Developing an Articulating Arm System for Focused Ultrasound Treatment of Cocaine Use Disorder; Investigating the Relationship between Policy and Equitable Access to Drug Abuse Care

Icalla, Janine, School of Engineering and Applied Science, University of Virginia
Allen, Timothy, EN-Biomed Engr Dept, University of Virginia
Forelle, MC, EN-Engineering and Society, University of Virginia

My technical work and STS research both address different issues in the realm of drug abuse treatment. My technical project aims to develop an articulating arm system as an aid to low-intensity focused ultrasound for use in reducing cocaine cravings. Low-intensity focused ultrasound serves as a novel and upcoming treatment for drug abuse. On the other hand, my STS project focuses on uncovering the reasoning behind the still existing disparities to drug abuse care for patients of various socioeconomic groups despite the passing of major federal policies, such as the Affordable Care Act and Mental Health and Parity Act. These major policies worked to make drug abuse care more accessible.
UVA's Center for Leading Edge Addiction Research (UVA CLEAR) currently conducts clinical trials to test the adequacy of using low-intensity focused ultrasound in reducing cocaine cravings. The ultrasound technology consists of a small transducer placed directly onto a patient's head, over a precise spot roughly within a centimeter of the insula. Existing equipment for holding the transducer in place for the entirety of treatment, approximately 15 minutes, is large, expensive, and cumbersome. As a results, patients and research coordinators must manually hold the transducer in place against the patient's head, leading to discomfort, arm fatigue, and involuntary hand movements that compromise the position of the transducer over the desired target area. Thus, our project focused on producing an articulating arm that addresses these issues.
Our final prototype consisted of a transducer holder attachment threaded onto a flexible gooseneck stand. Our transducer holder attachment relied on a ball joint mechanism secured in place by screws. This ball joint design, as well as the flexible nature of the gooseneck stand, allows for an extensive range of motion and large range of axial direction adjustments to enable precise positioning of the transducer onto a patient's head. Additionally, after extensive finite element analysis and physical compressive testing, our prototype showed incredible yield strength and resistance to large forces. These tests gave us the confidence to believe that our device will not only survive the forces of accidental head movements against the transducer but will also remain durable to allow UVA CLEAR to use our device for many years to come.
My STS research paper seeks to uncover why disparities in access to drug abuse care still exist despite the work of major federal polices, the Affordable Care Act and Mental Health Parity and Addiction Equity Act, to remove those barriers to care. I employ the Social Construction of Technology (SCOT) framework to define two relevant social groups most involved in the interpretation and implementation of these federal policies: insurance companies and state governments. I then employ the concept of interpretative flexibility, also from the SCOT framework, to explain how their varying interpretations of these federal policies lead to still existing barriers to care. From my analysis of these federal policy documents and public policy journals, I discovered that variation in the interpretation and implementation of these federal policies by insurance companies and state governments contribute to treatment inaccessibility.
I argue that unclear and modest policy reforms within the federal policies enable interpretation consistencies. I argue that the decision for some U.S. states to not implement Medicaid expansion, a provision of the Affordable Care Act, leaves many patients with no pathway to affordable coverage. I argue that variable and restrictive coverage within the continuum of treatment services across Medicaid-expansion states leaves many patients unable to afford care. Finally, I argue that differences in Medicaid provision implementation contribute to the residual effect of direct funding cuts to drug abuse treatment programs, contributing further to the issue of barriers to treatment. While these discoveries encompass issues with treatment accessibility from a patient perspective, I also argue that the relevant social groups' influence on treatment accessibility from a provider point of view must be studied to gain a more complete understanding of this overarching issue.
By working on my technical project and STS research paper in tandem, I have gained a much more comprehensive understanding of the pathway of drug abuse treatment options from the development stage all the way to the point at which it is patient-facing. My STS research allowed me to understand where my technical project fits into the current continuum of care for drug abuse. Using the knowledge I gained from my research paper, my group and I were able to produce a functional product at the lowest cost possible with the newfound understanding of how outside factors contribute to treatment affordability, wanting to ensure that we ourselves were not further contributing to barriers to care. My STS research paper also allowed me to further understand how relevant social groups, like states and insurance companies, will affect the extent of coverage for my technical project if and when it becomes a more prominent form of treatment for drug abuse. Overall, I also hope this knowledge informs my future work in developing other technology in the medical industry.

BS (Bachelor of Science)
Social Construction of Technology (SCOT), Drug Abuse Care, Focused Ultrasound, Articulating Arm

School of Engineering and Applied Science

Bachelor of Science in Biomedical Engineering

Technical Advisors: Dr. Timothy Allen, Tamika Braveheart, Andrew Kostelac

STS Advisor: Dr. MC Forelle

Technical Team Members: Emerson Smith, Mackenzie Zimmerman

All rights reserved (no additional license for public reuse)
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