Pepster device for PEP therapy takes out iAward

A breathing device that uses gaming techniques to help patients with cystic fibrosis complete positive expiratory pressure (PEP) therapy and lets parents and clinicians monitor progress over time has won its designer a $15,000 prize at the iAwards.

Pepster consists of a PEP therapy device that is linked to tablet or smartphone apps to monitor and motivate patients doing respiratory physiotherapy. For the patient, there are two games that encourage the correct technique and duration, while parents and clinicians can monitor progress and collect additional data such as the effect of environmental or lifestyle factors on the patient's health.

The device is currently being trialled with 30 patients with CF at the Mater Hospital in Brisbane before being readied for the approval process with the Therapeutic Goods Administration (TGA).

Designed by University of Queensland engineering PhD students Elliot Smith, Gavin Kremor and Jeremy Herbert – who have subsequently set up HSK Instruments to commercialise the device – Pepster was featured in the Apps4Broadband challenge last year and last week won a $15,000 prize for Mr Smith, who was named the Hills Young Innovator of the Year at the iAwards.

Mr Smith said the idea for Pepster came about in the final year of the team's electrical engineering degrees, which required a thesis project. He and his colleagues met with clinicians from the Mater about some of the problems faced in motivating children to do their physiotherapy, but also in properly monitoring how the therapy was progressing.

“From the clinical perspective, one of the big problems is that once they are out of the hospital, we don't know if they are doing the physio because of the inability to record anything on the current hardware,” Mr Smith said.

“From the parents' point of view, the lack of incentive and motivation really makes it hard for the parents to get their kids to do their exercises. So we decided to try to find a system to tackle both of those problems.”

PEP therapy uses inhalation and exhalation exercises that are designed to clear the thick mucus characteristic of cystic fibrosis. It is used as an alternative to chest physiotherapy using percussion.

Mr Smith and his team have designed a new PEP therapy device that can connect to standard face masks as well as to a tablet device. They have also designed two games – one involving spaceships and the other birds – that are controlled by the patient's respiration.

“Essentially there are different elements in the games that are controlled through the device, so their breathing changes things in the game,” Mr Smith said. “For example, in the space game, the spaceship moves up and down based on whether they are breathing in or out. The way to get the highest possible score in the game is to do what is clinically recognised as ideal physiotherapy.”

While the games are a motivating tool for the child, Pepster can also collect a great deal of data for clinical and research purposes that has previously been unavailable.

“First and foremost we want to know when they are doing the therapy and how often they are doing it, to see if they are attempting to do it at all,” Mr Smith said. “Secondary to that, we want to know how well they are doing it.

“Essentially they have a goal of breathing in for around about one second and out for three seconds. Their inspiration is a normal in-breath, and as they breath out there is resistance, which helps build up the pressure, which is what clears the mucus out.

“If you can imagine the inspiration to be zero and the expiration to be one, you get a square shape, and we are measuring how closely they fit to that shape.”

For parents and clinicians, there is a huge amount of information that can be extracted from the data, including whether the child is actually doing their therapy in the first place, when they are doing it and for how long, as well as changes over time and whether exterior factors have an influence.

“Their progression in terms of their physio performance on different dates is something that we are definitely looking at, and due to the fact that we now have the time stamp of when they have done the physio, we can then gather things like the weather on that day and all sorts of information like that to see if there are links that we would never have seen before.

“Measuring their progression in dealing with CF and environmental factors and lifestyle factors will give researchers and clinicians information on how we might better treat this in future.”

Mr Smith said there were other products for respiratory disorders such as asthma that use apps and gaming, and he is aware of one used clinically for measuring forced expiratory volume (FEV) that uses a game to encourage children to do the exercise, but he believes Pepster has something that the others don't.

“There's nothing that combines the gaming and the portable nature of this device,” he said. “With something that they have to do everyday, it differs from an FEV measurement which they might take once every six months.”

Pepster is currently being used in a clinical trial at Mater Hospital, involving 30 patients in total who are given the device for six weeks. They are asked to use it every day for about an hour, which is the typical routine for PEP therapy.

“That should all be wrapped up sometime in November and after that we'll start to look at some of the clinical implications of the data we have collected,” Mr Smith said.

“Then our goal is to get this device out in the public and into the hands of the people that need it, both here in Australia and anywhere in the world.”

Posted in Australian eHealth

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