Restoring Independent Living after Disability Using a Wearable Device: A Synergistic Physio-Neuro Approach to Leverage Neuroplasticity

The number of people living with various grades of disability is now in excess of 1 billion. A significant portion of this population is dependent on caregivers and unable to access or afford therapy. This emerging healthcare challenge coincides with new knowledge about the self-learning, self-organizing, neuroplastic nature of the brain, offering hope to those trying to regain independence after disability. As conditions such as stroke and dementia begin to affect more and more people in the younger age groups, there is an urgent, global need for a connected rehabilitation solution that leverages the advantages of neuroplasticity to restore cognitive and physical function. This chapter explains a novel approach using a Synergistic Physio-Neuro learning model (SynPhNe learning model), which mimics how babies learn. This learning model has been embedded into a wearable, biofeedback device that can be used to restore function after stroke, injury, the degenerative effects of aging or a childhood learning disability. This chapter enumerates the clinical studies conducted with adult stroke patients in two scenarios—with therapist supervision and with lay person supervision. The results indicate that such a learning model is effective and promises to be an accessible and affordable solution for patients striving for independence

Neural network control of a rehabilitation robot by state and output feedback

In this paper, neural network control is presented for a rehabilitation robot with unknown system dynamics. To deal with the system uncertainties and improve the system robustness, adaptive neural networks are used to approximate the unknown model of the robot and adapt interactions between the robot and the patient. Both full state feedback control and output feedback control are considered in this paper. With the proposed control, uniform ultimate boundedness of the closed loop system is achieved in the context of Lyapunov’s stability theory and its associated techniques. The state of the system is proven to converge to a small neighborhood of zero by appropriately choosing design parameters. Extensive simulations for a rehabilitation robot with constraints are carried out to illustrate the effectiveness of the proposed control

World-Wide FINGERS Network: A global approach to risk reduction and prevention of dementia

© 2020 The Authors. Alzheimer\u27s & Dementia published by Wiley Periodicals, Inc. on behalf of Alzheimer\u27s Association Reducing the risk of dementia can halt the worldwide increase of affected people. The multifactorial and heterogeneous nature of late-onset dementia, including Alzheimer\u27s disease (AD), indicates a potential impact of multidomain lifestyle interventions on risk reduction. The positive results of the landmark multidomain Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) support such an approach. The World-Wide FINGERS (WW-FINGERS), launched in 2017 and including over 25 countries, is the first global network of multidomain lifestyle intervention trials for dementia risk reduction and prevention. WW-FINGERS aims to adapt, test, and optimize the FINGER model to reduce risk across the spectrum of cognitive decline—from at-risk asymptomatic states to early symptomatic stages—in different geographical, cultural, and economic settings. WW-FINGERS aims to harmonize and adapt multidomain interventions across various countries and settings, to facilitate data sharing and analysis across studies, and to promote international joint initiatives to identify globally implementable and effective preventive strategies

Micro-doping in ultrafine-grained gold bonding wires

227 p.Wire bonding remains the dominant form of interconnection technology, and is expected to be used in 85% of total IC units worldwide by 2010. As device miniaturization continues, the diameters of wires get finer, requiring higher mechanical strength from the thin wires for handling. However, strong wires with low ductility pose an insurmountable hurdle in manufacturing because of formability issues. Therefore, strategies to attain both high strength and ductility (dual improvement) in Au wires need to be developed, a goal shared by researchers in the field of nanocrystalline (NC) and ultrafine-grained (UFG) materials.DOCTOR OF PHILOSOPHY (MSE

A Review on Motor Imagery with Transcranial Alternating Current Stimulation: Bridging Motor and Cognitive Welfare for Patient Rehabilitation

Research has shown the effectiveness of motor imagery in patient motor rehabilitation. Transcranial electrical stimulation has also demonstrated to improve patient motor and non-motor performance. However, mixed findings from motor imagery studies that involved transcranial electrical stimulation suggest that current experimental protocols can be further improved towards a unified design for consistent and effective results. This paper aims to review, with some clinical and neuroscientific findings from literature as support, studies of motor imagery coupled with different types of transcranial electrical stimulation and their experiments onhealthy and patient subjects. This review also includes the cognitive domains of working memory, attention, and fatigue, which are important for designing consistent and effective therapy protocols. Finally, we propose a theoretical all-inclusive framework that synergizes the three cognitive domains with motor imagery and transcranial electrical stimulation for patient rehabilitation, which holds promise of benefiting patients suffering from neuromuscular and cognitive disorders

Combining transcranial direct current stimulation and gravity-supported, computer-enhanced arm training in a chronic pediatric stroke survivor: a case report

Introduction: Transcranial direct current stimulation (tDCS) is a non-invasive method of brain stimulation that modulates cortical excitability via constant weak electric currents. Case presentation: We tested the feasibility and preliminary effects of combined tDCS with repetitive, task-specific practice of the affected upper extremity in a 19-year-old individual with no meaningful use of the right arm due to a chronic left middle cerebral artery infarction at the age of 12 years old. The subject underwent 10 training sessions over 2 weeks during which he received 40 minutes of tDCS while performing repetitive, multidirectional arm reaching and hand grasp/release activities in a gravity-supported, computer-enhanced environment. Potential side effects were investigated using the Digit Span test, the nine-item Patient Health Questionnaire, and the tDCS Adverse Effects Questionnaire. Clinical outcome measures were gathered pre-training, post-training and 2 weeks after the end of training. These measures included (i) the Jebsen-Taylor Hand Function Test, (ii) the Box and Block Test, (iii) the Fugl-Meyer Assessment for upper extremity, and (iv) Motor Activity Log. In addition, during the training sessions, we collected kinematic measures during arm reaching. The subject tolerated the brain stimulation well. There were no effects on mood or working memory. Clinical outcome measures showed improvements in upper extremity motor function that were retained 2 weeks after completion of training. Movement kinematic parameters showed similar trends in response to training: improvements in mean speed, maximum speed, and acceleration of arm reaching movements. Conclusions: Despite the fact that this case report does not detangle the effects of tDCS from motor training, it provides initial detailed clinical and kinematic data showing beneficial effects of tDCS for enhancing motor recovery when combined with Gravity-Supported, Computer-Enhanced Arm Training that are useful for future trials planning the use of this combined approach in pediatric stroke. We review the use of combined robotic-based arm training and tDCS for motor recovery in stroke

