[ARTICLE] Neurogenesis: Study Sparks Controversy Over Whether Humans Continue to Make New Neurons Throughout Life

ARTICLE IN BRIEF

A new study offers new data challenging the prevailing view that neurogenesis occurs beyond childhood into adulthood.

For two decades, humans have been comforted by scientific discoveries showing that specific regions of the human brain, primarily the hippocampus, continue to grow neurons throughout life, a finding that suggests more is better (for learning and memory that are governed by the hippocampus) and that there may be backup plans in case our old neurons die.

But scientists at the University of California, San Francisco (UCSF) have looked at dozens of tissue samples from autopsied brains and epilepsy patients undergoing resection and found that the birth of new neurons is robust in fetal life and during the first year of life but then decreases rapidly in childhood. In adults, it was not possible (with current technology used) to identify populations of new neurons. The oldest samples with evidence of neurogenesis came from seven-year-old and a thirteen-year-old, the researchers reported in the March 15 issue of Nature.

Until the late 1990s, it had long been thought that primates, including humans, are born with the complete set of neurons for a lifetime. Through development and beyond, humans lose neuronal cells, but never gain new ones. First came rodent and bird studies, then monkeys, refuting these age-old beliefs, and then evidence from humans as well.

In an editorial in the same issue of Nature, neuroscientist Jason Snyder, a doctoral candidate and assistant professor in the psychology department at the University of British Columbia, wrote that the findings “are in stark contrast to the prevailing view” and “certain to stir up controversy.”

The study was led by Arturo Alvarez-Buylla, PhD, the Heather and Melanie Muss professor of neurological surgery at the University of California, San Francisco. Dr. Alvarez-Buylla was at Rockefeller University in the 1980s working with his mentor, Fernando Nottebohm, PhD, who first reported the birth of new neurons in the brains of adult canaries and its possible link to learning their annual mating songs. Dr. Alvarez-Buylla has spent his career studying the mechanism of adult neurogenesis and began looking at human samples more than a decade ago.

“We find that neurogenesis in the adult hippocampus in humans, if it occurs at all, is an extremely rare phenomenon, raising questions about its contribution to brain repair or normal brain function,” said the neuroscientist. “We have just looked at one region of the brain. There is a lot more work to do. Clearly the fascinating process of making a new neuron continues in young children. We should continue to study how neurons are made and whether it is possible to induce new neurons to grow in the adult brain to treat brain diseases.”

STUDY METHODS, FINDINGS

Dr. Alvarez-Buylla and his colleagues studied 59 samples of human hippocampal tissue from UCSF and collaborating centers around the world. Thirty-seven came from postmortem brain samples and the rest were from fresh tissue excised from patients undergoing treatment for epilepsy. The samples came from fetuses, newborns, children, adolescents and adults. The oldest sample came from a 77-year-old.

The investigators used several techniques to tag neural stem cells and young neurons (the markers include doublecortin and PSA NCAM) to search for evidence of newborn and mature brain cells. They also used high resolution electron microscopy to examine the cell’s shape and structure to make sure they were looking at neurons and not glial cells.

Dr. Alvarez-Buylla and his colleagues found evidence of new neurons in the dentate gyrus of the hippocampus in the fetal brain tissue and in the samples from newborns and infants. They counted an average of 1,618 young neurons per square millimeter of brain tissue at birth. The older the infant, the fewer the new neurons. The tissue from one-year olds have five-fold fewer new neurons; there was a 23-fold decline by age seven, and new neurons were hard to find by adolescence. The teen brain had about 2.4 new cells per square millimeter of dentate gyrus tissue.

The investigators did find an occasional young neuron in a few adult post-mortem brain samples in the walls of the brain ventricles, as previously reported, but when looking at the hippocampus of samples from people over 18 years old, the group could not find the young neurons or much evidence of proliferation next to the dentate gyrus, said Dr. Alvarez-Buylla.

The group also looked for neural progenitor stem cells that give rise to neurons. Again, it was not surprising that the fetal brain was filled with these progenitors, particularly in regions were the dentate is growing, but these cells were gone by early childhood, he explained.

