Pain points: Students design neurological assessment tool for ICU patients

Visit a Neuro Intensive Care Unit (ICU) and you might be surprised to see a physician pinching a patient. However, pinches are just par for the course; physicians routinely use painful stimuli to assess a neuro ICU patient’s level of consciousness and neurological function.

These necessary evaluations—which are often conducted multiple times a day—can overtime cause visible bruising, skin damage, and mistrust between the patient’s family members and the provider, said Natasha Porwal, a biomedical engineering rising senior and co-leader of the DeltaT Undergraduate Design Team.

The team has developed a practical tool for neurological assessment that won’t harm the patient. The handheld device causes the patient to experience a burning sensation when applied but doesn’t cause any external damage to the skin. The science behind why this works is the strategic interlacing of hot and cold stimuli, also known as the “thermal grill illusion.”

An advantage of the team’s innovation is that it provides reliable and repeatable stimulus, unlike the current methods.

“Another drawback of the pinching method is that it has no standardization, since the amount of force applied varies greatly depending on the provider. Our solution also offers a way to standardize these evaluations,” said Iralde Sicilia, a biomedical engineering rising senior and co-leader of the team.

The scope of the project meant that the students had to flex their skills in 3D printing, Computer-Aided Design (CAD) software, instrumentation, and electronics to come up with a feasible prototype.

But Porwal and Sicilia said the highlight of the Design Team experience was shadowing providers in the Johns Hopkins Neuro ICU to understand how their device would be implemented in the clinic. During one visit, the team brought a “pinch-o-meter” device to measure the force of pinches that providers were using for assessments. Sicilia recalls that nurses, neurosurgeons, and physicians were lined up to test out how their pinches compared to their colleagues. “It was really great experience to meet all the providers and talk to them about the challenges they face when working with patients,” said Sicilia.

The team members are hopeful that the device will make a difference for Neuro ICU patients and their loved ones.

“What made this project stand out to our team was that it focused on improving the patient experience, rather than just looking at the problem from a provider’s perspective,” said Porwal.

Porwal, Sicilia, and team members Kyle Cooper, Tanish Madan, Dennis Ngo, Vaishnavi Pinni, Grace Qin, and Jeewoo Yoon displayed their prototype at the Whiting School of Engineering’s annual Design Day on May 1, where the team won the People’s Choice Overall Design Award, which recognizes the event’s most impressionable project.

The faculty mentor for the project was Constanza Miranda, associate teaching professor in the Department of Biomedical Engineering; and clinical mentors for the project were Adam Schiavi, an assistant professor of anesthesiology and critical care medicine and neurology, and Geoffrey Miller, an associate professor of emergency medicine and director of the Johns Hopkins Medicine Simulation Center.

Check out an interview with Natasha Porwal and Iralde Sicilia, leaders of the DeltaT Design Team.