Plenary speakers deliver 45 minute lectures during the mornings of the scientific SSNR program. The lectures will span broad surveys of recent major developments in the neurorehabilitation field.

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Wolpaw
Jonathan R. Wolpaw, M.D.
National Center for Adaptive Neurotechnologies
Albany Stratton VA Medical Center and State University of New York
Albany, New York, USA
 
Title: Neurorehabilitation in the 21st Century: New Science, New Strategies, New Expectations

Abstract: Once considered a backwater, neurorehabilitation is now among the most vibrant areas of preclinical and clinical biomedical research. Until recently, its main strategy has been skill-specific practice, which often fails to produce adequate recovery. Now, new recognition that the CNS remains plastic through life, new understanding of the CNS substrates of skilled behaviors, and newly developed technologies combine to redefine the therapeutic goal and provide new strategies that promise to improve the efficacy of skill-specific practice.

The substrate of a skill is a network of neurons and synapses that may extend from cortex to spinal cord. This network has been given the name heksor, based on the ancient Greek word hexis. Each heksor changes through life; it modifies itself to maintain the key features of its skill, the attributes that make the skill satisfactory. Muscle activity and kinematics may change; key features are maintained. Heksors overlap; they share CNS neurons and synapses. Through their concurrent changes, they keep CNS neuronal and synaptic properties in a negotiated equilibrium that enables each heksor to achieve the key features of its skill.

When CNS damage disrupts important skills, the primary therapeutic goal is to enable damaged heksors to repair themselves and reestablish a negotiated equilibrium in which each can once again produce its skill satisfactorily. Two new strategies can increase the efficacy of skill specific practice. One new strategy increases the capacity for plasticity. This gives damaged heksors more options for self-repair: they shape the additional plasticity through skill-specific practice. The other new strategy targets beneficial plasticity to a critical site in a damaged heksor. This improves skill-specific practice, which enables the heksor to achieve much wider beneficial plasticity. In animals and humans, combining skill-specific practice with these strategies produces large clinically significant improvements in recovery. These improvements persist.

For basic and clinical researchers, the challenge is to develop effective multitherapy protocols – protocols that combine these new strategies with skill-specific practice. Computational modeling can help identify and parameterize promising protocols. Controlled clinical trials that evaluate a new protocol mechanistically and compare it to current state-of-the-art treatment are essential. Assessments should evaluate relevant skills, overall function, and quality of life, and should extend at least six months after therapy ends. Study of pre-morbid factors as well as reflexes, evoked potentials, muscle activity, and kinematics during treatment can guide patient specific protocol modifications. Many multitherapy protocols will be noninvasive and suitable for home use with remote oversight. Reference: Wolpaw JR, Kamesar A. Heksor: the central nervous system substrate of an adaptive behaviour. Journal of Physiology 600.15:3423-3452, 2022. DOI: 10.1113/JP283291

 


Wang
Yiwen Wang
The Hong Kong University of Science and Technology, Hong Kong
 
Title: Dynamic Audio induced Coadaptive Learning for Motor Brain Machine Interfaces

 


Riener
Robert Riener
ETH Zurich, Switzerland
 
Title: Using robotic beds to improve sleep-related and other disorders

Abstract: Vestibular stimulation using rocking beds is a promising alternative to classical medical treatments for various sleep-related disorders as it is known to improve sleep architecture and sleep consolidation, leading to deeper sleep and shorter sleep onset times. Over the last 12 years, we were developing the rocking bed platform Somnomat Casa, that has dimensions of a standard single bed and can be operated by a single button, providing high performance, smooth and silent translational movements in order to stimulate the vestibular organ during fractions of the night or the entire sleep. It can also be expanded with various sensors, enabling closed-loop interventions and automatic long-term data collection. The bed has been used to increase sleep quality and comfort in healthy individuals. In a first clinical evaluation study, we assessed the feasibility and acceptability of the bed in Parkinson’s Disease patients. Later we conducted a five-month home study in a boy with a severe primary Mitochondrial disease and associated sleep disorder and could show that sleep duration increased significantly by 25%, caregiver effort was decreased by 75%, and subjective fatigue during daytime was reduced by 40%. In future projects we intend to use the Somnomat and other robotic bed platforms to treat patients with sleep disorders, other neurological and psychiatric disorders, as well as sleep apnea.

 


Miller
Lee Miller
Northwestern University, USA
 
Title: Bypassing the injured spinal cord: A biomimetic Brain Computer Interface for control of hand movement

Abstract: A recent survey of persons with high level spinal cord injury revealed that nearly 80% would undergo brain surgery to restore some use of their hands. To this end, the potential of existing intracortical Brain Computer Interfaces (iBCIs) lends real hope, yet even the most advanced iBCIs require the user to be wired to stationary equipment and allow only limited, intermittent control of a robotic hand. A number of years ago we developed a novel iBCI that used muscle activity (EMG) predictions to control the intensity of electrical stimulation of the temporarily paralyzed muscles of a monkey’s hand, so called, “Functional Electrical Stimulation” (FES). This FES iBCI allowed the monkeys to control not only the motion of their wrist and fingers, but also to exert force in a manner much more like the natural control of hand movement than with iBCIs that control only the kinematics of movement. Beyond the ability to restore voluntary limb movement, there is evidence that the tight synchrony between a user’s attempted movement and the peripheral stimulation that causes that movement, may invoke mechanisms of neural plasticity that could accelerate recovery from an actual spinal cord injury. In this talk I will describe the basic work that led to our proof-of-concept demonstration in monkeys, as well as our recent work to develop wireless versions of the FES iBCI that could allow restoration of a broader range of the activities of daily living. Finally, I will also describe our most recent efforts to develop related methods for humans with spinal cord injury.