Dr. Alvarez-Buylla said that the idea for this study was sparked by a visit to the laboratory Zhengang Yang, PhD, at Fudan University in China and co-author on the current paper.

Dr. Yang showed him some beautifully stained samples of hippocampal tissue from a 35-year-old. The tissue was collected within hours of his death. “We could find some new neurons close to the walls of the ventricle, but not in the hippocampus,” said Dr. Alvarez-Buylla. That was four years ago.

Dr. Alvarez Buylla returned to California and started looking at more hippocampal tissue in samples collected at UCSF. Then, he and his colleagues looked at more tissue samples from Jose Manuel Garcia-Verdugo, PhD, of University of Valencia in Spain and from Gary W. Mathern, MD, from the University of California, Los Angeles, also study collaborators.

“We are simply reporting what we observed, and to correct the record that there is no significant neurogenesis in the adult human hippocampus,” Dr. Alvarez-Buylla said.

“The process of making a new neuron in the adult brain remains a fundamental problem that we need to understand,” added Dr. Alvarez-Buylla, who is co-founder of Neurona Therapeutics, and serves on its scientific advisory board. “What’s next is to do more research.”

He thinks that the replacement of neurons in the complex human brain could potentially change brain circuits in detrimental ways. “Neurons have the potential to live for very long periods of time. There may be important reasons why we may need to keep the neurons we develop in fetal and early postnatal development.

There could be other reasons, he explained: “Making a new neuron in large brains, like ours, may be complicated by the changes in development. We have speculated that the early specification of stem cells (that is linked to location) could make it very difficult to seed stem cells within niches that continually expand to incredibly large sizes. It could also be associated to longevity; stem cells may not be able to self-renew infinitively and in species that live as long as we do, these key progenitors may get used up in early life. We, simply, do not know why some species retain significant neurogenesis in adulthood, while others, like us don’t.”

He also stressed that this study focused only in the hippocampus and in the search for the new neurons in the dentate. “There is a lot of human brain yet to be explored.”

“I think that we need to step back and ask what that means,” added UCSF neuroscientist Shawn F. Sorrells, PhD, the first author of the Nature paper. “If neurogenesis is so rare that we can’t detect it, can it really be playing a major role in plasticity or learning and memory in the hippocampus?”

EXPERT COMMENTARY

No one refutes the science that rodents continue to grow neurons throughout adulthood and that these neurons migrate to specialized regions like the dentate gyrus and the olfactory bulb. Elizabeth Gould, PhD, a neuroscientist at Princeton University, described neurogenesis in the dentate gyrus of adult rats in 1992. Fred H. Gage, PhD, a neurobiologist in the laboratory of genetics at The Salk Institute for Biological Sciences, published a series of studies suggesting that enriched environments and exercise could enhance adult neurogenesis in rats. Others showed that stress could diminish it.

Dr. Gage and his colleagues reported the first evidence of adult human neurogenesis in tissue samples from five cancer patients in 1997. Cancer doctors had used an imaging stain called bomodeoxyuridine (BrdU) in their patients to track tumor growth, and the scientists received permission to obtain brain slices right after the patients died. BrdU gets into the DNA of dividing cells, and the Salk scientists found staining in the dentate, which suggested that these were new neurons.

The science of adult neurogenesis continued to be debated as researchers questioned how robust the cellular growth is, where it is, and, most importantly, what is the purpose of this proliferation.

This new study may fuel this controversy. “This paper is the most thorough and rigorous study to date addressing human hippocampal neurogenesis,” said David R. Kornack, PhD, associate professor in the department of neuroscience at the University of Rochester. “It is such an important issue whether we continue to make new neurons in our brains as adults that the evidence has to be incontrovertible.”

Dr. Kornack has been studying neurogenesis for decades and was working with Pasko Rakic, MD, PhD, at Yale University School of Medicine, in the late 1990s when they identified evidence of adult neurogenesis in macaque monkeys — in a confocal microscope, they saw what they believed to be a small population of new neurons in the dentate gyrus of the hippocampus.

They published the study in 1999 in the Proceedings of the National Academy of Sciences, and Dr. Rakic continued to raise his concerns about adult neurogenesis in humans.

