Multimodal neuroimaging: novel engineering solutions for clinical applications and assistive technologies

We are proposing to take a new and creative approach to the way in which the brain is imaged and useful information is delivered to both doctors and patients. We will develop a suite of entirely novel compact, non-invasive and lightweight brain imaging systems which will allow patients to be monitored in a range of environments. This will open up new possibilities for how we guide the management of patients with brain injury and develop technologies which may assist profoundly disabled patients to interact with the world around them.
Our imaging systems will combine two technologies: near infrared spectroscopy which measures how oxygen is delivered and utilised by different regions of the brain, and electroencephalography which measures brain electrical activity. The combination of these technologies will provide a powerful tool to assess the effects of brain injury and its response to therapy, and to capture information about how well the brain is working which can be used to aid the patient. The systems will be wearable, and importantly, comfortable to wear for extended periods of time.
One system will be optimised for studies of brain injured patients outside of intensive care environments (when they may be semi mobile) during the critical rehabilitation stage of their management. The system will be specifically designed to help doctors to optimise the type and duration of therapies, minimise the risk of further injury to the brain, and thus improve the likelihood of patient recovery.
Another system will be designed to monitor patients who have chronic brain or other neurological injury which means they are severely physically disabled but still have some degree of brain function. For these patients we will optimise our brain imaging system to measure the activation of their brain during specific tasks and investigate whether we can use these measured signals to help the patients communicate with, and control, their environments - so called brain computer interfacing. No other brain imaging systems currently exist which are capable of delivering this type of information, in this range of patient groups.
In addition to building the new imaging systems, we will also develop computer programmes which are essential to extract the relevant information from the measured signals from the brain. This will involve developing routines for delivering images in real time, and incorporating a computer model of the brain to help us understand the meaning of the signals and images.
We will test our systems and methods on healthy volunteers before moving on to studies in patients with brain injury.
Our group has a long and successful track record of this type of translational research, i.e. the combined approach of hardware and software engineering of novel brain imaging technologies targeted at specific applications in healthcare, and introduction into clinical use. We have assembled a multidisciplinary team to meet the challenges of this ambitious project including engineers, mathematicians, clinicians, physicists and neuroscientists, and we have attracted the interest of an industrial project partner for potential commercial exploitation of our developed systems.

There are a number of major beneficiaries from the proposed research, beyond academia:

a) Continuous, non-invasive monitoring and imaging of haemodynamic, neuronal and metabolic signals in the brain is an unmet clinical need for many patient groups. For the brain injured adults on which this proposal focuses, such technology would not only guide individualised management in the acute phase after brain injury but also allow assessment of EEG responsiveness and associated haemodynamic and metabolic changes in patients with continued impairment of consciousness in the post-acute phase. Further, ambulatory monitoring of these variables in a range of neurological disorders (e.g. epilepsy, normal pressure hydrocephalus, multiple sclerosis) will become a reality for the first time.
For patients with chronic brain or other neurological injury the associated profound disability can render them dependent on carers for all aspects of daily life. For these patients
a robust, wearable tool for brain computer interfacing would provide a greatly improved means to interact with their environment and allow more independent living at home. For patients in a minimally conscious or persistent vegetative state, a bedside BCI system would provide a means to communicate with the outside world.
The modular design of our novel multimodal neuroimaging system will enable it to be adapted to different head sizes, e.g. for studies in infants and children where the compact and wearable features will be particularly advantageous. These studies could include the assessment of brain injury in newborn infants (e.g. hypoxia-ischemia encephalopathy, seizures, etc.) and of associated therapies (e.g. brain and body cooling). Our group has also recently demonstrated the value of continuous optical neuromonitoring in patients with cerebral malaria. The low cost and portable nature of the developed technologies could have significant impact on these types of developing world applications and we have already instigated a specific programme of work (funded by the Bill and Melinda Gates Foundation) to investigate this. This could represent a real breakthrough for patients who have no access to conventional brain imaging and whose treatment is substandard because of this.

b) An inexpensive and flexible technology for non-invasive and portable imaging of brain function has very many applications well beyond healthcare. Examples include: studies of brain function in young infants to inform the management of those at risk of developmental disorders such as autism; assessment of brain function in surgeons to enhance their performance in complex surgical tasks; monitoring of brain activity during exercise to optimise performance of elite athletes; and assessing the impact of malnutrition on the cognitive function of the developing brain.

c) Medical technology industries would benefit from establishing NIRS/EEG neuroimaging as a clinically effective tool for the assessment of brain function in applications where more expensive laboratory based studies are not feasible. We propose to demonstrate that combined NIRS/EEG can provide useful measures for healthcare applications. A successful outcome to our project could create a commercial market for the new technology, and ensure that the UK takes a lead in development of the emerging industry. The timescale for such impact could be fairly immediate (within 1-2 years) after the completion of the project. Beyond healthcare, other rapidly growing industries such as neuromarketing and gaming could also be targeted for commercial exploitation of our systems.