#SfN14 Wednesday: Rehabilitation for Movement Disorders

I’m going to continue posting about things I saw at #SfN14 in the upcoming weeks, both here and on the Medium.com site for PLOS’s coverage of the conference.

One of the two interesting posters I saw today was unpublished work. But like my own work, it is unpublished because it is an in-progress engineering feat with tremendous potential. I was taken with their project, since they are attacking a similar problem as our lab with a different approach.

Developmental movement disorders are a lifelong issue for the patients diagnosed with them. They are not currently curable, but in many cases, treatments are available that can aid the lives of people with movement disorders.

In our lab, we are trying to develop treatments and assistive devices for children with dystonia, which has a relatively high incidence, as pediatric movement disorders go. Current treatments that are available tend to be focus on either relieving symptoms (e.g., botox injections) or affecting brain activity (e.g., levodopa treatment, deep-brain stimulation). At the moment, we are doing a lot of analysis on how well deep-brain stimulation works for children with dystonia, as well as examining vibratory biofeedback therapy. We’ve looked into non-invasive brain stimulation methods as a form of symptom relief with mixed results.

The poster I saw today, however, was both striking in its approach and appealing to my sensibilities. The lab group, based at UCSD, is developing a form of biofeedback therapy that really uses every non-invasive method we have our hands on to treat subject. (They are working with people who have Parkinson’s, but that is related to the same brain area as dystonia: the basal ganglia.) What they have accomplished is really less important than what they plan to accomplish. They are trying to combine EEG, EMG, and haptic feedback from small, commercially available PHANTOM haptic robots with a virtual reality display for rehabilitation tasks.

Biofeedback therapy is already used in rehabilitation contexts, such as psychotherapy. BIOPAC, who had an exhibition at the conference this year, worked with USC’s Institute of Creative Technology to develop Virtual Iraq, a multimodal virtual reality simulation of Iraq battle zones for the treatment of PTSD in our military veterans. In addition, there is an overwhelming amount of evidence that manipulating sensory feedback can facilitate motor learning. This approach also has the benefit of being a non-invasive technology, which is something I feel strongly should be attempted when possible. Invasive procedures always bear with them risk and emotional trauma, and it tends to be unclear whether it’s worth doing that to children.

I was really excited about the progress the research group has made on this project. While they are only currently examining how their setup can help patients with Parkinson’s, my feeling is that the technology has broader application in treating movement disorders.

My own exposure to dystonia research has been limited to pediatric cases, but there is one form of dystonia called focal hand dystonia (colloquially known as “writers’ cramp”). This form of dystonia forces the hand to take abnormal postures whenever you try to make voluntary movements of the hand. This disorder is known to happen in musicians and athletes, and can cripple careers. Normally, the only way to get rid of it is to stop playing and hope it goes way, but this technology has the potential to facilitate recovery. I’m anxiously looking forward to seeing how their work develops!

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