“For me, this new study closes the chapter about the prevalence of hippocampal neurogenesis in human adults,” added Dr. Kornack. “We are learning the powers and limitations of the technology and defining what a new neuron is. The strength of the finding is that they did see new neurons in younger tissue and not in older tissue. It confirms that hippocampal neurogenesis declines with age, which was already shown in monkeys and rodents. We are a long-lived species that rely on stored memories and behavior for our survival and stability. It may be a disadvantage to replace old neurons.”

His mentor agrees. “I feel vindicated,” said Pasko Rakic, MD, PhD, the Dorys McConnell Duberg professor of neuroscience and professor of neurology at Yale University School of Medicine. “I wanted to discover adult human neurogenesis, but I just couldn’t find it.”

Dr. Rakic said that adult neurogenesis is a limited event in the human brain, where even fewer new neurons were found than in the macaques. Additionally, he said adult rats had 10 to 14 times more new neurons in the hippocampus than the macaques had. The decreases in the number of these cells from rats to primates suggests, he said, “it must be more important not to have new neurons.”

Dr. Rakic added: “In evolution, our advantage is to preserve learned behavior. For memory, it isn’t productive to have new neurons but to preserve our old ones. We need stability of our neurons. If we added new neurons, they would not hold the memories of our past experiences. I use the same neurons I did as a child when I think of my mother. We need to invest in understanding how to keep our old neurons healthy. People think this is a negative finding. I think it is positive. It shows the value of keeping old cells in our brain, cells that have accumulated a lifetime of knowledge.”

Dr. Gage, PhD, of the Salk Institute for Biological Sciences, said that this latest study doesn’t disprove adult neurogenesis. Their conclusion is based “on the absence of morphological features and the lack of expression of two marker proteins, DCX and PSA-NCAM,” he said. “Both markers are very sensitive to methodological factors inherent to human brain tissue. One is the postmortem delay, the time between the death of a person and the moment the brain is removed and fixed. DCX is rapidly broken down after death and its staining disappears within a few hours of postmortem delay.”

He continued: “In this paper, many subjects had very long postmortem delays of ‘less than 48 hrs.’ As there is no mention of matching between subjects, or other optimization done in terms of the markers used, this influence of postmortem delay and on DCX integrity, which will also differ strongly between subjects, would question their conclusion about neurogenesis, as no control for DCX degradation was included.”

He added that adult mouse and adult human neurogenesis may use different proteins and they did not quantify or measure adult neurogenesis but rather proteins expressed in mice and immature cells.

LINK UP FOR MORE INFORMATION:

•. Sorrells SF, Paredes MR, Cebrian-Silla A, et al Human hippocampal neurogenesis drops sharply in children to undetectable levels in adults https://www.nature.com/articles/nature25975. Nature 2018; 555(7696): 377–381.

•. Snyder JS. Questioning human neurogenesis https://www.nature.com/articles/d41586-018-02629-3. Nature 2018; 555(7696):315–316.

•. Kornack DR, Rakic P. Continuation of neurogenesis in the hippocampus of the adult macaque monkey http://www.pnas.org/content/96/10/5768. Proc Natl Acad Sci USA 1999; 96(10):5768–5773.

© 2018 American Academy of Neurology

 

via Neurogenesis: Study Sparks Controversy Over Whether Humans C… : Neurology Today

[Abstract] Systematic review of high-level mobility training in people with a neurological impairment.

Abstract

AIM:

The objective of this paper was to systematically review the efficacy of interventions targeting high-level mobility skills in people with a neurological impairment.

METHODS:

A comprehensive electronic database search was conducted. Study designs were graded using the American Academy of Cerebral Palsy and Developmental Medicine (AACPDM) system and methodological quality was described using the Physiotherapy Evidence Database (PEDro) scale.

RESULTS:

Twelve exploratory studies (AACPDM levels IV/V), of limited methodological quality (PEDro scores of 2-3 out of 10), were included. Interventions included treadmill training, a three-phase programme, a high-level mobility group, plyometric training, running technique coaching and walk training with blood flow restriction. Diagnoses included acquired brain injury, cerebral palsy, incomplete spinal cord injury and neurofibromatosis type 1. There were difficulties generalizing results from exploratory designs with a broad range of participants, interventions and outcome measures. However, it seems that people with a neurological impairment have the capacity to improve high-level mobility skills, running speed and distance with intervention. There were no adverse events that limited participation.

