Essential tremor is the world鈥檚 most common movement disorder, affecting an estimated 7 million people in the U.S. alone. The hallmark of this disease is an involuntary, rhythmic shaking during intentional movement, complicating everyday tasks like writing, eating and drinking. When resting or sleeping, however, most patients have few or no symptoms.

The disease can be treated with a surgical procedure called , or DBS, where a neurosurgeon implants an electrode deep in the brain; this wire is then tunneled under the skin to a battery in the chest, which provides electrical stimulation that quiets the symptoms. In current use, however, these implanted devices are constantly 鈥渙n鈥� 鈥� delivering stimulation even when a patient doesn鈥檛 need it 鈥� which wastes valuable battery life.

For the first time, 91探花 researchers have combined electrodes on top of the brain to sense movement in the parts of the body that experience essential tremor, along with a deep brain electrode, to deliver stimulation only when it鈥檚 needed. The approach, developed by electrical engineers, 91探花Medicine researchers and ethicists at the at UW, is described in a to be published in a forthcoming issue of .

It鈥檚 an important step toward developing fully-implanted, closed-loop deep brain stimulators to treat disorders like essential tremor and Parkinson鈥檚 disease 鈥� devices that one day might be controlled by the patient鈥檚 own thoughts or movements.

鈥淲e鈥檇 ultimately like to give individuals that ability and choice,鈥� said co-author , a 91探花electrical engineering doctoral candidate and member of the CSNE team. 鈥淥ne side effect of deep brain stimulation can be difficulty speaking, for instance. So if you鈥檙e about to drink a glass of water, you might want to turn up the stimulation so your hand doesn鈥檛 shake. If you鈥檙e answering the phone, perhaps you鈥檇 want to turn it down so your speech isn鈥檛 affected.鈥�

Delivering deep brain stimulation also can extend the battery life of these implanted devices, which currently last only three to five years.聽 Lengthening battery life is important because replacing the battery requires surgery, which carries risks to the patient such as infection.

鈥淲e鈥檙e saving about half of the battery power, based on our subjects so far, which was one of our main motivations,鈥� said senior author and 91探花electrical engineering professor . 鈥淏ut even more interesting are some early indications that suggest our closed-loop system results in better patient performance, with less tremor, better control of their hands and fewer side effects.鈥�

In the video above, essential tremor patients drew spirals under three conditions 鈥� with their deep brain stimulator turned off (left), with the device constantly on (middle) and with the 91探花CSNE system that delivers stimulation as needed (right). In the latter two conditions, patients experienced significant and comparable relief from tremor symptoms that cause their hands to shake.

The project originated in a partnership between the CSNE and medical device manufacturer Medtronic to test new ways of with essential tremor patients. This system not only delivers electrical stimulation like traditional DBS systems, but also has the capability to sense and respond to electrical signals generated by the brain itself. The 91探花team received an investigational device exemption from the U.S. Food and Drug Administration for these tests.

To treat essential tremor, a surgeon typically implants an electrode in the thalamus of a patient鈥檚 brain. It鈥檚 wired down the neck to another implanted device housed under the clavicle that contains a battery and the electronics that drive the system. This 鈥渙pen-loop鈥� system, in clinical use today, delivers constant deep brain stimulation at levels set by a doctor.

In three patients who received the Medtronic Activa PC+S Deep Brain Stimulation system, 91探花Medicine surgeons also implanted a small strip of electrodes on top of the brain鈥檚 motor cortex, the part of the brain that controls movement. The electrode strip can be used to sense when a hand or other extremity affected by essential tremor is moving. In a key innovation, the team developed machine learning algorithms to 鈥渄ecode鈥� neural signals coming from the brain and correlate them with essential tremor symptoms that warrant treatment by stimulation.

The neural biomarkers and algorithms used to 鈥渄ecode鈥� them differ by disease. While a similar treatment approach has been documented for Parkinson鈥檚 disease, this is the first time neural signals have been used to selectively treat essential tremor.

