Declining health and fitness are commonly known to accompany spinal cord injuries and disorders (SCI/D). Physical deconditioning and weakening of the upper limbs make essential daily activities such as wheelchair propulsion and body transfers more difficult to perform, thus challenging the activity and independence that persons with physical disabilities require throughout their lives. During the past few decades, attention has also focused on so-called cardiometabolic risk factors, including five critical health hazards: overweight/obesity, insulin resistance, hypertension, and lipid abnormalities. Evidence now suggests that these health risks appear soon after discharge from initial rehabilitation, tend to cluster, and in doing so represent more severe health hazards. They are also more challenging for stakeholders with SCI/D, their caregivers, and health care professionals to manage within the first year of living with a SCI/D and after that throughout their lifespans.

Current health guidelines designed for persons with SCI/D all recommend incorporating physical activity to a level permitted by their ability. Outdoor exercise is an option to fulfill this need. However, it may expose the individual to temperature extremes and uneven rolling surfaces that risk a fall from the wheelchair and ensuing injury. Thus, recent evidence suggests that home-based exercise is preferred for those with SCI. Home-based exercise also circumvents exercise barriers involving transportation, lack of physical access, and exercising in facilities that serve, have staff trained for, and use equipment designed for persons without a disability.

To meet the complex needs of upper extremity conditioning without the hazards imposed by standard arm ergometry, the newly upgraded and technologically advanced Vitaglide better serves as an exercise mode after SCI/D.

Equipment that satisfies the broad health needs of persons with SCI/D is challenging to find. Selected specialized exercise systems have used surface electrical stimulation to initiate the contraction of paralyzed muscles located below the injury level. These muscle contractions can be sequenced under microprocessor control to create purposeful movement such as cycling, although generally with poor motor efficiency and coordination. These electrically stimulated devices often exclude persons with injuries below the T10 spinal level and require special medical clearance and ongoing supplies such as electrodes and wire leads. Those with injuries and disorders that spare their sensation often find the electrical current uncomfortable, if not painful. While generally considered safe for home use, there is a need for electrode placement before each session. Risks of use include lower extremity fracture or bouts of autonomic dysreflexia. Importantly, there is limited transfer of lower extremity electrically stimulated exercise to benefit upper limb conditioning. It has long been clear that voluntary contractions of muscles above the injury level result in higher physical conditioning levels, and better risk reduction for cardiometabolic disease.

The arm crank ergometer has been a longstanding staple of upper extremity exercise for those with SCI/D. Essentially a table or platform mounted arm cycle, the device typically uses a rudimentary forward propulsion motion against resistance, with the upper limbs propelling the device while 180 degrees out of phase with one another. Few arm crank devices allow adjustment of the axis of rotation, meaning there is one set length for motion. Even fewer devices allow reverse propulsion against resistance. The continuous forward cranking imposes imbalanced forces that condition and tightens the anterior shoulder and chest while not similarly benefitting the posterior shoulder. The imbalance of the anterior and posterior shoulder actions may represent a cause of shoulder pain for persons with SCI/D. As the upper limbs of persons with SCI/D are essential for maintaining daily activities, the pain caused by cycle ergometry may exceed the benefit of physical conditioning.

To meet the complex needs of upper extremity conditioning without the hazards imposed by standard arm ergometry, the newly upgraded and technologically advanced Vitaglide better serves as an exercise mode after SCI/D. The device is a reciprocating ergometer with the arms moving near horizontally instead of in a cyclical pattern. The movement of the limbs are balanced between a forward pushing motion on one side of the body and a pulling action on the other side. In this way, the device maintains the anterior and posterior muscle balance for conditioning of the chest, shoulders, and back. Its features also permit synchronous rowing where both limbs move together in the same forward and backward direction. Unlike a cycling ergometer, the resistance for each arm can be set independently and spans work intensities that will develop both endurance and strength. The side arms allow the user to determine their preferred range of exercise motion instead of the device.

The Miami Project to Cure Paralysis at the University of Miami Health System has used the Vitaglide for several years as part of our comprehensive SCI/D lifestyle program and has been preferred by our program participants, so much so that they seldom use our cycle ergometers. The individualized resistance adjustment permits us to select optimum exercise intensities when the strength and endurance of the arms may be unequal. We have also found it easier to customize exercise programs and maintain records of performance incorporating time and work performed. Our ultimate goal is to encourage health-sustaining physical activity after SCI/D without injury.

