Precision neurorehabilitation

 A complete oxymoron. There is NOTHING PRECISE ABOUT STROKE REHAB! NO objective damage diagnosis, NO EXACT REHAB PROTOCOLS! Really no recovery at all since 100% recovery is the goal of all stroke survivors and currently only 10% get there. Everything in stroke is a COMPLETE SHITSHOW and these people are trying to put lipstick on a pig!

Precision neurorehabilitation

Dr. Steven Kautz, Chair of the Department of Health Sciences and Research in the College of Health Professionals at MUSC

Provided

This week Bobbi Conner talks with Dr. Steven Kautz about precision neurorehabilitation and the $6.5 million grant from NIH for research in this specialty area. Dr. Kautz is the Chair of the Department of Health Sciences and Research in the College of Health Professionals at MUSC.

TRANSCRIPT:

Conner: I'm Bobbi Conner for South Carolina Public Radio with Health Focus here at the radio studio for the Medical University of South Carolina in Charleston. The National Institutes of Health recently awarded a $6.5 million grant to start a center focused on precision neurorehabilitation at MUSC to help people affected by strokes and other neurological conditions. Doctor Steven Kautz is here to talk about the details. Doctor Kautz is the principal investigator for this research grant, and he's the Chair of the Department of Health Sciences and Research in the College of Health Professions at MUSC. Doctor Kautz, first tell us about precision Neurorehabilitation. What is this really?

Dr. Kautz: Precision neurorehabilitation as we're developing it is based on identifying the neural circuits that are impaired by an injury and then targeting them with the neuromodulation technique in order to rehabilitate those circuits and restore function. Essentially, we are seeking to rewire the brain to help it recover.

Conner: What might be different about this precision neurorehabilitation approach to stroke compared to a current standard approach to providing rehab following a stroke.

Dr. Kautz: In a conventional rehabilitation, a person would work with a therapist, say if they're trying to improve their arm function, they would typically practice performing tasks with the therapist. In the approach that we are trying to develop, we want to give the therapist tools to understand which specific neural circuit was impaired, and then they're able to choose the best activity to help improve that function, so that they can get the most responsiveness to the rehabilitation.

Conner: And can you give us an example of what might be different for one person versus another, as far as the rehab that you're suggesting?

Dr. Kautz: Sure. So, depending on which neural circuit is injured, we may stimulate completely different parts of the brain, after the stroke. When one side is injured in one person, it might be most beneficial for them for us to stimulate the injured side of the brain. But in another person, we might need to stimulate the non-injured side of the brain to get more effective rehabilitation for them.

Conner: Tell us about the NIH research grant that you received recently to start a center focused on precision neurorehabilitation research.

Dr. Kautz: Yeah, so we're very excited about this. Our center is part of the National Rehabilitation Research Infrastructure Network, and NIH selected six centers to recognize the institutions that were national leaders in an area of rehabilitation, like we are here at MUSC in neuromodulation. And so, we're to do research and train researchers from around the country in this new precision neurorehabilitation approach, so that more people throughout the country can experience this type of an approach. And we'll be developing new tools and disseminating them throughout the country.

Conner: And you just received this NIH research grant this fall. What are the next steps to get things up and running?

Dr. Kautz: The grant is a five-year grant and it will run through 2030. We have started our research projects and getting those up and running, and we have started planning for workshops that we will put on for investigators throughout the country so that we can help grow this field of precision neurorehabilitation.

Conner: Doctor Kautz, thanks for talking with us about this research.

Dr. Kautz: You're welcome. Thank you for having me.

Conner: From the radio studio for the Medical University of South Carolina in Charleston, I'm Bobbi Conner for South Carolina Public Radio.

Health Focus transcripts are intended to accurately represent the original audio version of the program; however, some discrepancies or inaccuracies may exist. The audio format serves as the official record of Health Focus programming.

Robot- and Technology-Boosting Neuroplasticity-Dependent Motor-Cognitive Functional Recovery: Looking towards the Future of Neurorehabilitation

 And that future is bleak since no one knows EXACTLY how to make neuroplasticity repeatable on demand!

Robot- and Technology-Boosting Neuroplasticity-Dependent Motor-Cognitive Functional Recovery: Looking towards the Future of Neurorehabilitation

by

Giovanni Morone^1,2,Marco Iosa^3,4,*,Rocco Salvatore Calabrò⁵,

Antonio Cerasa

^6,7,8,

Stefano Paolucci

⁴,

Gabriella Antonucci

³ and

Irene Ciancarelli

¹

⁴,

Gabriella Antonucci

³ and

Irene Ciancarelli

¹

¹

Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy

²

San Raffaele Institute of Sulmona, Viale dell’Agricoltura, 67039 Sulmona, Italy

³

Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy

⁴

Santa Lucia Foundation, Scientific Institute for Research, Hospitalization and Health Care (IRCCS), 00179 Rome, Italy

⁵

Neurorehabilitation Unit, IRCCS Neurolesi Center “Bonino-Pulejo”, 98124 Messina, Italy

⁶

S’Anna Institute, 88900 Crotone, Italy

⁷

Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy

⁸

Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy

^*

Author to whom correspondence should be addressed.

