3-D 'Occupational Therapy' For Children

It was her love of ballet that led her to work with children who have motor disabilities. The retired dancer, now an occupational therapist, is pioneering a new "virtual" method to analyze movement patterns in children - and more effectively treat those with debilitating motor disorders.



Dr. Dido Green of Tel Aviv University's Department of Occupational Therapy in the School of Health Professionals is using a "virtual tabletop" called the ELEMENTS SYSTEM, developed by her partners at Australia's Royal Melbourne Institute of Technology, to "move" kids with disabilities and provide home-based treatments using virtual reality tools. Combining new three-dimensional exercises with two-dimensional graphical movement games already programmed into the tabletop (which resembles an early video game), she reports not only success but also enthusiasm among her young patients.



"I've been working with children with movement disorders for the last 20 years," says Dr. Green. "By the time I meet these children, they're sick of us. They've been 'over-therapied,' and it's difficult to get them to practice their exercises and prescribed treatment regimes."



Fun for kids from three to fifteen



"The virtual tabletop appealed to children as young as three and as old as 15," Dr. Green reports. "The movement-oriented games allowed them to 'make music' and reach targets in ways that are normally neither comfortable nor fun in the therapeutic setting," she explains.



Dr. Green determined that children with partial paralysis and motor dysfunction resulting from disorders such as cerebral palsy may be helped by giving them a new interface to explore. Building upon earlier research she conducted at the Evelina Children's Hospital in London, Dr. Green found that virtual reality applications enhance the skill sets learned by her patients.



Coupled with new technology involving 3D Movement Analysis, a technique she is now integrating into research at Tel Aviv University, Dr. Green hopes to develop this virtual tabletop - type game into new and effective therapy treatment regimes.



"Traditional approaches are labor-intensive and their results limited," Dr. Green says. "Our research aims to create a complete system for therapist, parent and child. It could bring daily treatments into the home and provides therapists with a complete solution to track and analyze improvements or setbacks in the most accurate way to date."



From the virtual to the real world



In children who attended sessions with her interface for three days a week over a period of about one month, Dr. Green found some impressive results. One child with a paralyzed hand was able to perform more complicated movements, culminating in a "eureka!" moment when she opened a door for the first time in her life. The girl was also able to gain control over some motor movements essential for basic life tasks, such as buttoning sweaters, opening doors, or going to the washroom. These are skills some children never develop with current therapy regimes.



In the near future, Dr. Green hopes to develop the technique for remote rehabilitation, enabling children to practice movements at home with parental supervision. Therapists located elsewhere could "log in" with a webcam and computer to coach the students or monitor their progress.



The researcher also plans to analyze brain function using trans-cranial magnetic brain stimulation. Currently, brain function relating to motor activities is analyzed with magnetic resonance imaging (MRI). But many children are too impatient to sit in an MRI machine, so clinicians need a more accurate means of analyzing movement in children with disabilities to develop individualized therapy regimes.



Source:

George Hunka

American Friends of Tel Aviv University

Therapeutic Uses of a Nintendo Wii

By Bryan Cohen, eHow Contributing Writer

The Nintendo Wii brings physical activity to gaming.The Nintendo Wii gaming system was released in late 2006. With the creation of the WiiFit companion and the balance board, Nintendo has embraced the public's use of the console for weight management and exercise. The Wii has found its way into retirement homes, hospitals and physical training offices throughout the world as a new way to meld entertainment and therapy.


For Seniors

In Anaheim, the VIP Adult Day Health Care Center holds Wii gaming sessions twice a month. After just three months, the employees noticed that the seniors who attended had improved their motor skills and hand-eye coordination. Feedback from the patients was so positive that Dennis Miyadi, the occupational therapist in charge of the center has continued the Wii use and expanded it to their sister center in Santa Ana. The patients enjoy the games, cheer each other on and have the opportunity to play sports like table tennis or bowling which they gave up due to injury, age or poor health. The use of the Wii encourages older adults to be active and may improve their overall health.

Physical Therapy

Using the balance board, the wheel and the regular Wii controllers, physical therapists are incorporating game playing into their therapy sessions. Certain games synced up with the balance board can track the progress of a patient in a fun way that a chart, pencil and paper could not. Keeping the therapy entertaining and engaging is a must for a center that has many child or teenage patients. An article in Personal Training Magazine cites that introducing the Wii to patients has lead to a big jump in positive attitude about therapy and an increase in treatment compliance.