鈥淭his is exciting both for treating those patients with essential tremor, but also for future uses,鈥� says , a CSNE team leader and neurosurgeon with the 91探花Medicine Neurosciences Institute.聽 鈥淭his represents the first time a person can control their implanted device through the voluntary use of brain signals. We now can see a direct path to all sorts of uses in stroke, paralysis or other neurologic conditions that may be treated in the future using this general approach.鈥�

Most essential tremor patients have symptoms only during intentional movement 鈥� when they move their arm to eat, drink or write, for instance. The 91探花CSNE closed-loop system detects that movement and only delivers stimulation to quiet the tremor symptoms when needed.

鈥淒BS results in some of my most grateful patients,鈥� said team member and co-author , a neurosurgeon at the 91探花Medicine Neurosciences Institute who implanted the devices. 鈥淭hey used to call this disease 鈥榖enign essential tremor,鈥� but it isn鈥檛 that benign. Patients don鈥檛 go out to eat because they spill food and drink. They stop having friends over because they can鈥檛 pour a cup of coffee. They can鈥檛 sign checks. They need help getting dressed. Regular DBS works really well to give people their lives back. What we are working on is taking a really good treatment and making it even better.鈥�

To test how well the systems worked, the research team asked the patients to perform simple motor tasks 鈥� such as drawing a spiral shape with a pen, writing sentences or trying to hold their hands steady 鈥� under three conditions: With their Medtronic implanted deep brain stimulator turned off, with the system that delivered constant stimulation and with the new system that only delivered stimulation as needed.

With no stimulation, the patients experienced tremor throughout the tasks. The effectiveness of the CSNE team鈥檚 new system in quieting the tremor symptoms was comparable to the open-loop system 鈥� but with greater energy savings.

In the experiments described in the paper, the computational tasks were performed on an external laptop next to the patient. Next steps include transferring that computational power to the device implanted in the patient鈥檚 chest wall 鈥� thus creating a fully-implanted, closed-loop deep brain stimulator. The team has received FDA approval to move onto the next step in real-world testing, which is sending patients home with their stimulators in closed-loop mode.

The research was funded by Medtronic, the National Science Foundation and the U.S. Department of Defense.

Co-authors include , a Medtronic biomedical engineer who joined the company after performing the research as a 91探花doctoral student and CSNE team member, and philosophy doctoral student , who at the CSNE in the .

For more information, contact Chizeck at chizeck@uw.edu. To reach 91探花Medicine co-authors, contact Susan Gregg at 206-616-6730 or sghanson@uw.edu

Grant numbers: NSF: EEC-1028725

To make cars as safe as possible, we crash them into walls to pinpoint weaknesses and better protect people who use them.

That’s the idea behind a conducted by a 91探花 engineering team who 鈥� one used only for research purposes 鈥� to test how easily a malicious attack could hijack remotely-controlled operations in the future and to .

Real-world teleoperated robots, which are controlled by a human who may be in another physical location, are expected to become more commonplace as the technology evolves. They’re ideal for situations that are dangerous for people: fighting fires in chemical plants, diffusing explosive devices or extricating earthquake victims from collapsed buildings.

Outside of a handful of experimental surgeries conducted remotely, doctors typically use surgical robots today to operate on a patient in the same room using a secure, hardwired connection. But telerobots may one day routinely provide medical treatment in underdeveloped rural areas, battlefield scenarios, Ebola wards or catastrophic disasters happening half a world away.

In two recent papers, researchers demonstrated that next generation teleoperated robots using nonprivate networks 鈥� which may be the only option in disasters or in remote locations 鈥� can be easily disrupted or derailed by common forms of cyberattacks. Incorporating security measures to foil those attacks, the authors argue, will be critical to their safe adoption and use.

“We want to make the next generation of telerobots resilient to some of the threats we’ve detected without putting an operator or patient or any other person in the physical world in danger,” said lead author , a 91探花doctoral candidate in electrical engineering.

To expose vulnerabilities, the 91探花team mounted common types of cyberattacks as study participants used a teleoperated surgical robot developed at the 91探花for research purposes to move rubber blocks between pegs on a pegboard.

