How J.-C. Chiao and a Team of Graduate Research Students are Pioneering Physiotronics to Treat Pain, Gastroparesis
Dr. J.-C. Chiao and his team of graduate research students at SMU Lyle School of Engineering are pioneering the creation of medical implants that will give people with chronic conditions a new option for returning to their normal routines.
Making rapid advances in the field of physiotronics, through which electronics are interfaced with human anatomy, Dr. J.-C. Chiao and his team of graduate research students at SMU Lyle School of Engineering are pioneering the creation of medical implants and wearables that will give people with chronic conditions a new option for returning to their normal routines.
From dialing back debilitating pain on a smartphone screen to automatically regulating stomach motility, the low-cost, wireless and battery-free devices Chiao’s team is designing can intervene in the body’s organ-to-brain feedback loop and restore healthy organ functions in patients suffering from a wide variety of chronic medical conditions that are currently difficult, costly or impossible to manage.
“We’ve built implants on flexible substrates that can go into the brain, spine, stomach, bladder – all these places where electronics interface with soft tissues,” says Chiao.
He explains that once in place, physiotronic sensors and implants can perform a variety of medical evaluations and treatments by more accurately quantifying the severity of medical conditions, such as pain from neural activities, and treating the conditions by triggering various organ responses in the body.
“How do you characterize or document somebody’s pain? It is a subjective feeling. The person tells you how he or she feels, but even the person cannot one hundred percent understand or describe the pain, not to mention that the doctor relies on this number, a scale from one to ten. That’s just not precise,” Chiao says. “So that’s the number one issue: how do you sense one’s pain? And then once you know that somebody has pain, how do you safely inhibit the pain signals?”
Chiao says that the brain and spine implants that he and his collaborators are researching can distinguish between necessary pain, the pain that we all need to protect ourselves like retracting our hand from scalding water, and the debilitating pain that needs to be inhibited so that a person can return to a normal routine.
Collaborating with neuroscientists and anesthetists, the research team has built implants that can detect and analyze neuronal nociceptors signals in the brain and spine that are perceived as pain. Once the signals are detected and quantified, the implants can then emit small electrical voltages that interfere with the propagation of the signals in the neural pathways and therefore inhibit the perception of pain by the brain.
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“The pain signal needs to go from the pain source to the brain, and only your brain can recognize that that’s a pain signal,” he says. “So, the idea is that we send an electrical signal to stop neurons from being synchronized to propagate the pain signal, so the pain signal never reaches the brain. Therefore you don’t feel pain.”
The device simply mimics the natural organ-to-brain feedback mechanisms that we already have. When people feel wrist pain and then rub their wrists, they are interfering with the pain signals being sent to the brain by creating a different signal by the action of rubbing or squeezing their wrist.
“What we are doing is using an electronic device to provide that feedback,” says Chiao. “So, once the device in the body detects pain, it sends a signal to the outside, to say, a wearable or your smartphone. The smartphone then recognizes, yes, this is a pain signal and then asks the person, I detect pain signals. What do you want to do? So, you can send an electrical signal back to the neurons to stop that pain signal. Now you have an electronic feedback loop to manage your pain feeling.”
Artificial Intelligence algorithms can learn the patient’s responses to various levels of pain and respond quickly and automatically over time.
“Once you feel your best, the system now knows the best set of parameters and will be in the background managing your comfort level autonomously,” he says.
In researching how to manage chronic pain with implants, the team found that the devices that they’re developing could help with a wide range of other medical conditions that also work with brain-to-organ feedback mechanisms. The findings offer hope to patients suffering from paralysis of either the gastrointestinal tract or the bladder who could one day be fitted with wearable or smartphone-enabled implants that would allow them to regain normal functioning of impaired anatomy.
“We are working on the stomach motility issue,” he says about gastroparesis. “The Vagus nerve in patients with gastroparesis may be damaged due to diabetes or chemotherapy. The stomach does not move properly to digest food. With a small implant by an endoscope through mouth and esophagus onto the stomach wall, the electrical current from the implant can trigger the stomach to move properly again. Currently, there is no medication to treat such a condition.”
