Projects

SR Shrivastav, CR DeVol, VM Landrum, KF Bjornson, D Roge, KM Steele, CT Moritz (2024) “Transcutaneous Spinal Stimulation and Short-burst Interval Treadmill Training in Children with Cerebral Palsy: A Pilot Study”

Katie Landwehr JournalArticle, News, Publications, SpinalStim , , ,

Journal Article in IEEE Transactions on Biomedical Engineering

Non-invasive neuromodulation may be an alternative approach that can improve outcomes in CP when combined with physical therapy. Transcutaneous spinal cord stimulation (tSCS) is a novel, non-invasive neuromodulation technique that can modulate spinal and supraspinal circuits especially when implemented with physical therapy.

A) Short-burst interval locomotor treadmill training (SBLTT) with contact guard assist. B) Investigative spinal cord neuromodulation device (SpineX, Inc.) with stimulating electrodes on the T11 and L1 dorsal spinous processes and two ground electrodes on the anterior superior iliac spine (ASIS - not visible). C) Spinal stimulation waveform with 10 kHz carrier frequency. D) Protocol timeline including the assessments before and after each intervention and after 8-weeks of follow-up. tSCS = transcutaneous spinal cord stimulationAim: The purpose of this pilot study was to evaluate the effects of transcutaneous spinal cord stimulation (tSCS) and short-burst interval locomotor treadmill training (SBLTT) on spasticity and mobility in children with cerebral palsy (CP).

Methods: We employed a single-arm design with two interventions: SBLTT only, and tSCS + SBLTT, in four children with CP. Children received 24-sessions each of SBLTT only and tSCS + SBLTT. Spasticity, neuromuscular coordination, and walking function were evaluated before, immediately after, and 8- weeks following each intervention.

Results: Spasticity, measured via the Modified Ashworth Scale (MAS), reduced in four lower extremity muscles after tSCS + SBLTT (1.40 ± 0.22,) more than following SBLTT only (0.43 ± 0.39). One-minute walk test (1-MWT) distance was maintained during both interventions. tSCS + SBLTT led to improvements in peak hip and knee peak extension (4.9 ± 7.3° and 6.5 ± 7.7°), that drove increases in joint dynamic range of 4.3 ± 2.4° and 3.8 ± 8.7° at the hip and knee, respectively. Children and parents reported reduction in fatigue and improved gait outcomes after tSCS + SBLTT. Improvements in spasticity and walking function were sustained for 8-weeks after tSCS + SBLTT.

Interpretation: These preliminary results suggest that tSCS + SBLTT may improve spasticity while simultaneously maintaining neuromuscular coordination and walking function in ambulatory children with CP. This work provides preliminary evidence on the effects of tSCS and the combination of tSCS + SBLTT in children with CP.

AM Spomer, BC Conner, MH Schwartz, ZF Lerner, KM Steele (2024) “Multi-session adaptation to audiovisual and sensorimotor biofeedback is heterogeneous among adolescents with cerebral palsy”

Katie Landwehr JournalArticle, MotorControl, News, Publications , , , , ,

Journal Article in PLoS ONE

There is growing interest in the use of biofeedback-augmented gait training in cerebral palsy (CP). Audiovisual, sensorimotor, and immersive biofeedback paradigms are commonly used to elicit short-term gait improvements; however, outcomes remain variable. Because biofeedback training requires that individuals have the capacity to both adapt their gait in response to feedback and retain improvements across sessions, changes in either capacity may affect outcomes. Yet, neither has been explored extensively in CP.

Experimental protocol used to evaluate multi-session adaptation to multimodal biofeedback. Participants completed a four-day protocol using combined audiovisual and sensorimotor biofeedback. Audiovisual biofeedback on soleus activity was provided unilaterally on the more-affected limb whereas sensorimotor biofeedback was administered bilaterally using a resistive ankle exoskeleton. Each session was separated into baseline (1 minute), biofeedback (2, 10-minute bouts), and washout (1 minute) phases. The nominal torque value of the ankle exoskeleton was set at 0.1 Nm/kg during the first bout of the first session and incrementally adjusted by 0.025 Nm/kg over the subsequent bouts, according to the schedule shown. Overground walking data were collected pre- and post-intervention. A licensed physical therapist also performed a full physical examination at the pre-intervention session. Motion capture data were collected during at the pre- and post-intervention sessions and electromyography (EMG) data were collected bilaterally from the vastus lateralis, semitendinosus, soleus, and tibialis anterior across all sessions.Aim: The aim of this study was to evaluate the extent to which individuals with CP adapt gait and retain improvements during multi-session practice with a multimodal biofeedback paradigm, designed to promote plantarflexor recruitment. Secondarily, we compared overground walking performance before and after biofeedback sessions to understand if any observed in-session improvements were transferred. 

Methods: In this study, we evaluated the extent to which adolescents with CP (7M/1F; 14 years (12.5,15.26)) could adapt gait and retain improvements across four, 20-minute sessions using combined audiovisual and sensorimotor biofeedback. Both systems were designed to target plantarflexor activity. Audiovisual biofeedback displayed real-time soleus activity and sensorimotor biofeedback was provided using a bilateral resistive ankle exoskeleton. We quantified the time-course of change in muscle activity within and across sessions and overground walking function before and after the four sessions.

