Brain plasticity and rehabilitation robotic therapies

Brain Plasticity and Rehabilitation Robotic Therapies.

Cal State University, NorthridgeCenter Of Achievement / Brown

Center

by DAVID [email protected]

818-730-8756Blog: http://dkrehab.blogspot.com/

Dr. Hermano Igo Krebs, Principal Research Scientist and Lecturer– MechE Mechanical Engineering, Massachusetts Institute of Technology [Neuro-rehabilitation, functional imaging, human-machine interactions, robotics, and dynamic systems modeling & control]:

looking at a Powerpoint presentation, particularly related to the interaction of the brain vision processing areas "seeing" the resulting action and connecting it to the feeling of the muscles performing the action, seem to greatly improve the imprint on the brain with the involved processes.

From my own [DK] experiences, getting more than a two-dimensional screen view, seems that it would greatly enhance the learning, and resultant rehabilitation.  Considered VR-type interfaces, such that it appears to my brain that I am reaching "into" a scenario, or that " I'm picking up an object" - feeling and seeing the interaction….. [DK]

VISUALIZATION OF BODY PARTS

The brain differentiates processing functions in localized areas with structural connectivity between the areas

BRAIN PROCESSING AREAS OF FUNCTIONAL LOCALIZATION

FUNCTIONAL LOCALIZATION IN THE HYMAN BRAINBrett_etal 2002http://www.ece.uvic.ca/~bctill/papers/learning/Brett_etal_2002.pdf

The brain differentiates processing functions in localized areas with structural connectivity between the areas

BRAIN PROCESSING AREAS OF FUNCTIONAL LOCALIZATION

LOBES OF THE BRAIN WITH THEIR FUNCTION

http://magdalenanordh.wordpress.com/2010/06/29/motion-learning-and-performance-chapter-i-brain/

BRAIN PLASTICITY AND REHABILITATIONConnecting Your Brain To A Body Part.

Stable Hebbian Learning from Spike Timing-Dependent PlasticityM. C. W. van Rossum1, G. Q. Bi2, and G. G. Turrigiano1

The Journal Of Neurosciencehttp://neuro.cjb.net/content/20/23/8812.short

HEBBIAN LEARNING

The University of Southern California Institute for Creative Technologies [revolutionizing learning through the development of interactive digital media]

http://ict.usc.edu/

VIRTUAL REALITY

Virtual reality (VR) is a term that applies to computer-simulated environments that can simulate physical presence in places in the real world, as well as in imaginary worlds. Most current virtual reality environments are primarily visual experiences, displayed either on a computer screen or through special stereoscopic displays, but some simulations include additional sensory information, such as sound through speakers or headphones. Some advanced, haptic systems now include tactile information, generally known as force feedback, in these applications.

MOTOR LEARNING

Boyd,L.A., Vidoni, E.D., Daly, J.J. (2007). Answering the call: the influence of neuroimagining and electrophysiological evidence on rehabilitation. Journal of the American Physical Therapy Association, 87(6), 684-703.

ENHANCED LEARNING TO IMPROVE REHABILITATION

Specific interventions may stimulate new neural connections, enhance cortical reorganization, and promote lasting neural networks for improved motor responses

NATIONAL INSTITUTE OF HEALTHDisability and Rehabilitation Model

Nature8 March 1969

BRAIN PLASTICITY RESEARCH

Destroyed brain cells that control them or the bundles of nerve fibers that come out of them. The recovery of language is highly variable and can occur over years. Also amenable to rehabilitation are abstract thought, memory and emotion.On 8 March 1969, an extraordinary experiment was reported in the pages of Nature, Europe's leading science journal. It involved a group of people who took turns to sit in an old dentist's chair and describe the room around them. They commented on the presence of a phone on the table, a nearby vase, people's expressions and how they wore their hair. It was remarkable because all were completely blind.

BRAIN PLASTICITY RESEARCH

Nature8 March 1969

The scientific establishment took a dim view of the work and, for the most part, dismissed it as implausible. But today it stands as one of the first, and most striking, demonstrations of neuroplasticity, the brain's ability to adapt. The blind people had learned to "see" through the sensation of touch. Here's what happened. The back of the chair had been fitted with hundreds of tiny stimulators that were hooked up to a video camera. As the camera panned the room, those in the chair felt tiny vibrations that seemed to dance across their skin as the image moved. With practice, the blind volunteers' brains learned to turn these vibrations into a mental picture of the room. Some became so good at it that they ducked when a ball was tossed at the camera.

Nature8 March 1969

BRAIN PLASTICITY RESEARCH

What was regarded as fringe science 40 years ago is currently at the cutting edge of neuroscience. With the right training, scientists now know the brain can reshape itself to work around dead and damaged areas, often with dramatic benefits. Therapies that exploit the brain's power to adapt have helped people overcome damage caused by strokes, depression, anxiety and learning disabilities, and may one day replace drugs for some of these conditions. Some studies suggest therapies that tap into the brain's neuroplasticity are already making a big difference. Children with language difficulties have been shown to make significant progress using computer training tools that are the equivalent of cerebral cross-training.

Nature8 March 1969

BRIEF RESEARCH INTO STROKE REHABILITATION THERAPIES

Mirror-box Therapy Concepts.I used mirror box concepts to initiate my left ankle movement [3-months post stroke] [DK].

Hyperbaric TherapyElectrical Stimulus TherapyTMS - Transcranial Magnetic Stimulation. TMS Therapy uses a highly focused pulsed magnetic field to stimulate nerve cells in the area of the brain thought to control certain brain functions by altering those brain structuresStem Cell Replacement TherapyAquatic Therapy – balance, stretching, range of motion, strengthI have been coming to the COA for 1 ½ years – I learned to walk without a support about 3 months ago [25-months post stroke] [DK].

Nature8 March 1969

BRIEF RESEARCH INTO STROKE REHABILITATION THERAPIES

Vision Therapy - a type of physical therapy for the eyes and brain -- is a highly effective non-surgical treatment for many common visual problems such as lazy eye, crossed eyes, double vision, convergence insufficiency and some reading and learning disabilitiesI used several different computer programs to help with resolving peripheral vision and depth perception issues [began 3-months post stroke; depth perception improved 100% after 13 months] [DK].

Robotic Therapy -After my first robot arm & shoulder exercise [a demonstration session – I was able to raise my left leg behind me for the first time post-stroke] [DK].

Nature8 March 1969

THERAPEUTIC GOALS

Reduced tone – throughout the entire arm, shoulder, elbow, wrist and hand. Reduced pain – Stroke patients with loss of upper extremity movement often suffer shoulder pain, which sometimes can be exacerbated by therapy. Improved coordination – Patients treated with Reo Therapy have exhibited improvements in active range of motion and in overall coordination of arm movements.

Nature8 March 1969

THERAPEUTIC GOALS

Improved gait – Patients whose gait was affected by their in-ability to properly move their upper extremities showed a marked improvement in gait following therapy sessions. Functional gains – Therapists reported that following Therapy sessions, subsequent components of their patients’ therapy session were more productive, an improvement they attributed to the affects of robotic therapies.

PURPOSE/FUNCTION OF ROBOTICS

ENHANCED LEARNING TO IMPROVE REHABILITATION – o Brain-to-Body Connectivity = Functional gainso Stroke rehabilitation by muscle/brain re-education o Maintain or increase range of motion I chose InMotion as my initial therapeutic device to

1. gain mental stimulation through visual activities, which2. effectively improve shoulder [scapula movement] range of

motion, and3. enhance brain-to-body re-education

The Myomo device combines several treatment modalities into one device , and 1. can cost effectively improve range of motion, 2. enhance brain-to-body re-education through practical

Clinical Progression process3. be used as a therapeutic tool for improved motor function,4. and be effective as an assistive device

PURPOSE/FUNCTION OF ROBOTICS

ENHANCED LEARNING TO IMPROVE REHABILITATION –

1. Rehabilitation with highly repetitive training for severely affected patients.

2. Improved therapy efficiency and patient care OR • Guided therapeutic programs

3. An extensive 3D workspace OR • Visual aids [‘seeing it”]4. Augmented Feedback with functionally based ,motivating exercises to

train activities of daily living.5. Assist-as-needed support provided by the robotic exoskeleton that

automatically adapts to the patients’ capabilities.6. Clinical research shows that patients suffering from neuromuscular

dysfunction show better results when performing repetitive, intense, functionally based retraining, as part of their physical therapy program.