By mounting “man in the middle” attacks, which alter the commands flowing between the operator and robot, the team was able to maliciously disrupt a wide range of the robot’s functions 鈥� making it hard to grasp objects with the robot’s arms 鈥� and even to completely override command inputs. During denial-of-service attacks, in which the attacking machine flooded the system with useless data, the robots became jerky and harder to use.

In some cases, the human operators were eventually able to compensate for those disruptions, given the relatively simple task of moving blocks. In situations where precise movements can mean the difference between life and death 鈥� such as surgery or a search and rescue extrication 鈥� these types of cyberattacks could have more serious consequences, the researchers believe.

With a single packet of bad data, for instance, the team was able to maliciously trigger the robot’s emergency stop mechanism, rendering it useless.

The tests were conducted with the , an open source teleoperated robotic system developed by 91探花electrical engineering professor and former 91探花professor , along with their students. Raven II, currently manufactured and sold by Seattle-based , a 91探花spin-out, is a next generation teleoperated robotic system designed to support research in advanced techniques of robotic-assisted surgery. The system is not currently in clinical use and is not approved by the FDA.

The surgical robots that are FDA-approved for clinical use today, which typically allow a surgeon to remove tumors, repair heart valves or perform other procedures in a less invasive way, use a different communication channel and typically do not rely on publicly available networks, which would make the cyberattacks the 91探花team tested much harder to mount.

But if teleoperated robots will be used in locations with no secure alternative to networks or other communication channels that are easy to hack, it’s important to begin designing and incorporating additional security features now, the researchers argue.

“If there’s been a disaster, the network has probably been damaged too. So you might have to fly a drone and put a router on it and send signals up to it,” said , 91探花professor of electrical engineering and co-director of the 91探花BioRobotics Lab.

“In an ideal world, you’d always have a private network and everything could be controlled, but that’s not always going to be the case. We need to design for and test additional security measures now, before the next generation of telerobots are deployed.”

Encrypting data packets that flow between the robot and human operator would help prevent certain types of cyberattacks. But it isn’t effective against denial-of-service attacks that bog down the system with extraneous data. With video, encryption also runs the risk of causing unacceptable delays in delicate operations.

The 91探花team is also developing the concept of “,” which leverage the ways in which a particular surgeon or other teleoperator interacts with a robot to create a unique biometric signature.

By tracking the forces and torques that a particular operator applies to the console instruments and his or her interactions with the robot’s tools, the researchers have developed a novel way to validate that person’s identity and authenticate that the operator is the person he or she claims to be.

Moreover, monitoring those actions and reactions during a telerobotic procedure could give early warning that someone else has hijacked that process.

“Just as everyone signs something a little bit differently and you can identify people from the way they write different letters, different surgeons move the robotic system differently,” Chizeck said. “This would allow us to detect and raise the alarm if all of a sudden someone who doesn’t seem to be operator A is maliciously controlling or interfering with the procedure.”

Co-authors on the include 91探花electrical engineering graduate students and , of the 91探花computer science and engineering department, former 91探花computer science and engineering undergraduate , of the 91探花School of Law, and law student .

The research was funded by the National Science Foundation.

For more information, contact Bonaci at tbonaci@uw.edu and Chizeck at chizeck@uw.edu.

NSF grant: #CNS-1329751

Now, researchers from the 91探花 Department of Electrical Engineering, 91探花Department of Neurological Surgery and 91探花Department of Philosophy have teamed up with medical device manufacturer to use the Activa庐 PC+S Deep Brain Stimulation (DBS) system with people who have essential tremor. The system is not yet approved by the Food and Drug Administration for commercial use in the United States.

One drawback with existing DBS devices is that batteries only last three to five years, depending upon how frequently stimulation occurs. By increasing battery life, the 91探花researchers hope to lengthen the time between surgeries 鈥� which carry risks of coma, bleeding and seizures 鈥� that patients must undergo to replace the device.

鈥淭he technology we鈥檝e created using the Activa PC+S is unique in that it will selectively determine when and how stimulation should occur,鈥� said Jeffrey Herron, a 91探花doctoral student in electrical engineering. 鈥淚n doing so, we hope to increase battery life and reduce side effects.鈥�

The technology also aims to alleviate potential side effects from DBS therapy, which can include worsening of motor symptoms and speech and language impairments, by adjusting stimulation parameters.

