Researchers from the Fraunhofer Project Group for Automation in Medicine and Biotechnology PAMB are developing a system together with Mannheim University Hospital and businesses in the music industry with the aim of improving communication between surgeon, patient and speech therapist during awake craniotomies, which will help to avoid lasting speech impediments.
Awake craniotomies are very demanding on all those involved: Although the patient does not feel any pain, they nevertheless remain conscious whilst the surgeon removes the tumor in order to ensure that the physician can operate in the area in and around the speech center. The patient hears everything – from the regular beeping of the anesthesia monitor to the humming of the equipment used by the surgeon and the verbal exchanges which take place during the operation.
The surgeon must remain singularly concentrated for several hours, blocking out background noise. The patient, however, is placed under a substantial amount of stress during the procedure and would find the noise of the surgical instruments very uncomfortable. If the tumor is located near to the speech center, the speech therapist carries out various tests during the operation: The patient must read a piece of text out loud, name things and finish sentences. However, the constant background din and the noises of the operation immediately behind the patient's ear makes it difficult to communicate and for the speech therapist to carry out the necessary linguistic interpretation of the patient’s speech.
Jens Langejürgen, who deals with biomedical sensors and microsystems for PAMB, explains: "The awareness of logopedic findings has increased over recent years. Today, merely knowing whether the patient is able to speak at all is no longer sufficient. Rather, speech therapists are increasingly paying attention to details, to correct articulation." This is why the time has come for a communication system which makes awake craniotomies a more pleasant experience for all involved.
Jens Langejürgen is currently developing such a system in tandem with physicians from Mannheim University Hospital, the promotional center for business Startup Mannheim and three companies from the music industry. Together, they have formed the working group "Musik & Medizin(-technologie)" and are adapting cutting-edge audio technology to the conditions present in operating theaters. Langejürgen explains: "The headphones must be as sound-proof as possible to disturbing background noise as well as comfortable to wear, as awake craniotomies often last for many hours. The system must be easy to use and, as far as possible, it must also be hands-free for the surgeons, too". The team must also take into consideration the influence of masks and scrubs, as well as ensuring that patients remain easily accessible in case of emergency.
Initial tests carried out by the PAMB at Mannheim University Hospital in the Hybrid-OP, an experimental operating theater, have been successful. In the next step, the project partners will construct a fully functioning demonstrator in the Hybrid-OP and further develop the communication system together.
Therefore, it will not be too long before patients will be able to relax to their favorite music on the operating table, completely undisturbed by the background noises. Every now and again, the speech therapist will tune in, pause the music and carry out a few tests. Because the speech therapist will also be largely isolated from the background noise, they will be able to easily pick up on the slightest speech impediments. They will then be able to switch communication channel to the surgeon and share their findings.
Relatives of the patient, interpreters and other external helpers can all be involved in the communication if necessary. Because everything is recorded, the speech therapist is able to carry out a review afterwards and draw conclusions – these can then be applied to the next awake craniotomy. As a result, it will become increasingly less likely that a patient will be left to contend with a lasting speech impediment.
In 2016, the promotional center for business Startup Mannheim established the work group "Musik & Medizin(-technologie)" in order to foster understanding of and promote knowledge transfer between the two industries. In addition to the Fraunhofer Project Group for Automation in Medicine and Biotechnology PAMB, Mannheim University Hospital, Startup Mannheim and three businesses from the music industry (SPL electronics GmbH, Session pro GmbH and inEar Monitoring GmbH & Co. KG) are also all involved.
Fraunhofer IPA's Project Group for Automation in Medicine and Biotechnology PAMB at the University of Heidelberg's Mannheim University Hospital was established by the federal state of Baden-Württemberg and the Fraunhofer Group to unlock automation potential in medicine and biotechnology. Five interdisciplinary groups work at the intersections of diagnosis, therapy, laboratory and production, making this the first prominent establishment with this distinct focus. The project group is located in the CUBEX41 at Mannheim University Hospital.
Fraunhofer Institute for Manufacturing Engineering and Automation IPA