7. Objective analysis and documentation of the patient’s progress.

ClassifyingHuman-RobotInteraction.pdf [ATTACHED]Human-Robot Interaction An Updated Taxonomy.doc (A Simplified Taxonomy of Command and Control Structures for Robot Teams) [ATTACHED]

ROBOTICS – TAXONOMY

3.1 Task Type [the task to be accomplished sets the tone for the system’s design and use]3.2 Task Criticality [high, medium and low.]3.3 Robot Morphology [Robots can take many physical forms.]3.4 Ratio of People to Robots [The ratio of people to robots directly affects the human-robot interaction in a system. This taxonomy classification does not measure the interaction between the operators and the robots, simply the numbers of each.

ROBOTICS – TAXONOMY

Robotics – taxonomy and associated roboticsEXTRAMURAL, EXTERNAL and NON-SENSOR, NON-STIMULATION [ROBOT REACTIVE TO COMMAND PROMPTS]- situated or occurring outside the wall of an organ or structure.

ToyotaArmeoRupertHoward

EXTRADURAL, SENSOR, HUMAN STIMULATION [ROBOT REACTING TO HUMAN SIGNALS/ACTIONS]-outside the dura matter enveloping the spinal cord

REO/MOTORIKA –InteractiveMotionReWalkMYOMO

EPIDURAL- , SENSOR, ROBOT STIMULATION [ROBOT SIGNALS STIMULATING HUMAN ACTIONS] - an agent into the epidural space of the spinal canal

CalTech NOTE: This taxonomy is based on my personal research and is subject to evaluation. My taxonomy design is based on two factors: (1) type of human-robot interface and (2) If/How the robot stimulates or is reacting to/Is stimulated by human signals [DK].

Definition of Spasticity vs Recruitment

Spasticity: A state of increased tone of a muscle (and an increase in the deep tendon reflexes) when there is a sudden muscle movement. For example, with spasticity of the legs (spastic paraplegia) there is an increase in tone of the leg muscles so they feel tight and rigid and the knee jerk reflex is exaggerated, when the leg is suddenly moved.

Order of RecruitmentAs a general rule, motor units are recruited in order of their size. When the muscle is activated initially, the first motor units to fire are small in size and weak in the degree of tension they can generate. Starting with the smallest motor units, progressively larger units are recruited with increasing strength of muscle contraction. The result is an orderly addition of sequentially larger and stronger motor units resulting in a smooth increase in muscle strength.[2]This orderly recruitment of sequentially larger motor units is referred to as the "Henneman size principle", or simply "size principle."[2, 3, 4] Recording from the ventral rootlets in cats and measuring the amplitudes of motor axon spikes, Henneman et al concluded that motor axon diameter, conduction velocity and, by further inference, motor neuron cell size all increase with functional threshold.[2]

Definition of Spasticity vs RecruitmentOrder of Recruitment (continued)There are exceptions to the size-ordered activation of motor units. Motor unit recruitment patterns vary for different movement tasks, depending on many factors, including the mechanical function of the muscle, sensory feedback, and central control.[3] After nerve injury, the relationship between motoneuron size and the number and size of muscle fibers that the motoneuron reinnervates is initially lost.[4] With time, however, a size-dependent branching of axons accounts for the rematching of motor neuron size and muscle unit size, and the size-ordered organization of motor units properties is restored.[4]The 3 main types of motor units, which have different physiologic and staining properties, include the following:

[Refer to ATTACHMENT: Definition of Spasticity vs Recruitment.doc]

ROBOTS

Brain Plasticity and Rehabilitation Robotic Therapies.

