Posts Tagged Parkinson

[NEWS] Wireless ‘pacemaker for the brain’ could be new standard treatment for neurological disorders

A grey-colored sits on an illustration of a brain

A new neurostimulator developed by engineers at UC Berkeley can listen to and stimulate electric current in the brain at the same time, potentially delivering fine-tuned treatments to patients with diseases like epilepsy and Parkinson’s.

The device, named the WAND, works like a “pacemaker for the brain,” monitoring the brain’s electrical activity and delivering electrical stimulation if it detects something amiss.

These devices can be extremely effective at preventing debilitating tremors or seizures in patients with a variety of neurological conditions. But the electrical signatures that precede a seizure or tremor can be extremely subtle, and the frequency and strength of electrical stimulation required to prevent them is equally touchy. It can take years of small adjustments by doctors before the devices provide optimal treatment.

WAND, which stands for wireless artifact-free neuromodulation device, is both wireless and autonomous, meaning that once it learns to recognize the signs of tremor or seizure, it can adjust the stimulation parameters on its own to prevent the unwanted movements. And because it is closed-loop — meaning it can stimulate and record simultaneously — it can adjust these parameters in real-time.

“The process of finding the right therapy for a patient is extremely costly and can take years. Significant reduction in both cost and duration can potentially lead to greatly improved outcomes and accessibility,” said Rikky Muller, an assistant professor of electrical engineering and computer sciences at Berkeley. “We want to enable the device to figure out what is the best way to stimulate for a given patient to give the best outcomes. And you can only do that by listening and recording the neural signatures.”

WAND can record electrical activity over 128 channels, or from 128 points in the brain, compared to eight channels in other closed-loop systems. To demonstrate the device, the team used WAND to recognize and delay specific arm movements in rhesus macaques. The device is described in a study that appeared today (Dec. 31) in Nature Biomedical Engineering.

A WAND chip in a hand

Ripples in a pond

Simultaneously stimulating and recording electrical signals in the brain is much like trying to see small ripples in a pond while also splashing your feet — the electrical signals from the brain are overwhelmed by the large pulses of electricity delivered by the stimulation.

Currently, deep brain stimulators either stop recording while delivering the electrical stimulation, or record at a different part of the brain from where the stimulation is applied — essentially measuring the small ripples at a different point in the pond from the splashing.

“In order to deliver closed-loop stimulation-based therapies, which is a big goal for people treating Parkinson’s and epilepsy and a variety of neurological disorders, it is very important to both perform neural recordings and stimulation simultaneously, which currently no single commercial device does,” said former UC Berkeley postdoctoral associate Samantha Santacruz, who is now an assistant professor at the University of Texas in Austin.

Researchers at Cortera Neurotechnologies, Inc., led by Muller, designed the WAND custom integrated circuits that can record the full signal from both the subtle brain waves and the strong electrical pulses. This chip design allows WAND to subtract the signal from the electrical pulses, resulting in a clean signal from the brain waves.

A close up picture of an integrated circuit

Existing devices are tuned to record signals only from the smaller brain waves and are overwhelmed by the large stimulation pulses, making this type of signal reconstruction impossible.

“Because we can actually stimulate and record in the same brain region, we know exactly what is happening when we are providing a therapy,” Muller said.

In collaboration with the lab of electrical engineering and computer science professor Jan Rabaey, the team built a platform device with wireless and closed-loop computational capabilities that can be programmed for use in a variety of research and clinical applications.

In experiments lead by Santacruz while a postdoc at UC Berkeley, and by electrical engineering and computer science professor Jose Carmena, subjects were taught to use a joystick to move a cursor to a specific location. After a training period, the WAND device was capable of detecting the neural signatures that arose as the subjects prepared to perform the motion, and then deliver electrical stimulation that delayed the motion.

“While delaying reaction time is something that has been demonstrated before, this is, to our knowledge, the first time that it has been demonstrated in a closed-loop system based on a neurological recording only,” Muller said.

“In the future we aim to incorporate learning into our closed-loop platform to build intelligent devices that can figure out how to best treat you, and remove the doctor from having to constantly intervene in this process,” she said.

