Technological Solutions for Patient Lifting

One of the greatest dangers for both professional and non-professional caregivers is lifting patients, so much so that a bill was introduced in Congress last year to eliminate manual patient handling. While the bill still awaits passage, there are some interesting alternatives on the technology front.

For the last several years, Japan’s RIKEN Institute, in collaboration with Tokai Rubber Industries, Ltd., has been testing RIBA (Robot for Interactive Body Assistance), a carebot that can lift patients. Its latest iteration, RIBA-II, announced in 2011, can lift a person weighing up to 176 pounds straight from the floor. Unfortunately, it still looks like one of Darth Vader’s stormtroopers crossed with a toy bear.

Another approach is to eliminate the need for lifting entirely. Panasonic is marketing Resyone, a wheelchair that transforms into a flat-bed (not unlike a first class airline seat). It recently earned global safety standard ISO13482 approval, a first for a service robot.

This might work. Image courtesy of Daewoo.

This might work. Image courtesy of Daewoo.

In a robotics advance on the load-bearing belt, South Korea’s Daewoo Shipbuilding and Marine Engineering has created an exoskeleton for their shipyard workers. Already in use, it allows workers to lift materials weighing up to 70 pounds, with plans to increase the load capacity to 200 pounds. It’s not hard to imagine a version that could be employed in hospitals and other medical settings.

Unfortunately, for the foreseeable future, most of these solutions will likely be available at price points that only make them practical for institutions. In the meantime, please remember that the medical literature is filled with grim studies of injuries sustained by caregivers who tried to move bedridden or seated patients. One of those studies offers this cautionary description: “In a perfect world, a ‘safe’ lift would be 51 pounds if the object is within 7 inches from the front of the body, if it is at waist height, if it is directly in front of the person, if there is a handle on the object, and if the load inside the box/bucket doesn’t shift once lifted.” In other words, don’t be afraid to ask for help.



Disposing–and possibly profiting from–Old Technology

While new technology can make the lives of seniors easier, old technology is just another piece of clutter. Unless it’s an Apple I, even the early birds at the garage sale won’t want it.

What can you do with it? has a smart article with some useful ideas for handling the problem, from re-selling to recycling. They also have some important cautions:

  • Like disposing old motor oil, be aware of local environmental laws regulating what must be done with old electronics.
  • Like destroying old credit cards, be certain no one can reconstruct what was on your device. You may need to hire a professional to help you with this.
Ya never know...

Ya never know…

One caution we’d like to add to their list, after the traumatic experiences of friends who lost their comic book collections to overly zealous parental purging. Sure, there’s always going to be somebody who’ll offer ten bucks to take that old junk off your hands, but never toss anything without first checking its value as a collectible. That Apple I we mentioned? It sold at auction for $671,000.

UPDATE: The New York Times has a story today about re-selling iPhones. If the original price of your phone was discounted due to a two-year contract, it may actually be possible to realize a profit over what you paid. If you buy a phone knowing that you’re eventually going to re-sell it, make sure you keep everything that came with the original packaging and don’t get the phone engraved.

Several commentators on the Times story suggested that a good cost-saving strategy is to buy  your phone at a discount on a two-year contract, then keep the phone when the contract is up and switch to a lower cost or pay-as-you-go carrier.

Important note: If you plan to sell or trade-in your phone, check current reviews of whatever sites you’re seriously considering. The Times list cashforiphones among its suggestions, but CNet has a lengthy article warning against them, with excellent advice on what questions to ask about trade-ins. Consumer Reports has a list of trust-worthy stores and sites. In addition, you might want to consider eBay and Apple itself, which will send you a gift card.


ACA: Aspirin Not Included

The Pew Charitable Trust has put out a timely warning about auto-renewing insurance under the Affordable Care Act (aka Obamacare). Many plans will likely increase their premiums in November (no surprises there, alas), but those increases will be especially tricky for those who are receiving supplements under state exchanges.

aspirin.f1-184x300Pew suggests not letting your plan automatically renew and taking a hard look at numbers. Here’s the money quote: “Consumers who automatically re-up with the plan they already have could face steep and unexpected premiums and out-of-pocket costs, particularly if they received a federal subsidy.”

The increases will reflect changes to the “benchmark plan,” as Pew explains, “The subsidy people receive is pegged to the second-lowest priced Silver plan, the so-called ‘benchmark plan,’ meaning that the amount of a subsidy any individual receives no matter which plan he or she selects, is based on how much they would receive if they picked that benchmark plan.”

Whether or not you receive a subsidiary, it’s best to look very closely at the paperwork. The privately funded National Health Council has an online calculator to help determine some of the costs. If you’re deciding on a supplemental Medicare plan, it should also prove useful.


Report: Increase in e-Prescriptions

The Office of the National Coordinator Health Information Technology is out with a new data brief on changes in rates of physician e-prescribing, pharmacy capability to accept e-prescriptions, and the volume of e-prescriptions between December, 2008 and April, 2014.

Nationwide, there has been a rapid increase:

  • All states showed double-digit increases in the proportion of physicians e- prescribing using an EHR between December 2008 and April 2014. 
  • As of April 2014, 7 out of 10 physicians e-prescribe through an EHR, representing a ten- fold increase since December 2008. 
  • In 2013, more than half (57 percent) of new and renewal prescriptions were sent electronically. 
  • The volume of new and renewal prescriptions sent electronically has increased thirteen- fold from 2008 through 2013. 

Screen Shot 2014-07-17 at 7.10.42 PMNotably, however, “the four states with highest volume of prescriptions — California, Texas, New York, and Florida — are all below the national average” in new and renewed e-prescriptions.





FTC rules video clips should be close-captioned

In 2010, President Obama signed the 21st Century Communications and Video Accessibility Act to great fanfare, including a White House Press Conference appearance by Stevie Wonder. The purpose of the legislation is “to increase the access of persons with disabilities to modern communications.”

Four years later, the FTC is still working on refining its implementation. The latest rules regard short video clips, which the FCC now mandates should be closed captioned, in line with a previous ruling that full-length clips should be. From Chairman Tom Wheeler’s prepared remarks:

“Accessibility of programming must evolve with technology in order for us to maintain our commitment to universal access. When the number of U.S. households viewing TV programming exclusively on the Internet is poised to surpass the number viewing only via antenna, and 77% of Internet users regularly watch video clips online – often to get news, sports, and entertainment programming, it’s time to update our closed captioning rules to reflect these changes.”


You may notice that this video of the 2010 press conference is not close-captioned. That’s because the FTC has mandated rolling deadlines, based on the type of video clip. According to their press release:

  • January 1, 2016, will apply to “straight lift” clips, which contain a single excerpt of a captioned television program with the same video and audio that was presented on television.
  • January 1, 2017, will apply to “montages,” which occur when a single file contains multiple straight lift clips.
  • July 1, 2017, will apply to video clips of live and near-live television programming, such as news or sporting events.  Distributors will have a grace period of 12 hours after the associated live video programming was shown on television and eight hours after the associated near-live video programming was shown on television before the clip must be captioned online in order to give distributors flexibility to post time-sensitive clips online without delay.



Exoskeletons: Bionic Breakthroughs and Thoughtful Objections

Exoskeletons are touted as the breakthrough that will get those with spinal cord injuries to walk again. An academic prototype, controlled by brain waves, was featured at the beginning of the World Cup, and ReWalk, a commercial version from an Israeli-American company, recently became the first exoskeleton approved by the FDA for daily use in the United States. It’s been sold in other countries for three years already.

Yet nearly every person we’ve seen pictured wearing one was young or at most middle-aged. Worse, exoskeleton users need to balance on crutches, which actually leaves their hands less free than using a wheelchair. In fact, ReWalk’s own developer isn’t a candidate for it, because he can’t use his arms.

Granted, for hiking, as TEDx speaker Amanda Boxtel plans to use the Ekso Bionics’s exoskeleton, the crutches would serve nearly the same function as hiking poles.

Charles Engelbert Photography (970) 379-2005

Amanda Boxtel in Exoskeleton. Is this geniunely as cool as it looks?

As robotics advances, no doubt exoskeletons will become less cumbersome and their batteries will last longer than a reported two-to-three hours. Already since ReWalk’s 2008 prototype, the controller has shrunken from covering half the forearm to the size of a wristwatch. Perhaps lighter, sleeker, stronger versions will make the devices more suitable for those who are too frail to haul themselves on crutches. Perhaps later versions will not require crutches for balance. Most of all, perhaps later versions will cost considerably less than the nearly $60k of these first generation units.

