Difference between revisions of "Team:Pasteur Paris/Scenario"

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<p><a href="#Choice" class="link">NeuronArch’s choice</a></p>
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                <p><a href="#Choice" class="link">NeuronArch’s choice</a></p>
<p><a href="#Implant" class="link">Surgical implantation</a></p>
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                <p><a href="#Implant" class="link">Surgical implantation</a></p>
<p><a href="#Life" class="link">Daily life</a></p>
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<p><a href="#Doctor" class="link">Doctor</a></p>
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<p><a href="#Maintenance" class="link">Maintenance</a></p>
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                <p><a href="#Maintenance" class="link">Maintenance</a></p>
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<p>The amputations affect two categories of persons: the civilians (accidents, vascular issues…) and the military (artillery wounds, accidents). </p>
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                <p>Sometimes, severe injuries lead to amputation. Civilians as well as soldiers may be concerned, due to accidents, vascular issues, or even artillery wounds for the last category. Amputations are more frequently located on lower limbs<sup>[1]</sup> (<b>Figure 1</b>). However, bionic prostheses are nowadays developed mainly for the arms, not for the legs. For the prosthetic industry, designing bionic arms is more challenging because of its capacity to push technological boundaries in order to reproduce movements, sense of feeling, etc. Based on this observation, we focused on a trans-humeral amputation scenario. Nevertheless, NeuronArch’s solution is transposable in different anatomical amputation locations.</p>
<p>They are more frequently located on lower limb<sup>[1]</sup> (Figure 1).However, bionic prostheses are nowadays developed mainly for the arms. In fact, the prehension and the hand’s control are a huge challenge for the prosthetic industry, because it requires control by a set of nerves. We took this into consideration when building our 3D model and our scenario for a trans-humeral amputation. Nevertheless, NeuronArch’s system is transposable for different anatomical amputation locations.  
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                <div class="legend"><b>Figure 1: </b>Amputation locations</div>
<img src="https://static.igem.org/mediawiki/2018/e/e2/T--Pasteur_Paris--Scenario_Figure_1.svg">
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<div class="legend"><b>Figure 1: </b>Amputation's location</div>
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            <div class="block title"><h3 style="text-align: left;">NeuronArch’s choice</h3></div>
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                <p>After a serious accident, the patient is transferred to a hospital. The doctor makes a diagnosis: the injury is too severe and amputation is inevitable. If the situation allows, medical staff presents different relevant options to the patient. The first option is a classic amputation procedure. At best, it would allow the patient to have a myo-electrical prosthesis. The second option is the NeuronArch solution. The NeuronArch device would allow the patient to wear bionic prothesis, while the NeuronArch app would monitor his health and prosthesis status. In addition, this solution could be partially supported by Social Security in the next few years. After weighing both options, the patient obviously goes for the NeuronArch option!</p>
<div class="block title"><h3 style="text-align: left;" id="Choice">NeuronArch’s choice</h3></div>
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            <div class="block title"><h3 style="text-align: left;">Surgical implantation</h3></div>
<p>Following a serious accident, the patient arrives at the hospital. The doctor diagnoses that the injury is too severe and that amputation is inevitable. If the conditions allows for it, the hospital staff presents the patient with the different relevant options available to him. The first option is a classic amputation procedure which would allow the patient to have, at best, a myo-electrical prosthesis. The second option is the NeuronArch solution. The NeuronArch solution allows a bionic prothesis, and in addition is partially supported by Social Security. After weighing both his options, the patient therefore obviously chooses the NeuronArch option! </p>
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                <p>The first step for a new NeuronArch holder is to order a NeuronArch kit, including:<br>
 
