Editorial Feature

Robotic Telementors for Nurses: Ivar Mendez, Professor of Neurosurgery and Director of the Neural Transplantation Laboratory at Dalhousie University

Ivar Mendez, Professor of Neurosurgery and Director of the Neural Transplantation Laboratory at Dalhousie University talks to AZoRobotics about Robotic Telementors for Nurses.

KK - Could you please discuss the inspiration behind the application of the RP-7 robot?

IM - The expansion of neuromodulation and its indications has resulted in hundreds of thousands of patients implanted with devices worldwide.

As all patients require programming, this rapid growth has created a heavy clinical and economical burden on neuromodulation centers and  patients.

Remote point-of-care programming using the RP-7 robot may provide patients with real-time access to medical expertise in their own communities.

The RP-7 remote presence robot will provide real-time expertise where the patient is located, reducing barriers of time and distance and allowing for more effective and cost efficient management and follow-up of patients implanted with these devices.

KK - How does the RP-7 Robot allow experts to guide nurses in programming simulators?

IM - The head of the RP-7 has a mobile flat screen monitor that displays the image of the operator and a picture-in-picture window that displays the image of the person standing in front of the robot.

The head of the robot is movable and fitted with two sophisticated digital cameras as well as audio, microphone and amplification components allowing for real time two-way audiovisual communication. The robot was fitted with a custom-made arm designed to hold a touch-screen programmer (N’ Vision programmer, Medtronic Inc. Minneapolis, MN).

The control station allows the clinician to have real-time control of the robot and visualize the N’ Vision  programmer, patient and the nurse in the remote location. The clinician operating the robot is able to telestrate using a cursor that is displayed on the robot's head monitor.

Telestration is important as the experienced programmer can indicate, in real-time, to the nurse the buttons to touch on the screen of the N’ Vision programmer. The control station is also capable of storing video and still images of the remote presence sessions for archiving and further analysis.

Robot programming using the RP-7 remote presence robot. Image courtesy of Professor Ivar Mendez, Dalhousie University.

KK – What are the key feature of this robot?

IM - The RP-7 remote presence robot was developed by In Touch Health Inc., Santa Barbara, CA and is equipped with headphones, microphones, and a joystick to manoeuvre the robot in real time.

The RP-7 is 165 cm in height and has a wheeled triangular base of 63 X 76 cm, its dimensions are roughly comparable to the size of a human. The robot can travel at speeds of about 3 km/hour and has an 8-hour rechargeable battery.

KK - What conditions is this robot being used for and how?

IM - We have extensive experience of using the RP-7 in the clinical setting. Currently, the RP-7 is used in providing access to specialized expertise such as neurosurgery located in a tertiary academic medical centre to regional and community-base hospitals in Atlantic Canada.

We have RP-7 robots in Emergency rooms in hospitals that do not have neurosurgeons whereby the robots provide access to neurosurgeons located in the tertiary care centre.

The RP-7 has also been used in remote locations such as nursing stations in Inuit communities of the Canadian Arctic to provide access to physician expertise for emergency and primary care. 

KK - What other conditions are being explored for the application of this robot?

IM - We are exploring the use of portable remote presence devices that work with cell phone networks for postoperative follow-up of patients in their homes and for access to medical expertise at the site of accidents and for monitoring critically ill patients being transported in ambulances. 

KK - Where is there the biggest demand for this technology and why?

IM - In any situation that requires medical expertise in real time when this expertise is not available. I envision that mobile remote presence point-of-care health delivery will revolutionize the practice of medicine in the future.

KK - How is this robot controlled? Is it controlled by a HCP and is there a certain level of training involved in controlling this technology?

IM - The RP-7 is controlled wirelessly by a laptop computer (control station) equipped with a joystick. Connectivity between the control station and the RP-7 robot is provided by a standard 802.11 Wi-Fi internet link. It takes about half an hour to learn how to drive the robot, as the controls are very intuitive.

KK - What sensor technology has been incorporated into this system?

IM - The RP-7 has motion sensors that prevent it from touching or bumping into any potential obstacle in its path.

KK - Do the patients have any concerns about this technology? Is this technology too rigid and insensitive?

IM - We have evaluated the response of patients to the RP-7 in the clinical setting. Typically, patients get used to the robot interface in the first couple of minutes of the remote presence session.

