Michael W. Chang, MD, PhD, CMD
University of Washington, Department of Rehabilitation Medicine
"Engineering and Clinical Medicine"
ABSTRACT
The practices of engineering and medicine are moving on convergent
paths. Historically, the clinical practice of medicine has been
largely based on experience and hence has been very statistical in
nature. Large-scale (and expensive) prospective randomized trials
are often considered as the gold standard to support efficacy of
certain diagnostic and treatment procedures. Yet, when managing
an individual patient's disease using these procedures, outcomes may
not be satisfactory. With the rapid advancement of basic medical
science and technology, diagnosis and treatment of diseases may become
more deterministic than statistical. As the result, the practice
medicine may become similar to solving engineering problems.
Three research projects will be presented to demonstrate how various
engineering disciplines can be used in clinical medicine to better
patient care. These clinical studies resulted in (1) improving
efficiency of warfarin anticoagulation therapy, (2) improving
understanding of clinical management of dysphagia (swallowing
disorders), and (3) improving insights hence management of pressure
ulcers.
A current clinical research project, for which we are seeking for
engineering collaboration, will also be summarized. For many
patients with spinal cord injury (SCI), their independence largely
depends on the integrity of their upper limbs. Unfortunately,
activities like wheelchair propulsion and transfers, both needed for
their independence, place great demands on bones, joints, and soft
tissues of the upper limb. These essential activities can
accelerate the degenerative process in the upper limb leading to injury
and pain. Common treatments for upper limb pain are not effective
for SCI patients because primary factors contributing to upper limb
pain such as wheelchair propulsion and transfers cannot be
avoided. Future research should focus on understanding injury
mechanisms of the upper limb, improving wheelchair design and
propulsion methods, and altering transfer techniques that lessen stress
and cumulative trauma on the upper limb. Identifying factors related to
upper limb pathology that lead to prevention may be the key to treating
upper limb pain in SCI patients.