Identifying Clinically Important Functional Impairments and Rehabilitation Needs in Cancer Survivors and a Pilot Validation of the Cancer Rehabilitation Questionnaire

Objectives: Despite the availability of cancer rehabilitation, utilization at our institution was low. We designed the Cancer Rehabilitation Questionnaire (CRQ) to investigate the prevalence of functional impairments amongst cancer survivors and attitudes towards rehabilitation participation. We evaluated the performance of CRQ as a screening tool for detecting clinically important physical dysfunction. Design: A cross-sectional study was performed, recruiting cancer survivors at a university outpatient oncology clinic. Cancer survivors completed the CRQ and European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire – Core 30 Questionnaires. Descriptive statistical analysis and receiver operator characteristics analysis were performed to assess the ability of the CRQ to detect clinically important physical dysfunction, as measured by the EORTC QLQ-C30. Results: Of 204 participants, 87.3% reported impairments in at least 1 CRQ domain. Pain and weakness were most common. The number of positive items correlated with EORTC global health status and functional scales. A cut-off of ≥ 4 on the CRQ predicted clinically important physical dysfunction (sensitivity 61.8%, specificity 75.5%). Of those with impairments, 53.9% were unwilling to participate in rehabilitation. Transportation, need for caregivers, and cost were the main barriers. Conclusion: Our findings will guide resource allocation to overcome barriers to participation. The CRQ can help to stratify cancer survivors requiring further rehabilitation interventions. LAY ABSTRACT Functional impairments due to cancer and its treatment are common, and can be effectively addressed with rehabilitation. To better provide cancer rehabilitation, the Cancer Rehabilitation Questionnaire was designed to investigate what functional problems cancer survivors have and their attitudes towards participation in rehabilitation. We compared the cancer rehabilitation questionnaire with the European Organization for Research and Treatment of Cancer (EORTC QLQ-C30) to see if it could be used as a screening tool for rehabilitation needs. Of 204 participants, 87.3% reported functional impairments in at least 1 Cancer Rehabilitation Questionnaire domain. Pain and weakness were most common. The number of positive Cancer Rehabilitation Questionnaire items correlated with EORTC scales: ≥ 4 positive items in the Cancer Rehabilitation Questionnaire indicated that the number of physical impairments was clinically significant. Among participants with impairments, 53.9% were unwilling to participate in rehabilitation. Transportation, need for caregivers, and cost were cited as barriers. A simple screening tool, such as the Cancer Rehabilitation Questionnaire can help to stratify cancer patients requiring further rehabilitation and intervention

Poor tolerance of motor cortex rTMS in chronic migraine

Background:Two small studies had evaluated the efficacy of rTMS in migraine. One tested high frequency rTMS over the dorsolateral prefrontal cortex while the other evaluated 1 Hz rTMS over the vertex. Aim:To test the feasibility of 10 Hz rTMS of motor cortex as an adjunctive therapy in patients with chronic migraine.Materials and Methods: We randomized (2:1 ratio) chronic migraine patients on medical preventive treatment to receive either rTMS or sham therapy for 10 sessions. rTMS (80% resting motor threshold, 10Hz, 20 trains, 5 secs/train, inter-train interval 1 min, total 1000 stimuli/session) was applied over the right motor cortex. Result: Nine patients were randomized. Six received rTMS and three had sham therapy. Three patients in the rTMS arm withdrew from the study due to increased headache frequency and discomfort from the treatment. The remaining six cases (3 rTMS, 3 sham) completed the study. The study was prematurely stopped due to the significant worsening of headache from rTMS. No significant differences in outcome measures were found between real and sham rTMS. Conclusion:Although the study was terminated prematurely, the high dropout rate (50%) due to worsening headaches suggested that rTMS over the motor cortex is poorly tolerated in chronic migraine

Facilitating effects of Transcranial Direct Current Stimulation on EEG-based motor imagery BCI for stroke rehabilitation

This clinical trial investigates the facilitating effects of combining tDCS with EEG-based motor imagery Brain-Computer Interface (MI-BCI) robotic feedback compared to sham-tDCS for upper limb stroke rehabilitation. 32 hemiparetic stroke patients were recruited and screened for their ability to use EEG-based MI-BCI. Subsequently, 17 of these patients who passed screening and gave further consent were randomized to receive 20 minutes of tDCS or sham-tDCS prior to 10 sessions of 1-hour MI-BCI with robotic feedback for 2 weeks. The offline and online accuracies of detecting motor imagery from idle condition for the calibration session and the evaluation part of the 10 rehabiltiation sessions were respectively assessed. The results showed that there were no significant difference in the accuracies of the calibration session from both groups, but the online accuracies of the evaluation part of 10 rehabilitation sessions of the tDCS group were significantly higher than the sham-tDCS group. Hence the results suggest towards tDCS effect in modulating motor imagery in stroke