Alright. Folks will be getting started at 1115, so 3 more minutes, please
Stop!
Feel.
Al alright. He folks let's get back on the road here.
So our drawing at the end of this session is going to be for a custom virtual background.
As we've said before, you must be present to win.
So if anyone did not register for the conference via event bright, please complete the non register.
Non registered attendee form, using the link in chat
So I'm happy to introduce the presenters of our morning Planner recession lessons from the metal world Osteopathic Medicine and human-centered design. Dr.
Tyler, Senate, and Dr. Francisco Ward, presenting Dr.
Simm, is the provost and Vice President for the proposed Maryland College of Osteopathic Medicine at Morgan State University.
He is a Yale trained internist in disaster medicine expert who recently served as medical director for the Baltimore Convention Center field Hospital.
And served as National President of dock care, international where he set up processes and succeeded in opening global health outreach clinics in both Nicaragua and Guatemala he has done groundbreaking research on disaster person care and the education process Dr
Francisco Ward has been serving as chief of the division of occupational, physical, and rehabilitative medicine at Ascension St.
Agnes Hospital since 1999 he founded C.
Team rehabilitation centers and eventually merged his practice into national spine and pain center.
He currently serves as medical director for national spine and pain centers. St.
Agnes office providing comprehensive pain management, and rehabilitation services.
Oh, and one other thing I neglected to mention. Some of you may also recognize Dr.
Simm from his appearances on the doctor. No show, and one of my all-time favorites untold stories of the E.
R
What's up like ladies. We're in pain.
We're in a lot of pain, but neither one was giving us a story.
They're being super cajun all I know is the airline called us.
They said they needed me to medical attention. Hi! There! My name is Tyler Simmons.
I'll be your doctor, and I want to take care of you and help you go into the pain.
I need to get some information first. Get started on the plane, and and that's it.
Both of these people were complaining of pain, and they were going through the same cycle of pain, spasm, and they both got these big, swollen valleys.
It could have been pregnancy, but it could have been so many other things as well on a scale of 0 to 10 0 being Nope pain intending the worst pain possible how much pain.
Do you have 1015, oh, 20. What do you? So when these 2 patients started getting up their pain levels? I wasn't sure how much was sincere, but I was sure how to keep them in the images here?
Amazing command of that emergency room time. That's very good.
That's right.
And stories are a lot easier than reality. I wrote about 60 outlines of the stories frontal stories of the Er.
And what they kept telling me is, you need a human story.
You need tension. You need a beat or a segment to break up the story somehow.
Wow!
You need to connect the story to an audience, and you need someone attractive or idealized because TV is not reality.
No
Got it
It's reality like, but not reality. So we're gonna talk a little bit more about reality today.
And I'm going to share my screen when they're right.
Alright.
They, and they may let me
Share screen and we will bring this up and start talking about what we're going to be doing today.
Can you see it? Are we good, Brian?
You were not in we can see your speaker notes side so
Yeah, I think under display settings. If you can choose the display settings at the top, it might allow you to either reverse it or just show the display.
Yep.
Yup. I think we lost it so if you choose to present again, and then under display settings at the top of your screen, I think
Yup swap for his interview and slideshow
Either that depending on how many monitors you have.
Yeah, looks good on our end as long as it looked on your end.
Yeah, you're good.
Perfect. I know we are off and basically what I want to talk about today is how I look at people and take care of people. How design matters.
I want to go over a few basic rules that I think will be helpful to people and looking at people and seeing what's going on with them, and to have you think about that design and bad functioning that'll make a difference because when I go in to take care of a patient the first thing I'm thinking
is what is the person's agenda I'm in the Eon, and I can tell you many times I've spent hours and hours and tens of thousands of dollars trying to get to the bottom of what's going on when they really just wanted a note for the day off of work the next
day, so we had to flip. How we think about what's going on and go what is the patient's agenda?
But our goal is not to let people die. So the situation the patient has is also foremost, and online is the patients sick?
Are they overwhelmed? Are they engaged with their care, what are they send here by somebody else?
And then the next thing I'm thinking is, I need to know, where is this going?
We call this witnessing disease, sharing the future, handholding but that's how you build a relationship with a patient is by letting them know that you know what's going. On.