CONCLUSION:

There is preliminary evidence to support the efficacy of interventions to improve high-level mobility skills in people with neurological impairments. Well-controlled research with a larger sample is required to provide sufficient evidence to change clinical practice.

 

via Systematic review of high-level mobility training in people with a neurological impairment. – PubMed – NCBI

[Review] Current evidence on transcranial magnetic stimulation and its potential usefulness in post-stroke neurorehabilitation: Opening new doors to the treatment of cerebrovascular disease – Full Text

Abstract

Introduction

Repetitive transcranial magnetic stimulation (rTMS) is a therapeutic reality in post-stroke rehabilitation. It has a neuroprotective effect on the modulation of neuroplasticity, improving the brain’s capacity to retrain neural circuits and promoting restoration and acquisition of new compensatory skills.

Development

We conducted a literature search on PubMed and also gathered the latest books, clinical practice guidelines, and recommendations published by the most prominent scientific societies concerning the therapeutic use of rTMS in the rehabilitation of stroke patients. The criteria of the International Federation of Clinical Neurophysiology (2014) were followed regarding the inclusion of all evidence and recommendations.

Conclusions

Identifying stroke patients who are eligible for rTMS is essential to accelerate their recovery. rTMS has proven to be safe and effective for treating stroke complications. Functional brain activity can be optimised by applying excitatory or inhibitory electromagnetic pulses to the hemisphere ipsilateral or contralateral to the lesion, respectively, as well as at the level of the transcallosal pathway to regulate interhemispheric communication. Different studies of rTMS in these patients have resulted in improvements in motor disorders, aphasia, dysarthria, oropharyngeal dysphagia, depression, and perceptual-cognitive deficits. However, further well-designed randomised controlled clinical trials with larger sample size are needed to recommend with a higher level of evidence, proper implementation of rTMS use in stroke subjects on a widespread basis.

Introduction

Stroke patients should receive early neurorehabilitation after convalescence. For many years, researchers have aimed to identify new therapeutic targets to hasten recovery from stroke. However, we continue to lack a universally accepted, approved pharmacological therapy for these patients.^{1; 2; 3; 4 ;  5} After stroke, organisational changes in brain interneuronal activity in the affected area and the surrounding healthy tissue may on occasion promote functional recovery. Neurorehabilitation may help achieve this aim. Unfortunately, there are also occasions when neural reorganisation is suboptimal; in these cases, the problem persists and becomes chronic. In this context, transcranial magnetic stimulation (TMS) emerged as a tool for studying the brain and has been used since the mid-1980s to treat certain neuropsychiatric disorders. Neurorehabilitation is based on the idea that the brain is a dynamic entity able to adapt to internal and external homeostatic changes. This adaptive capacity, called neuroplasticity, is also present in patients with acquired brain injuries. The degree of recovery and the functional prognosis of these patients depend on the extent of neuroplastic changes.^{1; 2; 3; 4; 5 ;  6} When performed by experienced physicians, TMS is a safe, non-invasive technique which enables the organisation of these neural changes (Fig. 1). The technique’s applications are expanding rapidly.^{1; 2; 3; 4; 5; 6; 7; 8 ;  9}

Figure 1.

Modern TMS device.

We present the results of a literature review of the most relevant articles, manuals, and clinical practice guidelines addressing TMS (background information, diagnostic and therapeutic uses, and especially its usefulness for stroke neurorehabilitation) and published between 1985 (when the technique was first used) and 2015.

