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Posts Tagged Personalized Medicine
[Abstract] Cognitive Reserve as a useful variable to address robotic or conventional upper limb rehabilitation treatment after stroke. A multicenter study of the Fondazione Don Carlo Gnocchi
Rehabilitation plays a central role in stroke recovery. Besides conventional therapy, technological treatments have become available. About technological rehabilitation, its effectiveness and appropriateness are not yet well defined, hence researches focused on different variables impacting the recovery are needed. Results from literature identified the Cognitive Reserve (CR) as a variable impacting on the cognitive outcome. In this paper we aim to evaluate whether the CR influences the motor outcome in patients after stroke treated with conventional or robotic therapy and if it may address towards one treatment rather than another.
Seventy‐five stroke patients were enrolled in five Italian neurological rehabilitation centres. Patients were assigned either to a Robotic Group, rehabilitation by means of robotic devices, or to a Conventional Group, where a traditional approach was used. Patients were evaluated at baseline and after rehabilitation treatment of 6 weeks through Action Research Arm Test (ARAT), Motricity Index (MI) and Barthel Index (BI). CR was assessed at baseline using the Cognitive Reserve Index (CRI) questionnaire.
Considering all patients, a weak correlation was found between the CRI related to leisure time and MI evolution (r:0.276; p=0.02). Among the patients who performed a robotic rehabilitation a moderate correlation emerged between the CRI related to working activities and the MI evolution (r:0.422; p=0.02).
Our results suggest that CR may influence the motor outcome. For each patient, the CR and its subcategories should be considered in the choice between conventional and robotic treatment.
via Cognitive Reserve as a useful variable to address robotic or conventional upper limb rehabilitation treatment after stroke. A multicenter study of the Fondazione Don Carlo Gnocchi – Padua – – European Journal of Neurology – Wiley Online Library
[Abstract + References] A personalized flexible exoskeleton for finger rehabilitation: a conceptual design – Conference paper
Several robotic rehabilitation systems have already been developed for the hand requiring the biological joints to be aligned with those of the exoskeleton making the standardization of this devices for different anthropomorphic sizes almost impossible. This problem together with the usage of rigid components can affect the natural movement of the hand and injure the user. Moreover, these systems are also typically expensive and are designed for in-clinic use as they are generally not portable.
Biomimetic and bioinspired inspiration using soft robotics can solve these issues. This paper aims to introduce the conceptual design of a personalized flexible exoskeleton for finger rehabilitation modelled around one specific user’s finger with the help of a 3D scanning procedure presenting a dynamic FEM analysis and a preliminary prototype obtaining a low-cost and easy to use and wear device.
What is brain plasticity and why is it important following a brain injury?
Brain plasticity is the phenomenon by which the brain can rewire and reorganize itself in response to changing stimulus input. Brain plasticity is at play when one is learning new information (at school) or learning a new language and occurs throughout one’s life.
Brain plasticity is particularly important after a brain injury, as the neurons in the brain are damaged after a brain injury, and depending on the type of brain injury, plasticity may either include repair of damaged brain regions or reorganization/rewiring of different parts of the brain.
How much is known about the level of injury the brain can recover from? Over what time period does the brain adapt to an injury?
A lot is known about brain plasticity immediately after an injury. Like any other injury to the body, after an initial negative reaction to the injury, the brain goes through a massive healing process, where the brain tries to repair itself after the injury. Research tells us exactly what kinds of repair processes occur hours, days and weeks after the injury.
What is not well understood is how recovery continues to occur in the long term. So, there is a lot research showing that the brain is plastic, and undergoes recovery even months after the brain damage, but what promotes such recovery and what hinders such recovery is not well understood.
It is well understood that some rehabilitative training promotes brain injury and most of the current research is focused on this topic.
What techniques are used to study brain plasticity?
