{"id":98479,"date":"2022-06-02T00:00:00","date_gmt":"2022-06-02T05:00:00","guid":{"rendered":"https:\/\/www.unmc.edu\/newsroom\/?p=98479"},"modified":"2026-02-02T15:18:21","modified_gmt":"2026-02-02T21:18:21","slug":"combating-anxiety-with-innovation","status":"publish","type":"post","link":"https:\/\/www.unmc.edu\/newsroom\/2022\/06\/02\/combating-anxiety-with-innovation\/","title":{"rendered":"Combating Anxiety With Innovation"},"content":{"rendered":"\n
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\n\t\t\t\t\tAwake brain surgery. Feeling anxious yet?\t\t\t\t<\/p>\n\t\t\t\t

\n\t\t\t\t\t\t\t\t\t\t\tA<\/span>nxiety<\/strong>\n\t\t\t\t\t\t among patients considering deep brain stimulation surgery is common, but now UNMC innovators are using simulation and 3D printing to both screen and prepare patients for a surgery in which they remain awake.\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t

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Share<\/p>\n\t\t\t\t

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Related Links<\/p>\n\t\t\t\t\t

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Neurological Sciences<\/a><\/p>\n\n

iEXCEL<\/a><\/p>\n\n

Linder Maker Studio<\/a><\/p>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\n

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\n\t\t\t\t\t\tDennis Rieke, physician assistant with the UNMC Department of Neurosurgery, models the 3D-printed stereotactic head frame.\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<\/div>\n<\/div>\n\n\t

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Anxiety among patients considering deep brain stimulation surgery is so common, in fact, that the UNMC Department of Neurological Sciences has neuropsychologists on staff to screen patients to determine if they are ready for the challenging procedure and work with them to overcome their trepidation.<\/p>\n\n\n\n

The procedure is used to alleviate the symptoms of diseases such as Parkinson\u2019s, essential tremor, dystonia and other neurological conditions.<\/p>\n\n\n\n

It is challenging for many reasons. Patients are awake as a hole is drilled into their heads, and they often are asked by the surgeons to respond to questions or make movements as the delicate operation, which involves implanting one or more electrodes in the brain, is underway. The procedure itself lasts three to four hours.<\/p>\n\n\n\n

\u201cThey are feeling the pressure, they\u2019re hearing the drill,\u201d said Erica Aflagah, PhD, a neuropsychologist in the department. \u201cAt some point, there is microelectrode testing, which causes a loud, unusual noise. The surgeons are talking them through it, and they are good at that, but there are moments where a person could panic.\u201d<\/p>\n\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\t\n\t

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\u201cWe were finding that sometimes people who were otherwise good candidates had concerns about claustrophobia and panic when dealing with the head frame and attachment.\u201d<\/p>\n\t\t\t\t\t\t\t

Erica Aflagah, PhD<\/p>\n\t\t\t\t\t<\/blockquote>\n\t<\/div>\n\t\n

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\n\t\t\t\t\t\tBrian Maass, left, of the McGoogan Health Sciences Library\u2019s makerspace, displays the completed replica to Dennis Rieke of the UNMC Department of Neurosurgery.\nAt right, Aviva Abosch, MD, PhD, chair of the UNMC Department of Neurosurgery, dons the head frame and box models with help from Brian Maass.\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<\/div>\n<\/div>\n\n\t

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And for some patients, that moment arrives early \u2013 when they are fitted with a metal device known as a stereotactic head frame, which stabilizes their head during the surgery, and a plastic, box-like attachment called a fiducial localizer box, which is attached to the frame and obscures the patient\u2019s view.<\/p>\n\n\n\n

Dr. Aflagah and her colleague, Pamela May, PhD, have been told by neurosurgeons that the head frame can be anxiety-inducing for patients during the procedure.<\/p>\n\n\n\n

\u201cPart of our role is screening for anxiety that could interfere with the surgery process itself \u2013 claustrophobia, panic,\u201d Dr. Aflagah said. \u201cWe were finding that sometimes people who were otherwise good candidates had concerns about claustrophobia and panic when dealing with the head frame and attachment.\u201d<\/p>\n\n\n\n

The concerns are understandable. The head frame is an intimidating device. Made of metal, it is screwed tightly into the outer surface of the skull for the surgery. The fiducial localizer box obscures the vision, and although that section is removed during the surgery itself, the head frame then is bolted to the operating table, immobilizing the patient\u2019s head and neck.<\/p>\n\n\n\n

It\u2019s a tough experience for the neuropsychologists to mimic, and although they ask about claustrophobia, patients\u2019 self-reporting is not always accurate.<\/p>\n\n\n\n

