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.