 

Development

The organisation of language in the brain

The left hemisphere of the brain is the anatomo-functional seat of language in 96% of right-handed and 70% of left-handed individuals. Language processing in the left hemisphere involves certain anatomical pathways for language comprehension, repetition, and production (Fig. 2). Positron emission tomography and functional magnetic resonance imaging (fMRI) studies conducted during multiple language tasks have shown brain activation not only in the main language centres (lesions to these areas may cause Broca aphasia, Wernicke aphasia, etc.) (Fig. 3) but also in many other locations, such as the thalamus (alertness), the basal ganglia (motor modulation), and the limbic system (affect and memory). Language is the perfect model for understanding how the central nervous system works as a whole.^{10 ;  11}

Figure 2. The functional pathways involved in comprehension, repetition, and production of written, gesture, and spoken language, according to the Wernicke-Geschwind model. Within the left hemisphere, language organisation follows certain anatomical pathways for language comprehension, repetition, and production. Sounds are processed by the bilateral auditory cortex, in the superior temporal gyrus (primary auditory area), and decoded in the posterior area of the left temporal cortex (Wernicke area); the latter is connected to other cortical areas or networks which assign meaning to words. During reading, output from the primary visual area (bilaterally) travels to other parieto-occipital association areas for word and phrase recognition (especially the left fusiform gyrus, located in the inferior surface of the temporal lobe, where there is a key word recognition centre) and reaches the angular gyrus, which processes language-related visual and auditory information. In spontaneous language repetition and production, auditory information must travel through the arcuate fasciculus towards the left inferior frontal region (Broca area), which is responsible for language production; this area is also known to be involved in such other functions as action comprehension (mirror neurons). To produce written or spoken language, output from the Wernicke area, the Broca area, and nearby association areas must reach the primary motor cortex.^{10 ;  11}
Adapted with permission from Bear et al.¹⁰

[…]

Continue —> Current evidence on transcranial magnetic stimulation and its potential usefulness in post-stroke neurorehabilitation: Opening new doors to the treatment of cerebrovascular disease

[WEB SITE] This incredible smart band can help detect seizures when worn by people with epilepsy

A seizure-detecting smart band could help people with epilepsy notify their caregivers in the event of an emergency.

Embrace, a smart band created by Empatica, uses advanced machine learning (AI) to monitor seizures, collecting physiological data from users to try to detect unusual events such as convulsive seizures.

The Embrace band is paired to a smartphone or iPod via Bluetooth connection and works in tandem with the Alert app, which sends SMS and phone call alerts to selected caregivers when a seizure is detected.

Embrace will send a command to the Alert app when it detects a seizure (Empatica)

Empatica CEO Matteo Lai said: “Embrace is a Medical Grade device in Europe and the only FDA-cleared seizure monitoring smart watch, which uses AI to monitor for the most dangerous kinds of seizures, known as ‘grand mal’ or ‘generalized tonic-clonic’ seizures, and send an alert to summon caregivers’ help.

“Embrace stands apart from any seizure detection system in that it measures multiple indicators of a seizure.

“Its unique property is its use of Electrodermal Activity, a signal used by stress researchers to quantify physiological changes related to sympathetic nervous system activity, also known as the ‘fight or flight’ response.”

When Embrace detects a seizure, it will send a command to the Alert app, which then sends an alert to the designated caregiver.

“Users can add caregivers who are notified in real time with a phone call and an SMS containing the wearer’s GPS location.

Lai said: “There is also another product that works with Embrace, a diary app called Mate, where the caregiver can monitor sleep and physical activity for patients wearing Embrace.

“The Mate app displays the seizures automatically detected by the Embrace and patients can also insert other, non-convulsive seizures that aren’t automatically detected.”

Embrace costs £177 (Empatica)

Morgan, a user of Embrace, said: “I purchased the Embrace mostly because my seizures have all happened during my sleep.

“I also purchased it so that I could regain a lot of the confidence that I lost once I was diagnosed with epilepsy.

“On November 6th 2016, I had a seizure(s) that lasted over 40 minutes. The Embrace detected the seizures and my emergency contacts were notified… I believe the Embrace saved my life. It helps give peace of mind to me, as well as my friends and family.

“Having the Embrace has also helped me regain the confidence to start being active again.”

Embrace costs 249 US dollars (£177), and is available from the Empatica website.

 

via This incredible smart band can help detect seizures when worn by people with epilepsy – Evening Express

[WEB SITE] EBRSR – Evidence-Based Review of Stroke Rehabilitation

Introduction

Welcome to the 18th edition of the EBRSR. The EBRSR now includes in-depth reviews of well over 4,500 studies including over 2,300 randomized controlled trials. Parts of the EBRSR have been translated into a number of languages.

