Guest feature: AxonMagazine on the European Neuro Convention
The European NeuroConvention is renown as one the largest gatherings of brain and spine experts, bringing cutting-edge technology, interactive workshops, and talks from internationally renowned figures all into the same space. As it was hosted in London this year, and conveniently on our doorstep, we thought it only appropriate we head over and cover some of the activity for AxonMagazine’s first ever conference.
The conference itself brought together the latest advances from four key areas of Neuroscience: diagnostic, surgical, brain rehabilitation and brain stimulation. Given this broad landscape, we honed it on brain rehabilitation and stimulation so as to not compromise depth for breadth on these topics.
Even so, the amount of technology to immerse yourself in was staggering. From hyperbaric oxygen chambers, to virtual reality, to rehabilitative exoskeletons, there was certainly no shortage of innovation to puzzle over. Given that many of the tools employed to studying the brain are often restricted to clinical or experimental use, many neuroscience students are only able to learn about their theoretical bases from their academic material. You can imagine then, how the sight of a transcranial magnetic stimulation coil turned an otherwise stable journalist into an excitable wreck.
Transcranial magnetic stimulation, or TMS works by placing the coil on the location of choice on the scalp, and delivering single (sTMS), or repeated (rTMS) magnetic pulses, to induce an electrical current in the brain. Depending on the frequency of the stimulation, rTMS can exert excitatory or inhibitory effects on the portion of the stimulated cortex. Clinically, this isn’t an uncommon adjuvant therapy for major depression or for motor rehabilitation, and it’s particularly useful in an experimental capacity as an aid to mapping out the cortex. The evidence base for its efficacy in these contexts is vast, but certainly mixed, and so will be considered within the periphery of this article.
We asked one of the Psychiatrists working for MagVenture, a medical device company specialising in non-invasive magnetic stimulation systems, if they could give us a quick demonstration of their systems.
Subsequently, a low frequency pulse from one of their Macro X100 Butterfly Coils was applied to one of our forearms. Whilst watching the hand writhe and twist was certainly fun, watching him take it one step further to deliver more intense bursts to his own right primary motor cortex was infinitely more interesting. The clinican's left arm was, quite wildly, leaping and convulsing, much to his own delight, and our wide eyes.
Magventure's Macro X100 Butterfly Coil
Whilst playing with cortical stimulation was undeniably good fun, it was also rather difficult to say no to offers of playing with some of the interactive games designed for cognitive and motoric rehabilitation.
InMotionVR were kind enough to demonstrate to us CorpusVR, a virtual reality therapy platform which puts the patient in different gaming environments, depending on their individual goals. Its applications are fairly wide ranging within a cognitive rehabilitation capacity, and can be used to treat anxiety disorders, visuo-spatial neglect and chronic pain disorders. The benefit of this particular technology is the ability to gather instant performance feedback, and in turn continual review of their progress toward their goals. On a more qualitative note, we found the user interface to be both intuitive and aesthetic; we often forget just how important this fact is when considering the usage of rehabilitative technology in real life. Never mind the scientific principles on which these headsets operate – can a therapist understand it, apply it and control it easily? If these methods indeed work, and work well, then it’s important they permeate our health care, as after all, there are people waiting to benefit from them. However, for the busy clinician, wading through acres of user manuals to get a handle on how to get the most out of these tools isn’t going to be an attractive prospect. We recently uploaded an article covering therapeutic VR in our news section, which offers a more detailed account of its clinical applications - feel free to check it out.
It’s also fair to say that integrating a competitive element into the therapeutic arena, for the right patient in the right setting, can yield enormous benefits. The team at MindMaze have done just that, by developing the neuro-rehabilitative platform MindMotion™, which uses motion tracking technology and virtual environments to create competitive gameplay, providing gross or fine upper-limb rehabilitation.
We sat down with Dr Salim Ghoussayni, Mindmaze’s Market Development Director to walk us through their journey from the concept stage, to the physical realisation of their technology.
Dr Ghoussayni explained that there’s been a recent trend for rehabilitative technology to focus largely on the functional recovery of impaired gait following stroke, and MindMaze wishes to address this gap, despite some pressure from the healthcare industry.
‘We were often told by therapists that upper limb neglect is not our priority, and even if we want to focus on it, we don’t have the resources to do it’
What immediately leaps to mind when considering the MindMotion™, is its application within a paediatric neurological setting. For this demographic, who may experience motoric deficits as a result of TBI, Stroke, neurodegenerative disease or otherwise, a typical hospital setting can be sterile, scary, or monotonous. By introducing this instrument into a ward, there exists the opportunity to create a playful and competitive environment, and encourage repetitive usage of a device designed to make them better. By making use of our basic human desire to compete and perform, MindMaze have created a tool which ensures the consistent engagement of use-dependent plastic mechanisms critical to the rehabilitative process.
Dr Ghoussayni was keen to emphasise however, how this technology has also had success across a variety of patient demographics.
‘Age is absolutely a non-factor in the patient’s engagement level with MindMotion. When we introduced a 90-year-old man to some of the games, we struggled to get him off it’.
Beneficial? Certainly. Innovative? Undoubtedly. Affordable? Perhaps not - at least for UK public healthcare.
Fantastic as these machines are, we have to face the reality of how likely it is that the more expensive of these tools will be assimilated into the care environment en masse, slave as we are to public budgetary restrictions. It may be a case of investigating how we can achieve similar results via less expensive means, or a matter of waiting until the capital outlay for advanced therapeutic instruments isn’t quite so extreme.
There are, within the upper-limb rehabilitation sphere, cheaper and efficacious tools, albeit less stimulating perhaps. The Saebo extension glove is one such example, which assists with thumb and finger extension, a movement often affected following stroke. The user is able to selectively choose the level of assist per digit by using the tensioners located above the knuckles.
The glove itself is low-profile, and doesn’t draw the eye in the same way as does some of the more old-school, colourful and spring-loaded contraptions. The wearer need not worry about unwanted attention, but they may have concerns regarding the price tag: sitting at ~£400 per glove, it’s not exactly an item your any average individual would readily purchase. With the aforementioned MindMotion™ technology, despite its price, every patient on a ward can theoretically benefit from it and spread thin the cost. In this instance, purchasing one glove per patient could rack up a significant bill over time.
Last but not least, we take a look at IntelligentMotion’s robot, designed to provide assisted movement therapy for patients who may suffer from a traumatic brain injury, stroke, or multiple sclerosis. Improvement of trunk stability, and dynamic and static balance is the name of the game here, which the Hirob achieves by replicating the natural movements of a horse’s back during normal gait. The saddle-like seat requires the patient to maintain their upright position by stabilising their trunk and pelvis, helping to increase muscle tone in the patients back, and also the flexibility of their hips. Dr Markus Mitterhumer delivered a fantastic talk regarding the efficacy of the Hirob, however unfortunately we were not able to witness the robot in real-life, as the European team at IntelligentMotion were faced with hefty costs to transport the robot to the UK.
First Prototype of the Hirob
However, it probably wasn't as hefty as the cost of the Hirob, sitting at approximately £200,000. One wonders how many horses could similarly be purchased for that price, however being sentient creatures, adjusting the speed and intensity to suit the patient’s pathology could prove difficult.
Concept Design of the Hirob
Overall the conference was a total hit, and fulfilled its function as an inspiring example of what can be achieved when brilliant minds are applied to addressing the issues which neurological populations face.
Written by AxonMagaxine - see the original article here