'Smart' Prosthetics Restore Independence To People With Disabilities
People with paralysis can stand and move without a wheelchair. They
can operate computers to read email and play video games. Brown
University neuroscientist John Donoghue said these recent achievements
are previews of a major promise of neurotechnology - restoring movement
control and communication to people immobilized by injury or disease.
"We're at the dawn of a new age of neurotechnology," Donoghue said.
"Thanks to advances in biology, medicine, computer science and
engineering, we can repair the human nervous system - not with tissue
but with technology. Nearly 100,000 people have cochlear implants that
provide a sense of sound to the deaf. Retinal implants are in
development to restore sight to the blind. And there several systems
being created that will help people living with paralysis. Someday,
using their own muscles, people with paralysis will be able to feed
themselves or perhaps even walk. These electronic devices will allow
them to lead more independent lives."
Donoghue will discussed the fast-growing field of neuroprosthetics at a
press briefing at the annual meeting of the American Association for
the Advancement of Science (AAAS), the world's largest general
scientific society. At the meeting, held in San Francisco, Donoghue
took part in a symposium titled "Smart Prosthetics: Interfaces to the
Nervous System Help Restore Independence."
Donoghue, the Henry Merritt Wriston Professor at Brown and director of
the University's Brain Science Program, is a leader in neuroprosthesis
research and development. At the press briefing and in the symposium,
he gave an overview of brain-computer interfaces (BCIs) - systems that
create a direct communication pathway between the brain and an external
device such as a computer or a wheelchair.
One example of a BCI is BrainGate, the mind-to-movement system that got
its start in the Donoghue laboratory at Brown. BrainGate consists of an
implantable sensor and external processors that record and interpret
brain signals from the motor cortex, turning the brain's electrical
signals into movement commands that can control assistive devices.
The BrainGate system has allowed people with paralysis to operate a
computer in order to read e-mail, control a wheelchair and operate a
robotic hand in FDA-approved pilot clinical trials. Donoghue oversees
the trials in his role as chief scientific officer of Cyberkinetics
Neurotechnology Systems Inc., the Foxborough, Mass., company developing
and testing the technology.
Donoghue is also working with symposium organizer P. Hunter Peckham, a
professor of biomedical engineering and orthopaedics at Case Western
Reserve University, to develop a neuroprosthetic system that can
restore partial arm and hand function to people with paralysis.
The system will connect the BrainGate sensor with Peckham's functional
electrical stimulation (FES) system, which uses electrical impulses to
trigger muscle and limb movement. The first version will allow users to
make simple movements that could be used to perform tasks such as
eating or drinking - using their own arms and hands and under the
natural control of their own brains. The initial version of this FES
system would use arm supports. Later versions, however, won't require
supports - and will allow users to do activities that require more
dexterity, such as using cell phones or remote controls.
Donoghue and Peckham will complete a prototype within four years under
a contract with the National Center for Medical Rehabilitation Research
at the National Institutes of Health.
"This system will represent a quantum leap in rehabilitation
technology," Donoghue said, "and it will fundamentally alter the lives
of people with spinal cord injury."
Brown University
Source: Medical News Today
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Elderly Married Couples Don't Let Nursing Homes Keep Them Apart
Seniors work hard to keep their marriages alive and well, even after
one spouse falls ill and goes into a long-term care facility, according
to a new study from the University of Alberta in Edmonton, Canada.
Researcher Robin Stadnyk was surprised to discover that
community-dwelling spouses were heavily involved in the lives of their
institutionalized partners, and that many of the couples stayed active
together both inside and outside the nursing home.
Stadnyk, a post-doctoral researcher in the University of Alberta's
Department of Human Ecology, reviewed data from a qualitative study of
52 community-dwelling spouses in three Canadian provinces: Alberta,
Manitoba and Nova Scotia, for her PhD research. She found that the
participants were heavily involved in their spouses' lives, not only
through caretaking duties like doing laundry and helping with personal
hygiene, but also through nurturing activities that brought them closer
together.
"Most participants described close relationships with their spouses
before the placement in a long-term care home. They simply found ways
they could continue that closeness within the institutional walls,"
Stadnyk noted. Marriage-sustaining activities included watching TV
together, studying travel brochures and reviewing diaries to relive old
memories, even taking painting lessons together.