Andy Zhou and Benjamin C. Johnson of UC Berkeley join Santacruz as co-lead authors on the paper. Other contributing authors include George Alexandrov, Ali Moin and Fred L. Burghardt of UC Berkeley. This work was supported in part by the Defense Advanced Research Projects Agency (W911NF-14- 2- 0043) and the National Science Foundation Graduate Research Fellowship Program (Grant No. 1106400). Authors Benjamin C. Johnson, Jan M. Rabaey, Jose M. Carmena and Rikky Muller have financial interest in Cortera Neurotechnologies, Inc., which has filed a patent application on the integrated circuit used in this work.

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via Wireless ‘pacemaker for the brain’ could be new standard treatment for neurological disorders | Berkeley News

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[Systematic Review] Effectiveness of robotics in improving upper extremity functions among people with neurological dysfunction – Abstract

Publication CoverPurpose: the primary focus of this review was to find out the effectiveness of robotics in improving upper extremity functions among people with neurological problems in the arena of physical rehabilitation.

Material and Methods: Two reviewers independently scrutinized the included studies. The selected studies underwent quality assessment by PEDro scale. Randomized Controlled Trial (RCT) having a score of 4 or more were included in the review. A search was conducted in PUBMED, MEDLINE, CINAHL, EMBASE, PROQUEST, science direct, Cochrane Library, Physiotherapy Evidence Database (PEDro) and Google Scholar.

Results: A total of 202 studies were identified. After removal of duplication, inclusion and exclusion criteria’s n = 23 studies were included in the review process. For analysis, only the primary outcome measures of the studies were taken into account. Studies finally included in analysis were n= 21. The included studies were 19 in stroke, 1 in cerebral palsy (CP), and 1 study in multiple sclerosis (MS). No RCTs were reportedly found in spinal cord injury, Parkinson and motor neuron disease.

Conclusion: Studies related to stroke showed a clear definiteness in the improvement of upper extremity functions. Whereas on the contrary there still remains a need for quality trials in cerebral palsy, multiple sclerosis to establish the efficacy of robotics in upper extremity rehabilitation.

 

via Effectiveness of robotics in improving upper extremity functions among people with neurological dysfunction: A Systematic Review: International Journal of Neuroscience: Vol 0, No ja

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[BLOG POST] Virtual reality for people with stroke or Parkinson’s disease: bringing therapy home – Evidently Cochrane

Virtual reality for people with stroke or Parkinson’s disease: bringing therapy home

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In this blog, neuropsychologist Marta Bieńkiewicz explores the potential of virtual reality to help people with Parkinson’s disease, and after stroke, and looks at the evidence from Cochrane reviews.

By 2020 it is estimated that there will be 120 million active users of Virtual Reality (VR) via mobile headsets; nearly a fifth of whom will be using it for healthcare solutions (ABI report, 2015). The hype about VR is currently reaching fever pitch, thanks mostly to the increased accessibility of it for the average Joe (via solutions such as smartphones add-ons spectacles). All over the globe VR setups are being tested and investigated as a novel means of enabling more fun and efficient physical exercise as part of rehabilitation. But is all the money that goes into research and development for this technology justifiable? Could it be better spent – for example on training more therapists or providing activity groups for patients?

In an attempt to answer this question, let’s walk through some facts to get a better picture as to what VR is and what it might hold for people with stroke and Parkinson’s disease (PD).

The virtual reality (VR) environment

My first exposure to VR was during my PhD days. My future husband (as it turned out 5 years later) was doing his doctorate on the non-clinical applications of what was, at the time, a technology in its infancy. In the simplest of definitions, VR is a computer designed environment that can be displayed in a headset glasses or a cave (special room) to create a feeling of full immersion that you are somewhere else; completely detached from the real world yet fully engaged with the virtual world. The high immersion display might trick you into thinking you are on a tennis court playing a game at Wimbledon for example. The low immersion VR environments comprise computer displays – usually tablets or regular screens. In this case you can still enjoy a game or follow on-screen instructions, but your brain keeps check of its whereabouts.

So, the main concept behind VR-based rehabilitation games is twofold. Firstly, they provide a clear, visual means of prompting users’ movements (i.e. in the example of picking up an apple, the user might be guided toward it). Secondly, they increase the personal motivation of the user. The higher the engagement with the environment and varied scenarios, the higher the enjoyment and willingness to repeat the same exercise all over again (Lewis & Rosie, 2012). A Cochrane review (French et al. 2016) reported that repetitive training may improve walking distance and is probably effective for improving upper limb rehabilitation. For a fantastic example of how this field is moving forward see the KATA project based at John Hopkins University which uses a combination of VR (Pixar like!) display with robotic-assisted therapy for stroke.