Surgery Recovery

The Wii has been used to help patients recover muscle after having had surgeries like back surgery or knee replacement. The fitness package of the Wii helps these patients to improve their weight bearing and balance. The modifications available on the Wii allow patients who are still very weak after surgery to accomplish the motions to play the games. This type of therapy can be used after surgery, accidents or anything else that requires a long road back to recovery. When the road is paved with cute characters and bright colors, it may not seem as long or tough for the patients.

Brain Damage Recovery

The University Medical Center at Ohio State University in Columbus has begun using the Wii as therapy for patients who have recently had strokes, traumatic brain injuries or spinal cord damage. One patient used the Wii fitness games to rebuild the muscles in his right side that had been immobilized post-stroke. Other aspects of the Wii, such as the news and weather channels may also be able to improve brain function due to its simple interface.

Other Recovery Benefits

Many therapy sessions tend to be one-on-one sessions, but with a Wii, multiple people can be involved at once. This adds a social aspect to therapy that can help recovery in a more indirect way: with friendship. By socializing, patients can have an improvement in self-esteem, which can help future training and the patient's attitude. In patients engaging in therapy who are overweight, the Wii tracks Body Mass Index (BMI) and weight. These tracking functions can help patients to set weight loss goals during their training as well.

Neurorrobots to enhance quality of life of persons with motor disabilities

IK4 is taking part in the HYPER Project to develop “bio-inspired” development systems for replicating the natural movements of the human body. Medullar injuries caused by traffic accidents, cerebrovascular accidents or cerebral palsy are the most frequent causes of motor disability, a deficiency that seriously limits the quality of life of a significant number of people. The latest technological advances in neurorobotics and neuroprothesis could be a revolution for improving the processes of rehabilitation and for compensating the limitations that these people suffer in their daily lives.

This is the line of research of the HYPER project, in which the IK4 Technological Alliance is contributing their skills in advanced technology through their CIDETEC-IK4 and VICOMTECH-IK4 centres. Led by the Bioengineering Group of the Consejo Superior de Investigaciones Científicas (CSIC), the project also enjoys the collaboration of other bodies given over to scientific-technological and medical research, amongst which are the National Paraplegics Hospital in Toledo, Fatronik-Tecnalia, the universities of Zaragoza, Rey Juan Carlos and Carlos III, and the Institute of Bioengineering of Catalonia (IBEC). Projected to last for four years and with a budget of 5 million euros, this project is financed under the latest call within the Consolider-Ingenio programme launched by the Ministry of Science and Innovation.

The ambitious aim of the project is to develop “bio-inspired” systems for replicating the natural movements of the human body in the most exact possible manner, thus representing a significant advance both in rehabilitation and in compensation for facilitating the everyday activities of people with motor disabilities. Through the combined action of neurorobotics and neuroprothesis, the goal is to restore the motor function of patients with medullar injuries by means of the functional compensation for the disabilities and to promote the relearning of motor control in patients affected by cerebrovascular accidents and cerebral palsy.

The main novelty of HYPER lies in the fact that, for the first time, the combined and integrated use of neurorrobots and neuroprothesis will be investigated to develop hybrid systems, and which will enable a more natural interaction between human systems and machines for rehabilitation and compensation of motor disability. This combination of technologies is a giant leap compared to current devices (exoeskeletons, prothesis, functional electro-stimulation, etc).

Brain-machine interaction and virtual reality
To this end, research will be undertaken into four main technologies: the direct interaction between the brain and the machine (reading thought and transforming it into movement), neurorobotics (exoeskeletons that adhere to the human body), neuroprothesis (the stimulation of muscles with low currents) and virtual reality (to facilitate learning when using new devices).

To achieve this adaptation to the real needs of persons, the project will place the patients in the research centre itself, through working jointly with clinics and expert users throughout all the stages of the project (design, development and trials).

Cerebrovascular accidents and medullar injuries are the most common causes of paralysis, with an incidence of12,000 and 800 cases per million inhabitants, respectively. Both conditions, together with cerebral palsy, are responsible for the majority of cases of haemiplegia, paraplegia and tetraplegia, all of which cause considerable limitation of mobility. This is why HYPER aims to help improve the quality of life of those affected by these disabilities. It is hoped, moreover, that the knowledge thus developed will subsequently be applied to the treatment of other conditions such as Parkinson’s disease.

