TM The Side of Neuroplasticity Dr. Subhasis Banerji Using wearable biofeedback technology to undo unconscious habits which restrict recovery from disorders and disability 7/26/2016 1
TM Is all neuroplasticity positive? Good adaptations You assume you are Not so good adaptations here! No adaptations Adaptations Not so bad adaptations Unconscious Conscious Bad adaptations Choices Actions Unconscious Habits Experiences Electrical responses Plasticity led learning and structural change Backward Bicycle 7/26/2016 2
TM Neuroplasticity • CNS structural changes occur because of interaction between biological and environmental factors • 100 billion neurons constantly lay down new pathways for neural communication and to rearrange existing ones throughout life thereby aiding the processes of:- Learning Memory Adaptation
TM Popular knowledge says neuroplasticity leads to….. • Memorizing a new fact • „ Mastering a new skill • „ Adjusting in a new environment • „ Recovery from brain injuries • „ Overcome cognitive disabilities
TM The dark side of neuroplasticity leads to….. • Forgetting a fact • „ Deterioration of a skill • „ Mal-adjusting in a new environment • „ Ingraining disability after brain injuries • „ Reinforcement through adaptation of cognitive disabilities
TM Mechanisms of neural plasticity • First documented in Development Biology (Smith & Gasser, 1985) • The organism interfacing with its environment(stimulus) • “Experience” enters the brain by way of afferent inputs through the sensory modalities. • These signals are then relayed via neural networks to higher cortical areas. • Cortical areas respond with efferent responses affecting muscle, thus recreating “Experience”!
TM General approach… General Approach
TM
TM What people want… Low immediate relevance Emotional mismatch Resistance Disengagement – Brain/Muscle
TM Changes in function and its effect on biology Brain led changes on the dark side….. • Long term inappropriate use (learned behaviour) of brain and muscle results in altered function at neuron and muscle fibre levels resulting in “plateaus”. • It thus becomes a self-perpetuated disease. • It can be “unlearned”. Spike timing – dependent plasticity (STDP) (Corporale et al, 2008) Manipulations of sensory experience (Merzenich et al, 1998) Electrical activity plays crucial roles in the structural and functional refinement of neural circuits (Gilbert, 1998, Katz & Shatz 1996)
TM Changes in function and its effect on biology Muscle led changes on the dark side….. • Non-use of certain muscles results in tissue contraction, excessive muscle tone(spasticity), low ROM, joint stiffness • Excessive use of other muscles as compensation results in chronic pain and repetitive injury • Low functional use further reinforces maladaptation and brain re- mapping • Musculoskeletal overuse-underuse yo-yo is learned behaviour embedded in the brain not by evolution but by experience. • Can be “unlearned” by bringing attention to muscle (Taub et al, 1993; Bach-y-Rita, 1990)
TM How does “ability” affect biology? • The brain has a fundamental capacity to remap itself based on conscious and unconscious responses • Neurons that “fire” together will “wire” together (Hebb, 1949) – whether we consciously intend it to or not! • Such repeated patterns of firing get imprinted into the neuro-muscular system • At a fundamental level, these patterns are electrical- like in nature. The difficult part is understanding which reactions need to be activated and inhibited in both the brain and muscle.
TM How does “disability” affect biology? The dark side of neuroplasticity • Injured or affected joints and muscles alter the “map” within the brain, diminishes co-ordination of muscles and joints, especially stabilizers. The result is a less-than-stable platform for the arms and legs to work from; the person then has to exert a greater muscular force to achieve the results .In turn leads to earlier fatigue, decreased performance, injuries or pain. • Brain injury and trauma in turn may result in muscle disuse in various body parts, leading to atrophy, tissue contracture , spasticity, high tone and a progressive change in fibre type and quality. Brain and Muscle affect each other biologically at every stage of progression of chronic conditions
TM Can we use Physio-Neuro Training to re-architecture biology (and health) via the “function” route?
