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Can Technology Make a Difference in Pediatric Rehabilitation? – A NCMRR Webcast

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Interested in how technology can be used to make a difference in pediatric rehabilitation? A video cast from the National Center for Medical Rehabilitation Research (NCMRR) discusses the topic in Bethesda MD. The workshop is organized by the Motion Analysis Laboratory and supported by the National Science Foundation and the National Institutes of Health.

The workshop on August 9th, 2016 brought together a group of experts in rehabilitation to discuss how technology can help us to address pressing needs in pediatric rehabilitation. To follow all of the talks this past week and listen to “Can Technology Make a Difference in Pediatric Rehabilitation?”, follow this link, CLICK HERE.

J Wu, BR Shuman, BW Brunton, KM Steele, JD Olson, RPN Rao (2016) “Multistep model for predicting upper-limb 3D isometric force application from pre-movement electrocorticographic features.” IEEE Engineering Medicine & Biology

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Example of ECoG recording during upper-extremity force production.

Peer-reviewed paper at IEEE Engineering in Medicine & Biology Annual Conference:

Can we estimate upper-extremity force production from electrocorticographic recordings?

Example of ECoG recording during upper-extremity force production.Abstract: Neural correlates of movement planning onset and direction may be present in human electrocorticography in the signal dynamics of both motor and non-motor cortical regions. We use a three-stage model of jPCA reduced-rank hidden Markov model (jPCA-RR-HMM), regularized shrunken-centroid discriminant analysis (RDA), and LASSO regression to extract direction-sensitive planning information and movement onset in an upper-limb 3D isometric force task in a human subject. This mode achieves a relatively high true positive force-onset prediction rate of 60% within 250ms, and an above-chance 36% accuracy (17% chance) in predicting one of six planned 3D directions of isometric force using pre-movement signals. We also find direction-distinguishing information up to 400ms before force onset in the pre-movement signals, captured by electrodes placed over the limb-ipsilateral dorsal premotor regions. This approach can contribute to more accurate decoding of higher-level movement goals, at earlier timescales, and inform sensor placement. Our results also contribute to further understanding of the spatiotemporal features of human motor planning.

H Choi, TL Wren, KM Steele (2016) “Gastrocnemius operating length with ankle foot orthoses in cerebral palsy.” Prosthetics & Orthotics International

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Example of gastrocnemius operating length from one subject with different AFOs.

Journal article in Prosthetics & Orthotics International:

How does the operating length of the gastrocnemius vary with different common AFOs in children with cerebral palsy?

Example of gastrocnemius operating length from one subject with different AFOs.Background: Many individuals with cerebral palsy wear ankle foot orthoses during daily life. Orthoses influence joint motion, but how they impact muscle remains unclear. In particular, the gastrocnemius is commonly stiff in cerebral palsy. Understanding whether orthoses stretch or shorten this muscle during daily life may inform orthosis design and rehabilitation.

Objectives: This study investigated the impact of different ankle foot orthoses on gastrocnemius operating length during walking in children with cerebral palsy.

Study design: Case series, within subject comparison of gastrocnemius operating length while walking barefoot and with two types of ankle foot orthoses.

Methods: We performed gait analyses for 11 children with cerebral palsy. Each child was fit with two types of orthoses: a dynamic ankle foot orthosis (Cascade dynamic ankle foot orthosis) and an adjustable dynamic response ankle foot orthosis (Ultraflex ankle foot orthosis). Musculoskeletal modeling was used to quantify gastrocnemius musculotendon operating length and velocity with each orthosis.

Results: Walking with ankle foot orthoses could stretch the gastrocnemius more than barefoot walking for some individuals; however, there was significant variability between participants and orthoses. At least one type of orthosis stretched the gastrocnemius during walking for 4/6 and 3/5 of the Gross Motor Functional Classification System Level I and III participants, respectively. AFOs also reduced peak gastrocnemius lengthening velocity compared to barefoot walking for some participants, with greater reductions among the Gross Motor Functional Classification System Level III participants. Changes in gastrocnemius operating length and lengthening velocity were related to changes in ankle and knee kinematics during gait.

Conclusion: Ankle foot orthoses impact gastrocnemius operating length during walking and, with proper design, may assist with stretching tight muscles in daily life.

Clinical relevance: Determining whether ankle foot orthoses stretch tight muscles can inform future orthotic design and potentially provide a platform for integrating therapy into daily life. However, stretching tight muscles must be balanced with other goals of orthoses such as improving gait and preventing bone deformities.

Work by Dr. Steele and Ben Shuman featured in The Daily news post

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The team found that of the 473 children who had undergone surgery in their current study, those with higher Walk-DMC scores prior to surgery had better treatment outcomes, even after factoring in age and prior treatment.

The Daily, of the University of Washington, posted an article about Dr. Steele and Ben Shuman’s recent work on predicting cerebral palsy treatment outcomes based on motor modules, or muscle synergies. This work is in partnership with Michael Schwartz at Gillette Children’s Specialty Healthcare.  An excerpt from the article is below. To read the article in full, click here.

Ben Shuman, a PhD student in the Steele Lab, smiles while working with electromyography equipment (EMG). Photo credit: Liam Brozik

 

Michael MacConnell, Bradley Wachter, CJ Smith, and Sasha Portnova Present at the Undergraduate Research Symposium

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Undergraduate Research Symposium graphic displaying May 20th in Mary Gates Hall.

Our undergraduate researchers presented in Mary Gates Hall today, presenting their research from 11am-1pm. Member of the community, faculty, and staff stopped by to hear about Bradley and CJ’s work developing an open-source proximal control orthosis, Sasha’s wrist-driven, wrist-hand orthosis, and Michael’s work on ankle foot orthoses as a rehabilitation tool. Great job, everyone!

 

 

CJ and Bradley, members of our research team, discuss the outcome measures of their proximal control device with interested community members. Michael MacConnell, a member of our research team, shares his research with members of the community. Sasha Portnova, a member of our research team, fields questions from an interested member of the community about her wrist-driven, wrist-hand orthosis.