Text Box: Neurotechnology applications for cerebral palsy is well documented in the medical literature. Using medical electronics interacting with the human nervous system, neurotechnology application have revolutionized the tools used for scientific analysis, functional rehabilitation and activities of daily living. Electrical stimulation was the pioneering application and has been studied in cerebral palsy for nearly 50 years. Investigators studying these applications have observed reduced spasticity, improved motor control, increased range of motion and muscle strength, improved bladder function, better coordination of breathing and fewer respiratory infections, as well as better walking and balance. No one technology can achieve all of these observations but the applications are available. Systems are segmented into three main areas implanted, external or hybrid (a combination) of both. Implanted systems tend to be more “invasive” and therefore require a surgical or other procedure to install the system into the body of a potential user. Whereas, external systems are applied outside the body or on the surface of the skin. Finally, hybrid systems have components that are both implanted and external. As systems move from the lab to the clinic, there are a variety of things to consider before participating into a treatment, therapy or device protocol. Individuals must consider the time commitment, financial requirements and health benefits and risks that come with any program. Proper evaluation and supervision by a trained clinician, such as a physician or therapist is essential. Applications Just as there are many aspects to cerebral palsy, there are as many applications of neurotechnology. Below are descriptions of applications for different areas. This includes technology that is currently available, as well as some progress in research for what is coming in the near future. Lists of devices are available in the Resources section of this newsletter. Spasticity and Pain Management Involuntary muscle contractions or spasticity can restrict movement and cause rigidity for people with cerebral palsy. Common among people living with cerebral palsy, spasticity has a direct impact on daily living. Neurotechnology applications for CP may relieve pain and movement restrictions. The advantages of reducing spasticity without causing paralysis or weakness is that some previously undetected movement abilities may be discovered. Applications range in type and complexity. An example of a simple system is the use of surface electrical stimulation, such as a TENS (Transcutaneous Electrical Nerve Stimulation) or NMES (Neural Muscular Electrical Stimulation) unit. Using electrodes on the surface of the skin to deliver electrical stimulation creating a muscle contraction may be reduce spasticity if used over a period of 1-3 months. Other more complex systems for reducing spasticity or pain include implanted intrathecal baclofen pump therapy or implanted spinal cord stimulation devices. Realizing that these are treatments to reduce spasticity and pain, they may unmask increased voluntary control of muscles, improve range of motion or impact hand use or walking. Respiratory, Cough and Swallowing Assistance In some cases of cerebral palsy, breathing, coughing and swallowing are difficult to achieve. In the case of breathing assistance, current neurotechnology alternatives to mechanical ventilation are hybrid systems that include either a phrenic nerve stimulator or diaphragmatic stimulator. Unlike ventilator systems, which use mechanical pressure to force air into the lungs, the stimulation system pulls air into the lungs by stimulating the diaphragm muscle or the phrenic nerve. As the diaphragm contracts, the chest cavity expands and air is pulled into the lungs. Moreover, coughing is another respiratory function that may be difficult. Cough assistance systems (CAS) that are currently available use different pressures to clear the lungs through an external breathing mask attached to a separate control unit. Under investigation is a new hybrid system that uses an external controller and implanted electrodes to achieve a cough. The goal of this electrical stimulation system is to create a ‘cough on demand’. Also using electrical stimulation, surface electrodes may be applied to allow a person to swallow. The electrical stimulation contracts the muscles along the neck thus allowing a person to swallow offering a potential alternative to a feeding tube. Hand Function and Upper Extremity Rehabilitation Hemiplegia is one impact of cerebral palsy, leaving a person with the use of only one hand. Commercially available electrical stimulation systems to improve hand function have been developed for hemiplegia as a result of a stroke. Severely paralyzed people with CP may be candidates to use these same systems to improve hand function. The systems use surface electrodes to stimulation muscles in the forearm, thus providing gross hand grasp functions. Also using surface electrical stimulation is the area of rehabilitation for the upper extremities including the shoulder, elbow and wrist. Studies are currently being conducting to observe improvements in wrist muscle strength using NMES and improved arm movements using electrical stimulation handcycling.

Educate: Applications for Cerebral Palsy

Neurotechnology for Cerebral Palsy
Text Box: Cerebral Palsy is a prevalent neurological condition in our society. It is estimated that 2 of every 1,000 children have some form of cerebral palsy.1 The effects are wide ranging; the condition may impact speech, breathing, walking, balance or bladder function, just to name a few. In this issue of The Current, we explore the neurotechnology applications for cerebral palsy. These therapies and treatments are not a cure for the disorder or a prevention tool. Neurotechnology applications have proven to reduce spasticity, increase passive and active range of motion, improve bladder function, provide independent breathing, and aid with walking and balance. In essence, they assist with combating the secondary conditions related to cerebral palsy and provide enhanced function and rehabilitation. Not all therapies, devices or treatments are appropriate for all types of cerebral palsy and neurological diseases or disorders. Approved applications will vary. A medical evaluation should be conducted prior to use. This issue is for informational purposes only; a medical professional should be consulted prior to participating in any therapy, regimen or treatment. With that said, let’s explore the many options of neurotechnology for cerebral palsy. 1 D. Hirtz, D. J. Thruman, K. Gwinn-Hardy, M. Mohamed, A.R. Chaudhuri, and R. Zalutsky, “How common are the ‘common’ neurologic disorders?”, Neurology, Jan 2007; 68: 326-337

Neurotech Network Newsletter   

Summer 2009     Volume 4, Issue 3

The Current

Inside this issue:
Text Box: The newsletter was made possible by the Christopher & Dana Reeve Foundation and the support from our generous sponsors

The Current     © The society to increase mobility

 

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Educate: Applications for Cerebral Palsy

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Personal Experiences: Giant Steps

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On the Horizon: Updates in the World of Neurotech

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Resources for Cerebral Palsy

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Neurotech Vendors Target CP Market

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Come See Us! Neurotech Education Series

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