Abstract:
Method and apparatus for demonstrating hydrocephalus shunt implantation includes a fabricated body including a fill, a shell covering the fill and including respective torso, head, and valve openings formed in the shell, a simulated torso including the torso opening, and a simulated head including the head and valve openings. An implant includes an abdominal tube attached to the body within the torso opening and a ventricular tube attached to the body within the head opening. An insertion tube is selectively insertable and useable to thread each of the abdominal and ventricular tubes beneath the shell from the respective torso and head openings to the valve opening, for example, along a pocket of the body formed therebetween. The implant can further include a simulated valve connectible to respective free ends of the abdominal and ventricular tubes. The simulated valve can be passable into the body via the valve opening, and a flap can close the valve opening over the simulated valve.

Description:
BACKGROUND OF THE INVENTION 
       [0001]    1. Field of the Invention 
         [0002]    Embodiments of the present invention generally relate to a method and apparatus for demonstrating medical treatments and, in particular, the invention relates to demonstrating hydrocephalus shunt implantation to, for example, children and their caregivers. 
         [0003]    2. Description of the Related Art 
         [0004]    The word Hydrocephalus comes from the Greek: “hydro”, meaning water, and “cephalus”, meaning head. Hydrocephalus is an abnormal accumulation of cerebrospinal fluid (CSF) within cavities called ventricles inside the brain. CSF is produced in the ventricles, circulates through the ventricular system, and is absorbed into the blood stream. CSF is in constant circulation and has many important functions. It surrounds the brain and spinal cord and acts as a protective cushion against injury. CSF contains nutrients and proteins necessary for the nourishment and normal function of the brain. It also carries waste products away from surrounding tissues. Hydrocephalus occurs when there is an imbalance between the amount of CSF that is produced and the rate at which it is absorbed. As the CSF builds up, it causes the ventricles to enlarge and the pressure inside the head to increase. 
         [0005]    Presently, there is no known way to prevent or cure hydrocephalus. The most effective treatment is the surgical implantation of a shunt. A shunt is a flexible tube placed into the ventricular system that diverts the flow of CSF into another region of the body where it can be absorbed, such as the abdominal cavity. A shunt comprises a ventricular tube, a valve, and an abdominal (peritoneal) tube. The shunt tubes are about ⅛ inch in diameter and are made of a soft and pliable plastic that is well tolerated by our body tissues. The valve in the shunt is designed to maintain the CSF at normal pressure within the ventricles. 
         [0006]    To surgically place a shunt, the surgeon makes incisions in the head and abdominal areas. The tubes are passed into the fatty tissue that lies just beneath the skin. A small hole is made in the skull, and the membranes between the skull and brain are opened, generally by boring a hole therethrough. One end of the shunt, called the ventricular tube, is gently passed through the brain into the lateral ventricle. The other end, called the abdominal tube, is passed beneath the skin into the abdominal cavity through a small opening in the lining (peritoneum) of the abdomen. This is where the CSF will ultimately be absorbed. The valve is located on the back or the top of the head beneath the skin. The incisions are then closed. 
         [0007]    The foregoing surgical shunt implantation technique is commonly performed on children. Often, such children are so young that it may be difficult for them to understand why the procedure is being performed, or how the shunt system that has been surgically placed within their body functions to relieve their hydrocephalus. Such children may also have friends and family members who are similarly too young to readily understand the details of this medically necessary treatment. 
         [0008]    Therefore, there is a need in the art for a method and apparatus for educating children with respect to the details of shunt-based surgical treatments for hydrocephalus. 
       SUMMARY OF THE DISCLOSURE 
       [0009]    The invention includes a method and apparatus for demonstrating hydrocephalus shunt implantation. For example, the invention includes an apparatus comprising a fabricated body including a fill, a shell covering the fill and including respective torso, head, and valve openings formed in the shell, a simulated torso defined by the fill and the shell and including the torso opening, and a head defined by the fill and the shell and including the respective head and valve openings. The apparatus also comprises an implant including an abdominal tube attached to the body within the torso opening and a ventricular tube attached to the body within the ventricular opening. The apparatus further comprises an insertion tube having a diameter larger than those of the respective abdominal and ventricular tubes, and being useable to thread each of the abdominal and ventricular tubes beneath the shell from the respective torso and head openings to the valve opening. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0010]    So that the manner in which the above recited features of the present invention can be understood in detail, a more particular description of the invention, briefly summarized above, may be had by reference to embodiments, some of which are illustrated in the appended drawings. It is to be noted, however, that the appended drawings illustrate only typical embodiments of this invention and are therefore not to be considered limiting of its scope, for the invention may admit to other equally effective embodiments. 
