Pathology  Heart doesn’t pump nutrients to tissues efficiently tissues efficiently  Heart can’t develop pressure to eject needed stroke volume eject needed stroke volume Benefits of exercise as treatmentBenefits of exercise as treatment Improves vascular functionImproves vascular function Improves muscle functionImproves muscle function Reduces arrythmia riskReduces arrythmia risk Benefits of deep breathing asBenefits of deep breathing as exercise exercise Targets muscles of chest wallTargets muscles of chest wall Not as difficult for patientsNot as difficult for patients

3. Other Possible Applications Device may not be able to generate enough force to exercise chest wall Device may not be able to generate enough force to exercise chest wall Suggested to look into other applications Suggested to look into other applications Exercise monitor Exercise monitor Breathing monitor Breathing monitor Patient-specific use Patient-specific use 46 yo female experiences sudden drops in P O2 – stops breathing 46 yo female experiences sudden drops in P O2 – stops breathing Breathing patterns normal while sleeping Breathing patterns normal while sleeping Dr. Newman wants to use device to remind patient to breathe Dr. Newman wants to use device to remind patient to breathe

4. Current Devices Incentive Spirometer Incentive Spirometer Blow into mouthpiece Blow into mouthpiece Cost: $10 -$1000 Cost: $10 -$1000 Problems: Problems: Must be stationary Must be stationary during use Large, awkward shape Large, awkward shape Pneumotrace Pneumotrace Measures chest expansion Measures chest expansion Cost: $200 Cost: $200 Problems: Problems: Must be lying down for use Must be lying down for use Very complex device Very complex device

5. Current Devices RESPeRATE RESPeRATE Tells patient when to breathe Tells patient when to breathe via headphones via headphones Cost: $330 Cost: $330 Problems: Problems: Must wear headphones Must wear headphones Must carry additional device Must carry additional device VivoMetrics LifeShirt VivoMetrics LifeShirt Measures chest expansion and Measures chest expansion and heart rate heart rate Cost: Not Available for sale Cost: Not Available for sale Problems: Problems: Large Device Large Device Uncomfortable to wear Uncomfortable to wear Very conspicuous Very conspicuous

6. Vandy REx Measures chest expansion Measures chest expansion Cost: less than $100 without PDA Cost: less than $100 without PDA $14 for stretch sensor $14 for stretch sensor $18 for batteries and op amps $18 for batteries and op amps Why it’s better: Why it’s better: No additional devices No additional devices Comfortable to wear Comfortable to wear Small and inconspicuous Small and inconspicuous

7. Approach Bridge Bridge Differential amplifier Differential amplifier Bend Sensor Bend Sensor Voltage threshold detector Voltage threshold detector R s /R 2 =R 3 /R 1

8. Design Adjustable inelastic band Adjustable inelastic band Elastic section Elastic section Strain gauge/bend sensor Strain gauge/bend sensor PDA for digital output PDA for digital output DAQ system DAQ system Motor for vibration Motor for vibration Acquired components: Voltage source Voltage source Low power Operational Amplifier Low power Operational Amplifier

10. 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

11. 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

12. Tidal Volume Experiments Determine relationship between chest circumference and lung volume Determine relationship between chest circumference and lung volume Determine the output voltage of the device during a normal and a deep breath Determine the output voltage of the device during a normal and a deep breath Measurements used to adjust resistor ratings and gain Measurements used to adjust resistor ratings and gain

13. Expected Results Output voltage correlates to lung volume Output voltage correlates to lung volume Deep breath threshold will correspond to a given output voltage Deep breath threshold will correspond to a given output voltage If threshold not reach in a predetermined time period, alarm will sound If threshold not reach in a predetermined time period, alarm will sound Expect that the use of this device will increase lung capacity and force of expiration from lungs Expect that the use of this device will increase lung capacity and force of expiration from lungs

14. Tidal Volume Results Graphs show relationship between exhaled air and chest expansion Graphs show relationship between exhaled air and chest expansion Data from 2 group members Data from 2 group members Shows what constitutes deep breaths Shows what constitutes deep breaths May have to calibrate for each person May have to calibrate for each person Breath greater than 500 mL needed for detection Breath greater than 500 mL needed for detection

15. Resources REST1 Impedance Pneumograph by UFI. http://www.ufiservingscience.com/ DSRsp11.html REST1 Impedance Pneumograph 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.. http://www.answers.com/topic/lung http://www.answers.com/topic/lung