Category Archives: Technology

At-home treatment studied for MS “brain fog”

(This post first appeared as my column on http://www.multiplesclerosisnewstoday.com)

One of the most troubling symptoms of multiple sclerosis, especially for those of us who are still working, is “brain fog”…not being able to concentrate… not feeling “sharp” when working on a task or solving problems.

So it was interesting to read about a new study that reports that patients with MS had better problem-solving ability and response time after training with a technology called transcranial direct current stimulation, or tDCS. 

During tDCS, a patient wears a headset through which a low amplitude direct current is applied to the scalp. The stimulation makes it easier for neurons in the brain to fire. The result, say the researchers, is an improvement in the learning that takes place when patients use cognitive training games during rehabilitation. And, importantly, this technology doesn’t have to be applied in a clinic; it can be used by a patient at home.

“Our research adds evidence that tDCS, while done remotely under a supervised treatment protocol, may provide an exciting new treatment option for patients with multiple sclerosis who cannot get relief for some of their cognitive symptoms,” lead researcher Leigh E. Charvet, PhD, associate professor of neurology and director of research at NYU Langone’s Multiple Sclerosis Comprehensive Care Center, says in a release on this research. “Many MS medications are aimed at preventing disease flares but those drugs do not help with daily symptom management, especially cognitive problems. We hope tDCS will fill this crucial gap and help improve quality of life for people with MS.” 

In this study, published in the Feb. 22 issue of Neuromodulation: Technology at the Neural Interface, the tDCS was targeted at the brain’s dorsolateral pre-frontal cortex. That’s an area linked to fatigue, depression and cognitive function. Twenty-five participants were provided with a tDCS headset that they learned to apply with guided help from the research team.

In each session, a study technician would contact each participant through online video conferencing, giving him or her a code to enter into a keypad to start the tDCS session. That allowed the tech to control the dosing. Then, during the stimulation, the participant played a research version of computerized cognitive training games that challenged areas of information processing, attention and memory systems.

Researchers found participants in the group treated with tDCS showed significantly greater improvements on sensitive, computer-based measures of complex attention and increases in their response times compared to the group that did cognitive training games alone.

The NYU team is currently recruiting for additional clinical trials involving 20 tDCS sessions and a randomized sham-controlled protocol, to gather additional evidence of benefits of tDCS. If you are interested in participating in one of the studies, call 646-501-7511 or email nyumsresearch@nyumc.org.

Caution: There are tDCS-type products that are being sold directly to patients, without being supported by researchers or information about how to use them. The researchers suggest you stay away from these. If you’re considering tDCS, they say, first speak with your doctor.

 

Spinal stimulation helping quads move their hands

They’re not multiple sclerosis patients, but researchers using electrical stimulation of the spinal cord have returned some above-the-waste movement to two quadriplegics.

In the past, researchers have been successful returning some voluntary leg movement to quads when the lower spinal column was stimulated by electric pulses, but this appears to be the first report that electrical stimulation of the cervical spine can produce movement above the waist; in this case, in the hands. The research was first published on the web site “Neurorehabilitation and Neural Repair” and was more recently reported on the National Institute of Health web site.

The two patients had severe cervical spine injuries and had been paralyzed for more than 18 months. Doctors implanted 16 electrodes on their spine above and below their injuries.  Then the two received electrical pulses while trying to grasp and move a hand grip.

The researchers report that both patients’ hand strength improved after just one treatment session.  After additional sessions their hand strength improved some more, as did their hand control.  And the strength and control improvements continued even without the stimulation.

This translated to large gains in their ability to feed, bathe and dress themselves.  Their ability to move around in bed, and get in and out of bed, also improved.  One patient even regained the ability to pick up and drink from a cup.

The researchers, led by Dr. Daniel Lu at UCLA, think the stimulation reawakens spinal cord nerves that were damaged by the accident. The nerves then rewire themselves and relearn their old “jobs.”

Could this technique be used to reawaken the nerves of multiple sclerosis patients?  Beats me…but, to this layman, this research certainly seems encouraging.

 

Are wearable robotics in the future for MS gimps?

You have MS but you have some mobility.  You need help to walk because your legs are weak or stiff, and your balance is off, but canes don’t give enough help and braces are too cumbersome or limiting.  How great would it be to have something that’s relatively lightweight that you could wear and would help your legs move? That’s what a group of roboticists, mechanical and biomechanical engineers, software engineers, physical therapists and even apparel designers (!) is trying to create.exosuit

It’s called exosuit technology; form-fitting, fabric-based designs that are lightweight and non-restrictive. They use flexible sensors on the knees, hips and ankles, and compact, powerful motors, packaged in a belt, to help a patient walk with greater ease and stability.

The Wyss Institute for Biologically Inspired Engineering at Harvard University has just teamed with ReWalk Robotics Ltd to accelerate development of the Institute’s exosuit technologies.  “There is a great need in the health care system for lightweight, lower-cost wearable exoskeleton designs to support stroke patients, individuals diagnosed with multiple sclerosis and senior citizens who require mechanical mobility assistance,” says ReWalk CEO Larry Jasinski. “This collaboration will help create the next generation of exoskeleton systems.” Continue reading

Study to Monitor MS Symptoms in Real Time

Would it be useful to monitor your Multiple Sclerosis symptoms during the course of your day so that you and your doctor could be alerted that an exacerbation might be just around the corner?

A research project based in Europe is studying whether a wearable device and a smart phone could be used to monitor MS patients and those with two other relapsing/remitting central nervous RADAR-CNS logosystem diseases; epilepsy and depressive disorder.  It’s called the RADAR-CNS project; Remote Assessment of Disease and Relapse – Central Nervous System.  RADAR-CNS hopes to create wearable, remote monitoring technology to predict, and maybe even preempt, exacerbations.

“In recent years, the quality and quantity of data that we can collect using wearable devices and smartphones has exploded,” says Professor Matthew Hotopf, Director of the NIHR Maudsley Biomedical Research Centre in London.  “It may be that this sort of data can improve clinical care simply by providing more accurate information. Better still,” says Professor Hotopf, “it may be possible to spot when a patient is getting into trouble before their clinic visit.”

It’s hoped that this sort of information can be used to help improve a patient’s life quality and, possibly, change how his or her disease is treated.

Patients will have a say in how this remote monitoring will actually work, by helping to identify the most important symptoms to monitor and how best to monitor them, using methods that patients will accept.  Cost, the availability of the technology, security and privacy are also concerns that need to be addressed during this project.

The RADAR-CNS project began in April of 2016 and runs until March of 2021.