           [0011]      FIG. 1  is an illustration of an apparatus for educating children and others with respect to hydrocephalus shunt implantation in accordance with one embodiment; 
           [0012]      FIG. 2  is a rear view of an object of the apparatus; 
           [0013]      FIGS. 3 and 4  are illustrations of the apparatus of  FIGS. 1-2  being used to demonstrate implanting a shunt in the object. 
       
    
    
     DETAILED DESCRIPTION 
       [0014]      FIG. 1  illustrates apparatus  100  that children with hydrocephalus, their young friends and family members, and/or their caregivers may use to develop an understanding of the structure and function of a surgically-implanted shunt. The apparatus  100  includes an object  102  in the form of a specially configured plush toy, such as a toy bear, and an insertion tube  104 . The object  102 , shown in front elevational view, includes a body  106  having the typical body parts of a conventional toy bear, including a torso  108 , two arms  110 , a head  112 , and two ears  114 . The torso  108  includes an abdomen  116 , a chest  118 , and shoulders  120 . The body  106  further includes a shell  122 , the shell  122  being made, for example, from a plush fabric that has a soft exterior surface (e.g., for the comfort of children and others touching and handling the body  106 ), and being shaped and otherwise cut, sewn and/or stuffed (e.g., stuffed with a fill (not separately shown) of a resilient material, such as cotton batting) so as to give the body  106  a ‘teddy bear’ shape. The shell  122  includes an edge  124  that defines a torso opening  126  formed in the fabric of the shell  122  in the vicinity of the abdomen  116 . The edge  124  is reinforced with heavy stitching so as to resist tearing or undue widening. The structure and function of the body  106  is described in greater detail hereinbelow. 
         [0015]    The object  102  further includes an implant  128 . The implant  128  includes, in part, an abdominal tube  130 , which can be, for example, a fine-gage latex tube similar to the tubes used in real shunts. The abdominal tube  130  is elongate, and includes a free end  132  and a distal end  134  (obscured). In  FIG. 1 , the abdominal tube  130  is shown extending outward of the torso opening  126  from within the shell  122 . The distal end  134  is attached to the body  106  beneath the shell  122  (e.g., attached to the fill (not shown) that the shell  122  covers, or to a pocket beneath the shell  122  (e.g., to the fabric or membrane material of a pocket  256  of the body  106  shown and described hereinbelow with reference to  FIG. 2 )) and within the opening  126  by stitches, glue, VELCRO, staples, and the like. The structure and function of the implant  128  is described in greater detail hereinafter. 
         [0016]    The insertion tube  104  is rigid or semi-rigid, e.g., akin to a drinking straw or the like, and includes opposing ends  136 ,  138 . The end  136  includes a mouth  140 , and the end  138  includes a mouth  142 . The insertion tube  104  has a diameter that is larger than a diameter of the abdominal tube  130 . The structure and function of the insertion tube  104  is described in further detail hereinafter. 
         [0017]      FIG. 2  illustrates a rear view of the object  102 . The head  112  of the body  106  includes a back  244  and a top  246 . At the back  244  of the head  112 , the shell  122  includes an edge  248  that defines a valve opening  250  formed in the fabric of the shell  122 . The edge  248  is reinforced with heavy stitching so as to resist tearing or undue widening. The valve opening  250  is somewhat larger than the torso opening  126  shown in  FIG. 1 , and further features a flap  252  formed from a portion of the fabric of the shell  122 , and that is adapted to be pulled up and away from the back  244  of the head  112 , as shown, thereby revealing an interior surface  254  of the shell  122  that otherwise faces generally inward of the body  106 . 
