Biomedical engineers in Duke’s Department of Biomedical Engineering are teaming with otolaryngologists and speech pathologists in the Division of Head and Neck Surgery and Communication Sciences to apply augmentative and alternative communication technologies for patients with cognitive impairments and neuromuscular disabilities that make speech difficult or impossible.
Professor Kevin Caves, MEM, a rehabilitation engineer, a clinical associate in the Departments of Surgery and Medicine, and an instructor in the Department of Biomedical Engineering, says there are three primary ways Duke is working to improve the quality of life for people with speech disorders and other types of disabilities.
For nonspeaking people, primarily those with amyotrophic lateral sclerosis (ALS) who have lost the ability to speak, Duke is working to match commercially available speech-generating devices to their individual needs. “With ALS, people can communicate verbally at first, but as the disease progresses they rapidly lose the ability to control the muscles involved in speech,” says Caves. “We look for small, portable solutions, such as a tablet or device on their phone, to augment their speech.” When patients lose motor control of their limbs and are unable to type on a computer, Duke is helping them with devices that use head movements to control a computer mouse or eye tracking to select letters on a screen. Caves and his team evaluate patients individually, look at the likely progression of their impairment, and match them with the best device for their needs.
“We research and monitor technologies that we think might help people, then develop prototypes and engage with companies that can get the products to market,” Caves explains. With funding from the Rehabilitation Engineering Research Center for Information and Communications Technology Access (LiveWell RERC), Caves and his colleagues have initiated a number of proof-of-concept projects. These include a talking photo journal for people with complex communication needs; a device that helps people modulate their speaking volume; and an application that enables people who are deaf, hard of hearing, and nonverbal to communicate using their smart phone or tablet.
A large part of Caves’ work involves teaching the next generation of biomedical engineers to integrate technology with biology. In one class, students design projects for people in the local community who have unmet needs because of disabilities. At the end of the semester they design, build, test, and deliver a working device. One student designed a device to help patients with diabetic retinopathy who lose their vision and the sensation in their hands to safely use insulin pumps.
Caves foresees advances in noninvasive brain–computer interfaces in the near future, such as using EEG responses to channel information from the brain to onscreen keyboards. Caves and colleagues published a study in 2017 in Clinical EEG and Neuroscience investigating the performance of three brain–computer interfaces in an ALS population, and he anticipates that further research will continue to guide biomedical engineers in helping people with little or no physical ability to communicate. “We’re making great strides in identifying and solving problems that have a significant impact on human health,” he says.