We extend sincere gratitude to the Canadian Partnership for Stroke Recovery (CPSR), a joint initiative of the Heart and Stroke Foundation and Canada’s leading stroke research centres, for funding the EBRSR.

Many readers have e-mailed us with their comments and we encourage you do so as well. We also encourage you to e-mail us if you have any concerns regarding our analyses. This helps us to ensure our data and conclusions are the best possible.

Robert Teasell MD FRCPC
Andreea Cotoi MSc

Visit Site —> Introduction | EBRSR – Evidence-Based Review of Stroke Rehabilitation

[ARTICLE] Technological Approaches for Neurorehabilitation: From Robotic Devices to Brain Stimulation and Beyond – Full Text

Neurological diseases causing motor/cognitive impairments are among the most common causes of adult-onset disability. More than one billion of people are affected worldwide, and this number is expected to increase in upcoming years, because of the rapidly aging population. The frequent lack of complete recovery makes it desirable to develop novel neurorehabilitative treatments, suited to the patients, and better targeting the specific disability. To date, rehabilitation therapy can be aided by the technological support of robotic-based therapy, non-invasive brain stimulation, and neural interfaces. In this perspective, we will review the above methods by referring to the most recent advances in each field. Then, we propose and discuss current and future approaches based on the combination of the above. As pointed out in the recent literature, by combining traditional rehabilitation techniques with neuromodulation, biofeedback recordings and/or novel robotic and wearable assistive devices, several studies have proven it is possible to sensibly improve the amount of recovery with respect to traditional treatments. We will then discuss the possible applied research directions to maximize the outcome of a neurorehabilitation therapy, which should include the personalization of the therapy based on patient and clinician needs and preferences.

Introduction

According to the World Health Organization (WHO), neurological disorders and injuries account for the 6.3% of the global burden of disease (GBD) (1, 2). With more than 6% of DALY (disability-adjusted life years) in the world, neurological disorders represent one of the most widespread clinical condition. Among neurological disorders, more than half of the burden in DALYs is constituted by cerebral-vascular disease (55%), such as stroke. Stroke, together with spinal cord injury (SCI), accounts for 52% of the adult-onset disability and, over a billion people (i.e., about a 15% of the population worldwide) suffer from some form of disability (3). These numbers are likely to increase in the coming years due to the aging of the population (4), since disorders affecting people aged 60 years and older contribute to 23% of the total GBD (5).

Standard physical rehabilitation favors the functional recovery after stroke, as compared to no treatment (6). However, the functional recovery is not always satisfactory as only 20% of patients fully resume their social life and job activities (7). Hence, the need of more effective and patient-tailored rehabilitative approaches to maximize the functional outcome of neurological injuries as well as patients’ quality of life (8). Modern technological methodologies represent one of the most recent advances in neurorehabilitation, and an increasing body of evidence supports their role in the recovery from brain and/or medullary insults. This manuscript provides a perspective on how technologies and methodologies could be combined in order to maximize the outcome of neurorehabilitation.

Current Systems and Therapeutic Approaches for Neurorehabilitation

The great progress made in interdisciplinary fields, such as neural engineering (9, 10), has allowed to investigate many neural mechanisms, by detecting and processing the neural signals at high spatio-temporal resolution, and by interfacing the nervous system with external devices, thus restoring neurological functions lost due to disease/injury. The progress continues in parallel to technological advancements. The last two decades there has seen a large proliferation of technological approaches for human rehabilitation, such as robots, wearable systems, brain stimulation, and virtual environments. In the next sections, we will focus on: robotic therapy, non-invasive brain stimulation (NIBS), and neural interfaces.

Robotic Devices

Robots for neurorehabilitation are designed to support the administration of physical exercises to the upper or lower extremities, with the purpose of promoting neuro-motor recovery. This technology has a relatively long history, dating back to the early 1990s (11). Robot devices for rehabilitation differ widely in terms of mechanical design, number of degrees of freedom, and control architectures. As regards the mechanical design, robots may have either a single point of interaction (i.e., end effector) with the user body (endpoint robots or manipulanda) or multiple points of interaction (exoskeletons and wearable robots) (12).