TM The synergistic neuroplasticity model Augmented Feedforward Augmented Feedforward - Audio-video led imagery Augmented Feedback - EEG balance feedback - EMG balance feedback Augmented Feedback
TM The SynPhNe neuroplasticity model The SynPhNe Effect
TM Stepping Stones to “Self - Correction” • Re- map the Brain using movement – disrupt existing homeostasis • “Self - correct” muscle tone, synergy, hemispheric activation depending on personalized starting point • Modify habitual muscle fibre / neuron response simultaneously • Re-architecture brain-muscle responses by bringing hitherto unconscious responses within conscious control • Reinforce repeatedly and gently till it is imprinted into biology – achieve new homeostasis Thus leveraging principles of neuroplasticity can affect biology at tissue and function levels
TM Using wearable technology to accelerate re-structuring of function and health
TM What is SynPhNe? A wearable , portable , connected device that trains the brain and body as ONE system – Accelerates recovery – Provides new insights to therapist – Reduces therapist time spent on a patient – Is affordable to own or rent – Reduces fatigue and pain – Is easy to deliver by home caregiver
TM Exercises, Tasks Warm Ups – 20 min Task Practice – 20 min 5 reps each warm up 5 - 10 reps each task
TM Set Up Muscle self-correction Sess 3 Muscle self-correction Sess 12 Spatio-temporal training
TM A randomized 30-subject clinical trial of the SynPhNe system on hemiplegic stroke patients to improve recovery of hand function after stroke. Collaboration Study between Max Super Speciality Hospital, New Delhi and Nanyang Technical University, Singapore
TM Singapore Trials - Recovery depends significantly on Relaxation & Inhibition Association of muscle contraction, relaxation and number of repetitions The number of repetitions performed successfully is dependent on muscle relaxation as much as on muscle contraction. 79% of subjects showed positive changes in ARAT. 60% of subjects showed positive changes in Box and Block Test.
TM Outcomes Comparison X axis – Subjects 1-15 Y axis - % improvement at Week 3 wrt Week 0 baseline assessment score Although control group subjects started out as higher functioning individuals at Week 0 assessment, we find from the plot and two-tailed t-test that percentage improvements in both groups were not significantly different for FMA (Fugl-Meyer Assessment of Motor Recovery after Stroke) and ARAT (Action Research Arm Test) scales. We used FMA to understand “gross movement” and ARAT to assess Activities of Daily Living; Coordination; Dexterity; Upper Extremity Function “
TM Outcomes Comparison X axis – Subjects 1-15 Y axis - % improvement at Week 3 wrt Week 0 assessment score We find from the two-tailed t-test that percentage improvements in both groups were significantly different for Grip Strength (although may be attributed to an outlier) and 9 Hole Peg Test scales (could be attributed to more chronic and severe subjects in treatment group). We used Grip Strength Assessment to asses “strength” and 9 Hole Peg Test to assess “dexterity”.
TM ICF Outcomes IMPROVEMENTS IN ICF CODES FOR “FUNCTION” 80 70 60 50 40 30 20 10 0 Mental function Seeing Proprioceptive Touch function sensory of pain Mobility of joint Muscle power Muscle tone Control of of sequencing functions function functions functions functions voluntary complex movement movements functions
TM ICF Outcomes IMPROVEMENTS IN ICF CODES FOR “ACTIVITY” 120 100 80 60 40 20 0 Carrying out Lifting and Fine hand Hand and Driving Washing Caring for Toileting Dressing Eating Drinking daily routine carrying use arm us oneself body parts objects
TM Percentage change in Treatment Group MRH016 223 MRH022 203.6 MRH017 214.5 >40% OVERALL IMPROVEMENT MLH009 82.13 MLH021 86.34 MLH014 79.99 MRH015 66.07 MRH005 30.26 MRH020 30.26 40%>% OVERALL IMPROVEMENT>5% MLH023 28.15 MRH019 13.8 MLH008 8.251 MRH013 3.355 % OVERALL IMPROVEMENT< 5% MLH006 2.84 MLH003 -7.78 We consider overall improvement above 5% wrt starting baseline to be clinically relevant. (ref)These are supported by the ICF scores on the Problem Solving Form.
TM Patient satisfaction Enhancing Quality of Life
TM SynPhNe Wireless SENSORS: Internal environment EEG – 8 Brain acticity EMG – 8 Muscle activity HRV Heart tracking External environment Temp Room temp Humidity Room humidity Decibel level Surrounding noise Accelerometer Posture, Tremor Gyroscope Posture, Orientation changes SELF REPORTS: Pain – Sw/mobile Fatigue, Nausea, Discomfort - Sw Function, Activity, Ease of Use -mobile
Recommend
More recommend