Some spouses also brought their partners home for regular weekly and
even daily visits. One 82-year-old man in the study took
weight-training so he could lift his wife in and out of the car for the
weekly trip home.
"The findings defy the common assumption that the partnership of
marriage effectively ends when one spouse enters a care facility,"
Stadnyk said.
Even husbands and wives whose partners had dementia continued to
nurture their marriages, shifting from roles as give-and take-partners
to benevolent caretakers. They made sure favourite treats were
available for their spouses, and that they were able to attend special
events. "Many related these activities to their wedding vows, 'In
sickness and in health, for better or for worse'," Stadnyk said.
The results were published recently in the journal Topics in Geriatric Rehabilitation.
Spouses with institutionalized partners also found ways to cope with
their new solitude, described by one participant as 'limbo', by finding
'safe' activities such as family or church outings and limiting their
interactions to same-sex social groups.
Stadnyk suggests that rehabilitation workers help couples continue to
find ways to connect when one spouse is in a nursing home. Quiet,
private spaces are needed so couples can share quality time.
Improvements to policies to respect the private lives of residents are
also needed, Stadnyk said. Private accommodations, rather than shared
rooms, are often desired by couples and are increasingly being offered
in newer facilities. But even simple changes such as knocking on a
resident's door before entering are appreciated by spouses, Stadnyk
said. A secure place for personal items like diaries would also allow
couples to keep special possessions private. "One nursing home even
allowed a couple to keep a refrigerator in the resident's room, which
made it easy for the couple to share snacks."
Practitioners can also help couples find things to do together, and
encourage the well spouses to find activities on their own to sustain
their identities.
Contact: Bev Betkowski
University of Alberta
Article URL: http://www.medicalnewstoday.com/medicalnews.php?newsid=62695
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Robotic Exoskeleton Replaces Muscle Work
A robotic exoskeleton controlled by the wearer's own nervous system
could help users regain limb function, which is encouraging news for
people with partial nervous system impairment, say University of
Michigan researchers.
The ankle exoskeleton developed at U-M was worn by healthy subjects to
measure how the device affected ankle function. The U-M team has no
plans to build a commercial exoskeleton, but their results suggest
promising applications for rehabilitation and physical therapy, and a
similar approach could be used by other groups who do build such
technology.
"This could benefit stroke patients or patients with incomplete
injuries of the spinal cord," said Daniel Ferris, associate professor
in movement science at U-M. "For patients that can walk slowly, a brace
like this may help them walk faster and more effectively."
Ferris and former U-M doctoral student Keith Gordon, who is now a
post-doctoral fellow at the Rehabilitation Institute of Chicago, showed
that the wearer of the U-M ankle exoskeleton could learn how to walk
with the exoskeleton in about 30 minutes. Additionally, the wearer's
nervous system retained the ability to control the exoskeleton three
days later.
Electrical signals sent by the brain to our muscles tell them how to
move. In people with spinal injuries or some neurological disorders,
those electrical signals don't arrive full strength and are
uncoordinated. In addition, patients are less able to keep track of
exactly where and how their muscles move, which makes re-learning
movement difficult.
Typically, robotic rehabilitative devices are worn by patients so that
the limb is moved by the brace, which receives its instructions from a
computer. Such devices use repetition to help force a movement pattern.
The U-M robotic exoskeleton works the opposite of these rehabilitation
aids. In the U-M device, electrodes were attached to the wearer's leg
and those electrical signals received from the brain were translated
into movement by the exoskeleton.
"The (artificial) muscles are pneumatic. When the computer gets the
electrical signal from the (wearer's) muscle, it increases the air
pressure into the artificial muscle on the brace," Ferris said.
"Essentially the artificial muscle contracts with the person's muscle."
Initially the wearer's gait was disrupted because the mechanical power
added by the exoskeleton made the muscle stronger. However, in a
relatively short time, the wearers adapted to the new strength and used
their muscles less because the exoskeleton was doing more of the work.
Their gait normalized after about 30 minutes.
The next step is to test the device on patients with impaired muscle function, Ferris said.
