Carpal Tunnel to IEDs | Orthopedics This Week
Large Joints and Extremities

Carpal Tunnel to IEDs

IED Simulation / Creative Commons

At first sight, the Time Resolve Force Technology doesn't look like a cutting edge breakthrough. About the size of a roll of quarters the steel cylinder has some wires sticking out and buttons which makes it look like a cross between a fishing lure and a woodwind. But device’s creators, Dr. William Paske and his brother Charles who is currently marketing the device through his employment screening company Work Wright Inc. of Helena, Montana, see great potential.

William Paske/Work Wright Inc.
The device, which measures how quickly a person's fingers can press buttons, collects the subsequent data and precisely compares to a base line number, is giving promising and even exciting results. But there's an interesting off shoot that occurred during the testing phase of this diagnostic instrument. It appears from research data collected that the Time Resolve Force Technology actually may be able to diagnose mild traumatic brain injury (MTBI) as well. And this development has sparked the U.S. military’s as a tool for physicians serving in combat arenas. 

Checking for Carpal Tunnel

Carpal tunnel syndrome (CTS) is a collection of issues that result in pain and stiffness and may sometimes be caused by repetitive stress on soft tissues. It's also a huge portion of today worker's compensation costs. In fact, accord to Charles Paske, about 60 cents of every dollar in worker's compensation goes to the care of repetitive stress injuries of the upper extremities.  

Charles Paske goes on to say that the current diagnostic procedures for CTS are under-performing. "There is about a 48% rate for CTS diagnosis and that means the current gold standards for diagnosis are grossly inaccurate. That number is just as good as flipping a coin." Paske says the Time Resolve Force Technology device is above 90% accurate.

Based on a pre-existing relationship with the state of Montana, involving the pre-screening of workers for hand problems, the Community Medical Foundation for Patient Safety of Houston, Texas, became involved in the testing of the device. Matthew C. Mireles, B.S., M.P.H., Ph.D., President and Chief Executive Officer of the Foundation led the testing of this FDA-approved instrument. "We saw it as a fast non-invasive way to screen people, to say this job might not be optimal for you."

"I figured out a way here to see if the ulnar nerve and the median nerve are communicating properly, " explains Bill Paske. "If you hold a Styrofoam coffee cup in your hand, your hand knows to hold it a certain way. Too much force and you crush the cup, to little pressure and you drop it. It all involves your hand receiving the right sensory feedback. "I measure what that functionality is and that helps to determine CTS."

William Paske/Work Wright Inc.The device consists of three independent measurements of the index and small fingers and the thumb and checks for small changes in coordination. "We can make some fine measurements; we can see how things change over time, " adds Paske. In fact the device collects about 180, 000 bits of information every five minutes and tests both hands twice."We take advantage of the hand being tired, that's why we test twice."

 Change Doesn't Come Easy

CTS is a very common repetitive stress injury and Mireles says it first began to appear in the 1970s when word processing became a major job function. He says CTS isn't just one affliction but a syndrome that's comprised of many issues, from inflamed nerves to muscular and bone-centered problems around the wrist and through the channel, where constriction and compression can occur. "It was during the 80s and 90s that orthopedists and neurologists began to see a large number of sufferers, " states Mireles. "CTS became a cottage industry. Clinical diagnostic tools that are used are often inaccurate, painful and expensive. And today there is going to be a huge resistance to change in that routine."

Charles Paske knows resistance first-hand. Most of the physicians he’s approached about the device have not exactly been beating down his door. Said Charles Paske: "We had the device reviewed by several publications and have measured hundreds of people to develop an accurate base line. But for us, it simply comes down to people making more money not using our device, so how do you market it then?" Mireles isn't optimistic of acceptance anytime soon, and with so many companies turning it away, it doesn't appear that the device will be available to potential patients for quite some time. "Of course you don't want to just roll a product out, but this one has been tested, for nearly a decade. One surgeon in Houston told me he will not operate on another hand until he uses this device. However there's not a financial incentive for others to feel the same way. I once heard a cardiologist say 'Why would I talk to my patients about diet and exercise?' and I think that's the common feeling about this product."

 An Accidental Benefit Takes Center Stage

But remember that interesting aside that showed the Time Resolve Force Technology just might help with the treatment of MTBI? Charles Paske is banking on this unexpected outcome. The Paske brothers never intended for their device to be used to diagnose anything but hand conditions. Then a few patients that Mireles was testing came back with some interesting results. These patients didn't have CTS, but their results were off the base line findings. Paske’s research team delved deeper into the medical histories of these outlier patients and learned that each one had at some point in the past had suffered a form of brain trauma.

"We captured something very unique in the readings and began to think, 'Maybe TBI can be measured in the hand, '" says Mireles. At this point Charles Paske began to explore the further applications of the device and more testing began. The U.S. military became very interested in the Time Resolve Force Technology, not so much for severe brain trauma, but for the less severe type that often goes undiagnosed, but can have far reaching effects. "There are also going to be other applications, like in car crashes and sports medicine where MTBI is just getting the attention it deserves, " continues Mireles. "We can test based on a normal base line and can then form a decision from real data. Right now for these types of injuries it's poorly subjective. A coach will ask you your name or something like that." He adds that the Time Resolve Force Technology fits perfectly into these situations because it's small, more convenient than an MRI and quickly offers a reading. A military application could also promise custom readings where each soldier is tested before going on duty to assess his particular base line, with subsequent readings being made after an injury is sustained.

Beyond the Obvious Benefits

With the connection made between finger reaction time and brain health, the possibilities for the Time Resolve Force Technology are growing rapidly and they could be far reaching. Mireles says that he sees a future beyond MTBI and is in the process of planning an early Alzheimer diagnosis study. "Many people think memory is the first thing to be affected by Alzheimer's, but actually if you ask close family members of a sufferer they will tell you handwriting is usually one of the first signs." The proposed study will follow people in their 40s and test them using the Time Resolve Force Technology to find out when the first signs of Alzheimer's begin, because it could be much sooner than anyone thinks.  

It is interesting to note; however, that the one condition the Time Resolve Force Technology device was designed for will probably be the last for which it is used. "I think it's going to be a long time before it becomes accepted for repetitive stress injuries, " adds Mireles. "It will become more recognized for MBTI because of the military's interest and after that I think people will look at the carpal tunnel diagnosing potential because after all it has been approved by the FDA for that purpose.” I just find it amazing that Dr. Paske invented something so simple, quick and accurate and all of things he chose to focus on hand functionality and from that has come so many possibilities.


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