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A Student Design Project With a Real-life Application

Former Shepherd patient hopes to get a boost from tailored technology that could one day return him to his career as a surgeon.

Garrett Cuppels, M.D., was in the prime of his life. At 35, he was an avid runner, surfer, sailboarder and saltwater fisherman. He was also an up-and-coming orthopedic surgeon practicing in Delray Beach, Fla. He loved caring for his patients and tried to approach each case with empathy.

“I remember when I was an attending at the VA, I had to amputate a diabetic patient’s gangrenous leg below the knee,” he recalls. “I met with the family prior to the procedure, and they could see I was tearing up. It wasn’t something I wanted to do, but it ultimately would save his life.”

Dr. Cuppels faced his own tragedy in 2010 when he sustained a complete T-10 spinal cord injury (SCI) in a fall. Paralyzed from the waist down, he suddenly found himself a patient.

After completing his rehabilitation at Shepherd Center, Dr. Cuppels was eager to return to work. But, even though he had full use of his upper body, he says the orthopedic practice that hired him told him they could not keep him on after his injury.

“When I was recovering, I assumed my job would be waiting for me, but they didn’t accept me back,” says Dr. Cuppels. “I told them ‘My hands and my head still work,’ but they had already decided, so I had to start looking for a job.”

At a crossroads, Dr. Cuppels not only faced the challenges of adjusting to everyday life, but his life’s work and passion suddenly seemed beyond his reach. However, the kindness and ingenuity of a few strangers soon would help change this.

In the doctor’s quest for job prospects, a team of biomedical engineering students at the University of Wisconsin-Madison heard about his story. They decided to take on Dr. Cuppels’ case and build what they call a standing paraplegic, omni-directional transport, or SPOT device.

“We are trying to give Dr. Cuppels his life back,” says researcher James Madsen. “Getting him back into the operating room will make a huge difference for his wellbeing and sense of independence.”

They believe their one-of-a-kind design will allow Dr. Cuppels to safely and comfortably maintain a standing position so he can again move quickly and precisely during surgical procedures.

How it Works
Commercially available standing chairs either have a front wheel, mid-wheel or back wheel design, so there is no way to move sideways – something that would hinder Dr. Cuppels’ ability to move swiftly and smoothly in the OR. With this new system, the students say he will be able to move in any direction. That’s because it is outfitted with four wheels controlled by four independent motors, giving him full range of motion.

“He can move forward, on a diagonal, sideways. He can rotate in place. Nearly every movement you can think of is possible,” says Bret Olson, an undergraduate student, and design team member.

There is a standing mechanism that will allow Dr. Cuppels to transfer from his wheelchair and a hydraulic pump to move him into the standing position. He will be able to control his movements with a joystick and a computer interface that will allow him steady use of both hands during procedures.

University of Wisconsin-Madison engineering students and faculty work with former Shepherd Center patient Garrett Cuppels, M.D., to adjust the Standing Paraplegic Omnidirectional Transport (SPOT ) device in a student lab on campus.

The team has spent much of the past year making sure the device fits Dr. Cuppels’ needs and integrates safety features. For example, the researchers are making sure the platform doesn’t tip over as Dr. Cuppels leans over. An in-person test session in Wisconsin in November 2012 allowed the team to make further modifications, but they otherwise talk during a weekly session on Skype – something that continually reenergizes the researchers, they say.

The Importance of Technology
“We know technology is hugely important at different stages of SCI rehabilitation,” says John Anschutz, manager of the Assistive Technology Center at Shepherd Center. “Individual patient needs are often what inspire the most innovative and creative technology.”

Dr. Cuppels’ desire to get back to the operating room and care for patients has inspired the team.

“They have taken such care with this project. It’s really amazing,” Dr. Cuppels says. “It renews my faith in people. I feel lucky and blessed.”

And, as Anschutz adds, it’s not just creating a device that moves. The prototype needs to be fashioned to Dr. Cuppels, remain stable as he leans over the operating table and support the fine precision of a surgeon’s hand. Of course, making sure the platform fits the operating room presents its own set of challenges.

The team has tried to anticipate these challenges. For example, they have asked: Will it fit through doorways, is it the right height and will other OR equipment get in the way? They have examined whether the device follows FDA regulations and can be easily sanitized in between cases.

Of course, other issues are bound to arise as the prototype is tested in the OR. Madsen says that, as with other bumps along the way, they will persevere. He and the team are hopeful their creation will eventually help people with paraplegia in other jobs, as well.

“They have done a phenomenal job,” Dr. Cuppels says. “They’ve talked to people in ORs to ensure the device will comply with strict regulations. They have called companies to secure donations. Even if this doesn’t become the first paraplegic robotic surgeon per se and I’m at square one, I think these guys have created something that crosses a lot of boundaries. I hope it will encourage others with SCI to consider medical school and even surgical careers. The device may also benefit people in other occupations where they need this level of precision.”

The prototype costs around $13,000, which has been partly supported by donations from companies.

For the students, the project lets them apply what they have learned to a real-world setting and know they are helping someone. For Dr. Cuppels, it provides hope that he will return to work.

For more information, view this University of Wisconsin-Madison video on the project.

Written By Amanda Crowe, MA, MPH

About Shepherd Center

Shepherd Center provides world-class clinical care, research, and family support for people experiencing the most complex conditions, including spinal cord and brain injuries, multi-trauma, traumatic amputations, stroke, multiple sclerosis, and pain. An elite center recognized as both Spinal Cord Injury and Traumatic Brain Injury Model Systems, Shepherd Center is ranked by U.S. News as one of the nation’s top hospitals for rehabilitation. Shepherd Center treats thousands of patients annually with unmatched expertise and unwavering compassion to help them begin again.