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KENTFIELD — Brian Lande leans over the railing of his wife's hospital bed and gives her a kiss.
Melissa Carleton's eyes open and her gaze meets Lande's, but only for seconds before she drifts back to sleep. He rubs her right ear and whispers that he will be back in the morning.
It's difficult for Lande to leave Carleton's bedside. She has been minimally conscious with brain damage since surgery in March to remove a fist-sized brain tumor.
They're newlyweds, married a year ago today on a Norwegian cruise ship anchored in a fjord. And they're new parents: Carleton gave birth to their healthy son two months ago while remaining in a coma-like state.
Lande has become so in tune to changes in her health that earlier this month he alerted doctors to a dangerous blood clot in time for it to be dissolved. But for the times he and family members can't be there, Lande has turned to technology: Motion sensors on Carleton's wrists track movements — a hand lifted or an arm raised.
It's a novel use for the wearable movement technology, and people in the industry say Carleton's results show there is a potential for more uses for patients with brain injuries.
Lande had help getting the sensors and analyzing the results and wants other families to have easier access to the technology. And he hopes a collaboration can occur with Fresno State to make that happen.
"If other people would benefit, that would make this all the more perfect," Lande says.
For now, the sensors on Carleton's wrists have helped confirm what he could only suspect: His wife is making progress.
"It has made me be much more confident that what I'm seeing isn't biased by my love for my wife."
Looking for progress
As he sat by Carleton's side three months ago, Lande was becoming more convinced that she was more active and more aware of her surroundings.
About a week before she gave birth on May 22 to West Nathaniel Lande, Lande saw a big change: "Her eyes were open more and her arm movements were stronger."
At the University of California at San Francisco hospital, physical therapists for weeks had been unable to document enough improvement to justify continuing intensive physical therapy. The hospital wanted to reduce the treatment from five hours a week to three.
"I was very upset," Lande says, but at the same time, he understood the hospital's reluctance. Doctors and therapists spent minutes a day with Carleton — not enough time to capture her full range of activity.
He also knew the doctors couldn't rely on his assessment, because even he had doubts: Was his evaluation driven by grief, his perception marred by eagerness to have his wife return to her vibrant self?
Before her brain was injured, Carleton had a busy Fresno therapy practice and ran a breast cancer support group at Saint Agnes Medical Center.
To help his wife, Lande needed an objective appraisal.
He tried over-the-counter fitness motion sensors that measured steps, but they were not sensitive enough.
Lande needed help and he knew where to find it. In 2010 when he met Carleton, he was on a two-year leave of absence from his job as a Santa Cruz County sheriff's deputy and was using his Ph.D. in sociology to work at the Defense Advanced Research Project Agency, part of the federal Department of Defense. His technology project involved the use of sensors to quantify and measure soldiers' social interactions, including facial expressions and body language.
To measure Carleton's movements, "I knew the easiest way was to use some of the same technology," he says. But he couldn't afford sensors that can cost $5,000 to $7,000.
He reached out to APDM Inc., an international company based in Oregon that makes sensors to track movement. "Obviously, we wanted to help," says Matthew Johnson, APDM director of sales and marketing. "My wife went into labor about the same time as Melissa. ... Our hearts went out to them."
Johnson sent two sensors on straps that could be fastened around Carleton's wrists like watches.
The sensors are capable of collecting 128 data points of information per second, Johnson says. Consumer-grade sensors typically can take about one sample per second.
The wireless sensors include accelerometers to measure acceleration, gyroscopes for angular velocity and rotational speeds and magnetometers to measure direction.
"It's the same technology that is used in airplanes for navigation," Johnson says. "That's kind of the best way to think about it. Couple it with a GPS and you can fly an airplane."
The APDM sensors have been used to look at how a person walks, including gait and balance, but Lande's use of the sensors "is different from any of the measurements we've ever done," Johnson says.
Once he received the sensors, Lande turned to Ben Waber, a friend and colleague from his defense agency days who has expertise in analyzing motion data. Waber is a Massachusetts Institute of Technology scientist and president and CEO of Sociometric Solutions, a Boston-based company that measures social interactions using wearable badges.
Potential to help others
It was the first time Waber had analyzed movements from a patient like Carleton: "This was literally just me in my spare time, trying to do something that would be helpful to Brian and Melissa."
But from his analysis, Waber says: "It does look like Melissa has certainly gotten stronger over time."
Waber also could tell that Carleton's right arm is a little bit stronger than her left, which could help direct physical therapists to do more strength exercises for that arm.
Looking at Carleton's movements over time also can provide clinicians with more than a snapshot of her activity, Waber says. It can help predict her wake-sleep cycle so treatments can be scheduled to coincide to the times when she is most alert.
Using the wearable technology to measure Carleton's progress has another benefit: It's cheaper than the more traditional method of taking magnetic resonance imaging (MRI) scans for brain activity, Waber says. "Each MRI costs on the order of $1,000."
Waber is now working on software that will give Lande a daily printout of the results.
Carleton's case shows there is potential for new medical applications for motion sensors, Waber says. "I do think at the very least we're proving what can be done."
The sensors have provided the proof that Lande needed, and doctors at UCSF deferred to the data. "We got her back to five hours of physical therapy," Lande says.
In June, Carleton was moved from the UCSF hospital to Kentfield Rehabilitation & Specialty Hospital in Marin County. She is getting several hours of therapy a day there — and the work is paying off. On Wednesday, Carleton moved her legs on command — a first, Lande says.
Lande is being cautious not to place too much hope on the motion sensor data. Tracking her movements "doesn't predict that Melissa is going to keep on getting better," he says.
The next step, he says, is to take the information from the sensors and design therapies for Carleton. Lande has contacted a Rutgers University psychologist in New Jersey who has used movement analysis techniques to help patients with autism. He hopes she can help tailor therapies to speed Carleton's recovery.
He is confident enough in the motion sensor technology to become a booster and hopes to get professors and students at California State University, Fresno, involved in making a cheaper — and easier to use — version of the software for analyzing the data. The technology should be more accessible to the public, Lande says.
Michael Caldwell, associate vice president for faculty affairs at Fresno State, says he is assembling an interdisciplinary team to discuss a possible collaboration with Lande. "Our hope is the team can make a difference for patients who are comatose," Caldwell says.
The motion sensors are no substitute for a husband's personal observations.
While the sensors charge and are off Carleton's wrists, Lande doesn't need them to know that Carleton seems to be aware that he and their son are in the room.
As Lande changes West's diaper in a portable crib pushed into a corner, the baby's cries grow louder. Carleton's eyes open.
Swaddling West in a blanket, Lande soothes him as he brings him to his mother's bedside. "All right, Melissa, you've got a little guy next to you." Baby an mother relax.
Lande has more on his mind than motion sensor analysis. He is thinking about a first wedding anniversary celebration.
The day won't be what he had initially envisioned. "Before this happened, I was going to take Melissa on an anniversary cruise to Alaska." Now, "I can't even take Melissa out for dinner."
Nevertheless, she will have a special day, he says. "I can still make her feel good — that may be all I can do for her right now."
And he has ideas for a special, romantic day at the rehabilitation hospital, soliciting help on the Facebook "Support Melissa Carleton" page for a photographer to take pictures and for a seamstress to sew Carleton a new dress.
The celebration will be small and intimate. Carleton, a very private person, would want it no other way, Lande says.
When the ship's captain married them a year ago, only a handful of people were witnesses to the ceremony, Lande says. "We had a small wedding, and it makes sense to have a small anniversary."