This type of device, along with externally-worn equipment, is known as a system, because it encompasses the complete path followed by an electrical signal. In this case, the system will use either externally-worn sensors or recorded neural signals in the brain to modify stimulation within limits that are established by a clinician.

In addition, researchers are also exploring the use of voluntary neural commands by the patient to modify the therapeutic stimulation. 鈥淭his will let the patient decide when to adjust their stimulation, to reduce side effects,鈥� said Howard Chizeck, 91探花professor of electrical engineering. 鈥淭he negative effects of stimulation on speaking could be reduced voluntarily for a while, at the cost of more tremor,鈥� Chizeck said.

Activa PC+S has been made available to a select number of research institutions worldwide for physician-sponsored research. This collaboration stems from work at the (CSNE), which is based at the 91探花and is one of 17 Engineering Research Centers funded by the National Science Foundation. Medtronic is an industry member in the CSNE.

The 91探花team received US Food and Drug Administration approval for an investigational device exemption in November 2014 and, subsequently, Institutional Review Board permission to conduct this research with human subjects. 91探花Medicine鈥檚 Dr. Andrew Ko and his team have started to recruit patients.

鈥淥ne part of my job that gets me particularly excited is when an operation has the potential to significantly improve a patient鈥檚 function and quality of life,鈥� said Ko, whose research expertise lies in DBS and epilepsy. 鈥淭he patients whom I treat are complex and require multidisciplinary care. This collaboration that teams up neurological surgery, electrical engineering and philosophy really gets at the multidisciplinary approach at the 91探花and allows us to explore DBS therapy in a truly innovative manner.鈥�

Timothy Brown, 91探花doctoral student in philosophy, is working with researchers on the neuroethics of DBS device design and use. Brown will help shape the research study by exploring how people who have voluntary control over DBS therapy might come to think of themselves (and their abilities) differently than people without that same control.

In conjunction with the Activa PC+S device, scientists will use Medtronic鈥檚 Nexus-D system, which performs real-time command and control of the implanted device.

Research being conducted with the DBS system may one day unlock the mechanism of action for DBS therapy鈥攃urrently, clinicians do not understand how it works, despite its efficacy鈥攁nd lead to future advances in treatment. To date, more than 125,000 patients worldwide have received Medtronic DBS therapy.

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For more, contact Chizeck at chizeck@uw.edu or 206-221-3591 and Susan Gregg with 91探花Medicine at sghanson@uw.edu or 206-616-6730.

They are working with a team of eight other organizations as part of the , an initiative designed by two of this year’s to encourage new technologies that help society in our increasingly connected world.

“We are working on an application of technology that’s clearly for the public good, and that’s what motivated our team’s idea,” said , a 91探花professor of electrical engineering and team leader from the university.

91探花engineers and partner organizations will test and demonstrate their disaster-response technology for the news media and university community from 1 to 4 p.m. May 13, in the atrium (second floor), before presenting their project in Washington, D.C., in June. The team formed about six months ago at an initial brainstorming gathering in D.C.

The group, called the , aims to combine existing “smart” technologies to better serve society during disaster and crisis response. This includes using teleoperated robots for rescues and safety operations; a high-tech dispatch system that gathers information from cameras and sensors and pushes it out to first responders; drones for damage surveillance and rescues; and to be worn by search-and-rescue dogs.

“The key is we’re taking many developed technologies from different organizations and putting them together in a way that’s innovative,” Chizeck said.

In addition to the UW, the Smart Emergency Response System team members are BluHaptics, Boeing Co., MathWorks, Massachusetts Institute of Technology Media Lab, National Instruments, North Carolina State University, University of North Texas and Worcester Polytechnic Institute.

At the UW, engineers in Chizeck’s lab as well as at spinout company are leading the effort to develop robots that can interact more seamlessly with human operators. The technology lets a robot operator actually feel feedback in the form of pressure on his or her hand controller from a robot on the ground. This force feedback can help the operator avoid objects and realize when the robot鈥檚 arm has reached its limits. Known as haptic feedback, this technology essentially instructs the human operator through touch sensation as though the person were in the field with the robot.