Human brain plasticity has mostly been studied using non-invasive imaging methods, because these techniques allow us to measure the gray matter (neurons), white matter (axons) at a somewhat coarse level. MRI and fMRI techniques provide snapshots and video of the brain in function, and that allows us to capture changes in the brain that are interpreted as plasticity.
Also, more recently, there are invasive stimulation methods such as transcranial direct current stimulation or transcranial magnetic stimulation which allow providing electric current or magnetic current to different parts of the brain and such stimulation causes certain changes in the brain.
How has our understanding advanced over recent years?
One of the biggest shifts in our understanding of brain plasticity is that it is a lifelong phenomenon. We used to previously think that the brain is plastic only during childhood and once you reach adulthood, the brain is hardwired, and no new changes can be made to it.
However, we now know that even the adult brain can be modified and reorganized depending on what new information it is learning. This understanding has a profound impact on recovery from brain injury because it means that with repeated training/instruction, even the damaged brain is plastic and can recover.
What role do you see personalized medicine playing in brain therapy in the future?
One reason why rehabilitation after brain injury is so complex is because no two individuals are alike. Each individual’s education and life experiences have shaped their brain (due to plasticity!) in unique ways, so after a brain injury, we cannot expect that recovery in two individuals will be occur the same way.
Personalized medicine allows the ability to tailor treatment for each individual taking into account their strengths and weaknesses and providing exactly the right kind of therapy for that person. Therefore, one size treatment does not fit all, and individualized treatments prescribed to the exact amount of dosage will become a reality.
What is ‘automedicine’ and do you think this could become a reality?
I am not sure we understand what automedicine can and cannot do just yet, so it’s a little early to comment on the reality. Using data to improve our algorithms to precisely deliver the right amount of rehabilitation/therapy will likely be a reality very soon, but it is not clear that it will eliminate the need for doctors or rehabilitation professionals.
What do you think the future holds for people recovering from strokes and brain injuries and what’s Constant Therapy’s vision?
The future for people recovering from strokes and brain injuries is more optimistic than it has ever been for three important reasons. First, as I pointed above, there is tremendous amount of research showing that the brain is plastic throughout life, and this plasticity can be harnessed after brain injury also.
Second, recent advances in technology allow patients to receive therapy at their homes at their convenience, empowering them to take control of their therapy instead of being passive consumers.
Finally, the data that is collected from individuals who continuously receive therapy provides a rich trove of information about how patients can improve after rehabilitation, what works and what does not work.
Constant Therapy’s vision incorporates all these points and its goal to provide effective, efficient and reasonable rehabilitation to patients recovering from strokes and brain injury.
Where can readers find more information?
- Please see Constant Therapy for more information.
About Dr Swathi Kiran
Swathi Kiran is Professor in the Department of Speech and Hearing Sciences at Boston University and Assistant in Neurology/Neuroscience at Massachusetts General Hospital. Prior to Boston University, she was at University of Texas at Austin. She received her Ph.D from Northwestern University.
Her research interests focus around lexical semantic treatment for individuals with aphasia, bilingual aphasia and neuroimaging of brain plasticity following a stroke.
She has over 70 publications and her work has appeared in high impact journals across a variety of disciplines including cognitive neuroscience, neuroimaging, rehabilitation, speech language pathology and bilingualism.
She is a fellow of the American Speech Language and Hearing Association and serves on various journal editorial boards and grant review panels including at National Institutes of Health.
Her work has been continually funded by the National Institutes of Health/NIDCD and American Speech Language Hearing Foundation awards including the New Investigator grant, the New Century Scholar’s Grant and the Clinical Research grant. She is the co-founder and scientific advisor for Constant Therapy, a software platform for rehabilitation tools after brain injury.
For three days this week, Roanoke, Virginia, is the capital of the precision neuroscience world.
The first-ever scientific meeting to explore an ultra-personal approach to brain health — the Virginia-Nordic Precision Neuroscience Conference — opened this week at the Virginia Tech Carilion Research Institute.