Brain Sci. 2023, 13(12), 1687; https://doi.org/10.3390/brainsci13121687

Original submission received: 1 November 2023 / Accepted: 15 November 2023 / Published: 7 December 2023

(This article belongs to the Special Issue Robot-, Virtual Reality- and Sensor-Based Therapies Boosting Neuroplasticity in the Context of Motor and Cognitive Neurorehabilitation: Current State of the Art and Applications)

Download keyboard_arrow_down Versions Notes

The sequelae of neurological disorders are the leading causes of disability in all industrialized countries. Conventional rehabilitation usually allows a small proportion of patients suffering from neurological disabilities to completely recover independent walking or functional grasping, and other activities of daily living [1]. For these reasons, an increasing number of research studies and randomized clinical trials are pursuing the use of new robots and technologies to improve the efficacy of rehabilitation [2,3,4,5,6]. They have become more usable and widespread every year, thanks to new principles of neuroscience translated into clinical practice through technological innovations. However, despite their diffusion in neurorehabilitation, many questions remain unanswered.

In particular, the disputes about their efficacy, together with the high purchase cost for most of these devices [7,8], the absence of clear and univocal guidelines for better dosages to use and parameter values to set, and the somewhat diffuse skepticism of some members of the rehabilitation teams, may limit their use in clinical settings.

Finally, most of the available studies and clinical indications focus on stroke and multiple sclerosis, even though robots might be beneficial for other pathologies, such as Parkinson’s disease, traumatic brain injuries, spinal cord injuries, and other brain degenerative diseases [9,10,11].

This Special Issue aims to provide an overview of the use of new technologies in the neurorehabilitation of people with motor and cognitive disabilities stemming from central nervous system diseases.

In general, studies address the effectiveness of therapy versus conventional therapy, while in daily clinical practice, the clinician must choose the suitable type of neurorehabilitation assisted by a specific robot for each specific patient [12]. For this reason, in recent years, the ideal type of robot and related cognitive stimulation for patients with specific characteristics has been investigated in line with personalized medicine [13,14]. Therefore, a Special Issue that addresses the use of technologies in multiple types of patients and for different objectives can represent a step forward in increasing our knowledge on the topic and arriving at a competent and skillful use of robotics and technology in neurorehabilitation clinics.

In this Special Issue, two systematic reviews investigated the efficacy of robot-assisted gait training (RAGT) on balance recovery using overground exoskeletons (Lorusso M et al.) and of many different robotic devices including overground exoskeletons, grounded exoskeletons, and end-effectors (Loro A et al.). Xie et al. investigated the optimal intervention timing of RAGT, with two protocols allowing us to better understand the clinical effects of robot-assisted therapy for arm function recovery (Pournajaf S. et al.) and for walking recovery (Kolářová, B et al.) by means of two distinct, well-planned, and methodologically rigorous randomized controlled trials. Finally, a feasibility study investigated the use of an intelligent algorithm based on an assist-as-needed controller in RAGT, which was conducted by Laszlo C. and co-authors.

But, robots are not the only emerging technology in neurorehabilitation. In two pilot studies by De Luca R and a systematic review, the potential of virtual reality (VR) in neurorehabilitation was examined. The first study looked at how executive functioning and coping mechanisms in traumatic brain injury patients might be improved with VR-based cognitive rehabilitation training, and the second examined how traumatic brain injury patients’ attention processes might be affected by non-immersive VR training. The systematic review was conducted by Martino Cinnera et al. and explored the efficacy of VR in patients with unilateral spatial neglect due to stroke. Regarding the gender differences in subjects affected by traumatic brain injuries, Bruschetta R et al. demonstrated that females who underwent VR training showed better cognitive recovery.

The technologies aiming to modulate neuroplasticity and thus improve the function for reducing pain should be combined to allow for an improvement in the clinical effects. This is the case of two studies in this Special Issue. In one study, De Luca R et al. combined robotic verticalization and music therapy in chronic disorders of consciousness, and in another study, Calabrò et al. combined transcranial magnetic stimulation and muscle vibration for women with chronic pelvic pain.

Sato M. et al. investigated the different contributions of the frequency and the duration of PES, peripheral sensory nerve electrical stimulation, on the excitability of the primary motor cortex. Facciorusso S. et al. performed a bibliometric analysis of research trends regarding sensor-based rehabilitation in neurological diseases.

Finally, a study conducted by Varalta V. et al. demonstrated an improvement in global cognitive status and in attention functions when subjects affected by Parkinson’s disease were treated with an upper limb motor protocol, underlining the strong interconnections that exist between motor and cognitive functions for the upper limbs.

There is no doubt that robots and technologies are changing clinicians’ ways of thinking in rehabilitation, and even if they are not the definitive solution for improving plasticity-dependent functional recovery, they will certainly play a fundamental role in improving the efficacy of neurorehabilitation.

Author Contributions

Conceptualization, M.I., I.C. and G.M.; writing—original draft preparation, G.M.; writing—review and editing. All authors performed a review and editing. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.