         [0018]    The body  106  further includes lightweight fabric or membrane material in sufficient quantity, and so arranged as to form a pocket  256 . The pocket  256  extends from the abdomen  116  in the vicinity of the torso opening  126  (see  FIG. 1 ), upward underneath the shell  122  across the chest  116  and a shoulder  120  of the torso  108  above one of the arms  110  of the body  106 , (see also  FIG. 1 ) and extends onward and upward therefrom, still beneath the shell  122 , along the back  244  of the head  112 . The pocket  256  is further provided with an opening (not separately indicated) of a size, shape, and location so as to communicate with the valve opening  250  formed in the shell  122 . The membrane or fabric of the pocket  256  is attached together with the interior surface  254  of the shell  122  by means of the stitching provided along the edge  248 . In this way, a position of the pocket  256  beneath and adjacent to the shell  122 , and relative to the remainder of the body  106 , is stabilized. A similar interconnection between the pocket  256  and the shell  122  is provided at the torso opening  126  (see  FIG. 1 ), thereby providing further stability. 
         [0019]    A fastener  258  is incorporated within the back  244  of the head  112  in the vicinity of the flap  252 . The fastener  258  is of the hook-and-pile variety (e.g., VELCRO), and includes a fastener portion  260  attached to the flap  252  adjacent the edge  248 . The fastener  258  also includes a fastener portion  262  attached to the shell  122  within the pocket  256  and adjacent the edge  248 . As shown in the embodiment of  FIG. 2 , the fastener portion  260  is the ‘pile’ portion of the fastener  258  and the fastener portion  262  is the ‘hook’ portion thereof. In other embodiments, the reverse may be the case. 
         [0020]    The pocket  256  extends upward from the back  244  of the head  112 , still beneath the shell  122 , to the top  246  of the head  112 . At the top  246  of the head  112 , between the ears  114 , the shell  122  further includes an edge  264  that defines a head opening  266  formed in the fabric of the shell  122 . The edge  264  is reinforced with heavy stitching so as to resist tearing or undue widening. The head opening  266  is of similar size to the torso opening  126  shown in  FIG. 1 . An interconnection similar to that described hereinabove between the pocket  256  and the shell  122  at the torso and valve openings  126 ,  250 , is also provided at the head opening  266 . 
         [0021]    The implant  128  further includes a ventricular tube  268 , which can be, for example, a fine-gage latex tube similar to the tubes used in real shunts. The ventricular tube  268  is elongate, includes a free end  270  and a distal end  272  (obscured) and has a diameter smaller than that of the insertion tube  104 . In  FIG. 2 , the ventricular tube  268  is shown extending outward of the head opening  266  from within the shell  122 . The distal end  272  is attached to the body  106  beneath the shell  122  (e.g., attached to the fill (not shown) that the shell covers, and/or to the fabric or membrane material of the pocket  256 ) and within the head opening  266  by stitches, glue, VELCRO, staples, and the like. 
         [0022]    The implant  128  still further includes a simulated valve  274  that can be removably positioned within the pocket  256 . In an alternative embodiment, the valve  274  is attached to the body  106  within the pocket  256 . The valve  274  comprise two couplers  276 , one each for the respective free ends  132  ( FIG. 1 ),  270  of the abdominal and ventricular tubes  130  ( FIG. 1 ),  268 . 
         [0023]    Referring now to  FIGS. 3-4 , the insertion tube  104  can be used in cooperation with the object  102  to guide the abdominal tube  130  upward through the pocket  256  toward the simulated valve  274 . Referring now specifically to  FIG. 3 , a user pulls on the flap  252  to disengage the fastener portions  260 ,  262  of the fastener  258  apart from each other (see, e.g.,  FIG. 1 ), and rotates the flap  252  away from the remainder of the shell  122  so as to open the valve opening  250  and expose the simulated valve  274 . The end  136  of the insertion tube  104  is inserted into the valve opening  250  and is threaded downward through the pocket  256  toward the torso opening  126 . In order to facilitate the foregoing step, one or both of the shell  122  and the fill (not separately shown) covered by the shell  122  is relatively pliable relative to the insertion tube  104 . With the end  136  of the tube  104  extending generally outward of the torso opening  126 , the free end  132  of the abdominal tube  130  is passed into the mouth  140  of the insertion tube  104  and is threaded upward therethrough in the direction of the mouth  142  of the insertion tube  104  until such time as a substantial portion of the length of the abdominal tube  130  is contained within the insertion tube  104 . 
