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The orb speaks for infants

Monday July 1, 2013
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If Martin Schiavenato, RN, PhD, were to gaze into a crystal ball, he would envision a future in which patients no longer experience pain or suffering.

Schiavenato, who until recently was an assistant professor at the University of Miami School of Nursing and Health Studies, has spent the past several years working with a team of medical engineers to create an orb-like device that has the ability to assess pain in premature infants. The device, which resembles a crystal ball, uses sensors to monitor a patientís behavioral and physiological signs of pain. By notifying clinicians of a patientís pain level, Schiavenato hopes his device will lead to better pain management practices.

"I remember looking at the polygraph test administered by law enforcement professionals and wondering how it was possible that we could detect when a person was lying, but not when they were in pain," he said.

While Schiavenatoís invention still needs to undergo additional testing, it shows great promise detecting pain both in infants and in nonverbal patients, such as intubated patients or those who suffer from cognitive impairment.

"Assessing pain in infants has always been one of the most difficult challenges for clinicians," Schiavenato said. "Premature infant pain responses are unique and different from those of an adult."

As a result, Schiavenato says, pain has often been undertreated in infants, with many clinicians fearing the adverse effects of analgesics, such as morphine, and weighing the risks of these medications against the potential advantages.


Martin Schiavenato, RN, PhD, second from left, explains his pain-detecting orb to students. Photo courtesy of Martin Schiavenato.
"Until recently, it was believed that neonates didnít feel pain," Schiavenato said.

While clinicians have walked a fine line as they determine how to treat pain in infants, Schiavenato says there is evidence that failing to treat their pain early can lead to significant and long-lasting physiological consequences. These can include hypersensitivity to pain, a reduced immune system response, and even long-term disabilities and developmental delays.

Schiavenatoís own interest in how pain is managed in infants began 18 years ago when he was working as a nurse in the NICU of a Tallahassee, Fla., hospital. One of his young patients had a rare and painful genetic disease that caused her skin to blister and slough off. The baby died several days after birth but left a lasting impression on Schiavenato.

"When it was time for me to choose a specialty, I decided to work to alleviate pain in infants," he said.

Schiavenato, who has a PhD in nursing and innovative technologies, joined the faculty at the University of Rochester (N.Y.), where he worked to develop a scale that enables providers to better assess pain in preschool-aged children. In 2009, Schiavenato was awarded an RWJF Nurse Faculty Scholars award to support the invention of his device.

Today, a patent is pending for the orb device, which uses a computer chip to interpret a patientís pain signals. Leads are placed over an infantís chest to calculate heart-rate variability in response to distress, while another sensor is placed in the palm of the hand to record an instinctive finger-splaying response to pain. A third sensor monitors facial responses to pain. The computer then calculates the subjectís pain levels and displays the findings on a glass orb that can turn various colors to reflect the patientís pain levels.

While Schiavenato noted his device also has the ability to work on non-verbal children and adults, he says the parameters and sensors would vary according to the age and condition of patients.

Now an associate professor at Washington State University College of Nursing in Spokane, he also is working on fine-tuning many of the deviceís characteristics, such as how the orb changes colors based on a patientís pain levels.

"Clinicians will be able to set a patientís baseline color and note changes in color to determine if pain increases," he said.

He continues to test the device, but said he would love to see his device brought to market by a medical supply company.

"Twenty-plus years ago, open-heart surgery was being performed on infants without any pain meds," Schiavenato said. "Weíve come a long way since then, and hopefully in the future, we will have an even better handle on how to effectively manage pain in all patients."


Linda Childers is a freelance writer. Post a comment below or email editorSouth@nurse.com.