\u201cEveryone\u2019s going to have anxiety, especially undergoing awake brain surgery, but the concern is, \u2018Will they be able to respond to providers\u2019 simple commands or to follow through the procedure?\u2019\u201d Dr. May said. \u201cWe wouldn\u2019t want the anxiety to get in the way of their ability to react to the surgeon\u2019s requests in time.\u201d<\/p>\n\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\t\n

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\n\t\t\t\t\t\tThe replica head frame, held by Brian Maass, left, of the McGoogan Health Sciences Library\u2019s makerspace, is making a difference, said Dennis Rieke of the UNMC Department of Neurosurgery. \u201cThere\u2019s a noticeable difference when people have gone through a procedure before as to how comfortable they are,\u201d Rieke said. \u201cThis is a simulation, obviously, but just having a little experience goes a long way in making people feel more relaxed.\u201d\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<\/div>\n<\/div>\n\n\t

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The department of neurological sciences frequently works with the Nebraska Medicine Department of Psychology and UNMC Department of Psychiatry when dealing with patients\u2019 pre-surgery anxieties. So Drs. May and Aflagah approached Justin Weeks, PhD, psychotherapy director of the departments\u2019 Anxiety Subspecialty Treatment Program.<\/p>\n\n\n\n

As Dr. Weeks tells it, the heart of any evidence-based treatment of anxiety is exposure, where patients face their fears. In cases where Dr. Weeks and his team have worked with patients who are considering deep-brain stimulation surgery, \u201cwe haven\u2019t been able to have them engage in exposure\u201d where the head frame and box are concerned, he said.<\/p>\n\n\n\n

The reason? The fiducial localizer boxes are expensive \u2013 (about $30,000) \u2013 and using them for practice risks damaging them. Brainstorming with the anxiety program\u2019s medical director, Lauren Edwards, MD, the group came up with an idea: What about a virtual reality simulation? With the iEXCEL program right down the street, would the designers and programmers there be able to create a virtual reality scenario that could mimic wearing a head frame\/box device while the patient was wearing a VR headset of some kind?<\/p>\n\n\n\n

The short answer, said Bill Glass, iEXCEL\u2019s artistic director, was no.<\/p>\n\n\n\n

\u201cThe problem with the VR for this type of use is, normally with VR your focal point is a short distance in front of your eyes,\u201d Glass said. \u201cBut the head frame and box would be much closer to your face.\u201d<\/p>\n\n\n\n

Still, the iEXCEL team was intrigued by the problem. Glass wondered: What about a 3D model?<\/p>\n\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\t\n

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\n\t\t\t\t\t\tThe 3D-printed replica, at left, was the result of a creative and collaborative effort by different departments and programs at UNMC, including iEXCEL, psychiatry, neurological sciences, neurosurgery and the McGoogan Health Sciences Library.\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<\/div>\n<\/div>\n\n\t

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The iEXCEL team borrowed a head frame and box from the UNMC Division of Neurosurgery, and computer 3D artist Anthony Lanza meticulously photographed, measured, researched and modeled the costly pieces of equipment, working with neurosurgery physician assistant Dennis Rieke, who provided information and feedback during the process.<\/p>\n\n\n\n

\u201cThe devices had multiple pieces that come apart, so I photographed them in 360 degrees,\u201d Lanza said. \u201cThen I loaded the photos into a 3D app as a reference and started modeling it,\u201d he said.<\/p>\n\n\n\n

\u201cIt\u2019s very iterative. I\u2019d get a base, and since I had the devices at my desk, I could look at them, compare them to the 3D model. When we gave devices back, it became more challenging.\u201d<\/p>\n\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\t\n\t

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"I love the projects we get here \u2013 every day it\u2019s something new, and I feel like I\u2019m helping my community by being part of UNMC and iEXCEL."<\/p>\n\t\t\t\t\t\t\t

Anthony Lanza, 3D artist<\/p>\n\t\t\t\t\t<\/blockquote>\n\t<\/div>\n\t\n\t

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Lanza, who is currently working on a project for the UNMC College of Dentistry, puts in a lot of research before creating virtual 3D models. He came to UNMC from the gaming industry as a modeling\/texturing software expert, and he said he enjoys working to facilitate medical education.<\/p>\n\n\n\n

\u201cI like teaching and research,\u201d he said. \u201cTransitioning from gaming to working in higher education \u2013 I was previously at Bellevue University \u2013 was great for me. I love the projects we get here \u2013 every day it\u2019s something new, and I feel like I\u2019m helping my community by being part of UNMC and iEXCEL.<\/p>\n\n\n\n

\u201cI got to model a device to help people with their anxiety before they have to get brain surgery. To me, that\u2019s more rewarding than, \u2018Oh, there\u2019s the bottle I modeled in the background of that video game.\u2019\u201d<\/p>\n\n\n\n