“The idea is really to combine the skills and situational awareness of a human operator with the precision and repeatability of an autonomous robot. This way we can rely as much on a robot as we can on a human,” said , co-founder and vice president for engineering at BluHaptics, and a postdoctoral researcher with the 91探花.

For example, a first responder at a disaster scene could control a robot from a nearby command center to go into the field and turn off a gas valve. The responder could see on a computer screen from the robot’s field of vision and steer it toward the valve. When the robot approaches the correct valve, it would send force feedback to help the human operator make a safe and efficient valve turn.

Using a robot from National Instruments, based in Austin, Texas, the 91探花engineering team mounted a camera and high-end router to allow the human operator to see from the robot’s perspective. The idea is for the human to feel immersed in the robot’s landscape, seeing depth and real-time movements and receiving force feedback from the robot.

This telerobotics technology, combined with the other smart systems, could help with future disaster responses and even create jobs, particularly for veterans, team leaders said. The robotics technology itself is not complicated to operate and could be used by anyone, not just highly trained technicians.

“We are trying to show that these robotics and communication system can be used by anyone. It’s really about making something that’s simple to use,” Ryden said.

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For more information, contact Chizeck at chizeck@uw.edu or 206-265-3609 and Ryden at fredrik@bluhaptics.com or 206-724-9160.

For questions about the Smart Emergency Response System team, contact team leader Justyna Zander at justyna.zander@mathworks.com or 508-215-6287.

Using technology developed by 鈥檚 lab in the Department of Electrical Engineering, a team of 91探花scientists and engineers working at the Applied Physics Laboratory is creating a control system for underwater remotely operated vehicles, or ROVs.

These instruments can perform a variety of undersea tasks too dangerous — or even impossible — for humans, including oil and gas exploration, biohazard clean-up and mining, and environmentally sensitive scientific research.

In June, the 91探花and BluHaptics team will travel to Washington, D.C. to showcase this technology at the SmartAmerica Challenge, as part of the Smart Emergency Response Systems team. The will be a three-day event, including a White House presentation, a technology exposition and a technical-level meeting.

The 91探花research team is working with a 鈥渟ubmersible manipulator test bed鈥� at the APL, which is made up of specialized, submersible equipment similar to what鈥檚 used in the oil and gas industry for offshore operations. This equipment is submerged in a large water tank for a realistic test environment.

鈥淓ssentially, we鈥檙e combining the spatial awareness of a computer system with the perceptive capability of a human operator,鈥� said聽, a senior engineer in the Department of Ocean Engineering and part of the BluHaptics team. 鈥淭o do this, we use what鈥檚 called a haptic device.鈥�

Haptics describes feedback technology that takes advantage of the sense of touch by applying forces, vibrations or motions to the user. The haptic device is used both to control the robot and to provide force feedback to the user.聽 This feedback guides the human operator to the desired location, pushing back on the hand to avoid collisions or other mistakes.

The haptic input device is similar to using a mouse with a computer, Stewart said, 鈥渂ut it鈥檚 giving three-dimensional input, so you鈥檙e actually defining a point in space where you want the robotic arm to go.鈥�

鈥淗aptics does for the sense of touch what computer graphics do for vision,鈥� said Chizeck, who co-directs the .

The technology creates a virtual representation based on a combination of sonar, video and laser inputs — sensory feedback that enhances the human-robotic interface and speeds up operations. This translates into tackling the task at hand safely and more efficiently, while greatly reducing the risk of damage to the environment.

The BluHaptics robotic control system is based on key algorithms developed by Fredrik Ryden in electrical engineering as part of his doctoral work. This work was originally directed to robotic surgery, which allows surgeons to operate remotely via a computer connected to a robot — a surgical alternative for certain medical procedures that can mean enhanced precision and less trauma for the patient, and decreased fatigue for the surgeon. BluHaptics is now applying and modifying these same algorithms to underwater robotics.

Read the about BluHaptics on the Center for Commercialization’s website.