Neurofeedback treatment of spasticity in spinal cord injured patients
Lead Research Organisation:
University of Glasgow
Department Name: School of Engineering
Abstract
Brief description of the context of the research including potential impact:
Spasticity is a frequent secondary consequence of spinal cord injury. While it can be successfully treated by medications in people who are wheelchair users, for patients who can still walk these medications, which act as muscle relaxants, reduce walking ability. For these people nonpharmacological treatment are recommended. Interventions can be broadly divided into those targeting periphery (surface electrical stimulation, vibration, botulin injections, stretching) and those targeting central nervous system (transcranial magnetic stimulation, biofeedback based on modulation of muscle activity). Treatment that target the central nervous system might be more effective because they target the neurological cause of spasticity.
Here we propose to clinically test the efficacy of a non invasive treatment, called neurofeedback. It is based on voluntary modulation fb brain activity from the motor cortex and is inspired by incidental findings reported on 4 patients during neurofeedback treatment of central neuropathic pain. These findings were reported in publications (Hassan et al. BMC neurology 2015, AlTaleb et al. J NeuroEng rehab 2019 accepted ) and the mechanism of modulation of H reflex through the neurofeedback has been further explored on able bodied people by our group (Jarjees and Vuckovic J Psychophysiol 2016). The effect of 20 min treatment remained for the rest of the day. Neuro technology is a rapidly growing field of medical technology and consumer grade electroencephalography (EEG) devices for measuring brain activity in real time are available over the Internet on affordable prices. In the future that would allow people suffering from spasticity to have a home based treatment which they could use on demand.
Aims and objectives:
The aim of the project is to explore the mechanism of neurofeedback as a method of reducing spasticity and to obtain pilot data of long term (several weeks) neurofeedback treatment on clinical population
Specific objectives are
1. Design the optimal neurofeedback system (software) to modulate the H reflex based on EEG recording and neuromodulation
2. Eplore the mechanism of central regulation of H reflex in able-bodied people and in people with SCI
3. Test the effect of neurofeebdack protocol on spasticty in SCI patients in upper and lower extremities
4. Analse changes in gate parameters and in brain activity as measured by EEG, that are a consequence of prolonged (longer than one month) neurofeedback
5. Analyse range of movements of upper extremities
Novelty of the research methodology:
The methodology is based on non-invasive neuromodulation, i.e. neurofeedback. The only comparable research is biofeedback modulation of H reflex based on measurement of muscle activity (EMG) (Thompson et al. J Neurophysiol. 2019) that has complex experimental design and requires multiple sessions to reduce H reflex, which is considered a marker of spasticity.
We believe that our approach is comparable with the effect of the repetitive transcranial magnetic stimulation but it does not require an external stimuls.
The other novelty is that while doing neurofeedback, we record patient brain activity that can be used for further post hock analysis to understand the underlying neurological mechanism. Methods based on magnetic stimulation is typically incompatible with EEG recording due to excessive noise created by the stimulator.
Due to small number of patients we will organise a cross over studies so that each patient will be their control.
We will employ standard clinical measures of spasticity (pendulum test, Ashwort scale, 10m walking test) as well as neurological assessment such as Motor Evoke Potential and H reflex as well as bassline EEG recording and quantitative post hock analysis of EEG signal recorded during neurofeedback.
We aim to recruit 10 patients with subacute and 10 with chronic spina
Spasticity is a frequent secondary consequence of spinal cord injury. While it can be successfully treated by medications in people who are wheelchair users, for patients who can still walk these medications, which act as muscle relaxants, reduce walking ability. For these people nonpharmacological treatment are recommended. Interventions can be broadly divided into those targeting periphery (surface electrical stimulation, vibration, botulin injections, stretching) and those targeting central nervous system (transcranial magnetic stimulation, biofeedback based on modulation of muscle activity). Treatment that target the central nervous system might be more effective because they target the neurological cause of spasticity.
Here we propose to clinically test the efficacy of a non invasive treatment, called neurofeedback. It is based on voluntary modulation fb brain activity from the motor cortex and is inspired by incidental findings reported on 4 patients during neurofeedback treatment of central neuropathic pain. These findings were reported in publications (Hassan et al. BMC neurology 2015, AlTaleb et al. J NeuroEng rehab 2019 accepted ) and the mechanism of modulation of H reflex through the neurofeedback has been further explored on able bodied people by our group (Jarjees and Vuckovic J Psychophysiol 2016). The effect of 20 min treatment remained for the rest of the day. Neuro technology is a rapidly growing field of medical technology and consumer grade electroencephalography (EEG) devices for measuring brain activity in real time are available over the Internet on affordable prices. In the future that would allow people suffering from spasticity to have a home based treatment which they could use on demand.