The contribution of IK4
To achieve this ambitious objective, the nine participating centres will contribute advanced knowledge, each in their own discipline. In the case of IK4, VICOMTECH-IK4 will be responsible for adapting the technology to the needs of the potential users of these devices and for exploiting the potential of virtual reality in the project, which will involve a complete simulation of the human body. CIDETEC-IK4 will develop the sensors inserted in the protheses and measure the pressure to respond with naturalness and comfort to the movement ordered by the patient, and find energy solutions adapted to the devices.

Brain-Recording Device Could Herald Future Development For Monitoring And Controlling Seizures

19 Apr 2010

Scientists have developed a brain implant that essentially melts into place, snugly fitting to the brain's surface. The technology could pave the way for better devices to monitor and control seizures, and to transmit signals from the brain past damaged parts of the spinal cord.

"These implants have the potential to maximize the contact between electrodes and brain tissue, while minimizing damage to the brain. They could provide a platform for a range of devices with applications in epilepsy, spinal cord injuries and other neurological disorders," said Walter Koroshetz, M.D., deputy director of the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health.

The study, published in Nature Materials, shows that the ultrathin flexible implants, made partly from silk, can record brain activity more faithfully than thicker implants embedded with similar electronics.

The simplest devices for recording from the brain are needle-like electrodes that can penetrate deep into brain tissue. More state-of-the-art devices, called micro-electrode arrays, consist of dozens of semi-flexible wire electrodes, usually fixed to rigid silicon grids that do not conform to the brain's shape.

In people with epilepsy, the arrays could be used to detect when seizures first begin, and deliver pulses to shut the seizures down. In people with spinal cord injuries, the technology has promise for reading complex signals in the brain that direct movement, and routing those signals to healthy muscles or prosthetic devices.

"The focus of our study was to make ultrathin arrays that conform to the complex shape of the brain, and limit the amount of tissue damage and inflammation," said Brian Litt, M.D., an author on the study and an associate professor of neurology at the University of Pennsylvania School of Medicine in Philadelphia. The silk-based implants developed by Dr. Litt and his colleagues can hug the brain like shrink wrap, collapsing into its grooves and stretching over its rounded surfaces.

The implants contain metal electrodes that are 500 microns thick, or about five times the thickness of a human hair. The absence of sharp electrodes and rigid surfaces should improve safety, with less damage to brain tissue. Also, the implants' ability to mold to the brain's surface could provide better stability; the brain sometimes shifts in the skull and the implant could move with it. Finally, by spreading across the brain, the implants have the potential to capture the activity of large networks of brain cells, Dr. Litt said.

Besides its flexibility, silk was chosen as the base material because it is durable enough to undergo patterning of thin metal traces for electrodes and other electronics. It can also be engineered to avoid inflammatory reactions, and to dissolve at controlled time points, from almost immediately after implantation to years later. The electrode arrays can be printed onto layers of polyimide (a type of plastic) and silk, which can then be positioned on the brain.

To make and test the silk-based implants, Dr. Litt collaborated with scientists at the University of Illinois in Urbana-Champaign and at Tufts University outside Boston. John Rogers, Ph.D., a professor of materials science and engineering at the University of Illinois, invented the flexible electronics. David Kaplan, Ph.D., and Fiorenzo Omenetto, Ph.D., professors of biomedical engineering at Tufts, engineered the tissue-compatible silk. Dr. Litt used the electronics and silk technology to design the implants, which were fabricated at the University of Illinois.

Recently, the team described a flexible silicon device for recording from the heart and detecting an abnormal heartbeat.

In the current study, the researchers approached the design of a brain implant by first optimizing the mechanics of silk films and their ability to hug the brain. They tested electrode arrays of varying thickness on complex objects, brain models and ultimately in the brains of living, anesthetized animals.

The arrays consisted of 30 electrodes in a 5x6 pattern on an ultrathin layer of polyimide - with or without a silk base. These experiments led to the development of an array with a mesh base of polyimide and silk that dissolves once it makes contact with the brain - so that the array ends up tightly hugging the brain.

Next, they tested the ability of these implants to record the animals' brain activity. By recording signals from the brain's visual center in response to visual stimulation, they found that the ultrathin polyimide-silk arrays captured more robust signals compared to thicker implants.

