Physiatry Practice Management Resources

'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

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

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