And then you could make things better and help treat them
So one thing that all of us notice when looking at people is there funny looking animals?
They don't look like a lot of other animals, and they don't look well designed.
When you say, what is the strong point of the human being?
Is it watching Netflix? Is it climbing trees, and what is the evolutionary significance of what we have?
That's going to help us survive? And the answer generally comes down to a big brain that we can out.
Think of fish that we could out maneuver a deer that we can capture food, using tools, and going, beyond our bodies, and to make things happen because of our bodies are not going to do well against a bear or other animals one of the things that we know doesn't work is the low back
Working in the er shift doesn't go by that.
I don't see someone that has low back pain or limited motion, or inability to work due to back pain, because our spine is meant to be curved, so that our organs are protected inside and we stand up all the way so that we can see what's going on we expose our organs which
Are dangerous in the wild, and we start to pinch the lower lumbar vertebrae and the sacr and develop pain.
The other thing that is easy to notice, and a common problem in the emergency room is that the knees seem to have been designed late and by the lowest bidder.
You look at the great shoulder, and it goes around and around, up and down.
And go multiple directions. The knee can flex an extent.
She simple and not very effective? That means it's gonna break.
That means it's going to get damaged, and it means we're gonna have problems.
Another big issue we deal with is the brain is in charge more and more.
We're learning that health comes from what the brain lets happen overseas, or doesn't let happen, but getting medicine to the brain is harder than getting medicine elsewhere, because of the blood brain barrier right the body is so protective of the brain that it filters out things that we try and
Give to it
Next one, I think, is pretty obvious. The male of the species has their genitals.
Exposed, which forces them to think about it more than other more than they probably should, and also in dangers, are reproductive capacity.
If you ever gone out drinking and eating and trying to breathe at the same time, you will know that oftentimes things don't go in the right place at the right time and that things do get caught so the trachea and Esophagus empty into the same space which is not a good
Idea I think we should have done that better allergies is really it's really a reaction to yourself, and you don't want to be attacking yourself, which is what allergies are so yes, Peanuts.
May have some other issues with causing swelling, but in general allergies are not a healthy thing, and the eyes also, I would remodel quite significantly, because, as you can see, I'm wearing glasses most people wear glasses later, in life, the near side of far side it becomes critical that's just why, we're
Thinking about things, but as doctors, we are science-based professionals who want to use rules to make things better, and the rules we use basically start in science.
Newton's laws of motion or basic laws that everyone should know.
I thought I would use that as an introduction that just says that if a body is moving it's gonna keep moving till you stop it.
And if you stop it or use a force on it, it's going to move in the direction you force it, and if 2 bodies put force on each other then they can interact each other, but basically it's additive.
Why am I doing this well, first talk about how the body is badly built.
We need to understand Wolf's law. Wolf's law, which has been the way we thought about those for the last 100 years say that the area of greatest pressure wherever you have pressure or people sitting bone will form phones reap every 2 to 3 years every 3 months a small segment of
Bone reform, if you use your bones badly within 2 to 3 years, your bones will be now formed, your bones will no longer move as well.
The other. Law. I wanted to bring up is law. Appropriate reception, and this is the law that the scientists are the Patapudian won Nobel Prize for this year where he said: that the brain really oversees the muscles It's not just the 204
Muscles in the 360 joints.
It's actually the brain orienting them, telling them how they can work and really managing and supervising what's going on there.
So those are some of the basic laws of science. But for design purposes I can give you a couple of things and if you take home from here you'll understand people better.
You'll know what people are uncomfortable, because the seat is designed badly.
The table is designed badly, the camera isn't high enough.
And people just move in ways that will break down the body, hire them out and stop them from being able to function.
The laws. I want you to learn are called friets.
One of motion couple of simple ones. Law number one. The body moves to displace energy.
So if I be to the right, I should automatically twist to the left.
To displace energy across the whole vertebrae.
That's neutral mechanics. If you look at somebody walking and they look hurtky, jerking.
They're not neutral mechanics. Neutral mechanics is a good stride, smooth walking and smooth functioning that's freight's law.
Number one. I have a corollary here, and that's why I keep notice to remember.