Or perhaps none of that is necessary. Despite Time magazine naming it “among the top 25 best inventions in 2013,” not everyone who uses a wheelchair is exulting over exoskeletons. New Zealand teacher Red Nicholson says, “I have no more desire to be strapped to a robot than I do to go swimming with great white sharks”

Anthropologist and disability rights activist William Peace, author of the blog “Bad Cripple,” questions their value with some very serious number-crunching. What’s truly important for those with SCI, both he and medical experts agree, is to reduce “secondary medical complications caused by an extreme sedentary lifestyle,” such as life-threatening infections caused by bed sores and urinary and bowel dysfunctions.

In contrast to the 60k cost of ReWalk, writes Peace, the price of the required equipment to ensure exercise would be: “$11,000 wheelchair, $500 wheelchair cushion, a $5,000 handcycle, a $4,000 sit ski… Total material costs are a little over $20,000.”

That’s three complete packages for the price of one ReWalk, a device that isn’t even suitable for everyone who uses a wheelchair.




Social Security Gets Ahead of the Curve

The New York Times reports that the Social Security Administration, suffering from budget cuts, is closing field offices. A plan prepared by the National Academy of Public Administration suggests it’s all good: By the year 2025, everybody can just do everything online.

As much as we’d like to share their optimism, we’re a little surprised that they apparently missed last April’s PewResearch Internet Project Report on Older Adults and Technology Use.

The crucial distinction Pew made, echoing our own feelings, is that there are two different groups of “elderly” to consider. Those who are young(ish), well-educated and affluent, and those who are much older, less educated, and sadly much poorer.

The drop-offs are critical:

74% of those who are 65-69 use the Internet, but only 37% who are 80 years or older.

87% of college graduates over 65 use the Internet, but only 40% with a high school education or less.

90% over 65 with a household income of $75,000+, but only 39% with an income of 30,000 or less.

While the age usage will inevitably shift upwards, as far as income and education, the people who will need Social Security services the most are not online. It’s hard to imagine that will change much in sixteen years.

13-internet-usage-for-older-adultsClick on the image to enlarge for a detailed breakdown.

X-treme Wheelchairs

One of the greatest fears of aging is immobility. But a new generation of demanding wheelchair athletes is pushing hard at those limits. Competitive skateboarder Robert Thompkins decided that no mere wheelchair was going to keep him from his passion.

He’s allied with wheelchair technology pioneers Colours Wheelchairs, known for breakthrough lightweight chairs with independent suspension, to develop a prototype wheelchair for chairskating, an extreme sport that is every bit as high-flying crazy as board skating.

As it turns out, one of Thompkins’s biggest challenges is regulations that limit his local skateboard park to skateboards only, another example of older, well-intentioned laws lagging behind current technological realities.





Streamlining Regulations to fit Reality

In an editorial in Health Affairs, Amy Comstock Rick, CEO of the Parkinson’s Action Network, details the benefits of the Tele-Med Act (HR 3077), a bipartisan measure that would allow Medicare providers to remotely treat patients in other states without first having to obtain licenses in those states.

Telemedicine, the ability to remotely diagnose conditions and deliver care over the Internet and wireless networks, has long since stopped being the subject of Wired articles and become part of the day-to-day working lives of medical providers. For just one example, Neil Martin, Chair of Neurosurgery at Ronald Reagan UCLA Medical Center, can examine fMRI images of stroke victims on his iPhone and give life-saving instructions to surgeons in rural hospitals or to his UCLA colleagues while he’s stuck in LA traffic.

Unfortunately, often such consultations can only be conducted within states, because of outmoded licensing requirements. A change in the law is vital to correct imbalances in medical supply and demand, warns Comstock Rick. In Delaware, there are approximately 2,000 people living with Parkinson’s Disease, yet there are no doctors in the state who specialize in its treatment.

Her rallying cry must resonate for anyone concerned with advancing medicine: “The concept of only seeing doctors within your own state lines is an archaic remnant of a former time in America before computers, smartphones, and widespread broadband connectivity.”