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- the NeuronArch device, making the bridge between the stump and a bionic prosthesis;<br>
<div class="block title"><h3 style="text-align: left;" id="Implant">Surgical implantation</h3></div>
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- an implantation stem featuring the engineered biofilm;<br>
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- a charging station, to recharge the device and synchronize data with a distant server;<br>
<p>The first step for a new NeuronArch holder is to have the implantosteointegrated by an orthopedic surgeon. The latter receives the internal device in a sealed package. During the surgery, the surgeon drills the bone in its center along its longitudinal axis, while a nurse lifts the NeuronArch system out of the package and drains the culture liquid of the biofilm with a syringe. The part which contains the liquid will serve as protection in order for the surgeon to be able to grasp the stem with the surgical clips without fear of damaging the biofilm or the membrane (Figure 2). He inserts the stem into the bone. The orthopedist places some screws to hold the device in place (they will be removed subsequently). The surgeon can now take the protection out (quarter turn system) and complete with stitches around the stump.</p>
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- a personal access to the app / website, to monitor information, such as device’s battery level, health status, etc.
<img src="https://static.igem.org/mediawiki/2018/d/d2/T--Pasteur_Paris--Scenario_Figure_2.svg">
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</p>
<div class="legend"><b>Figure 2: </b>Diagrams of osseointegration’s steps</div>
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                <p>When the kit delivered, an orthopedic surgeon will osseointegrate the stem (<b>Figure 2</b>). This stem is sent in a sealed package. During surgery, the surgeon drills the bone in its center along its longitudinal axis, while a nurse lifts the NeuronArch stem out of the package. Thanks to a syringe, the nurse drains the culture liquid of the biofilm, contained in a protective cap. Once empty, this cap stays in place in order to allow the surgeon to manipulate the stem with surgical clips without damaging the biofilm and the membrane. The specialist inserts the stem into the bone (Figure 3). The orthopedist places some screws to hold the device in place (to be removed subsequently). The surgeon can now take the protection cap out thanks to a simple quarter turn system, and then complete the surgery by stitching the stump.</p>
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<p>Before the release from the hospital, the surgeon assist the patient in configuring the medical data which the former will have access to, always with the patient’s agreement.  </p>
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                <img src="">
<p>On leaving the hospital, the NeuronArch holder starts the process with a rehabilitation phase. A complete healing and implant-bone adhesion is indeed necessary before the patient can fix his NeuronArch interface device and the bionic prosthesis. During this period the nerve regrowth will take place and thanks to an integrated optical system in a sleeve, the production of neutrophins is stimulated in the biofilm, enhancing the nerve growth towards the stump area. Even though we didn't have the opportunity to test this technique during our lab experiments, with its local and targeted action, the optical system is more interesting than the chemical inducer medication system. </p>
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                <div class="legend"><b>Figure 2: </b>Stem with its protection cap</div>
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<div class="block title"><h3 style="text-align: left;" id="Life">Daily life</h3></div>
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                <img src="">
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                <div class="legend"><b>Figure 3: </b>Diagrams of osseointegration steps</div>
<p>During the night, the amputee took off his prosthesis. So, in the morning, the NeuronArch holder connects his interface device to the stem with the quarter turn system. After this, he puts his bionic prosthesis. </p>
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<p>He controls and moves in an intuitive way thanks to the connection between nerves and prosthesis allowed by NeuronArch. He can consult the NeuronArch app to either take an appointment with the doctor, check the battery status of his interface device, or his health data. </p>
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            <div class="block title"><h3 style="text-align: left;">Daily life</h3></div>
<p>In the evening, the amputee removes his prosthesis and put the interface device on the charging station. During the night, the device is recharged and the data are synchronized with NeuronArch servers. </p>
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                <p>In the morning, after a night without, the holder plugs the NeuronArch device (<b>Figure 4</b>) and his bionic prosthesis to the stem. Installation is simple, with an ergonomic quarter turn system. His bionic arm moves in an intuitive way thanks to the connection between nerves and the prosthesis, made possible by NeuronArch. With the app he installed on his smartphone (<b>Figure 5</b>), he is now able to check the battery status of his device, to consult his health data or to take an appointment with his primary doctor or his prosthetist (<b>Figure 6</b>). </p>
 
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<div class="block title"><h3 style="text-align: left;" id="Doctor">Doctor</h3></div>
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<p>To maintain the patients data’s security, the patient has a QR code on his NeuroArch application. When he goes to the doctor, the NeuronArch holder shows it to the doctor who scans it. The QR code is used as a “key” to enter in the patient’s NeuronArch files.   </p>
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                <div class="legend"><b>Figure 4: </b>NeuronArch device implementation</div>
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<div class="block title"><h3 style="text-align: left;" id="Maintenance">Maintenance</h3></div>
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                <div class="legend"><b>Figure 5: </b>NeuronArch app notification </div>
<p>We also thought about the NeuronArch’s post-implantation maintenance. Indeed, we created an interface device locked by eight screws. In this way, a prosthetist trained for the NeuronArch maintenance can open it and check the electronics parts such as the battery. If something is defective, the prosthetist will proceed with repairs or replace the part. The data on the SD card inside is encrypted, therefore safe. NeuronArch is conceived to last a life time. </p>
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<div class="block title"><h1>REFERENCES</h1></div>
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                <div class="legend"><b>Figure 6: </b>NeuronArch app scenario</div>
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<li style="list-style-type: decimal;">JM. André and J. Paysant, Les amputés en chiffres : épidémiologie, Cofemer, 2006 </li>
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                <p>At night, battery is low and collected data needs to be transmitted to the server, in order update his health data and to improve machine learning. Thus, the amputee removes his prosthesis and put the NeuronArch device on the charging station (<b>Figure 7</b>). After several hours, the device is charged, data is synchronized (<b>Figure 8</b>), and NeuronArch is ready to start a new day.</p>
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                <div class="legend"><b>Figure 7: </b>NeuronArch device laying on charging station</div>
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                <div class="legend"><b>Figure 8: </b>Recharging and synchronization</div>
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            </div>
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            <div class="block title"><h3 style="text-align: left;">Doctor</h3></div>
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                <p>For his semestral check up, the NeuronArch holder goes to the doctor. In order to share data collected the last six months and his health status with the specialist, the patient shows his personal QR code available on the app (<b>Figure 9</b>). This code acts like a key that maintains his personal data secure. When scanning it, the doctor access to the patient’s dashboard and is now able to provide adapted advice and treatments regarding the situation. </p>
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                <div class="legend"><b>Figure 9: </b>During a medical appointment</div>
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            <div class="block title"><h3 style="text-align: left;">Maintenance</h3></div>
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            <div class="block full">
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                <p>Whether the NeuronArch device encounter a hardware issue, maintenance is made possible (<b>Figure 10</b>). The plastic case, containing the electronic parts, can be unsealed thanks to height screws. To perform this maintenance process, a prosthetist specifically trained can open and check the whole device. If something wrong, the prosthetist will repair or replace the defective parts. The embedded SD card is encrypted, to keep personal data far from prying eyes. NeuronArch have been designed to last a life time.</p>
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            <img src="">
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            <div class="legend"><b>Figure 10: </b>Maintenance operation</div>
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Revision as of 09:13, 15 October 2018

