For the young and old, neurotech devices for cerebral palsy are breaking new ground
CP is one of those conditions that impacts many people but is not always widely known in the general public. New and established neurotechnologies are now being developed, investigated and applied for adults and children living with cerebral palsy. Learn about what is currently available and emerging from the development pipeline in neurotech and CP.
Cerebral palsy impacts nearly 1 million people in North America and about 12,000 births per year. It is the most common motor disability of childhood, according to the CDC. CP is caused by an abnormality in the development of the human brain or damage to the developing brain which affects the ability to control muscles in the body. Most people living with CP have difficulty with movement or posture. Other related conditions can accompany CP such as seizures, vision or hearing impairments, speech difficulties, joint problems or intellectual disabilities. Despite the obstacles, there are several famous people living with CP like comedian Josh Blue, activist Maysoon Zayid, athlete Bonner Paddock and actor RJ Mitte from the Breaking Bad series.
There are several motor types of cerebral palsy which are depended on the location in the brain of the abnormality. The most common type is spastic cerebral palsy impacting about 80% of cases. For a person living with this type of CP, they will have increased muscle tone or spasticity leading to stiff movements. This may afflict one side of the body, hemiplegia, or just the lower extremities, diplegia. In more severe cases, people may be living with quadriplegia due to CP. Less common types of cerebral palsy are dyskinetic CP which impacts motor patterns or ataxic CP resulting in balance or depth perception deficits.
Since cerebral palsy can impact the entire body, we will explore the various types of neurotechnologies that may be applied for movement but also for cognitive or respiratory functions. Access to technologies may be through home use, through a medical facility or even from an adaptive gym.
Technologies
There are several categories of neurotechnologies currently available for people living with CP. Most of the devices are in the neural rehabilitation category. Neural rehabilitation refers to the activities that aim to aid recovery or to maximize compensation for functional alternatives. This may be in the form of repetitive motion therapy using stationary robotics for either the lower limbs or the arms and wrists. Motion therapy may also be available in the form of an exoskeleton, a mobile body robot with sensors to detect volitional movements. These are relatively new but as the components and materials improve with these technologies, the equipment is becoming smaller and more flexible to the human body. Typically, these devices need some training with a physical therapist or rehabilitation specialist prior to independent use. Several vendors in this category offer devices and/or adjustments for pediatric users.
Two other neurotechnologies for movement are in the rehabilitation category, vibration therapy and electrical stimulation prostheses. Vibration therapy may be whole-body or targeted areas of the body. The concept of mechanical vibration to stimulation the muscles to improve balance, spasticity or even bone growth, depends on how it is applied. Targeting the musculoskeletal system, this dynamic physical actvity is intended to promote muscle and bone strengthening. Electrical stimulation prostheses are another modality to improve limb function, either upper or lower limb. Using surface electrodes, low level forms of electrical stimulation are applied to the peripheral nerves resulting in a muslce contraction. This contraction may be coordinated with a movement such as lifting the foot in the swing phase of the gait process. Common examples of electrical stimulation systems include drop-foot stimulation systems for walking or arm stimulation systems for reaching or grasping.
For people living with cerebral palsy, exercise is a need like anyone else but access to equipment might not be as easy. One option is to use an electrical stimulation cycle or FES bike. These devices use surface stimulation placed on the surface of the skin over specific muscles to allow for either leg or arm cycling. The benefits are well known including reduced muscle atrophy, improved joint health and range of motion as well as cardiovascular health. Systems are available for home use but may not be financially feasible. Similar to robotic systems, many FES cycling systems can be affordably accessed through a neurogym or post-rehabilitation facility with a monthly fee and some systems are adaptable for children.
Electrical stimulation can also be applied for respiratory or breathing assistance. Several companies offer minimally invasive devices that stimulate either the phernic nerve or the diaphragm muscle. Electrodes are implanted and connected to an external stimulator. The system allows the user to breath without the use of a ventilator. Other external devices are also available to assist with cough or swallowing. These devices are administered through a physician prescription and some are available for pediatric use.
For those with higher level impairments due to CP, communication may not be so easy. With some impaired speech, typical voice to text may not work and can be frustrating to use. Neurotechnologies using EMG (electromyography) can detect some muscle movement around the eyes or face to allow the user to use a computer to communicate.
Commercial devices under development can also be applicable for people living with CP, Cognixion is developing brain interface technology using EEG (electroencephalogram) and augmented reality embedded into a wearable for speech generation by the user. The company is seeking beta testers of the device. If you are interested, you may apply here.
Another commercial venture, Pathmaker Neuroscience, is developing a non-invasive or external device for the treatment of spasticity. The technology uses direct electrical or electromagnetic stimulation of targeted regions of the body to suppress spasticity in the body. The device is currently in final clinical development in the U.S. and Europe and should gain regulatory approval in the near future.
Research
On-going clinical research projects for adults and children in the area of neurotechnology and cerebral palsy span across many locations around the world. Several different studies are evaluating the use of brain and surface stimulation to improve upper arm and hand function, walking, balance or even strength training. There are several modalities under investigation that are expressed in acronyms. Here are a few defined:
TMS or Transcranial Magnetic Stimulation is a medical device that applies electrical pulses to the brain using an external magnetic coil over the head. The magnetic field goes through the skull to the brain were it stimulations targeted areas of the brain. The modality has been approved in many countries for the treatment of various neurological conditions and some psychiatric conditions like depression. In CP it is being investigated as a rehabilitation tool.
tDCS or Trancranial Direct Current Stimulation is a portable, wearable brain stimulation technology that delivers a low electrical current to the brain. The user positions a positive electrode (anode) and a negative electrode (cathode) on either side of the scalp. The neuromodulation is painless and has many applications. It is being explored for it’s impact on neural plasticity in the brain paired with rehabilitation techniques.
TES or Trancutaneous Electrical Stimulation is the use of surface electrodes to muscles. Sticky electrodes are typically placed on the surface of the skin in the area of the targeted muscle. When electrical stimulation is applied, the intent is the contract of a muscle. Many small low channel devices are currently available on the market. The latest research is investigating the use of these electrodes embedded into a wearable suit or sleeve.
Resources
A resource directory was developed by Neurotech Network specifically for the United Cerebral Palsy annual conference that is available here. For the most updated information and to access more resources about available and emerging neurotechnologies for adults and children living with Cerebral Palsy visit our resource directory. You will find a listing of some of the devices mentioned here and more.
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References:
- CDC Cerebral Palsy Home Page: https://www.cdc.gov/ncbddd/cp/index.html
- Cerebral Palsy Foundation: https://www.yourcpf.org/
- Neuromodec: https://neuromodec.com/