DK personal comments identified in dark red color with [DK]

ATTACHMENTS:ClassifyingHuman-RobotInteraction.pdf Human-Robot Interaction An Updated Taxonomy.doc (A Simplified Taxonomy of Command

and Control Structures for Robot Teams)

ToyotaArmeoRupertREO/MOTORIKA InteractiveMotion

SHOULDER/ARM ROBOTWRIST/HAND ROBOTResearch notes

ReWalkMYOMO

CLINICAL PROGRESSION-PROG 1+2EXERCISE LEVEL1+2LIVE BETTER VISITS OVERVIEW

CalTech

Toyota

Armeo

Rupert

Rupert

Howard

REO Therapy by MOTORIKA

InteractiveMotion

InteractiveMotion

ReWalk

ReWalk

MYOMO

myomo Mobility System -- mPower 1000

CalTech

FUTURE OF REHABILITATION ROBOTS

WRIST / HAND and FINGER robotsInMOTION – wrist and hand robotMYOMO – 3-year NIH research studyInMOTION – 5-year NIH research studyHoward – hand robot

KNEE robotInMOTION – “KNEE-bot”

Citations

NOTE: Citations hidden behind every page.Functional Localization In The Human Brain Brett_etal 2002http://www.ece.uvic.ca/~bctill/papers/learning/Brett_etal_2002.pdf

Boyd,L.A., Vidoni, E.D., Daly, J.J. (2007). Answering the call: the influence of neuroimagining and electrophysiological evidence on rehabilitation. Journal of the American PhysicalTherapy Association, 87(6), 684-703.

Jaeger, R.J. (2006) Rehabilitation robotics research of the National Institute on Disability and Rehabilitation research. Journal of Rehabilitation Research and Development, 43[Editorial], xx

Stable Hebbian Learning from Spike Timing-Dependent Plasticity M. C. W. van Rossum1, G. Q. Bi2, andG. G. Turrigiano1 The Journal Of Neuroscience

http://neuro.cjb.net/content/20/23/8812.short

The University of Southern California Institute for Creative Technologies [revolutionizing learning through the development of interactive digital media] http://ict.usc.edu/

Shumway-Cook A.Woolacott, M.H. (2001) Motor Control and Practical Applications 2nd edition, Baltimore: Lippincott Williams & Williams

ClassifyingHuman-RobotInteraction.pdf [ATTACHED]Human-Robot Interaction An Updated Taxonomy.doc (A Simplified Taxonomy of Commandand Control Structures for Robot Teams) [ATTACHED]

Nature, 8 March 1969.

Citations

NOTE: Citations hidden behind every page.Toyota Toyota Shows Machines to Help Sick, Elderly Move

By YURI KAGEYAMA AP Business Writer November 2, 2011 Follow Yuri Kageyama on Twitter at http://twitter.com/yurikageyama

Armeo http://vimeo.com/couchmode/hocoma/videos/sort:newest/26050709

REO/MOTORIKA http://www.motorika.com/?categoryId=65709http://www.motorika.com/?categoryId=66291

InteractiveMotionhttp://interactive-motion.com/Rehabilitation Robotics | Interactive Motion Technologies

Robotic rehabilitation for stroke and other neurological conditions. ... In Motion Robot's featured in the National Stroke Association video: Brain Attack ...interactive-motion.com/news.htm

ReWalk http://www.argomedtec.com/products.asp

Rupert http://www.ncbi.nlm.nih.gov/pubmed/17281846Neural Systems and Rehabilitation Engineering, IEEE Transactions Issue Date: Sept. 2007, Volume: 15 Issue:3, page(s): 336 - 346

MYOMO http://www.myomo.com/Howard http://www.technovelgy.com/ct/Science-Fiction-News.asp?NewsNum=937

CalTech http://thesis.library.caltech.edu/3666/http://robotics.caltech.edu/wiki/index.php/Main_Page

Attachments

DK personal comments identified in dark red color with [DK]

ATTACHMENTS:

ClassifyingHuman-RobotInteraction.pdf Human-Robot Interaction An Updated Taxonomy.doc (A Simplified

Taxonomy of Command and Control Structures for Robot Teams)

ClassifyingHuman-RobotInteraction.pdf Definition of Spasticity vs Recruitment.docToyotaArmeoREO/MOTORIKA InteractiveMotionReWalkRUPERTMYOMOCalTech

Brain Plasticity and Rehabilitation Robotic Therapies.

by DAVID [email protected]

Blog: http://dkrehab.blogspot.com/818-730-8756

with SEAN [email protected], [email protected]

Questions

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