rehabilitation

Is it Time for MS Patients to Receive Cognitive Rehabilitation?

Neuro-Optometric Rehabilitation - an introduction to the diagnosis and treatment of vision disorders secondary to neurological impairment

Restoring Sight to the Blind: Effects of Structural and Functional Plasticity

Visual restoration after decades of blindness is now becoming possible by means of retinal and cortical prostheses, as well as emerging stem cell and gene therapeutic approaches. After restoring visual perception, however, a key question remains. Are there optimal means and methods for retraining the visual cortex to process visual inputs, and for learning or relearning to “see”? Up to this point, it has been largely assumed that if the sensory loss is visual, then the rehabilitation focus should also be primarily visual. However, the other senses play a key role in visual rehabilitation due to the plastic repurposing of visual cortex during blindness by audition and somatosensation, and also to the reintegration of restored vision with the other senses. I will present multisensory neuroimaging results, cortical thickness changes, as well as behavioral outcomes for patients with Retinitis Pigmentosa (RP), which causes blindness by destroying photoreceptors in the retina. These patients have had their vision partially restored by the implantation of a retinal prosthesis, which electrically stimulates still viable retinal ganglion cells in the eye. Our multisensory and structural neuroimaging and behavioral results suggest a new, holistic concept of visual rehabilitation that leverages rather than neglects audition, somatosensation, and other sensory modalities.

Structural & Functional Neuroplasticity in Children with Hemiplegia

About 30% of children with cerebral palsy have congenital hemiplegia, resulting from periventricular white matter injury, which impairs the use of one hand and disrupts bimanual co-ordination. Congenital hemiplegia has a profound effect on each child's life and, thus, is of great importance to the public health. Changes in brain organization (neuroplasticity) often occur following periventricular white matter injury. These changes vary widely depending on the timing, location, and extent of the injury, as well as the functional system involved. Currently, we have limited knowledge of neuroplasticity in children with congenital hemiplegia. As a result, we provide rehabilitation treatment to these children almost blindly based exclusively on behavioral data. In this talk, I will present recent research evidence of my team on understanding neuroplasticity in children with congenital hemiplegia by using a multimodal neuroimaging approach that combines data from structural and functional neuroimaging methods. I will further present preliminary data regarding functional improvements of upper extremities motor and sensory functions as a result of rehabilitation with a robotic system that involves active participation of the child in a video-game setup. Our research is essential for the development of novel or improved neurological rehabilitation strategies for children with congenital hemiplegia.

Children-Agent Interaction For Assessment and Rehabilitation: From Linguistic Skills To Mental Well-being

Socially Assistive Robots (SARs) have shown great potential to help children in therapeutic and healthcare contexts. SARs have been used for companionship, learning enhancement, social and communication skills rehabilitation for children with special needs (e.g., autism), and mood improvement. Robots can be used as novel tools to assess and rehabilitate children’s communication skills and mental well-being by providing affordable and accessible therapeutic and mental health services. In this talk, I will present the various studies I have conducted during my PhD and at the Cambridge Affective Intelligence and Robotics Lab to explore how robots can help assess and rehabilitate children’s communication skills and mental well-being. More specifically, I will provide both quantitative and qualitative results and findings from (i) an exploratory study with children with autism and global developmental disorders to investigate the use of intelligent personal assistants in therapy; (ii) an empirical study involving children with and without language disorders interacting with a physical robot, a virtual agent, and a human counterpart to assess their linguistic skills; (iii) an 8-week longitudinal study involving children with autism and language disorders who interacted either with a physical or a virtual robot to rehabilitate their linguistic skills; and (iv) an empirical study to aid the assessment of mental well-being in children. These findings can inform and help the child-robot interaction community design and develop new adaptive robots to help assess and rehabilitate linguistic skills and mental well-being in children.

Monitoring gait outcomes in rehabilitation with human pose estimation and wearable sensors

Using multisensory plasticity to rehabilitate vision

Designing the BEARS (Both Ears) Virtual Reality Training Package to Improve Spatial Hearing in Young People with Bilateral Cochlear Implant

Results: the main areas which were modified based on participatory feedback were the variety of immersive scenarios to cover a range of ages and interests, the number of levels of complexity to ensure small improvements were measured, the feedback and reward schemes to ensure positive reinforcement, and specific provision for participants with balance issues, who had difficulties when using head-mounted displays. The effectiveness of the finalised BEARS suite will be evaluated in a large-scale clinical trial. We have added in additional login options for other members of the family and based on patient feedback we have improved the accompanying reward schemes. Conclusions: Through participatory design we have developed a training package (BEARS) for young people with bilateral cochlear implants. The training games are appropriate for use by the study population and ultimately should lead to patients taking control of their own management and reducing the reliance upon outpatient-based rehabilitation programmes. Virtual reality training provides a more relevant and engaging approach to rehabilitation for young people.

