VA Studies New Ways To Treat PTSD

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The VA Palo Alto Health Care System is collaborating with Fujitsu Laboratories of America (FLA) on research to improve treatment of post-traumatic stress disorder (PTSD) in war veterans.

The research focuses on the problems many veterans have in driving cars, leading to a higher-than-average accident rate for this group of people. As part of a "treatment study," the VA investigators gather data on veterans' reactions in particular situations during their drives while administering treatments that include cognitive appraisal and breathing re-training. This is part of "driving rehab" therapy that veterans are offered at about a third of VA hospitals.

The Palo Alto VA researchers attach sensors to the steering wheel, brake pedal, and gas pedal in the veteran's car, record his heart rate and respiration, and combine that data with the car's location at points in time, as well as factors on the road that might trigger PTSD symptoms.

In an earlier phase of this study, the researchers found it was very difficult to correlate the different data streams so that they could understand what happened and when. Now, they employ Fujitsu's remote monitoring technology to time-synchronize the data. In addition, they use Fujitsu's platform to analyze and transmit the EKG data into an iOS app that is used for in-field physiological monitoring and biofeedback. Also, they now can integrate GPS data from an iPhone to determine location at every instant.

"The advantage of this very precise measurement is that we can be more sure that our treatment is working or not working," said Steve Woodward, staff psychologist at the VA's National Center for PTSD, in an interview with InformationWeek Healthcare. The Fujitsu system, he added, has made the research "a ton easier and has provided a platform for adding devices."

[ Wearable devices equipped with sensors and Web connections help consumers track health and fitness. Take a look at what's possible now. 10 Wearable Devices To Keep Patients Healthy. ]

So far, he said, about 25 veterans--all of them survivors of improvised explosive device blasts--have gone through the treatment study, which lasts a month for each patient. "Anecdotally, they've done pretty well," Woodward noted.

When a veteran enrolls in the study, he has a session with a psychologist, discussing his driving experience in Afghanistan or Iraq and the stress he has experienced while driving in the U.S. Then he has three in-car treatment sessions.

In the car with the veteran are a rehab specialist who administers the treatment and a staff member who sits in the back seat recording on-road incidents on an iPhone 4S that includes the GPS. The data from the iPhone, the accelerometers attached to the car, and a Zephyr monitoring belt on the veteran also goes via Bluetooth to a miniature computer Web server aboard the car. When the researchers return to their office in the hospital, they download the data into their own database.

Fujitsu's own researchers came to Woodward to test a system they were developing to monitor stress in consumers, said David Marvit, VP of data-driven health care for FLA, in an interview. "We felt we should do some application on it to demonstrate it to ourselves, and also we wanted to pick a service we felt was valuable and important," he said.

Although the company believes it has a moral obligation to help veterans suffering from PTSD, Marvit said, its goals for the technology go far beyond that condition. "Pretty much anybody living in America could benefit from a better understanding of their stress and how to manage it," he said.

In a broader sense, he pointed out, the ability to combine data streams in a time-synchronized way has a lot of applications in the mobile health space. "The future lies in using the different data streams to contextualize each other so you can make smarter inferences. Most of the stuff that's on the market today is one sensor with one type of analytic software that's built on top of it," said Marvit. For example, he said, an application for measuring physical fitness and a glucose monitor for a patient with diabetes can't talk to each other.

"So our vision--what's driving this--is to build a platform so that all these other sensors can be integrated and you can apply analytics to the data they generate."

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