To say, Yeah, we could talk about every one segment emotion, but it really is the whole body.
So I would encourage you to watch racing. Look at runners, see who looks comfortable, and who doesn't?
The comfortable is neutral mechanics, and that is side betting and rotating to opt in opposite directions.
And that's a smooth, functional ability. If you see people who are side bending and roomating to the same side in order to stand up from a chair, get up or move.
Those are people who are in non neutral mechanics.
Those are people who are gonna have problems and not function. Well, and that's something you have to be aware of and worry about, because they are gonna break down.
They are gonna have pain and they are. Gonna be unhappy, and as I've learned in the er they will take it out on you because displacement of energy and displacement of pain does make people feel better
Third law of the motion is realizing that when the back is out and then shoulders are going to go out, the neck is going to go out, and the head is going to go. Out.
The humans are animals that really focus on the eyes and avoidance of pain.
Think of humans eyes as functioning like a jaguar chasing their prey, jumping up and down, but making sure their vision is straight on and can see what they're chasing. After.
So the eyes are going to predominate and overtake and allow the back to be out of good motion and pain to help, because, of course, the brain is in charge.
I am. Gonna bring up the sixth sense, because, according to science, the sixth sense is proprioception.
It is, knowing your body's orientation, your body's structure, and how it can move, and how the brain can tell it to move.
It is not talking to dead people. I think we all have that experience in other senses, but not here so, Al promoter neurons are the nerves that move muscle gamma motodorans, are finer nerves spun around the output of neurons to tell the brain where the nerves are
Where the muscles are, and how things things are functioning.
If you ever wonder why I'm massage helps you feel better.
It's because it's affecting the gallon load of neuron awareness of what's going on with body
So moving on.
When we look at broken people by design, in the workplace, it's mostly over exertion.
It's not knowing the body is being overstressed.
It's not knowing people can't function well, and the second most common problem is trips and falls from poor design for placement were levels of chairs levels of desk, placement of furniture and the third most common is chemical exposure so as an AR doc i'll tell you that there
Are things we see all the time that really could be cured by design.
One of the things that I've been looking at, and I stopped doing er about a month and a half ago to start a new medical school at Morgan State University, which is a historically black college and university in Baltimore and we're working on building a medical school so I stepped away
From the Er, and as I stepped away I said: You know I can't count the number of times I had a self lacerations on the eye, because 80 Year olds don't walk well, and if they walk with their glasses and fall they cut themselves and they cut themselves badly it looks like
They were in a in a fight, and just didn't even raise their hands to protect themselves.
So we sew that up, and that's just poor eyeglass design.
I'm not saying you need helmets that will go under your eyeglasses.
But somehow the eye glasses should break away or have cushions or not cut people as bad.
The other injury that I see a tremendous amount of the er is basically fatigue of the hands.
That end up getting cut. People do it in the kitchen.
They do it it with waves. They do it in industrial places.
I worked next to a Pepsi Cole factory, so they kept us with a constant stream of patients who had to make the Pepsi get in the bed, and the in the can and often times, their hands got in the way and things got got cut or hurt, what are my partners Elizabeth
Clayborne, since she was tired of holding the noses of little kids who were squirming and trying to get away because the hands on a little kid's nose doesn't work so she developed a NASA clip and basically it's a nasal tampon
That clasped on the nose, so that you don't have to be there in the patient's face, trying to get it to stop
So I am going to transition to another doctor who has done this, well and made a difference in using design to help people avoid engine.
And that's Dr. Francisco Award a long time friend, a well respected doctor, and someone who has a number of patents helping us do things differently in medicine. So Dr.
Ward
Not to unmute yourself
I can hear you
Hi! Can you hear me? Tyler? Okay, so today I'm gonna talk about data driven joint surgeries and can.
Can I can I be seen? Okay, I can't see the screen. Yeah, I'm saying
You are seen, and I will advance the slides for you
So data, driven joint surgeries, joint monitoring data.
The time has come where this, very important procedure that is being done at replacing joints.
I cannot be just kind of looked at from the standpoint of who who needs one, is based on what a doctor and a particular patient that really says so.
