Presented by Brad Aiken
Doctor and science-fiction writer Brad Aiken presents on new and upcoming technologies in neurological rehabilitation. Topics include breakthrough advances that can help people recover from stroke, brain injury, and spinal cord injury. Current, cutting-edge technologies will be discussed, as well as likely upcoming advances in this field.
6. Neurological Rehabilitation
Past to Present
Traditional Approaches to Rehabilitation
Two basic approaches
Teach compensatory techniques
Promote neurological recovery
7. Neurological Rehabilitation
Traditional Approaches to Rehabilitation
Teach compensatory techniques
Train to compensate for lost function with unaffected
side
Adaptive equipment to compensate for lost function
Crutches, Walkers, Wheelchairs
Braces
etc
23. Neurological Rehabilitation
New trends in Stroke Rehabilitation
Increased emphasis on treatment techniques and technology
to promote neurological recovery
24. Advances in NeuroRehab
Promoting Neurologic Recovery
Theory vs Fact
Are we really doing anything to promote brain recovery, or are
we just mitigating the effects of inactivity while the brain
recovers naturally?
Recent technology has allowed us to begin to answer the
question of what is going on in the brain in response to our
treatment
25. Advances in NeuroRehab
Techniques for Demonstrating Neurologic Recovery
fMRI (functional MRI)
PET (Positron Emission Tomography)
TMS (Transcranial Magnetic Stimulation)
Doesn’t require volitional activity
Can only stimulate brain tissue near the scalp
NIRS/NIRI (Near Infrared Spectroscopy/Imaging)
Only maps superficial cortex (1cm depth)
Limited resolution
Low cost, portable
26. Advances in NeuroRehab
Techniques for Demonstrating Neurologic
Recovery
fMRI (functional MRI)
28. Stroke
fMRI pre and post 3 week course of grasp-release therapy with Hand-
Wrist Assistive Robot. Takahashi et al. U Cal Irvine
29. Stroke
fMRI studies show:
The brain is capable of reorganization
We can increase activity in various areas of the brain after stroke
This activity pattern can be affected by various rehabilitation
therapies
Improvement can be made even YEARS after a stroke
30. Advances in NeuroRehab
These techniques are showing that cortical
restructuring is taking place in the brain in
response to the treatment we provide
[ Neuroplasticity ]
31. Advances in NeuroRehab
Resultant changes in the approach to stroke
rehab
New technologies to promote neuroplasticity
New therapeutic techniques
Counseling patients re: potential chronic
improvement
Long-term exercise programs
32. Advances in NeuroRehab
New techniques to promote neuroplasticity
Therapeutic robotics
Functional Electrical Stimulation (FES)
33. Advances in NeuroRehab
New Technologies in Rehab
Therapeutic Robotics
Passive/active-assisted , robotically aided motion
Robot assists in producing the lost motion
Accurate, reproducible repetitions
Results in functional improvement in acute and chronic stroke
patients
? Induces structural reorganization in the brain
34. Advances in NeuroRehab
New Technologies in Rehab
Therapeutic Robotics
works by repetitive motion training
37. Advances in NeuroRehab
MIT Manus
P/AAROM
Back-drivable
“Video Game” interface
Improve Function
Results can be assessed with
precise measurement of
active motion by the
computer interface
45. Advances in NeuroRehab
New Technologies in Rehab
Therapeutic Robotics
Pros
Reproduction of motion is more accurate than manual therapy
(should improve training effect)
Achieves more reps per session than manual therapy
Accurate documentation of results
Very cool (fun to use = increased motivation)
46. Advances in NeuroRehab
New Technologies in Rehab
Therapeutic Robotics
Cons
very expensive
Limited availability out of the research setting, but this is
beginning to change
47. Advances in NeuroRehab
Functional Electrical Stimulation (FES)
Using electricity to activate paralyzed muscles in
order to mimic the normal function of those muscles
48. Advances in NeuroRehab
Functional Electrical Stimulation (FES)
Surface electrodes
Requires stronger shock
Implanted electrodes
Requires an invasive procedure
Risk of infection or rejection
49. Advances in NeuroRehab
Functional Electrical Stimulation (FES)
Motion occurs when the muscle is shocked
Manually triggered
Controlled by a computerized sequence of shocks
Controlled by a brain-computer interface
57. Advances in NeuroRehab
Exoskeletal Devices
ReWalk
Now available for personal use throughout Europe
Awaiting FDA approval for personal use in US
58. Advances in NeuroRehab
ReWalk
Claire Lomas has T4 paraplegia
from equestrian accident
She completed the 2012 London
Marathon in 16 days with the help of
a Re-Walk
59. Advances in NeuroRehab
Exoskeletal Devices
eLEGS– Berkeley Bionics (now called Ekso from Ekso Bionics)
Variable speed gait
60. Advances in NeuroRehab
Exoskeletal Devices - Ekso
In clinical trials at Kessler
Gait and balance improve with training
Increase in O2 consumption, heart rate, and ventilation with activity with
the Ekso (suggests that the activity is not just passive, and should have
beneficial metabolic/cardio effects)
Muscle-firing found in leg muscles during Ekso walking
Now in clinical use at Craig Rehab (April, 2012)
61. Advances in NeuroRehab
Exoskeletal Devices
Rex (New Zealand)
Joy-stick control
“walking wheelchair”
“walking standing-table”
62. Advances in NeuroRehab
Exoskeletal Devices
HAL (Japan)
Hybrid Assistive Limb
Cyberdyne Corporation
2 modes:
Myoelectric-triggered motion
(Must have some muscle activity)
Robotic autonomous control
mode (triggered by angle sensors
and ground-reaction force)
65. Advances in NeuroRehab
Brain - Computer Interface
3D control of a robotic arm
http://www.youtube.com/watch?v=QRt8QCx3
BCo&feature=player_detailpage
66. Advances in NeuroRehab
Brain - Computer Interface
3D control of a robotic arm
http://www.youtube.com/watch?v=QRt8QCx3BCo
68. Advances in NeuroRehab
Future Directions
The greatest promise lies with the potential to
integrate these new technologies
Brain-Computer Interface to initiate movement
Exoskeletons or FES to create movement
Nanotechnology to make the devices small enough and
light enough to be user-friendly
69. Advances in NeuroRehab
Future Directions
Brain - Computer Interface
Gather more information from the brain
Current technology uses a single chip implanted
over a small area of the brain, gathering
information from only a few of the billions of
neurons in our brain
Goal: Use multiple chips to gather information
from multiple areas of the brain
70. Advances in NeuroRehab
Future Directions
Brain - Computer Interface
Improvement in software to more precisely replicate
normal muscle movements (natural motion)
Internal Power Source
71. Advances in NeuroRehab
Future Directions
Brain - Computer Interface
Finding a power source for wireless transmission from cortical implants
minute amounts of electricity that can be
harvested from the pulse of a blood vessel
72. Advances in NeuroRehab
Future Directions
Functional Electrical Stimulation (FES)
Current studies use only a few stimulators over
key muscles
For fine motor control, we’ll need multiple
stimulators throughout the body.
Small enough and made from the right
materials to minimize rejection
Self powered
73. Advances in NeuroRehab
Future Directions
Goal:
Regain control of the body using only thought
waves to move the arms and legs
74. Advances in NeuroRehab
Future Directions
Brain-Computer interface to FES :
Bypass the damaged area of the brain or spinal
cord by sending thought waves to electrical
stimulators in the muscles
75. Advances in NeuroRehab
Future Directions
Brain-Computer interface to Exoskeletal Brace :
Bypass the damaged area of the brain or spinal
cord by sending thought waves to the motors
controlling the brace.