There was a high degree of satisfaction amongst patients being evaluated in clinics using the RP-7 robot. Ninety-five percent of the patients indicated that they would use the RP-7 robot again for their clinical evaluations, with 84% of patients reporting that they were "very comfortable" in their interaction with the assessing physician using the RP-7 robot.

In 53% of the remote presence sessions, an interpreter or family member accompanied the patient. Ninety percent of those caregivers felt that the use of the RP-7 robot was very helpful in promoting interaction with the physician conducting the session.

KK - How was this tested in the preliminary study?

IM - A validated scale to measure satisfaction was used to assess the satisfaction of participants to the different criteria. The scale ranges from the lowest score (1) reflecting poor or very dissatisfied answers to the highest score (5) reflecting excellent or very satisfied answers. Most patients gave high satisfaction scores to the robotic sessions.

KK - Is there any difference in the accuracy or clinical outcomes of remote-presence versus conventional programming?

IM - All the patients were programmed with no disruption of connectivity or adverse events that required the clinician to abort the session. No difference in programming accuracy was observed between the remote and direct conventional programming sessions.

The average time needed to program the patients was essentially the same for the direct (26.3 minutes) and remote presence (27.6 minutes) sessions.

KK - What was the outcome of your study?

IM - This study establishes the proof-of-principle that remote programming of neuromodulation devices using robotic telepresence and expert telementoring of an individual with no previous experience, to accurately program a device is feasible.

We envision a time in the future, where patients with implantation devices will have real-time access to neuromodulation expertise from the comfort of their own home.

KK - How will this technology help to meet the need for experts required to serve the rapidly expanding number of patients with neuromodulation therapies?

IM - In the future, remote presence systems will incorporate in their hardware and software programming capabilities for neuromodulation devices. With such systems, the expert programmer will be able to directly interact with the neuromodulation device and the patient without additional human intervention.

We envision a time, in the near future, where patients implanted with neuromodulation devices will have real-time access to an expert clinician from the comfort of their own home.

KK - How will this technology shape the current status of patient care?

IM - Although applications of remote presence medicine using robots such as the RP-7 may be initially directed to specialized medical expertise, emergency situations, remote locations and the developing world, perhaps its major impact could be in the delivery of primary health care.

We can envision the use of remote presence devices by allied health personnel in a wide range of scenarios from home care visits to mental healthcare follow-up sessions where access to medical expertise in real time would be just a phone call away.

KK - Where can our readers find out more information on this technology?

IM - More information on our latest research can be found from the following source: Ivar Mendez, Michael Song, Paula Chiasson, Luis Bustamante. Point-of-Care Programming for Neuromodulation. Neurosurgery, 2013; 72 (1): 99.

About Ivar Mendez

Dr. Ivar Mendez is Professor of Neurosurgery and Director of the Neural Transplantation Laboratory at Dalhousie University and the Queen Elizabeth Health Sciences Centre. Dr. Mendez received his MD and PhD in Anatomy from the University of Western Ontario, London, Ontario where he also completed his post-graduate training in Neurosurgery.

Dr. Mendez is a Fellow of the Royal College of Physicians and Surgeons of Canada and the American College of Surgeons. As a Clinician/Scientist, Dr. Mendez’ research focus is in functional neurosurgery, brain repair, stem cells, robotic neurosurgery and computerized systems in neurosurgical applications. His laboratory research has been supported by peer-reviewed funding from a number of sources including the Canada National Centers of Excellence, Canadian Institutes of Health Research, Canada Foundation for Innovation and Parkinson’s Disease Foundation of USA.

In 2002, Dr. Mendez and his team performed the first long distance telementoring neurosurgery in the world and in 2013, he reported the first experience in remote programming for neuromodulation devices. Dr. Mendez was the President of the Canadian Neuromodulation Society (CNS) from 2009 – 2012 and under his leadership he promoted the access of neuromodulation therapy to all citizens of Canada. He is currently the Past President of the CNS.

For his pioneering work in the use of remote presence devices to deliver health care to underserviced populations, Dr. Mendez received the 2012 Canadian Red Cross Humanitarian of the Year Award, the 2011 Health Canada Award for Contributions to the Improvement of the Health of Canadians, and Queen Elizabeth II Diamond Jubilee Medal in 2012.

Dr. Mendez has been appointed as the Fred H. Wigmore Professor of Surgery and Chairman of the Department of Surgery at the University of Saskatchewan and Unified Head of Surgery of the Province of Saskatchewan. As of June 1st, 2013 he will oversee all surgical activities in the Province of Saskatchewan.

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