""

Sometimes, severe injuries lead to amputation. Civilians as well as soldiers may be concerned, due to accidents, vascular issues, or even artillery wounds for the last category. Amputations are more frequently located on lower limbs[1] (Figure 1). However, bionic prostheses are nowadays developed mainly for the arms, not for the legs. For the prosthetic industry, designing bionic arms is more challenging because of its capacity to push technological boundaries in order to reproduce movements, sense of feeling, etc. Based on this observation, we focused on a trans-humeral amputation scenario. Nevertheless, NeuronArch’s solution is transposable in different anatomical amputation locations.

Figure 1: Amputation locations

NeuronArch’s choice

After a serious accident, the patient is transferred to a hospital. The doctor makes a diagnosis: the injury is too severe and amputation is inevitable. If the situation allows, medical staff presents different relevant options to the patient. The first option is a classic amputation procedure. At best, it would allow the patient to have a myo-electrical prosthesis. The second option is the NeuronArch solution. The NeuronArch device would allow the patient to wear bionic prothesis, while the NeuronArch app would monitor his health and prosthesis status. In addition, this solution could be partially supported by Social Security in the next few years. After weighing both options, the patient obviously goes for the NeuronArch option!

Surgical implantation

The first step for a new NeuronArch holder is to order a NeuronArch kit, including:
- the NeuronArch device, making the bridge between the stump and a bionic prosthesis;
- an implantation stem featuring the engineered biofilm;
- a charging station, to recharge the device and synchronize data with a distant server;
- a personal access to the app / website, to monitor information, such as device’s battery level, health status, etc.

When the kit delivered, an orthopedic surgeon will osseointegrate the stem (Figure 2). This stem is sent in a sealed package. During surgery, the surgeon drills the bone in its center along its longitudinal axis, while a nurse lifts the NeuronArch stem out of the package. Thanks to a syringe, the nurse drains the culture liquid of the biofilm, contained in a protective cap. Once empty, this cap stays in place in order to allow the surgeon to manipulate the stem with surgical clips without damaging the biofilm and the membrane. The specialist inserts the stem into the bone (Figure 3). The orthopedist places some screws to hold the device in place (to be removed subsequently). The surgeon can now take the protection cap out thanks to a simple quarter turn system, and then complete the surgery by stitching the stump.

Figure 2: Stem with its protection cap
Figure 3: Diagrams of osseointegration steps

Daily life

In the morning, after a night without, the holder plugs the NeuronArch device (Figure 4) and his bionic prosthesis to the stem. Installation is simple, with an ergonomic quarter turn system. His bionic arm moves in an intuitive way thanks to the connection between nerves and the prosthesis, made possible by NeuronArch. With the app he installed on his smartphone (Figure 5), he is now able to check the battery status of his device, to consult his health data or to take an appointment with his primary doctor or his prosthetist (Figure 6).

Figure 4: NeuronArch device implementation
Figure 5: NeuronArch app notification
Figure 6: NeuronArch app scenario

At night, battery is low and collected data needs to be transmitted to the server, in order update his health data and to improve machine learning. Thus, the amputee removes his prosthesis and put the NeuronArch device on the charging station (Figure 7). After several hours, the device is charged, data is synchronized (Figure 8), and NeuronArch is ready to start a new day.

Figure 7: NeuronArch device laying on charging station
Figure 8: Recharging and synchronization

Doctor

For his semestral check up, the NeuronArch holder goes to the doctor. In order to share data collected the last six months and his health status with the specialist, the patient shows his personal QR code available on the app (Figure 9). This code acts like a key that maintains his personal data secure. When scanning it, the doctor access to the patient’s dashboard and is now able to provide adapted advice and treatments regarding the situation.

Figure 9: During a medical appointment

Maintenance

Whether the NeuronArch device encounter a hardware issue, maintenance is made possible (Figure 10). The plastic case, containing the electronic parts, can be unsealed thanks to height screws. To perform this maintenance process, a prosthetist specifically trained can open and check the whole device. If something wrong, the prosthetist will repair or replace the defective parts. The embedded SD card is encrypted, to keep personal data far from prying eyes. NeuronArch have been designed to last a life time.

Figure 10: Maintenance operation