Aims and objectives:
The aim of the project is to explore the mechanism of neurofeedback as a method of reducing spasticity and to obtain pilot data of long term (several weeks) neurofeedback treatment on clinical population
Specific objectives are
1. Design the optimal neurofeedback system (software) to modulate the H reflex based on EEG recording and neuromodulation
2. Eplore the mechanism of central regulation of H reflex in able-bodied people and in people with SCI
3. Test the effect of neurofeebdack protocol on spasticty in SCI patients in upper and lower extremities
4. Analse changes in gate parameters and in brain activity as measured by EEG, that are a consequence of prolonged (longer than one month) neurofeedback
5. Analyse range of movements of upper extremities
Novelty of the research methodology:
The methodology is based on non-invasive neuromodulation, i.e. neurofeedback. The only comparable research is biofeedback modulation of H reflex based on measurement of muscle activity (EMG) (Thompson et al. J Neurophysiol. 2019) that has complex experimental design and requires multiple sessions to reduce H reflex, which is considered a marker of spasticity.
We believe that our approach is comparable with the effect of the repetitive transcranial magnetic stimulation but it does not require an external stimuls.
The other novelty is that while doing neurofeedback, we record patient brain activity that can be used for further post hock analysis to understand the underlying neurological mechanism. Methods based on magnetic stimulation is typically incompatible with EEG recording due to excessive noise created by the stimulator.
Due to small number of patients we will organise a cross over studies so that each patient will be their control.
We will employ standard clinical measures of spasticity (pendulum test, Ashwort scale, 10m walking test) as well as neurological assessment such as Motor Evoke Potential and H reflex as well as bassline EEG recording and quantitative post hock analysis of EEG signal recorded during neurofeedback.
We aim to recruit 10 patients with subacute and 10 with chronic spina
Organisations
Studentship Projects
| Project Reference | Relationship | Related To | Start | End | Student Name |
|---|---|---|---|---|---|
| EP/R513222/1 | 01/10/2018 | 30/09/2023 | |||
| 2282629 | Studentship | EP/R513222/1 | 01/10/2019 | 01/10/2023 | Ioana Susnoschi-Luca |
| Description | Firstly, we have characterised brain connectivity during a multiplayer brain-computer interface game, both between regions of the same brain (interbrain), and between brains of two individuals. We have found that the type of game (competitive or collaborative) influences the functional connections of the brain. Interbrain synchrony existed only during gaming but not during resting state in collaborative and competitive gaming. Moreover, mental strategies that characterize successful gaming in the physical world might not be adequate for computer-based gaming. Secondly, we have indication that voluntary modulation of brain activity through neurofeedback can selectively affect the reflex response circuit at the level of the spinal cord. If confirmed by further results, this implies that neurofeedback, a non-invasive intervention with minimal risks associated, could be used to improve symptoms associated with spasticity (contractures, reduced range of motion, muscle spasms). We do not yet have results from the study including patients with spasticity after spinal cord injury (also part of this award). |
| Exploitation Route | If the intervention is successful in reducing spasticity in patients after spinal cord injury, the protocol for neuromodulation could be implemented in neurofeedback clinics that patients could attend after being discharged from hospital. It could also be developed for home use, to help people with problematic spasticity. |
| Sectors | Healthcare,Pharmaceuticals and Medical Biotechnology |
| Description | Glasgow Science Festival in Action 2022: Public Engagement and Events Training |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Public/other audiences |
| Results and Impact | I have attended a week-long training in public engagement for science communication focused on changes in climate and the environment. Together with the group I was part of, we created an activity targeted at children in primary six (11 years old) that aimed to raise their awareness on food miles - the distance that food has travelled before reaching the consumer. The activity encouraged children to find five staple food items and trace their journey, from production to their plate. To increase the impact, children's task was to do a number of simple exercises that depended on how large their food mileage was. This activity was made available online during Glasgow Science Festival 2021 (Science on the sofa), and was accessible to anyone. It was publicised on media channels. |
| Year(s) Of Engagement Activity | 2021 |
| Description | Talk at 7 Minutes of Science |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Postgraduate students |
| Results and Impact | 7 Minutes of Science is a conference-like meeting where postgraduate students present their research. Its aim is to increase awareness of the research carried out in the College of Science and Engineering at University of Glasgow. |
| Year(s) Of Engagement Activity | 2023 |
| Description | Video for Explorathon - Researchers' Night Scotland |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Media (as a channel to the public) |
| Results and Impact | I put together a video tour of the lab and of the research that our research group is conducting. The video premiered on Facebook as part of Scotland Explorathon 2021 and reached a broad and diverse audience. Most people had not been aware of what rehabilitation engineering involves, and they were interested in finding out more about our research. |
| Year(s) Of Engagement Activity | 2020 |
| URL | https://www.facebook.com/ernscot/videos/412936853214827 |