Here we're looking at Osteoarthritis, and what everyone can see is that on the far left we have a normal need right with symmetrical joint space and that would be a nice young person's needs right but as we age everyone develops a certain degree.
Of Osteoarthritis, and that us you arethritis shares itself by loss of joint space, and the knees.
So, if I want to have me pain and come in as a 50 year old or 6 year old, and and the the the orthopedic, or the PA gets an Xray they will show varying degrees of Austria through the changes such as the loss of joint space which is progressive as
We move from left to right. What this doesn't show, however, is how much pain the patient actually has, or loss of function, because if you look at if you look at no these various pictures here, you'll see the gentleman on the left side he may have hip no and ankle pain or the one in
The middle, but you can have Austria athletic changes and be totally functional without pain, or you can have pain and have Minimal Austria arthritic changes.
Those just not a direct link between the X-ray and the function.
So you cannot you, when you just get an X-ray when a patient comes in and has pain you you can see that they have pain, and they have astrophysic changes, but if you were to Xray them.
Before they had pain. While they were still riding their bikes, dancing or jogging, you would see that patients or functional without pain, and that's an important point to to realize so as a result of this this availability and access to Arthuroplasties.
And I'm gonna talk about hip and need to start.
So Arthur plasties and new knees. Once
We see a an increase. Now these are similar data points with different different scales.
But it's clear that the frequency is increasing in both hip and the arthropologies, and as the baby boomers age, we're having more and more encounters where the cost and the frequency and the the utilization of resources for this procedure continues to clime
And as we all know, we do not have unlimited resources.
So the question then becomes, How do we? How do we determine who is a good candidate for a hip or in the arthroposy we mentioned earlier that you cannot just look at the X-ray because as the X-ray shares us through the choices that's a very imprecise measure
As to the loss of function or the pain we have.
Mris, that have clearly been increased, and utilization and physicians didn't know this originally, but we've discovered back in the nineties that MRI.
Show pathology, more philosophic changes that are not associated with pain or function.
But when they're used after a pain, a patient comes in to see a doctor.
We're finding through the changes and we're using that as a justification for a a knee or a hip replacement and that's that's very imprecise.
When the patient comes in and says, well, I have. I have near hip pain, and I am having trouble playing basketball, or I'm having trouble hiking very subjective and and the the episodes of that functional loss are usually transient they they fluctuate from day to day and
Week to week, and so it's not a very precise measure.
And the other thing that she's used are these validated instruments that people will say, Well, tell me, fill out this form, and tell me about your your your function again.
Very imprecise. So in the future. What I what I know, and what I personally what I perceive is the right thing to do is to introduce data, so that we can look at compliance and what we're doing before the choice for hip or nearth or plasty is
Executed so that it's not just up to a patient complaint that's temporary.
At that moment, or shows a decline in function. But they're not doing the things that are known to be helpful like weight, loss or exercise aerobic activity.
We have no way of monitoring their weight, their food, choices.
We know that other things affect pain and functional outcomes, such as aerobic activity and mind.
Body exercises and strengthening programs these things have been shown to decrease the pain and increase the function, thereby changing the the timing as to who needs a surgery?
Or who could be? Who can be addressed conservatively, and lastly, the whole idea of force, coupling, whereas various muscles work together like Salsa dancers, so for those of you that are comfortable with dancing and i'm not one of them if you're if you're dancing closely
As this also dancers would do the the coordination of those steps, matter and force coupling is having multiple muscles all working together, and if one muscle becomes weaker or tighter or loses function it can affect the whole effect, it can affect the dynamics on the
Joint so if somebody were to have a force cup coupling add themality, they would present as progressive pain.
But the cure for that is not necessarily replacing a joint, but to properly address the force coupling with fit with directed physical therapy and compliance with those types of actions so the next slide please so overall we know that the the the imprecise nature and the tendency
Of going towards Joint replacements, because they're so easy and and and profitable.
I'm proposing the joint monitor which is a patent, that I actually got many years ago.
Technology has advanced because I let it become open so that other people could kind of improve on it.
But the concept here is is the same, and that is, if we had, and we utilized a joint monitor as a wholeter monitor for muscular skeletal movement and movement dynamics it would take the guess work out of who needs orthopedic intervention in the form of
Arthropologies, to the hip or the media, and particular, because it allows us to see what is really happening in that patient's life.