In the future, the researchers hope to design implants that are more densely packed with electrodes to achieve higher resolution recordings.

"It may also be possible to compress the silk-based implants and deliver them to the brain, through a catheter, in forms that are instrumented with a range of high performance, active electronic components," Dr. Rogers said.

The study received support from NINDS, NIH's National Institute of Biomedical Imaging and Bioengineering (NIBIB), the U.S. Department of Energy's Division of Materials Sciences, the U.S. Army, the Defense Advanced Research Projects Agency (DARPA), and the Klingenstein Foundation.

Source:
NIH/National Institute of Neurological Disorders and Stroke

21st century treatment proves successful for adults living with cerebral palsy

ANN ARBOR, Mich.—The simplest tasks in life, like putting on clothing or tying gym shoes, can be extremely difficult for an adult living with cerebral palsy (CP).

Researchers at the University of Michigan are finding ways to provide easier access to care using home-based programs that use the Internet to monitor changes in performance.

U-M School of Kinesiology professor Susan Brown and colleague Dr. Edward Hurvitz, the chair of the Department of Physical Medicine and Rehabilitation at the U-M Medical School, have completed a study that looked at the effectiveness of a home and internet-based upper limb training program for adults with CP. Their research effort, "Upper Limb Training and Assessment Program," or ULTrA program, was designed to aid adults with cerebral palsy who have upper limb and hand impairments. Until now, no study has ever looked at changes in upper limb coordination and the potential impact on everyday tasks in adults with CP.

The concept was simple: Allow patients to complete regular therapy exercises from the comfort of their home using the Internet, an at-home computer interface, and trainers on the other end of the computer. The goal was also simple: Make movement-based training more convenient and accessible for adults with cerebral palsy. This particular intervention was unique because it used low-cost technology to monitor participants while collecting invaluable, movement-related home training data.

The study tested 12 adults with CP who had pronounced arm and hand mobility issues. Participants completed a series of arm reaching and hand manipulation tasks in their homes for 40 minutes a day, five days a week for a period of eight weeks. Using the Internet and streaming video, the ULTrA program allowed participants to interact with research personnel at the School of Kinesiology's Motor Control Laboratory. Each participant's home was equipped with a computer-based upper limb training unit, a high-speed Internet connection, and a training guide.

"One of our major goals of the study was to incorporate a variety of arm reaching and hand movements exercises that we hoped would improve mobility and do it at a time that was convenient for them," Brown said.

In one of the most notable training sessions, a participant was asked to slide, or turn, as many playing cards (from a casino-style card slider/holder) as possible in 30 seconds. The number of cards a person was able to turn was recorded—part of the larger data collection effort that would help determine how well the in-home therapy was working. The data showed a 64 percent improvement in task performance by the affected hand, and a 41 percent improvement in the less affected hand. Significant improvement in the ability to grasp and manipulate common objects was also seen, providing evidence that training led to improved hand and arm function.

Participants were able to receive coaching and encouragement via web cameras—which also allowed the staff to modify programs as needed without having participants coming into the research lab or clinic.

"We believe home-based therapy shows great promise for patients who otherwise have limited access to interventions due to insurance coverage, travel barriers and time constraints," Hurvitz said.

Apart from rehabilitation, the researchers said, there is real potential to use this technology beyond adults with CP. A variety of populations with neurological problems could benefit from this type of therapy including stroke, multiple sclerosis, and spinal cord injury. These populations could potentially improve movement speed and hand manipulation skills similar to the gains seen in the participants in this study. Brown and Jeanne Langan, a research fellow at the Motor Control Laboratory, have recently begun studies examining the effectiveness of the home and Internet-based training in individuals with stroke.

The study will appear in an upcoming issue of Neurorehabilitation and Neural Repair, the leading journal in the field of rehabilitation.

The University of Michigan School of Kinesiology continues to be a leader in the areas of prevention and rehabilitation, the business of sport, understanding lifelong health and mobility, and achieving health across the lifespan through physical activity. The School of Kinesiology is home to the Athletic Training, Movement Science, Physical Education, and Sport Management academic programs—bringing together leaders in physiology, biomechanics, public health, urban planning, economics, marketing, public policy, and education and behavioral science since 1894. For more information, visit www.kines.umich.edu



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