By Deborah Borfitz

November 20, 2019 | A wearable technology platform could extend the value of telemedicine to the treatment of mental health disorders—notably, post-traumatic stress disorder (PTSD), which is alarmingly prevalent among veterans. The Zeriscope system will be formally tested in a clinical trial next year by 40 veterans residing near the Medical University of South Carolina (MUSC), where neurologist Robert J. Adams—inventor of the technology—is a professor.

Adams was an early adopter of stroke telemedicine and more than a decade ago built a large program delivering urgent stroke care over the internet using cart-based technology at MUSC. The next phase of development for telemedicine, he reasoned in 2011, was to make it wearable, portable, and able to access patients wherever they might be.

Making Connections

The idea that telemedicine might be wearable by patients, and not just medical professionals, didn’t take root until Adams talked about Zeriscope with a friend, Ron Acierno, who is a licensed psychologist. Acierno immediately identified PTSD as a potential application of the technology, given that one phase of treatment typically includes directly exposing patients to the environment triggering their symptoms—for example, going to a crowded store or busy festival.

This “in vivo exposure” is the portion of prolonged exposure therapy that happens outside the clinic, Adams explains, and patients derive benefit from “the right combination of stimulus and stress.” Therapists will sometime physically accompany patients during this leg of their treatment to help them through the experience.

A potentially more scalable approach would be to outfit patients with Zeriscope so their therapist can be with them remotely from the clinic seeing and hearing what they experience, speaking to them by earpiece, and watching their biological signs on their computer dashboard.

Using Zeriscope, therapists can function “much like a physical trainer,” Adams says. They can ensure patients show up for their appointed exercise (accountability) and exert the right degree of effort (engagement).

As patients speak, therapists can keep them engaged and encouraged while monitoring their emotional state in real time, says Adams. Prolonged exposure therapy, while evidence-based and widely recommended, has a high dropout rate and the cure rate, while good, is “less than universal.”

About one-third of PTSD patients who try the treatment don’t respond to it, Adams says. “Our clinical partners believe more personal interaction between patient and therapist during in vivo treatment will improve both retention and outcomes.”

Great Expectations

The principal investigator for the forthcoming PTSD trial is Sudie Back, a professor in the MUSC department of psychiatry and behavioral sciences who also treats patients at the Ralph H. Johnson VA Medical Center and MUSC Health. Zeriscope will optimize its system for in vivo exposure sessions with patients, Adams says. This involves making improvements to the patient interface and signaling from the body sensors, designing the dashboard with the psychophysiological information, and allowing post-processing and investigative analytics.

Therapists will be able to use Zeriscope in real time and record the sessions for later reference as needed, Adams notes. Up until now, therapists have had no way to correlate environment, patient response, and psychophysiology. The team expects “exciting new discoveries” from the research, he says.

The preliminary work and subsequent, one-year trial are being funded by a $900,000 grant from the National Institute of Mental Health's Small Business Innovation Research program to Zeriscope, Inc., whose CEO is Bill Harley, Adams says. The first phase will be an open-label trial with five veterans while the technology gets fine-tuned. The larger trial will formally get underway in 2020.

Future trials of Zeriscope for PTSD may well extend to veterans nationwide, Adams continues, since the technology is “amenable to remote and long-distance kinds of [trial] designs where patients may well not be in the same vicinity.” Psychiatrists also indicate the platform would have utility in the treatment of other clinically important mental health conditions, such as agoraphobia and social anxiety disorder.