The reality of stroke and Parkinson’s disease

Stroke and Parkinson’s disease are two different neurological conditions. The first one happens suddenly and changes mobility overnight, which may mean changing from being a fully active person to being limited in one’s independence. The second is characterised by gradual and sneaky progression of compromised mobility. Either condition may make everyday life increasingly a real struggle. When it is not easy to get dressed, the idea of doing physical exercise seems totally unattainable. People find themselves not being able to do the tasks they previously took for granted – preparing a sandwich, driving a car, or simply going out of the house, and now add to it catching up with the modern technology.

Exercise may help

If you are a sufferer, these two aspects might discourage you from reading on – exercise and VR sounds too hard to even bother! But here is the thing. While guidelines on how to improve mobility in neurological conditions are scarce, the ones that are there (Keus et al., 2014)suggest that the power of exercise might help. Studies suggests that intense exercise in Parkinson’s may slow down the progression of the disease due to neuroprotective benefits (Alberts et al., 2016Corcos et al., 2013) and help maintain independence (van Nimwegen, 2011). After stroke, physiotherapy is usually started straight away or during the hospitalisation period. In fact, many research teams are convinced that the time window for the real functional recovery of lost limb power (i.e. regaining the previous dexterity) is quite short and is limited to 6 months post accident or shorter (Cortes et al., 2017). This is the window of opportunity for brain reorganisation, after which improvement is maybe not impossible, but certainly more challenging.

Depending on patients’ needs, exercise should target general mobility, dexterity, walking, or specific daily activities. There are exercise-based interventions in particular that were reported to show improvement in people with Parkinson’s Disease: such as tandem or automated stationary cycling (Ridgiel et al., 2015) and pole-striding (Bombieri et al., 2017Krishnamurthi et al., 2017), and for stroke: physical rehabilitation (Pollock et al., 2014) or robot-assisted interventions (Mehrholz et al., 20152017). In both conditions, it is thought to be important to start as soon as possible and introduce exercise regime as a regular part of daily life.

For people with PD or after stroke who are keen to become more fit and actively steer their rehabilitation, VR could be their new best friend.

Does virtual reality offer real life benefits?

The Cochrane review of VR (Dockx et al., 2016) and gaming for Parkinson’s, with a focus on walking and balance, provides us with evidence that VR based training may lead to better improvements for stride length, but overall may have similar effects on walking parameters and balance as conventional therapy, while the effect on quality of life is uncertain. The upper limb interventions were not included.

On the contrary, the Cochrane review of VR in stroke focused interventions (Laver et al., 2015) was primarily focused on upper limb function and found that VR based interventions may lead to greater improvements in both function and daily task performance compared to conventional therapy. Global mobility and grip strength remained on level par. It is not clear how long-lasting those effects are, nor which characteristics are the most meaningful for patients’ recovery. The number of studies examined was small and information insufficient to look into other dimensions such as quality of life or cognitive functions.

So what does this all mean? The interventions using VR were overall found to be probably similar to the conventional therapies, with the potential added value in the form of accurate feedback and the ability to stimulate users by creating personalised, motivational and fun interventions (Dockx et al., 2016Laver et al., 2015). If more evidence is found to confirm those findings, it would mean VR can be potentially be as good as a supervised therapy, which is great news. Why? Because it means you can bring it home.

Why Occupational Therapists can sleep well at night (for now…)

Let’s make it clear, this is not an overnight take-over of conventional therapy. VR and gaming solutions have the potential to provide a similar level of care to traditional exercise-based therapy, without having to replace it. At least for the next decades, think of it as a potential complementary therapy subsidised by the NHS or private insurance: part of a medical treatment that would encourage patients to do meaningful exercise in between the supervised physiotherapy sessions. Conversely, VR-based exercise units in hospitals could train patients in daily tasks, emulating their home environment. Beyond that, the technology is simply not mature enough to match that of a human eye and brain in terms of assessment and choice of best treatment. However, with Artificial Intelligence looming on the distant horizon, this is not beyond the realms of possibility…some day.

Tread carefully though when it comes to any products or apps that are advertised as a rehabilitation tool on the consumer market. In order for it to be a relevant training tool it needs to be paired with sensors (attached to your body or embedded in a special clothing) in order to provide feedback.

Looking to the future: Extended Reality

The future however, might lie in a newly born sister of VR, namely Extended Reality (ER). This technology is also based on wearable headsets (such as Hololens) but allows the user to be immersed in the virtual reality while seeing the physical environment.

The idea is that the juxtaposed feedback information is relevant and not interruptive for your current activity (e.g. walking a dog). It is also a safer mode of exercise as it does not require being detached from one’s surroundings despite a high level of immersion in the virtual environment/of immersion. At least four labs so far have been investigating this idea for stroke and Parkinson’s (Technical University of MunichUniversity of RochesterUniversity of Connecticut and Northeastern University). Along with ER developments, the level of immersion and therefore enjoyment can be increased with the sound spatialisation and touch sensation (i.e. Ultrahaptics). One could easily imagine that ER opens new horizons for combining a very accurate feedback tool with, for example, robotic therapy.

Hopefully the next years will bring answers to questions such as the level of transferability of VR/ER training into real life skills. Further research is necessary to inform tailored technology-based exercise regimes and to clarify whether or not rehabilitation with limited supervision is a feasible model.

The take home message

While certainly the technological development in the current era is both exciting and a little daunting, it brings solutions that were not previously available at such affordable cost. VR essentially offers a therapy that is likely to become almost as good as conventional therapy from within the comforts of your own home. VR and gaming can be fun, can provide excitement of immersion and prevent boredom while also achieving exercise goals for task-specific rehabilitation. While current solutions are not yet up to the ‘buy now’ level, this area should definitely make your watchlist.

References may be found here.

Marta Bieńkiewicz has nothing to disclose.

Source: Virtual reality for people with stroke or Parkinson’s disease: bringing therapy home – Evidently Cochrane

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[WEB SITE] Here’s an idea: Play your way to recovery – ideas.ted.com

As anyone who’s ever recovered from an injury knows, physical therapy can be painful, boring and slow. TED Fellow Cosmin Mihaiu is out to change that with MIRA, software that disguises physical therapy exercises as fun-to-play videogames. Here’s how it works.

Unlikely — fun! — physical therapy. “Traditionally, a patient doing physical therapy at home is, at most, looking in the mirror. There’s no other feedback or encouragement,” says Mihaiu. MIRA, built by his team in Romania and the United Kingdom, changes that. It’s a set of simple, fun-to-play videogames that encourage precise movement while offering audio and visual stimulus and a sense of achievement. By reaching their onscreen goals, patients also do their physical therapy exercises. So a patient recovering from a broken arm might fly a bee to gather pollen — while flexing and extending the arm. Someone recovering from a stroke might navigate a submarine through water to improve the precision of movement in the shoulder.

Off-the-shelf hardware and tailored exercises produce a personal experience. Each of the ten games offers a range of exercises that can be tailored to each patient’s needs; it’s up to the therapist to prescribe which ones to play, and for how long. Mihaiu and his team built software that can be played via a Kinect motion-sensing input device and a PC. Using readily available and relatively cheap hardware is one way they hope to promote adoption by clinics and hospitals — and eventually by patients at home.

BECAUSE PATIENTS KNOW THAT THEIR CLINICIANS CAN SEE WHETHER AND HOW THEY ARE DOING THE PRESCRIBED EXERCISES, THEY’RE MORE LIKELY TO COMPLY.

The inspiration for MIRA: a fall from a tree. When he was seven, Mihaiu fell out of a tree he’d used as a (poor) hiding place. “The doctors encased my arm and torso in a cast, and because I was stuck in that position for six weeks, I could no longer extend my elbow when the cast came off,” he says. A physical therapist prescribed exercises that called for him to flex and extend his elbow 100 times a day. Unsurprisingly, little Cosmin balked at such tedium. But that meant his recovery took far longer than it should have done. Years later, as a computer engineering student at the University of Babeș-Bolyai in Romania, Mihaiu remembered this childhood experience during a brainstorming session for the Microsoft Imagine Cup innovation competition. “We thought, what if we could get people to play their way to recovery?” he recalls. They didn’t win, but the idea stuck, and MIRA — which stands for Medical Interactive Recovery Assistant — was born.

VIDEO —> Cosmin Mihaiu: Physical therapy is boring — play a game instead

Continue —>  Here’s an idea: Play your way to recovery | ideas.ted.com.

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