Category Archives: Neuroplasticity

Self-Motivation Key to Neural Regeneration

Some extremely important work is being done by Grégoire Courtine, a neuroscientist at the Swiss Federal Institute of Technology Lausanne.

His group has achieved the very important milestone of being able to rehabilitate a rat to walk again after causing hind leg paralysis by near complete severing of the spine.

This type of injury is common in Spinal Cord Injury and results in very weak signals being transmitted with not enough bandwidth to create any meaningful motor movement.

Next Dr. Courtine inject drugs that mimic the normal chemical signals from the brain into the damaged spinal cord.   They also insert two electrodes and stimulate across the injury site.

Animals left lying idle during recovery showed improved nerve growth, but did not regain function.

Animals put on a treadmill with assisted leg movements showed some improvement, but nothing that would be considered a breakthrough.

However, when a third element was added, a goal of food, then the rats not only responded, but they learned to walk again.  Some animals even regained the ability to run and climb.

This is an extraordinary result that has not been seen before.   The success appears to have been achieved by three factors.

  • Improved chemical environment for neural signaling using drugs and electric stim.
  • The use of assisted motor training that used a robotic harness to remove balance and weight issues and allowed the animal to focus on forward movement.
  • The final and most important factor seems to be the introduction of a goal and positive achievement of that goal.  In this case, running after some food and finally after 30 minute work-outs achieving that goal multiple times.

Examples the concept of “success” based motor learning is seen over and over.  One example would be the reliance on the “good arm” of stroke patients and consequently the loss of motor learning in the “bad arm”.

The work of Dr. Courtine could prove to be a breakthrough for Spinal Cord Injury patients and a confirms the thesis of BRIGHT that “success” based motor learning is likely a key therapeutic approach for children with Cerebral Palsy as well.

Treadmill therapy (exoskeleton assisted) for cerebral palsy

A  study using the Lokomat robotic assisted treadmill was conducted at University of Munich, Germany. The results are very exciting because they are exactly as we would have expected based on the research of BRIGHT.

The study shows that assisted gait training improves Gross Motor Skills in a very short period of time (just three weeks of periodic training).  It also shows that results improve with more intense training.

This strengthens the case of BRIGHT that a fully autonomous exoskeleton that will allow 24×7 training would be the ideal treatment approach for Children with CP.  Children that are more severely impaired would stand the most to gain because current systems like the Lokomat are bulky and require the child to exercise in a controlled environment.  This is demotivatational and impractical and therefore, only when more sophisticated exoskeleton suits which allow the child freedom to interact in a natural setting will the child be motivated to “train” intensively and thus achieve improvement through re-routing of the brain through neuroplasticity.

Robotic-assisted treadmill therapy improves walking and standing performance in children and adolescents with cerebral palsy

Abstract

Objective

Task-specific body-weight-supported treadmill therapy improves walking performance in children with central gait impairment. The aim of the study was to investigate the effect of robotic-assisted treadmill therapy on standing and walking performance in children and adolescents with cerebral palsy and to determine parameters influencing outcome.

Methods

20 Patients (mean age 11.0±5.1, 10 males and 10 females) with cerebral palsy underwent 12 sessions of robotic-assisted treadmill therapy using the driven gait orthosis Lokomat. Outcome measures were the dimensions D (standing) and E (walking) of the Gross Motor Function Measure (GMFM).

Results

Significant improvements in dimension D by 5.9% (±5.2, p=0.001) and dimension E by 5.3% (±5.6, p<0.001) of the GMFM were achieved. Improvements in the GMFM D and E were significantly greater in the mildly affected cohort (GMFCS I and II) compared to the more severely affected cohort (GMFCS III and IV). Improvement of the dimension E but not of D correlated positively with the total distance and time walked during the trial (rs=0.748, p<0.001).

Conclusions

Children and adolescents with bilateral spastic cerebral palsy showed improvements in the functional tasks of standing and walking after a 3-week trial of robotic-assisted treadmill therapy. The severity of motor impairment affects the amount of the achieved improvement.

Keywords: Driven gait orthosis, Body-weight-supported treadmill therapy, Task-specific learning

Abbreviations: DGO, driven gait orthosis, CP, cerebral palsy, GMFM, gross motor function measure, GMFCS, gross motor function classification system, BWSTT, body-weight-supported treadmill therapy

    • Ingo Borggraefe

      Affiliations

      • Department of Paediatric Neurology and Developmental Medicine, Dr. von Haunersches Children’s Hospital, University of Munich, Germany
      • Corresponding Author InformationCorresponding author. Tel.: +49 89 5160 7851; fax: +49 89 5160 7745.

      email address

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    • Jan Simon Schaefer

      Affiliations

      • Department of Paediatric Neurology and Developmental Medicine, Dr. von Haunersches Children’s Hospital, University of Munich, Germany

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    • Mirjam Klaiber

      Affiliations

      • Department of Paediatric Neurology and Developmental Medicine, Dr. von Haunersches Children’s Hospital, University of Munich, Germany

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    • Edward Dabrowski

      Affiliations

      • Children’s Hospital of Michigan, Division of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Department of Pediatrics, Detroit, MI, USA

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    • Corinne Ammann-Reiffer

      Affiliations

      • Rehabilitation Centre, Affoltern a. Albis, University Children’s Hospital Zurich, Switzerland

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    • Beat Knecht

      Affiliations

      • Rehabilitation Centre, Affoltern a. Albis, University Children’s Hospital Zurich, Switzerland

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    • Steffen Berweck

      Affiliations

      • Department of Paediatric Neurology and Developmental Medicine, Dr. von Haunersches Children’s Hospital, University of Munich, Germany

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    • Florian Heinen

      Affiliations

      • Department of Paediatric Neurology and Developmental Medicine, Dr. von Haunersches Children’s Hospital, University of Munich, Germany

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Robot-aided Neuro-rehabilitation

Professor Neville Hogan’s work with Robot-aided neuro-rehabilitation

Using robots to assist the rehabilitation process will inevitably provide more precise, objective, and detailed data on what actually happens during recovery. That will in turn lead to a better understanding of the key biomechanical and neurological (and perhaps even psychological) factors required for successful rehabilitation. A better understanding of the biology of recovery will lead to better ideas of how technology can help rehabilitation. It promises to be an exciting future.

Neville Hogan, PhD

Recent Publications: