Developing a virtual reality visualization tool to extend the benefits of mirror therapy to patients with Spinal Cord Injury
Visualisation of movement in virtual reality has been demonstrated to have the potential to be used for the treatment of pain and motor dysfunction. However, it is currently limited to use with patients who have an intact and functioning limb at the same level as the impaired or missing limb. This project aims to develop a Virtual Reality tool to support the treatment of phantom pain in spinal cord injured patients. Applying the principles of mirror box therapy, the project will use spiking neural networks to develop a computational model for motion prediction, extending the current capacity of the virtual mirror box to enable simulation of the movement of any impaired limb from any unimpaired limb. The computational models developed in this project will offer a tool which will extend the known benefits of mirror therapy and motor visualisation for use in patient groups previously unable to access this type of treatment.
Bimanual Coordination after Incomplete Spinal Cord Injury
People who have suffered an incomplete cervical spinal cord injury (iSCI) demonstrate difficulties with moving their arms and hands and highlight restoration of arm and hand function as a major priority for research. Clinical evidence shows that bimanual therapy may be more effective than unimanual therapy however to date little research has examined how the two limbs interact during bimanual tasks. Published work shows that one way to overcome the difficulties associated with performing bimanual tasks is to couple the limbs spatially and temporally and that the degree and nature of this is dependent upon task characteristics. This study will examine how individuals with a cervical (C5-C7) incomplete spinal cord injury reach and grasp objects bimanually. Five different experimental tasks will examine the effect of the objects’ distance, height, size, friction, stability on underlying control strategies that will be assessed using a kinematic recording device and surface electromyography.
Brain Machine Interfaces for Spinal cord injured
We have explored the classification of surface EEG signals preceding real or imagined rapid point-to-point
wrist movements made toward different targets. Our results highlight that multiple command states correlated to movement direction in this task can be extracted from the patterns of EEG activity that precede movement initiation. The classification of signals could serve as the basis for multidimensional BMI control. The results achieved are now at a stage that would merit study within a group of potential BMI users. Our objectives are to:
1. Provide a comparative study of the spatial and temporal EEG activations preceding real, attempted and imagined movement in normal and SCI subjects.
2. Optimise on-line EEG classification and feature recognition algorithms to achieve high accuracy, multidimensionality and computational efficiency.
3. Develop a multidimensional BCI demonstrator that can be trialed by tetraplegic patients (virtual BMI electric wheelchair).
The above applied research will also address fundamental questions on the structure of the central motor drive associated with the initiation of goal directed movements about joints with multiple degrees of freedom. In particular, we anticipate information on how different motor synergies associated with movements made to different spatial targets are generated and with this gain further insight into the role of cortical processing in the activation and deactivation of different populations of muscles in goal directed tasks.
Development of an epiduroscope with radiation-free navigation assistance and neural activity detection capabilities
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The possibility to safely access the spine with a small endoscope would enable a disruptive approach to the treatment of correlates of spinal injuries. Yet, to the present day, spinal endoscopy (epiduroscopy) suffers from severe drawbacks. In particular, epiduroscopes are very small, and the consequent poor image quality mandates the use of continuous x-ray to guide them into and through the spine. The consequent exposure of the patient to very high x-ray doses does not allow the use of this potentially revolutionary tool on a systematic basis. We have recently demonstrated a technique to derive the position of a spinal catheter using photonic technologies, which do not expose the patient to harmful radiation. This project is aimed at using this this technique to build a full-featured prototype of an epiduroscope capable of safe navigation without the assistance of x-rays, including pre-clinical functional tests.
Development and Testing of an Ergometer for an Experiment in Functional Recovery
A cycling exercise machine is being designed with associated electric motor and electronics. The
machine will be used with a commercial virtual reality racing game and a remote monitoring device.
The design will allow us to do an experiment that tests the hypothesis that it is the combination of
electrical stimulation and voluntary drive to the paretic muscles that has the best therapeutic effect,
seen in improved walking ability. This grant will fund the development of a prototype system and
tests with volunteers at the Royal National Orthopaedic Hospital prior to our application for another
grant to perform a proof-of-concept and feasibility study on a larger group of subjects. Students are
doing most of the development work, but this initial grant will pay for parts, materials and technician
time. If the experiment gives a positive result, the system will be suitable for clinical use.
Development of a functional electrical stimulation (FES) device for promotion of hand function in incomplete tetraplegia (TETRA GRIP)
Research has demonstrated that FES based training devices can lead to improved hand and arm function following spinal cord injury. However, there is a need to develop an improved device and control techniques to enable routine use outside the clinical setting. This PhD project will aim to produce a system that can be easily used by people with a range of ability following tetraplegia. New stimulation techniques using ‘current steering’ will be used to automatically fine tune the movement produced, removing variations due to electrode position, fatigue and spasticity. While the principle use of the device will be for training hand function, it is envisaged that it may also be used as a long-term orthosis. A feasibility study/clinical trial will be used to demonstrate the device in clinical use. The principle goal is to increase the functional independence of people with C5, C6 or C7 incomplete tetraplegia.