Endpoint robots for the upper extremity, include Inmotion2 (IMT, USA) (13), KINARM End-Point (BKIN, Canada), and Braccio di Ferro (14) (Figure 1A1, left). Only some of these devices have been tested in randomized clinical trials (15), confirming an improvement of upper limb motor function after stroke (16). However, convincing evidence in favor of significant changes in activities of daily living (ADL) indicators is lacking (17), possibly because performance in ADL is highly affected by hand functionality. A good example of lower limb endpoint robot is represented by gait trainer GT1 (Reha-Stim, Germany). Its efficacy was tested by Picelli et al. (18), who demonstrated an improvement in multiple clinical measures in subjects with Parkinson’s disease following robotic-assisted rehabilitation when compared to physical rehabilitation alone (18). Endpoint robots are also available for postural rehabilitation. For instance, Hunova (Movendo Technology, Italy, launched in 2017) is equipped with a seat and a platform that induce multidirectional movements to improve postural stability (Figure 1A1, right).

 

Figure 1. Neurorehabilitation therapies. (A1) Endpoint robots: on the left the “Braccio di Ferro” manipulandum, on the right the postural robot Hunova. Braccio di ferro (14) is a planar manipulandum with 2-DOF, developed at the University of Genoa (Italy). It is equipped with direct-drive brushless motors and is specially designed to minimize endpoint inertia. It uses the H3DAPI programming environment, which allows to share exercise protocol with other devices. Written informed consent was obtained from the subject depicted in the panel. Movendo Technology’s Hunova is a robotic device that permits full-body rehabilitation. It has two 2-DOF actuated and sensorized platforms located under the seat and on the floor level that allow it to rehabilitate several body districts, including lower limb (thanks to the floor-level platform), the core, and the back, using the platform located underneath the seat. Different patient categories (orthopedic, neurological, and geriatric) can be treated, and interact with the machine through a GUI based on serious games. (A2) Wearable device: the recent exoskeleton Twin. Twin is a fully modular device developed at IIT and co-funded by INAIL (the Italian National Institute for Insurance against Accidents at Work). The device can be easily assembled/disassembled by the patient/therapist. It provides total assistance to patients in the 5–95th percentile range with a weight up to 110 kg. Its modularity is implemented by eight quick release connectors, each located at both mechanical ends of each motor, that allow mechanical and electrical connection with the rest of the structure. It can implement three different walking patterns that can be fully customized according to the patient’s needs viaa GUI on mobile device, thus enabling personalization of the therapy. Steps can be triggered via an IMU-based machine state controller. (B1) Repetitive transcranial magnetic stimulation (rTMS) representation. rTMS refers to the application of magnetic pulses in a repetitive mode. Conventional rTMS applied at low frequency (0.2–1 Hz) results in plastic inhibition of cortical excitability, whereas when it is applied at high frequency (≥5Hz), it leads to excitation (19). rTMS can also be applied in a “patterned mode.” Theta burst stimulation involves applying bursts of high frequency magnetic stimulation (three pulses at 50 Hz) repeated at intervals of 200 ms (20). Intermittent TBS increases cortical excitability for a period of 20–30 min, whereas continuous TBS leads to a suppression of cortical activity for approximately the same amount of time (20). (B2) Transcranial current stimulation (tCS) representation. tCS uses ultra-low intensity current, to manipulate the membrane potential of neurons and modulate spontaneous firing rates, but is insufficient on its own to discharge resting neurons or axons (21). tCS is an umbrella term for a number of brain modulating paradigms, such as transcranial direct current stimulation (22), transcranial alternating current stimulation (23), and transcranial random noise stimulation (24). (C) A typical BCI system. Five stages are represented: brain-signal acquisition, preprocessing, feature extraction/selection, classification, and application interface. In the first stage, brain-signal acquisition, suitable signals are acquired using an appropriate modality. Since the acquired signals are normally weak and contain noise (physiological and instrumental) and artifacts, preprocessing is needed, which is the second stage. In the third stage, some useful data or so-called “features” are extracted. These features, in the fourth stage, are classified using a suitable classifier. Finally, in the fifth stage, the classified signals are transmitted to a computer or other external devices for generating the desired control commands to the devices. In neurofeedback applications, the application interface is a real-time display of brain activity, which enables self-regulation of brain functions (25).

