NeuroCIMT Project 5: Reflexioning

Training the modulation of reflex activity in subjects with Spinal Cord Injury and Cerebral Palsy

Reducing spasticity by training

Cerebral palsy is a condition caused by abnormal development or damage to the parts of the brain that control movement, balance, and posture. Patients often suffer from spasticity, negatively affecting their ability to walk. The same goes for people with partical spinal cord injury, who can also experience spastic movements in their arms or legs. spasticity results in increased stiffness of a joint. Previous studies have shown that by giving patients feedback about their actual muscle activity, they can be trained to regain control over their hyperactive reflexes.

Muscle response to external force
This project aims to develop a mechanical perturbator which can be used to determine whether spasticity is the cause of increased stiffness and can be used to train the subjects in decreasing the spasticity. The researchers are going to apply perturbations on the ankle or knee, and measure the response of the muscles. These results will be presented to the patient, who will have to try and adjust the resulting muscle activity.

Mechanical perturbator
The first step is to develop the perturbator. What kind of perturbations should be applied, how can the response best be quantified? And is het possible to achieve the required system identification fast enough to provide the patient with useful feedback in real time? Since electrical stimulations of the joint is too painful, the apparatus will apply mechanical forces to the joints. One of the key questions is whether the patients can adapt the response to these perturbations and if these mechanical perturbations will be large enough to lead to the desired training effects.

Serious gaming
The measurement of resulting muscle activity, and the feedback about these values, will be incorporated in a gaming application to keep the patients motivated to complete their intensive training programme. To reach an optimal effect, patients need to train for several weeks on end, three to four times a week, half an hour to an hour each time. Especially for the cerebral palsy affected children involved, this is quite a challenge.

Improve walking speed
The project starts with healthy people, and moves on to patients with spinal cord injury from the Sint Maartens Kliniek and children with cerebral palsy who are treated in the VUmc. Eventually, the project should lead to a better training scheme to decrease the negative consequences of spasticity and improve the walking ability of  patients.

Application perspective
Frans Steenbrink, ‎Applied Research Manager Motekforce Link
‘In this project, our company’s main job is to develop a virtual reality application to help patients regain control over their malfunctioning joints. We are specialised in developing both hardware and software for this type of medical applications. We will focus on product development, and we hope to be able to demonstrate a prototype within the scope of this project. Ideally, this project should lead to a product that ends up in rehabilitation centres and specialized hospitals.’

Motekforce Link, Sint Maartens Kliniek, Twente Medical Systems International, University of Twente, VU University Medical Center