Luke MacNeill Recognized For Research On ‘Wide-Awake’ Surgery
Three researchers are being recognized as New Brunswick Health Research Foundation (NBHRF) Rising Stars this month for their innovative work to improve healthcare, whether through direct patient care, improvement in prosthetics equipment, or health programming for children and youth.
Saint John-native Luke MacNeill was recognized for his study on the experience of patients during wide-awake forefoot surgery. The paper was published in the journal Foot and Ankle Surgery last November. MacNeill worked with Horizon orthopedic surgeon Dr. Joshua Mayich as his main collaborator, and John Wright, a medical student who is now a resident in Anesthesia.
“I guess what stimulated the research was, New Brunswick has an aging population with limited healthcare resources. This has prompted many healthcare providers to look at novel, cost-effective ways to deliver healthcare to their patients. And one method is wide-awake surgery,” he said.
MacNeill said more orthopedic surgeons have been conducting surgery with their patients wide awake in the last decade or so. These surgeries, which rely primarily on the use of a local anesthetic, have fewer risks and side effects than surgery with general anesthesia or sedation. They are also cheaper to perform because they don’t require the presence of anesthesiology staff or equipment.
But MacNeill said the patient experience has been put on the backburner.
“These benefits are great, but they mean very little if patients are experiencing a distressing or traumatic operation,” he said.
MacNeill and Mayich have been working on the subject in two published papers and two more recently completed studies. In this research, they found that patients feel little or no pain during surgery, and that the mild to moderate anxiety patients experience pre-surgery declines steadily over the course of the operation.
Patients who undergo wide-awake surgery also have substantially less post-operative pain and anxiety compared to those receiving surgery with general anesthesia.
“Not only did we find that the patient experience was tolerable, but wide-awake surgery actually seems to improve on traditional surgeries in some respects,” he said. “Our results indicate that surgeons can continue to use this technique without worrying about traumatizing their patients.”
The psychology PhD candidate said UNB’s strong relationship with Horizon Health Network has afforded him many opportunities for collaborative research that focuses on patients.
“You don’t really get these types of research opportunities at most universities, and certainly not in most psychology departments,” he said.
Now MacNeill is also looking into the different types of sensations and emotions that patients experience during their wide-awake surgeries, as well as the experience of the surgeons conducting these operations.
Force Sensors For Cheaper, Lighter Prosthetics
UNB Fredericton masters candidate Alex Belyea’s proportional control paper was published in the Journal of Neural Engineering in June. Conducted with Professors Kevin Englehart and Erik Scheme of UNB’s Institute of Biomedical Engineering (IBE), it looked at an alternative to electromyogram (EMG) sensor technology for body-powered prosthetic limbs.
EMG relies on electrical signals on the skin to identify what the muscles below are doing. But this approach is highly susceptible to drift and signals can change when a warmer day makes the user’s skin sweaty, for example.
“That kind of promotes the research into alternate sensor types. One of these that I was looking at was force sensors, looking at the pressure signal. So if you can feel at your forearm and you’re moving your hand around, then you can see that there are certain pressure patterns to the muscles and you can see other tissues kind of move around,” Belyea said.
Previous studies have found that FMG sensors have a very high classification accuracy, which means it can be trained to correctly identify a motion as one. This allows users of prosthetic limbs multiple degrees of freedom, including controlling multiple fingers, wrist and elbow as opposed to only opening and closing a hand, for instance. FMG sensors can also make prosthetics more intuitive to use as opposed to extending an arm to open a hand and flexing it to close the hand.
With his study, Belyea was looking at whether FMG also has a high usability when implemented in prosthetics. FMG-based devices often run into issues related to high latency, among other things.
“[With FMG] either you wait between motions or your ability to control the speed of the device is severely diminished,” he said. “It becomes important not just to look at the classification accuracy but rather the device usability.”
Belyea also looked at whether something may hinder FMG sensors from being highly usable, and he compared it with EMG sensors.
If FMG is shown to work well, it could have the potential to significantly lower the costs of prosthetic limbs as compared to EMG-based systems. FMG-based prosthetics would also be lighter and slimmer.
“So if less expensive technology were able to work in a clinical setting and be proven to be reliable, then that could potentially increase the availability for these kind of multi-degree freedom prosthetics to individuals who otherwise would not be able to afford them,” Belyea said.
The New Brunswick native said his interest in prosthetic sensors was sparked after he met Scheme during his undergraduate degree in mechanical engineering. His master’s work is more on the electrical side.
How Life Stressors Affect Kids’ Physical Activity
Patrick Abi Nader, a post-doctoral fellow at the Centre de Formation Médicale du Nouveau-Brunswick in Moncton, is part of a team that studies the physical activity and habits of children and youth in New Brunswick.
The study, called MATCH, has been following 937 children since they were in grade five or six since 2011. The project is led by Mathieu Belanger, the Director of Research at the Centre de formation médicale du Nouveau-Brunswick, an epidemiologist with the Vitalité Health Network, an associate professor with the department of family medicine at the Université de Sherbrooke, and an adjunct professor in the kinesiology department of Université de Moncton.
NBHRF recognized Abi Nader as a Rising Star for a paper he wrote as part of this study that focuses on the effect of life stressors on the physical activity levels of these kids. It also looked at how the stressors, like breakups, parents’ divorce, lack of financial means and others can influence youth’s participation in organized and unorganized sports.
“Children in Canada in general, and in other countries too, when they cross the transition from childhood to adolescence, they tend to experience a great decrease in their physical activity levels,” he said.
Among the findings, Abi Nader noted that girls who experienced a stressor classified under “personal events,” such as break-ups and struggles at school, reported increased participation in organized and unorganized physical activity. Girls also reported higher participation in unorganized physical activity after experiencing “extrinsic events” like moving homes with their family, or parental divorce.
For boys, extrinsic events and extrinsic circumstances, which can include things like lack of transportation or finances, led to increases in unorganized physical activity.
“Youths’ [boys and girls] continued participation in organized and unorganized physical activity, despite experiencing a life stressor, may be a sign of resiliency or adaptability,” Abi Nader said.
For both girls and boys, personal circumstances which could include things like the loss of interest in physical activity was the only indicator that was related to a strong decrease in moderate to vigorous physical activity.
Abi Nader said he personally hopes the MATCH study would lead to the creation of better physical activity programs, or the improvement of existing programs. He’s hoping the study can help recommend ways to better reach youth today, and how programs can fit them better and get them more active.
As an active person himself, he feels this the focus on physical activity is important.
“Physical activity is one of the behaviors that is recommended as a non-medical or [non] supplement-based behaviour that we can do for our health that can promote better mental health, emotional and physical health. All of these things are usually individual priorities,” he said. “I feel that we should raise people that have access to these benefits as well. I’m convinced that as a population as a whole, we can do better at being active every day.”
The Lebanese citizen said the applicability of the study was one of the things that led to his move to New Brunswick after completing his PhD in kinesiology and physical activity in the U.S.
“I learned about Mathieu’s work through connections that do work in kinesiology and physical activity too,” he said. “I was very interested in learning and applying, more so than just learning, complex statistical methods to model longitudinal trends. And since I’m in physical activity and I care a lot about promoting it, it was a great opportunity that Mathieu invited me to join his team. Once I got here, I applied also for my own scholarship and I was able to secure it with New Brunswick Health Research Foundation.”
Now Abi Nader is preparing another publication focusing on how the weather condition in New Brunswick can influence youth and children’s sedentary behaviours during different seasons.
This story is sponsored by the New Brunswick Health Research Foundation.