Continue —> Frontiers | Technological Approaches for Neurorehabilitation: From Robotic Devices to Brain Stimulation and Beyond | Neurology

[Abstract] Customized robot aided palm (finger) opening and closing physical rehabilitation aids system development

Abstract

It is a universal fact that the world is contending with an ageing population and ageing is having a particularly significant impact in developed countries. However, there are limitations in terms of the availability of manpower in healthcare, which is creating challenges in this area. Professor Jen-Yuan (James) Chang, of the Department of Power Mechanical Engineering, National Tsing Hua University (NTHU), Taiwan, and Dr Yu-Cheng Pei, Attending Physician in the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taiwan, are elementary school friends who are collaborating on a project entitled ‘Development of Customized Robotic-Assistive Exoskeleton System for Palm-Finger Physical Rehabilitation’. The idea behind the project, which is based at NTHU, is to explore the potential of automation, such as the rehabilitation robot the researchers are developing to solve the limitation in manpower that healthcare is facing.

Full Text PDF

via Customized robot aided palm (finger) opening and closing physical…: Ingenta Connect

[Online Game] Mobility Mission Online Game – Stroke.org

Mobility Mission Online Game

Mobility Mission is an entertaining online game that addresses post-stroke mobility challenges. Stroke is a serious condition, and learning to deal with the effects of surviving a stroke can be challenging. This game will help you gain a better understanding of post-stroke mobility challenges such as spasticity, paralysis, foot drop, as well as management and treatment options you can discuss with your healthcare provider. As you travel through the four levels of the game you will learn how to improve your safety at home and acquire tips to lower your risk of falling. Your journey is waiting!

PLAY NOW

 

via Mobility Mission Online Game | Stroke.org

[WEB SITE] How the National Stroke Association is Advancing Stroke Rehabilitation with Exoskeleton Technology

The National Stroke Association’s mission is to reduce the incidence and The National Stroke Association’s mission is to reduce the incidence and impact of stroke through education and programs focused on prevention, treatment, rehabilitation and support that addresses the needs of stroke survivors, caregivers and healthcare professionals in the stroke community nationwide. The National Stroke Association provides services to more than 90,000 stroke survivors, 30,000 caregivers and 110,000 healthcare professionals in the U.S. and Canada, with the number of individuals benefiting from the National Stroke Association’s services and resources growing every day.

The National Stroke Association and Ekso Bionics have formed an educational partnership dedicated to increasing awareness of and access to advanced stroke rehabilitation exoskeleton technology that enables earlier mobility and restored independence for survivors of stroke.

“

The partnership between the National Stroke Administration and Ekso Bionics [is] very beneficial, and it’s very appropriate that they use the term “Hope After Stroke” because it’s true. There is hope after the stroke.”

—JESSICA “JESS” MCNAIR, STROKE SURVIVOR

Moving As One for Hope After Stroke

An estimated 17 million people around the world experience a strokeeach year. More than 60% of survivors of acute stroke find themselves unable to walk or in need of intervention in walking. Impaired ambulation is greatly associated with fall risks, dependency, limited participation in social activities, and lower quality of life.

However, with the advent of robotic technologies, such as the EksoGT™, the first FDA-cleared exoskeleton device for stroke rehabilitation, the possibility of assisting with ambulation may aid the recovery process by providing earlier mobility and restored independence.

The National Stroke Association and Ekso Bionics educational campaign will include three branches:

National and Regional Push to Elevate Survivor Voices

Showcasing survivors of stroke and their care team in national and regional arenas to highlight the impact of robotic exoskeleton technologies in rehabilitation.

 

Visit Site —> National Stroke Association Partnership | Ekso Bionics

[Fact Sheet] Recovery After Stroke: Movement And Balance – PDF file

Moving around safely and easily may not be something you think about, unless you’ve had a stroke. Many stroke survivors have trouble moving around. These problems range from balance issues to arm or leg paralysis. As a result, about 40 percent of stroke survivors have serious falls within a year of their strokes. But, there is good news. Rehab and therapy may improve your balance and ability to move.

Download this fact sheet

via National Stroke Association at http://www.stroke.org