         [0024]    As shown in  FIG. 4 , the insertion tube  104  is then pulled back outward of the pocket  256  along the direction indicated by arrow  478  until such time as the free end  132  of the abdominal tube  130  appears in the vicinity of the valve opening  250 . (The insertion tube  104  is now put aside.) The free end  132  of the abdominal tube  130  is then inserted into one of the couplers  276  of the simulated valve  274 . In order to facilitate the foregoing step, the abdominal tube  130  can be relatively flexible so as to permit the abdominal tube  130  to be bent and maneuvered easily within the insertion tube  104  upon the free end  132  of the abdominal tube  130  being threaded therethrough. 
         [0025]    The process of threading the abdominal tube  130  upward through the pocket  256  from the vicinity of the torso opening  126  to the vicinity of the valve opening  250  is repeated, e.g., with respect to all related or corresponding aspects, in order to thread the ventricular tube  268  ( FIG. 2 ) downward through the pocket  256  from the vicinity of the head opening  266  ( FIG. 2 ) to the vicinity of the valve opening  250 . In particular, once the insertion tube  104  is pulled outward of the pocket  256  such that the free end  270  of the ventricular tube  268  appears in the vicinity of the valve opening  250 , the insertion tube  104  is once again put aside. The free end  270  of the ventricular tube  268  is then inserted into the other coupler  276  of the simulated valve  274 . In order to facilitate the foregoing step, the ventricular tube  268  can be relatively flexible so as to permit the ventricular tube  268  to be bent and maneuvered easily within the insertion tube  104  upon the free end  270  of the ventricular tube  268  being threaded therethrough. 
         [0026]    With each of the abdominal and ventricular tubes  130 ,  268  ( FIG. 2 ) extending from the respective torso and head openings  126 ,  266  ( FIG. 2 ) toward the valve opening  250  formed in the shell  122  and connected to the simulated valve  274 , all of the components representative of a shunt for treating hydrocephalus will have been placed in subcutaneous positions in the body  106  of the plush toy bear corresponding to those at which such a shunt would be surgically implanted and arranged in a human child with hydrocephalus. The flap  252  is then rotated back toward the remainder of the shell  122  at the back  244  of the head  112 , causing the fastener portions  260 ,  262  of the fastener  258  to adhere to each other, thereby securing the flap  252  in place over the pocket  256 , closing the valve opening  250 , and obscuring the simulated valve  274  from view. 
         [0027]    The foregoing description of the operation of the apparatus  100  also serves as a description of how the apparatus  100  may be used to demonstrate hydrocephalus shunt implantation to a child with hydrocephalus, as well as their family members and young friends and classmates. That is, by operating the apparatus  100  as described above in the presence of such a person or persons, the desired demonstration will be accomplished with little need for verbal description. Once the shunt, its components, and position within the body is demonstrated, either the demonstrator, or the person or persons to whom the shunt implantation was demonstrated, may reopen the flap  252 , disconnect the tubes  130 ,  268  ( FIG. 2 ) from the simulated valve  274 , pull the tubes  130 ,  268  back out of the respective portions of the pocket  256  that lead to the valve opening  250 , and pull the tubes  130 ,  268  out of the respective torso and head openings  126 ,  266  ( FIG. 2 ), so as to prepare the apparatus  100  for a repetition of the demonstration process, as needed or as desired. 
         [0028]    In alternative embodiments of the apparatus  100 , each of the respective distal ends  134 ,  272  of the abdominal and ventricular tubes  130 ,  268  is affixed or anchored to a respective coupler  276  of the valve  274 , rather than to the fill (not separately shown) or the pocket  256  of the body  106 . In accordance with such alternative embodiments, the insertion tube  104  is used to guide the respective free ends  132 ,  270  of the abdominal and ventricular tubes  130 ,  268  respectively downward and upward through the pocket  256  toward the respective torso and head openings  126 ,  266 , rather than respectively upward and downward therethrough toward the simulated valve  274 . 
         [0029]    While the foregoing is directed to embodiments of the present invention, other and further embodiments of the invention may be devised without departing from the basic scope thereof, and the scope thereof is determined by the claims that follow.