Because implants require surgery, the team focuses on device miniaturization, wireless signal transduction and battery-free wireless powering so they can be implemented by endoscopic or minimally-invasive procedures. Smaller implants will reduce the scale and complexity of surgery. The wireless communication between the implant and smartphone empowers patient’s personalized management.
For gastrointestinal devices, Chiao sees the whole implant procedure taking about 20 minutes with a patient going home on the same day as the procedure. The implantation procedure could also be repeated more easily if the implant position should need to be altered later on.
“We focus on battery-less implants,” says Chiao. “For two reasons: it’s much safer without additional chemicals in the implants; and the implant will be much smaller as the long-term battery capacity can take up a significant volume. Electronic chip size can be in a millimeter scale these days. Removing the battery can make the implant much smaller to fit it through an endoscope.”
A former defense and telecom researcher, Chiao has spent the last 15 years developing biomedical applications of his electrical engineering expertise, racking up several patents to his name in the process. The son of an engineer himself, Chiao had a proclivity for electronics growing up, and once he eventually enrolled as a student in Taiwan University, he was captivated by the endless possibilities that he could pursue in the electrical engineering department.
“When I went to college, I found that everything I thought about electrical engineering was wrong,” he says. “Electrical engineering is so broad: they’re working on chemistry, physics, computers, robots, airplane flight control, semiconductors, photonics, power grids, and they are working on biology and medicine! So-called electrical engineering doesn’t really exist. It means everything actually.”
As a student, Chiao volunteered to assist a professor in his work on fiber optics, and then in the military, he worked on radar systems. His experience then paved the way for his graduate work in microwave, millimeter waves and micro-electro-mechanical system (MEMS) research at the California Institute of Technology.
Now the Mary and Richard Templeton Centennial Chair for the Electrical and Computer Engineering Department at SMU Lyle, Chiao heads a research team that he describes as a diversity of sharp minds gathered from throughout the world, most of whom have no previous research experience in medical devices.
“My group is like the United Nations. I have students from all over the world,” he says. “My goal is to give creativity freedom to students so I can see their growth. Sometimes when a student applies to our school for a Ph.D., and even if the academic background does not fit, if this person has potential and self-motivation, I believe she or he can learn quickly and contribute innovation to our works by thinking outside the box.”
Because of fresh perspectives and diverse backgrounds, Chiao says his research team brings novelty into an already innovative field of study, such as when doctoral student Khengdauliu Chawang adapted the noninvasive microsensor technology so that it can be incorporated into food packaging to detect spoilage, potentially mitigating enormous and costly waste in the food industry worldwide. Chawang grew up in the Indian region of Nagaland where many suffer from malnourishment due to food scarcity. For her invention, she won the Best Women-owned Business Pitch honor during the Institute of Electrical and Electronics Engineer’s Big Ideas competition at the 2022 IEEE Sensors Conference.
Venturing into the various medical applications of his research, Chiao, sees the technologies as a potential solution for the worldwide grand challenges in chronic diseases that he describes as a coming pandemic for the healthcare system. And, inasmuch as mental health issues all involve the brain, he says the budding technologies could one day be used to treat depression and anxiety disorders by detecting measurable signals in the brain’s feedback loop. Particularly, his group now is working on noninvasive methods to detect body chemistry toward this challenge.
“What is pain, exactly?” Chiao asks. “Some people say, it’s so painful for me to have a break-up. If you ask them which part of your body is experiencing pain, they say it’s their heart. But that is impossible. It should be in their brain. However, this kind of very subjective feeling, such as stress and anxiety, may affect our entire body. Can we use noninvasive wearables to sense quantifiable physiological and biochemical signals around our body to detect that kind of feeling? Maybe by understanding better about how our body react to anxiety, stress or even anger, we can improve our mental health and, of course, overall physical health.”
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