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This work was supported by a grant from the National Institute of Neurological Disorders and Stroke.
For more on Ferris, who also has an appointment in biomedical engineering and physical medicine and rehabilitation, see: http://www.kines.umich.edu/faculty/full-time/ferris.html.
Contact: Laura Bailey
University of Michigan
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Robotic Therapy Helps Restore Hand Use After Stroke
A robotic therapy device may help people regain strength and normal
use of affected hands long after a stroke, according to a University of
California, Irvine study.
Stroke patients with impaired hand use reported improved ability to
grasp and release objects after therapy sessions using the Hand-Wrist
Assisting Robotic Device (HOWARD). Each patient had at least moderate
residual weakness and reduced function of the right hand, although the
affected hands were neither totally paralyzed nor unable to feel. Seven
women and six men who had suffered a stroke at least three months prior
participated in the pilot study using this robotic device.
"Most spontaneous improvement in function occurs in the first three
months after a stroke, and after that things tend to plateau," said Dr.
Steven C. Cramer, senior author of the study and associate professor in
neurology, anatomy and neurobiology at UCI. "Robot-assisted therapy may
help rewire the brain and make weak limbs move better long afterwards."
Previously, robotic devices have improved post-stroke shoulder and leg
function. Cramer said this study is one of the first attempts to
specifically aid hand function. Cramer presented HOWARD study findings
at the American Stroke Association's International Stroke Conference
2007 in San Francisco.
Developed by UCI researchers, HOWARD aids patients as they grasp and
release common objects. The robotic device wraps around the hand and
couples with a computer program that directs patients though a physical
therapy program. HOWARD users initiate hand motion, with the robot
monitoring and assisting the activity in order to meet therapeutic
goals.
"The HOWARD therapy isn't passive; the patient has to jumpstart the
program and initiate the motor command," Cramer said. "But if the hand
is weak and can only budge one-tenth of an inch, the robot helps to
complete the task so the brain relearns what it's like to make the full
movement."
In the UCI study, each patient, average age 63, received 15 two-hour
therapy sessions, spread over three weeks, designed to improve their
ability to grasp and release objects. All worked with HOWARD for the 15
sessions. For seven patients, HOWARD shaped and helped complete
movements across all sessions, while six had complete support from
HOWARD for only the second half of the sessions.
At the end of three weeks, all patients had improved in their ability
to grasp and release objects. Their average score on an Action Research
Arm Test -- which measures the ability to perform such real-world tasks
as grasping a block, gripping a drinking glass, pinching to pick up a
small marble or ball bearing, and putting your hand on your head --
improved by nearly 10 percent. And their average score rose by nearly
20 percent on the Box-and-Blocks Test, which assesses manual dexterity
as one moves blocks from one side of a box to another in one minute.
The patients also developed a 17 percent greater range of motion in
their hands and wrists and were rated as less disabled on a standard
occupational therapy assessment tool called the Fugl-Meyer score.
"Assessing changes in before-and-after scores within each subject,
these were highly significant gains after three weeks of therapy,"
Cramer said.
The UCI team is now using what they learned from study participants to
create a "son of HOWARD," with improved hand-robot connections and more
software options to individualize therapy and keep patients interested.
Stroke is a major cause of long-term disability in the United States.
More than 700,000 Americans suffer strokes annually. Stroke is the
third leading cause of death in the country. And stroke causes more
serious long-term disabilities than any other disease. Nearly
three-quarters of all strokes occur in people over the age of 65 and
the risk of having a stroke more than doubles each decade after the age
of 55, according to the National Institute of Neurological Disorders
and Stroke.
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Lucy Der-Yeghiaian, Jill See, Vu Le and Craig D. Takahashi are
co-authors of the study, which was partly funded by a National
Institutes of Health Institutional Training Grant.
About the University of California, Irvine: The University of
California, Irvine is a top-ranked university dedicated to research,
scholarship and community service. Founded in 1965, UCI is among the
fastest-growing University of California campuses, with more than
25,000 undergraduate and graduate students and about 1,400 faculty
members. The second-largest employer in dynamic Orange County, UCI
contributes an annual economic impact of $3.7 billion.
Contact: Tom Vasich
University of California - Irvine
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