Results: All individuals were able to significantly increase soleus activity from baseline using multimodal biofeedback (p < 0.031) but demonstrated heterogeneous adaptation strategies. In-session soleus adaptation had a moderate positive correlation with short-term retention of the adapted gait patterns (0.40 ≤ ρ ≤ 0.81), but generally weak correlations with baseline walking function (GMFCS Level) and motor control complexity (ρ ≤ 0.43). The latter indicates that adaptation capacity may be a critical and unique metric underlying response to biofeedback. Notably, in-session gains did not correspond to significant improvements in overground walking function (p > 0.11).

Interpretation: This work suggests that individuals with CP have the capacity to adapt their gait using biofeedback, but responses are highly variable. Characterizing the factors driving adaptation to biofeedback may be a promising avenue to understand the heterogeneity of existing biofeedback training outcomes and inform future system optimization for integration into clinical care.

 

KM Steele (2023) After Universal Design Book Chapter – “Shaping Inclusive and Equitable Makerspaces”

Katie Landwehr AccessEngineering, News, OtherPublication, Projects, Publications , , , ,

Book Chapter in After Universal Design: The Disability Design Revolution, Edited by Elizabeth Guffey

“Makerspaces are often used to help build new assistive technology and increase accessibility; however, many of these spaces and tools remain inaccessible. We need to make sure disabled people can access these spaces and create the products and designs that they actually want.”
– DO-IT Scholar

Dr. Steele was asked to contribute a case study focused on her work with AccessEngineering into Shaping Inclusive and Equitable Makerspaces.

Description: How might we develop products made with and by disabled users rather than for them? Could we change living and working spaces to make them accessible rather than designing products that “fix” disabilities? How can we grow our capabilities to make designs more “bespoke” to each individual? After Universal Design brings together scholars, practitioners, and disabled users and makers to consider these questions and to argue for the necessity of a new user-centered design.

As many YouTube videos demonstrate, disabled designers are not only fulfilling the grand promises of DIY design but are also questioning what constitutes meaningful design itself. By forcing a rethink of the top-down professionalized practice of Universal Design, which has dominated thinking and practice around design for disability for decades, this book models what inclusive design and social justice can look like as activism, academic research, and everyday life practices today.

With chapters, case studies, and interviews exploring questions of design and personal agency, hardware and spaces, the experiences of prosthetics’ users, conventional hearing aid devices designed to suit personal style, and ways of facilitating pain self-reporting, these essays expand our understanding of what counts as design by offering alternative narratives about creativity and making. Using critical perspectives on disability, race, and gender, this book allow us to understand how design often works in the real world and challenges us to rethink ideas of “inclusion” in design.

Spring 2024 CREATE Research Showcase

Katie Landwehr HuskyADAPT, News, Presentation , , ,

The Center for Research and Education on Accessible Technology and Experiences (CREATE) hosted a Research Showcase and Community Day 2024 on May 20th. These events brought industry and community partners — leaders working and living in the disability and accessibility space — together with faculty and student researchers. Co-sponsored by HuskyADAPT. CREATE’s mission is to make technology accessible and to make the world accessible through technology.

Steele Lab members, Alexandra (Sasha), Mia, Kate, and Alisha,  presented posters at the CREATE Research Showcase to highlight design, development & research of technology to support individuals with disabilities.

Mia, Kate, and Alisha presented a poster on “The Switch Kit: bridging the gap in therapeutic toys for children with medical complexities“. This research involved the creation and evaluation of a therapeutic toy named the “Switch Kit,” designed for young children with medical complexities. The kit allows family members and clinicians to customize switches tailored to the unique needs of each child.

Alexandra presented a poster on “Camera-Based Interface for Hand Function Assessment”. Currently, hand function assessment (e.g., joint range of motion) in a clinical setting is done with low-resolution tools and oftentimes in a subjective manner that is time-consuming. With a camera-based interface, we wanted to improve the speed of collecting information about patient’s hand function, improve repeatability and objectivity, and enhance result presentation for both patients and clinicians.

Introducing Dr. Charlotte DeVol Caskey!

Katie Landwehr Graduation, MotorControl, News , , , , ,

Congratulations to Dr. Charlotte DeVol Caskey on earning her Doctorate in Mechanical Engineering! Dr. Caskey’s PhD thesis dissertation was titled Effects of Spinal Stimulation on Neuromechanics of Gait for Children with Cerebral Palsy. Congratulations and best of luck as you move forward as a Postdoc in the Human Neuromechanics Laboratory at the University of Florida in Gainesville!

A group of 6 diverse individuals posing in front of a projector screen for a picture following Dr. Caskey's successful presentation.
Two women dressed in business attire posing for a photo. Charlotte is wearing glasses, a black pant suit and teal blouse. Tori is also wearing a black suit and a dark blue button down shirt.
A group of 8 people posing for a picture while standing on a dock overlooking Lake Union with a large bridge and the Seattle skyline in the background.