In pursuit of a universal, biomimetic iBCI decoder: Exploring the manifold representations of action in the motor cortex

My group pioneered the development of a novel intracortical brain computer interface (iBCI) that decodes muscle activity (EMG) from signals recorded in the motor cortex of animals. We use these synthetic EMG signals to control Functional Electrical Stimulation (FES), which causes the muscles to contract and thereby restores rudimentary voluntary control of the paralyzed limb. In the past few years, there has been much interest in the fact that information from the millions of neurons active during movement can be reduced to a small number of “latent” signals in a low-dimensional manifold computed from the multiple neuron recordings. These signals can be used to provide a stable prediction of the animal’s behavior over many months-long periods, and they may also provide the means to implement methods of transfer learning across individuals, an application that could be of particular importance for paralyzed human users. We have begun to examine the representation within this latent space, of a broad range of behaviors, including well-learned, stereotyped movements in the lab, and more natural movements in the animal’s home cage, meant to better represent a person’s daily activities. We intend to develop an FES-based iBCI that will restore voluntary movement across a broad range of motor tasks without need for intermittent recalibration. However, the nonlinearities and context dependence within this low-dimensional manifold present significant challenges.

The Multisensory Scaffold for Perception and Rehabilitation

Deception, ExoNETs, SmushWare & Organic Data: Tech-facilitated neurorehabilitation & human-machine training

Making use of visual display technology and human-robotic interfaces, many researchers have illustrated various opportunities to distort visual and physical realities. We have had success with interventions such as error augmentation, sensory crossover, and negative viscosity.  Judicial application of these techniques leads to training situations that enhance the learning process and can restore movement ability after neural injury. I will trace out clinical studies that have employed such technologies to improve the health and function, as well as share some leading-edge insights that include deceiving the patient, moving the "smarts" of software into the hardware, and examining clinical effectiveness

Brain-Machine Interfaces: Beyond Decoding

A brain-machine interface (BMI) is a system that enables users to interact with computers and robots through the voluntary modulation of their brain activity. Such a BMI is particularly relevant as an aid for patients with severe neuromuscular disabilities, although it also opens up new possibilities in human-machine interaction for able-bodied people. Real-time signal processing and decoding of brain signals are certainly at the heart of a BMI. Yet, this does not suffice for subjects to operate a brain-controlled device. In the first part of my talk I will review some of our recent studies, most involving participants with severe motor disabilities, that illustrate additional principles of a reliable BMI that enable users to operate different devices. In particular, I will show how an exclusive focus on machine learning is not necessarily the solution as it may not promote subject learning. This highlights the need for a comprehensive mutual learning methodology that foster learning at the three critical levels of the machine, subject and application. To further illustrate that BMI is more than just decoding, I will discuss how to enhance subject learning and BMI performance through appropriate feedback modalities. Finally, I will show how these principles translate to motor rehabilitation, where in a controlled trial chronic stroke patients achieved a significant functional recovery after the intervention, which was retained 6-12 months after the end of therapy.

Science and technology to understand developmental multisensory processing

Portable neuroscience: using devices and apps for diagnosis and treatment of neurological disease

Scientists work in laboratories; comfortable spaces which we equip and configure to be ideal for our needs. The scientific paradigm has been adopted by clinicians, who run diagnostic tests and treatments in fully equipped hospital facilities. Yet advances in technology mean that that increasingly many functions of a laboratory can be compressed into miniature devices, or even into a smartphone app. This has the potential to be transformative for healthcare in developing nations, allowing complex tests and interventions to be made available in every village. In this talk, I will give two examples of this approach from my recent work. In the field of stroke rehabilitation, I will present basic research which we have conducted in animals over the last decade. This reveals new ways to intervene and strengthen surviving pathways, which can be deployed in cheap electronic devices to enhance functional recovery. In degenerative disease, we have used Bayesian statistical methods to improve an algorithm to measure how rapidly a subject can stop an action. We then implemented this on a portable device and on a smartphone app. The measurement obtained can act as a useful screen for Parkinson’s Disease. I conclude with an outlook for the future of this approach, and an invitation to those who would be interesting in collaborating in rolling it out to in African settings.