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By Richard Zane, M.D., Chief Innovation Officer, Sarah Wendel, M.D., Administration, Operations, and Quality Fellow & Adeel A. Faruki M.D., Operations, Executive Leadership, and Innovation Fellow, University of Colorado Anschutz Medical Campus

When healthcare professionals at the University of Colorado Anschutz Hospital lined up to receive the Pfizer-BioNTech COVID-19 vaccine in December and January, some were wearing one of the newest approaches to wearable technology — a coin-sized device affixed with medical-grade adhesive to their upper left chests.

The low-cost medical grade device was the BioButton^TM, an FDA-cleared device that provides continuous vital sign monitoring of skin temperature, respiratory rate, and heart rate at rest. It was developed by BioIntelliSense, a clinical intelligence company based in Golden, Colo., and has been utilized as a scalable and cost-effective solution for health screening and COVID-19 symptom monitoring.

As vaccines became available to healthcare professionals starting in December 2020, our CARE Innovation Center, along with CU Innovations and UCHealth, partnered with BioIntelliSense. The goal was to explore the clinical applications of the BioButton^TM for monitoring vaccination as a foundational step in developing a scalable post-vaccine monitoring program that could be deployed broadly.

Healthcare workers at the University of Colorado Hospital on the Anschutz Medical Campus were offered BioButton^TM as an operational pilot designed to evaluate the logistics of deployment, operational feasibility, and interest in wearable technology for post-vaccine symptoms self-monitoring.

They were provided a BioButton^TM at no cost, and interested individuals were asked to wear the device 2 days before and 7 days after receiving the vaccine. Upon activation of the device, participants were surveyed to assess ease of applicability of the device and if the wearable technology made them feel more comfortable with COVID vaccination. In addition, voluntary daily health surveys assisted participants in monitoring signs and symptoms that may require further assessment. The operational pilot was performed in two phases. The first phase had volunteers assisting with device setup and activation. The second phase allowed participants to obtain the device and a setup guide from various pick-up locations.

We learned many lessons during our operational pilot, including discovering that participants can obtain the BioButton^TM wearable, place the device, and complete setup without direct assistance. But we also determined that allowing individuals to obtain devices from pick-up locations free of cost resulted in a significant number of devices being obtained and never activated.

The participation of our frontline healthcare workers in this vaccine monitoring program serves as a key operational milestone in our ability to scale the program for the larger populations. We believe it will be essential to assist participants through the activation and setup process to improve device utilization during the expansion of this pilot to other populations.

As COVID-19 vaccines become more available, BioButton^TM or other wearable technology could help improve vaccine acceptance by enabling individuals to monitor themselves for side effects.

As supplies of COVID-19 vaccines become more available, BioButton^TM or other wearable technology could help improve vaccine acceptance by enabling individuals to monitor themselves for side effects. Nearly 134 million in the U.S. have been fully vaccinated against COVID-19 as of May 29, 2021, and almost 167 million have received at least one dose. If wearable devices enable more of the world’s population to be vaccinated, we fully support expanding the use of this type of technology to other individuals.

At the UCHealth CARE Innovation Center, located on the University of Colorado Anschutz Medical Campus, we continually explore the ever-changing healthcare landscape with the goal of working alongside leading industry and start-up partners to revolutionize healthcare. We emphasize entrepreneurial, quick-to-market innovations that eschew bureaucratic red tape.

Established in 2016, the UCHealth CARE Innovation Center focuses on designing innovation platforms to cut through the predictable obstacles that encumber other large organizations so our partners and people around the world, can benefit.

Development of the COVID-19 vaccine has proven to be a significant clinical achievement in addressing the global pandemic. Wearable devices like the BioButton^TM are a promising step in addressing this worldwide crisis.

BioIntelliSense’s strategic partnership with CU Innovations, UCHealth, and its CARE Innovation Center explores the clinical applications of the company’s wearable medical devices and medical-grade services. The alliance is committed to developing and validating new models of data-driven care that are patient-centered and built for scale. We aspire to bring technological advancements into the hands of our patients and providers to improve outcomes and change the practice of medicine.

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