Technological approaches for Neurorehabilitation; Video games, virtual reality, robots: these technologies can help reduce the impact of brain damage. Playful, they motivate the patient and encourage him to increase the intensity and duration of his exercises. Customized, they adapt to everyone’s progress. Still need to evaluate them. This is the goal of the NeuroTech platform launched by the Vaud University Hospital Center (CHUV) in Lausanne.
Technological approaches for Neurorehabilitation
Whether you have had a head injury or a stroke, or you have a chronic disease such as multiple sclerosis, the brain is injured. Depending on the affected area, he may be unable to perform certain tasks. To rehabilitate, neurorehabilitation centers have a variety of methods that allow the patient to find – at least in part – the lost motor or cognitive function. The use of digital technologies could increase the efficiency of treatments and speed up recovery. The Neuro Tech platform, created in 2016 by the Vaud University Hospital Center (CHUV) – associated with various academic and industrial partners, Swiss and foreign – aims to test and evaluate them rigorously,
Our brain has an astonishing faculty of plasticity that allows it to reorganize its neural networks. “In the broadest sense, this capacity is at the base of learning, during childhood and throughout life,” says Professor Philippe Ryvlin, Head of the Clinical Neuroscience Department at the CHUV. It is also this flexibility that allows the brain, to some extent, to “repair”: when some neurons are destroyed, others come to the rescue to restore the lost function.
Taking advantage of this neuronal plasticity, neurorehabilitation aims to “activate connections between neurons that have not been harmed or, in stable stages of a neurological disorder, to stimulate the path reached to try to restore connections”, explains Arseny Sokolov, doctor in the Department of Clinical Neuroscience at CHUV.
Alongside technologies already commonly used by therapists – such as robots or exoskeletons to drive walking – now appear watches and other connected objects (see box), brain-machine interfaces (implants or electrodes), as well as “serious” video games some of which immerse patients in virtual reality.
Rehabilitation is a long and tedious process. It requires repeating the same cognitive exercise or repeating the same movement over and over again. “The progression is slow, which is frustrating for the patient,” says Professor Andrea Serino, director of the MySpace Laboratory CHUV. To increase motivation, nothing beats playful practices like those offered by video games. Taken by his desire to gain points, the patient increases the intensity of his effort and prolongs the duration of the exercise. This is crucial because the longer the session, the better the therapeutic effect. Not to mention that some exercises combine cognitive and physical effort, which is beneficial (read “Video games accelerate progress”). In addition, the player can have access to his score and see the extent of his progress. Like his therapist, for whom it is also an asset: “Instead of reassessing, week by week, the progress made as we do now, we can measure the effects of rehabilitation in real time,” says Philippe Ryvlin.
As for tools using brain-machine interactions, they could allow learning that is practically impossible to achieve today, such as reviving a paralyzed arm. One of the methods tested at the hospital in Vaud consists in implanting electrodes in the muscles of the immobilized arm of the person, who controls the amplitude of the stimulation with his valid hand, while making small movements with his inert hand. “After two weeks of training, patients are starting to move their hands and, as time goes on, progress is growing,” says Stephanie Clarke. The head of the Department of Neuropsychology and Neurorehabilitation at the CHUV even quotes the case of a man who, “very proud”.
Not a panacea
In the future, when the various existing devices have evolved, patients treated in a specialized center will be able to continue, alone, the exercises. Even train at home. The remote rehabilitation will be at hand.
Should we fear that, in the long run, machines will replace physiotherapists, occupational therapists, neuropsychologists and logopedists? “It would be naïve to think that a tool can replace a professional who has received specific training and experience,” says Serino. Nothing replaces the sensitivity of the human being. “However, Stephanie Clarke believes that” it will change the way we approach rehabilitation. Therapists must be able to determine which patient will respond to such treatment. Because, as attractive as they are, these new tools are not a panacea. One of them may be useful to one individual and not to another, depending on the nature of the injury. To make the best use of them, it will be necessary to take into account the recent achievements of the neurosciences,
The field is in full swing and various potentially interesting digital technologies are already available. It is still necessary to test and validate them rigorously. Not only to demonstrate their technological performance, but also, stresses Philippe Ryvlin, “to ensure that they improve the health and quality of life of patients”.
Although the road is still long before all patients can benefit, “the technologies developed today have a high potential, says the doctor. These are the tools of tomorrow. There is no doubt that they open up new horizons for rehabilitation.
Epilepsy: connected objects to anticipate crises
In addition to their contribution to neurorehabilitation, the advanced technologies studied in the Neuro Tech program can be very useful in cases of seizure epilepsy. This neurological disorder is due to the excessive activity of brain nerve cells that causes a kind of “short circuit” in the brain. The person then suddenly loses consciousness and falls – with all the dangers that this represents – before being agitated with convulsions. It is therefore important to detect the attack in order to quickly alert the entourage who can take the necessary precautions to limit the risks.
Bracelets and other connected objects have been developed for this purpose. “They measure different signals to detect the crisis, including the electro dermal reaction (the one that makes us sweat and which is also the cause of the famous detector of lies), and they contain motion detectors,” says Philippe Ryvlin , Head of the Clinical Neuroscience Department of the CHUV.
Doctors already have a commercial tool: the Embrace bracelet (manufactured by Empatica), which is one of the few connected objects to have been approved by the FDA (the US regulatory agency in the field of health). It remains to be seen if it is really useful and especially “if it has an impact on the quality of life of patients,” says Philippe Ryvlin. That’s why his team launched a clinical study of forty of them.
Epilepsy can be manifested by other forms of seizures whose detection is more difficult. It is then necessary to capture a larger number of signals (e.g. heart rate). It is also necessary to customize the measured parameters, which implies integrating intelligence tools to connected objects so that they learn to recognize the crises of a given individual. This poses a problem of energy consumption – if the device runs continuously, its battery is quickly discharged – which requires the development of other advanced technologies. A technological challenge launched by the CHUV team, in collaboration with EPFL.