“The promise, hope, and opportunity for precision neuroscience is great — with the potential for realizing the brain and mind’s full potential, preventing disorders, and restoring brain health after injury or degenerative disease,” said Virginia Tech President Tim Sands, who welcomed about 200 scientists on behalf of Virginia Tech and Carilion Clinic. “It is also the responsibility of the scientific and medical communities to help define the real possibilities, differentiate hype from reality, and help focus the scientific enterprise and resource allocation on areas where the promise can be realized.”
More than 1,000 disorders of the brain and nervous system result in more hospitalizations than any other disease group, including heart disease and cancer.
“By understanding an individual’s genetics, behavior, education, habits, life experiences such as physical and psychological trauma — all the things that make people who they are — the neuroscientific community may be able to develop individually tailored plans for people to optimize education, health care, diet, exercise, and environments where they are likely to thrive cognitively, socially, and physically,” said Michael J. Friedlander, Virginia Tech’s vice president for health sciences and technology and the founding executive director of the Virginia Tech Carilion Research Institute.
The collaboration grew from an idea developed by Friedlander and Tor S. Haugstad, a neurologist and neuroscience chair at Sunnaas National Rehabilitation Hospital in Oslo, Norway, worked to develop as the Norway/U.S. Neuroscience Collaboration, initially called NUNC. The effort has grown to include multiple universities in Norway as well as in several other Nordic countries, and universities and foundations throughout Virginia.
People respond to brain injuries differently, which is one of the motivations for further development of the precision neuroscience field.
“We may get two people in our department with very similar brain injuries, and one may be rendered with a low level of consciousness while the other can recover and return home to his family and work life,” said Haugstad, who also chairs the traumatic brain rehabilitation program at Sunnaas National Rehabilitation Hospital. “We need to discover at cellular and molecular levels why people respond so differently, and tailor treatment and rehabilitation to the specific person.”
The meeting, which will continue through Friday, is the first to bring the top minds of precision neuroscience from across the globe together in a think-tank setting to explore the challenges and promise of bringing personalized medicine to brain health and brain disorders.
“One individual’s experience with Alzheimer’s disease, Parkinson’s disease, a traumatic brain injury, or various other neurological or psychiatric disorders will not be exactly like anyone else’s,” Friedlander said.
“From a business and health care point of view, clinical trials may fail because they target generic diseases that manifest very differently in different people,” Friedlander said. “If a drug or treatment doesn’t work in 75 percent of the people, it is considered a failure — but it worked in 25 percent. Should we forget about the 25 percent of people it helped and scrap potentially lifesaving therapies that may have cost hundreds of millions of dollars during a decade of development?”
By targeting groups of patients based on their predicted manifestations of a particular brain disorder, the success rate for finding new treatments will improve and the investment risk can be lessened, according to Friedlander.
“Essentially the pharmaceutical industry and investors de-risk their investments by having more precise, targeted therapies and tests that are more likely to be successful,” Friedlander said. “The treatment may be effective for 10 percent of people with a particular brain disease, but we can learn a lot about why those 10 percent may have benefitted based on their genetic composition and expression patterns and their life experiences. Then, we get back to work on a treatment for the next 10 percent, and the next 10 percent. It may not be one size fits all.”
Researchers will discuss innovations ranging from a Nobel prize-winning imaging system that visualizes the action of molecules within the brain, to the work of physician-scientists who are on the frontlines of health care delivery for brain injury, neurodegenerative diseases of aging, and brain developmental disorders.
In many ways, the conference has special meaning for the partner cities in Virginia and in Europe, Haugstad said.
“Roanoke is a city with a history of rail that, through innovation and spirit, is reinventing itself, and it is leading the way in precision neuroscience,” Haugstad said. “In Norway, a country that depends on oil revenue, the cities are changing much like cities in Virginia, by finding new ways to live and move forward. Together, we are very good partners.”