Rieke, who has been involved in deep brain stimulation at UNMC since 2006, said Lanza wasn\u2019t overstating the device\u2019s potential impact.<\/p>\n\n\n\n

\u201cThere\u2019s a noticeable difference when people have gone through a procedure before as to how comfortable they are,\u201d Rieke said. \u201cThis is a simulation, obviously, but just having a little experience goes a long way in making people feel more relaxed.\u201d<\/p>\n\n\n\n

Deep brain stimulation can be a life-changing surgery, Rieke said. He has seen bedbound patients able to travel again, patients able to drink from cups without lids for the first time in years. But it is an elective surgery \u2013 patients must decide they are prepared for the challenges of the procedure.<\/p>\n\n\n\n

\u201cAnything we can do to help them with that preparation is an advantage,\u201d he said.<\/p>\n\n\n\n

iEXCEL doesn\u2019t do a lot of modeling for 3D printing, Glass said. But when they brought Lanza\u2019s virtual model to the McGoogan Library\u2019s makerspace, the library\u2019s Brian Maass was happy to assist.<\/p>\n\n\n\n

\u201cI had to adapt the model, which was in a visual format,\u201d Maass said. \u201cThe 3D printer uses a framework of triangles that the computer sends to it. So I had to get the model into a format the system would understand.\u201d<\/p>\n\n\n\n

Glass said Maass\u2019 input was invaluable.<\/p>\n\n\n\n

\u201cThis would not have been possible without Brian\u2019s knowledge and passion,\u201d Glass said. \u201cThe tests and problem-solving that he worked out allowed him to produce and deliver an elegant solution.\u201d<\/p>\n\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\t\n

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\n\t\t\t\t\t\tBrian Maass, assistant professor and digital technologies librarian at the McGoogan Health Sciences Library, displays the 3D printed replica of the stereotactic head from and fiducial localizer box, to be used to help patients overcome anxiety as they prepared for deep-brain stimulation surgery.\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<\/div>\n<\/div>\n\n\t

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The result was a realistic looking, though somewhat lighter, replica of the head frame and box that delighted the team. Dr. Weeks\u2019 group and the neurology department each have one. The prototypes are so realistic that Dr. Weeks thinks they may eventually become standard tools across the country for addressing pre-DBS anxiety.<\/p>\n\n\n\n

\u201cPreviously, we\u2019ve done things like watching videos of other people being prepped for the surgery, so patients would have some sense of what is happening, but we didn\u2019t have anything this tangible,\u201d Dr. Weeks said. \u201cThis is going to be helpful \u2013 because you always want to be able to engage in exposure in advance of the situation and learn to adapt to that anxiety and prepare.\u201d<\/p>\n\n\n\n

Drs. Aflagah, May and Weeks said they are delighted with the device \u2013 and the patients they\u2019ve talked to are eager to try it.<\/p>\n\n\n\n

\u201cI\u2019m quite pleased with how it looks from a neuropsych perspective,\u201d Dr. Aflagah said. \u201cIt\u2019s nice to have something concrete to show people and have them try on. It makes us better able to assess. We\u2019re still relying on self-reporting, on how they feel they\u2019re going to react, but the model will help patients be more objective.\u201d<\/p>\n\n\n\n

The duo said they are ecstatic with the results of the multidisciplinary collaboration.<\/p>\n\n\n\n

\u201cWe are very grateful,\u201d Dr. May said. \u201cIt was exciting to see how these other departments responded to our request and cared so much about helping our patients.\u201d<\/p>\n\n\n\n

Dr. Weeks agreed.<\/p>\n\n\n\n

\u201cThis kind of teamwork, all in the cause of patient care \u2013 this is why UNMC is a special place.\u201d<\/p>\n\n\n\n

Aviva Abosch, MD, PhD, chair of neurosurgery, said she was grateful to the team \u201cfor making the effort to create this device that is being used to educate and allay the concerns of our patients. I am excited to see what benefits derive from this project.\u201d<\/p>\n\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\t","protected":false},"excerpt":{"rendered":"

UNMC innovators are using simulation and 3D printing to both screen and prepare patients for deep brain stimulation surgery.<\/p>\n","protected":false},"author":27,"featured_media":103274,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"60603,51652,67168,48361,41266,68787","_relevanssi_noindex_reason":"","footnotes":""},"categories":[1],"tags":[],"class_list":["post-98479","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","department-college-of-medicine","department-iexcel","department-library","department-multimedia-stories","department-neurological-sciences","department-neurosurgery","department-psychiatry","department-unmc-front-page","department-unmc-today-todays-headlines"],"yoast_head":"\nCombating 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