How many steps are climbing? How many steps they're making, how their muscles are acting when they're going upstairs, whether they're quadriceps are weak or not firing efficiently you know they the joint monitor by evaluating the actual movement, dynamics
the speed at which join is moving, the speed at which it slows down, etc.
Provides provides quantifiable data which then becomes very helpful and and many aspects.
Here's an example of that where you have a joint monitor and they're hooked up to at first in an office somewhere, but then we send them home and they can we can monitor them while they're just doing the regular activities.
This can then be uploaded back to the physician, back to the various stakeholders.
The insurance company would know that look, we have this patient who is clearly declining over time by 10% per 3 months, or they are compliant, and they're doing these activities yet they're still not imposing in terms of their pain and their functional expectations.
Therefore this patient may need a joint replace, so what is the joint monitor look like the patent device that I developed has potentiometers that can be that can sense change in and motion, and 2 or 3 directions?
This technology would then be applied to a patient, and the case on the right.
We have, a a hip monitor. The Brace type would be different for me, but the principles are the same, and this gives us actual data.
So what does this data do? It provides a disruptive technology.
It breaks the mold of what we currently have.
Where the aging population with normal X-rays showing arthritic changes.
Now we're going to have. We're gonna not just have escoating replacements, but we're gonna have an idea as to what's the actual previewing Baseline will know that there they have one is failure.
Of conservative measures as a pain doctor. We see that all the time where somebody says in the note the patient failed concerning treatment, but what does that actually mean?
This provides a mechanism to know exactly what that means.
Patient, was compliant, patients failing, and were addressed the various issues it can improve.
Expectations regarding post-searchable function, because we know exactly what the patient's function was before they had the surgery, and we can begin to collect democratic and and population data so that we know what's normal for our 60 year old what's normal for a 7 year old we can see the changes
And have quantifiable expectations as to what they should expect after they have a hip or neat replacement, so that we can address how much therapy is enough therapy.
For example, the Post-operative safety and reduced need for revisions is a very, very important point, because the age of hip replacements, but the age, of pip replacements, but the age of patients having Arthur plasties, is increasing because the techniques have gotten better but for
Example, when somebody tells a 75 year old after they've had a hip authority.
We don't want you to bend beyond 90 degrees. We don't want you to bend beyond 90 degrees.
We don't want you to a certain amount. There's no way of the patient having knowledge of when they do that, whereas using the joint monitor provides either vibrations sense or sound sense back.
To the patient so that we can train them better as to what post-operative activities they should avoid, so that they don't have a need for revisions either from dislocating a joint or from accelerated loosening of a joint this also optimizes the
Rebuiltative intervention, because we now know what muscle to address what aspect of joint notion is that we can then decide.
Is there a particular muscle tightness? That's that's that's limiting this as a as a disrupting force coupler and the forces are working together, which one is not working and the therapist can then work specifically to address those limits and it becomes more consistent from
Therapist or therapist, because in the real world every therapist that we send the patient to provides a different intervention.
The the quality and goals of rehabilitation.
We then can know what this patient is expected to to terminate it 4 weeks, because they've been very compliant, and they're making excellent progress versus another one that needs 8 or 12 weeks for example, this whole idea of Maxwell medical improvement.
That the workers compensation group uses to you know just when is enough, and you often can expect somebody to to to get better than they could when they were.
You know, fully functioning, enable, bodied, and lastly cost containment becomes an issue here because data driven and evidence-based care will flatten out the line for who's so that we don't have growing numbers of people having procedures with increasing costs without any data to show what's
What's actually necessary and what's not necessary cause.
Nobody wants to be told that they don't need a mirror.
Placement. If they're doctor says they need it.
But now we have some mechanism to show that it is or isn't needed, or if they have or haven't been compliant, they need this much.
Therapy, etc. So this becomes very disruptive to what's currently the process by which it's decided who needs a joint replacement.
So. Thank you.
And I think this dovetails with the last speaker said, Which is people want predictable risk and a disaster, as a risk, not a certain.
But it's a risk that we can see and predict.
So we are open to questions, debates, discussion.
We.