Sensorimotor -independent brain representations in association cortices

How flexible are association cortices? I will present a series of fMRI experiments addressing this question by investigating individuals born without hands, who use their feet as effectors to perform everyday actions. These results suggest that computations in association cortices are abstracted from visuomotor features and experience, similarly to the visual -independence of the association networks in people born blind, highlighting these regions’ ability to compensate for experience in any specific modality. These findings also open new avenues to utilize effector-independence in the action system for motor rehabilitation.

Brain Awareness Week @ IITGN

Using Systems Neuroscience Approaches to Understand Motor Learning & Recovery Post-Stroke

Conscious access on the left in right parietal stroke

Rehabilitation in ataxia: current evidence and practice

Affordable Robots/Computer Systems to Identify, Assess, and Treat Impairment After Brain Injury

Non-traumatic brain injury due to stroke, cerebral palsy and HIV often result in serious long-term disability worldwide, affecting more than 150 million persons globally; with the majority of persons living in low and middle income countries. These diseases often result in varying levels of motor and cognitive impairment due to brain injury which then affects the person’s ability to complete activities of daily living and fully participate in society. Increasingly advanced technologies are being used to support identification, diagnosis, assessment, and therapy for patients with brain injury. Specifically, robot and mechatronic systems can provide patients, physicians and rehabilitation clinical providers with additional support to care for and improve the quality of life of children and adults with motor and cognitive impairment. This talk will provide a brief introduction to the area of rehabilitation robotics and, via case studies, illustrate how computer/technology-assisted rehabilitation systems can be developed and used to assess motor and cognitive impairment, detect early evidence of functional impairment, and augment therapy in high and low-resource settings.

Treatment of spasticity in HSP and leukodystrophies

How can we develop and implement evidence based rehabilitation in rare disorders?

Neuroimaging in human drug addiction: an eye towards intervention development

Drug addiction is a chronically relapsing disorder characterized by compulsive drug use despite catastrophic personal consequences (e.g., loss of family, job) and even when the substance is no longer perceived as pleasurable. In this talk, I will present results of human neuroimaging studies, utilizing a multimodal approach (neuropsychology, functional magnetic resonance imaging, event-related potentials recordings), to explore the neurobiology underlying the core psychological impairments in drug addiction (impulsivity, drive/motivation, insight/awareness) as associated with its clinical symptomatology (intoxication, craving, bingeing, withdrawal). The focus of this talk is on understanding the role of the dopaminergic mesocorticolimbic circuit, and especially the prefrontal cortex, in higher-order executive dysfunction (e.g., disadvantageous decision-making such as trading a car for a couple of cocaine hits) in drug addicted individuals. The theoretical model that guides the presented research is called iRISA (Impaired Response Inhibition and Salience Attribution), postulating that abnormalities in the orbitofrontal cortex and anterior cingulate cortex, as related to dopaminergic dysfunction, contribute to the core clinical symptoms in drug addiction. Specifically, our multi-modality program of research is guided by the underlying working hypothesis that drug addicted individuals disproportionately attribute reward value to their drug of choice at the expense of other potentially but no-longer-rewarding stimuli, with a concomitant decrease in the ability to inhibit maladaptive drug use. In this talk I will also explore whether treatment (as usual) and 6-month abstinence enhance recovery in these brain-behavior compromises in treatment seeking cocaine addicted individuals. Promising neuroimaging studies, which combine pharmacological (i.e., oral methylphenidate, or RitalinTM) and salient cognitive tasks or functional connectivity during resting-state, will be discussed as examples for using neuroimaging for empirically guiding the development of effective neurorehabilitation strategies (encompassing cognitive reappraisal and transcranial direct current stimulation) in drug addiction.

Intensive sensorimotor rehabilitation restores gait disfunction and microstructure caused by experimental cerebral palsy in rats

Oral administration of 4-methylumbelliferone combined with rehabilitation promotes anatomical plasticity and functional recovery in the chronic stage of spinal cord injury

Robot-assisted voluntary shoulder rehabilitation training modifies synergetic muscle control in a chronic stroke patient: a case report

EEG beta de-synchronization signs the efficacy of a rehabilitation treatment for speech impairment in Parkinson’s disease population

FENS Forum 2024

Effectiveness of action observation treatment integrated with virtual reality in the motor rehabilitation of stroke patients: A randomized controlled clinical trial

FENS Forum 2024

Effects of a prehabilitation programme based on pain neuroscience education in patients scheduled for lumbar radiculopathy surgery

FENS Forum 2024

Functional stimulation system for rehabilitation of gait and driving neural plasticity after spinal cord injury

FENS Forum 2024

Transcranial magnetic stimulation neurofeedback – A multimodal, multiphase approach to stroke rehabilitation using EEG BCI

FENS Forum 2024