 


MarchalCrespo
Laura Marchal-Crespo
Delft University of Technology, the Netherlands
University of Bern, Switzerland
 
Title: Towards minimally supervised multisensory robotic neurorehabilitation: A human-centered design approach

Abstract: The recovery of sensorimotor functions after an acquired brain injury requires a long, highly intense, and repetitive training program. Several new technologies have been developed to support this highly demanding training, among the most prominent being robotic devices and virtual reality. Recently, there has been an increased interest in minimally supervised and unsupervised rehabilitation to increase therapy dosage in group therapy and complement conventional therapy at patients’ homes. These new inventions should be co-created between different stakeholders if we aim to facilitate their usability and acceptance by the final user. In this talk, I will present how we follow a human-centered design approach to design highly intuitive and usable haptic robotic devices for upper limb rehabilitation and immersive virtual reality environments using off-the-shelf Head Mounted Displays (HMD) to provide a rich high fidelity multisensory rehabilitation experience in minimally supervised environments.

 


Forrest
Gail Forrest
Kessler Foundation, USA
 
Title: Gait research for individuals with a spinal cord injury

Abstract: To be announced

 


Ferrante
Simona Ferrante
The Polytechnic University of Milan, Italy
 
Title: May Digital Medicine change the model of care? The use case of a smart ink pen to monitor handwriting.

Abstract: Nowadays, we are surrounded by digital tools and novel technologies. Are these technologies able to change the actual model of care providing valid information at the point of need?
In this lecture the methodology to co-design, develop and validate novel digital tools will be presented in general and in the specific use case of a smart ink pen to monitor handwriting. Handwriting represents a harmony of cognitive, sensory and fine motor control abilities. Thus, alterations in handwriting are indicative signs of an umbrella of neurological pathologies that concern both the motor and cognitive spheres. In this context a digital tool able to measure reliable and valid indicators of performance, coupled with an explainable machine learning algorithms can produce meaningful alerts at the point of need.

 


Farina
Dario Farina
Imperial College London, United Kingdom
 
Title: To be announced
In collaboration with Oskar Aszmann and Antonio Bicchi

 


Delp
Scott Delp
University of Stanford, USA
 
Title: Translating Research into Products that Improve Health

Abstract: A publication is the principal output and measure of impact of work performed in universities. Scholarly publications frequently describe a discovery, invention, or novel method. In some instances, the positive impact of scholarly work on society can be greatly increased by translating the discovery, invention, or method into a product that is deployed on a scale that is much larger than is typical for a scholarly publication. This is especially important in biomedical research and engineering because of the potential for research to improve human health. In this lecture, I will describe three approaches that are effective for translating research into products that improve human health: a needs-driven approach, a technology-driven approach, and an open-source approach. I will use examples from my work in neuromodulation, neuromuscular physiology, and biomechanics to illustrate these approaches and make observations that apply more generally. My goal is to share insights that will help those who are interested in technology translation be successful in their endeavors.

 


Dietz

Volker Dietz

Balgrist University Hospital, Switzerland
 
Title: Neurophysiological Basis of Neurorehabilitation

Abstract: Rehabilitation should be designed on the basis of neurophysiological insights underlying normal and impaired sensorimotor functions, which requires interdisciplinary collaboration and background knowledge. Recovery of sensorimotor function after CNS damage is based on the exploitation of neuroplasticity, with a focus on the rehabilitation of movements needed for self-independence. This requires a physiological limb muscle activation that can be achieved through functional arm/hand and leg movement exercises and the activation of appropriate peripheral receptors. Such considerations have already led to the development of innovative rehabilitation robots with advanced interaction control schemes and the use of integrated sensors to continuously monitor and adapt the support to the actual state of patients. For a positive impact on outcome of function, rehabilitation approaches should be based on neurophysiological and clinical insights, keeping in mind that recovery of function is limited. When appropriately applied, robot-assisted therapy can provide a number of advantages over conventional approaches, including a standardized training environment, adaptable support and the ability to increase therapy intensity and dose, while reducing the physical burden on therapists. Rehabilitation robots are thus an ideal means to complement conventional therapy in the clinic, and bear great potential for continued therapy and assistance at home using simpler devices. In my talk I will highlight fundamental neurophysiological factors influencing the recovery of sensorimotor function after a stroke or spinal cord injury. I will thus provides insights on essential neurophysiological mechanisms to be considered for a successful rehabilitation.

 


Cipriani
Christian Cipriani
The Sant’Anna School of Advanced Studies, Italy
 
Title: The myokinetic control interface: tracking implanted magnets as a means for prosthetic control

Abstract: Upper limb amputation deprives individuals of their innate ability to manipulate objects. Such disability can be restored with a robotic prosthesis linked to the brain by a human-machine interface (HMI) capable of decoding voluntary intentions, and sending motor commands to the prosthesis. Clinical or research HMIs rely on the interpretation of electrophysiological signals recorded from the muscles. However, the quest for an HMI that allows for arbitrary and physiologically appropriate control of dexterous prostheses, is far from being completed. Here we propose a new HMI that aims to track the muscles contractions with implanted permanent magnets, by means of magnetic field sensors. We called this a myokinetic control interface. In this talk I will present the concept, the features and the work done in the past years to prove its feasibility, limits and potentials in implementing direct and simultaneous control over multiple digits of an artificial hand.

 


Celnik
Pablo Celnik, M.D.
Shirley Ryan AbilityLab
 
Title: To be announced

 


Bicchi
Antonio Bicchi
University of Pisa, Italy
 
Title: To be announced
In collaboration with Dario Farina and Oskar Aszmann

 


Aszmann
Oskar C. Aszmann
Medical University of Vienna, Austria
 
Title: To be announced
In collaboration with Dario Farina and Antonio Bicchi