Neurotechnology for Brain Injury Fact Sheet

You or someone you care about has sustained a brain injury. You have heard that there are many advances and interesting research occurring in the treatment and management of brain injuries. This article will help inform you about neurotechnology, a new field that offers technical devices and therapies for persons living with brain injury. This article will also review some important aspects of neurotechnology, including the types of technologies and important issues to consider before pursuing the use of a device or therapy. One way in which this article might be useful is to serve as the basis for discussion with a trained medical professional who is familiar with your specific condition.

What Is Neurotechnology?

Neurotechnology is a broad term used to refer to medical electronics used to interact with the human nervous system. The field has made rapid advancements in recent history: components have shrunk, electronics improved, and we, as a society, have become more accepting of interacting with technology. For instance, think about how common a heart pacemaker is today compared to only two decades ago. Devices are available commercially for brain injury treatment in such areas as pain management, breathing assistance, rehabilitation techniques and diagnostic practices. There are also many new technologies being investigated in research centers. These devices cannot reverse the damage to the brain. They are tools that can be used, for instance, to combat secondary conditions, provide further independence or to aid in the rehabilitation process.

The basis of neurotechnology is the electrical signals the body uses to send messages. Electrical stimulation is the primary feature of this technology. Even though a muscle is paralyzed, it does not mean that the muscle cannot contract when it is stimulated. For those with mobility impairments that do not have peripheral nerve damage, electrical stimulation may be utilized; it is being demonstrated through exciting new technologies. The technologies are also being reviewed to excite neurons in the nervous system.

In the 1950’s, the first attempt was made to apply electrical stimulation to the phrenic nerve to allow a person to breathe without a ventilator. This gradually developed into a field of science called FES (Functional Electrical Stimulation). FES encompasses a variety of therapeutic techniques and treatments used to activate muscles that may not be functioning properly due to injury, disease or a physical abnormality. Over the decades, this field of science that combines medicine, biomedical engineering and technology evolved into what is now called neurotechnology.

Areas of Neurotechnology

Neurotechnology can be divided into four areas: Neuromodulation, Neural Prostheses, Neural Rehabilitation, NeuroPharmaceutical, and NeuroSensing and Diagnostics. Each area has a distinct definition however some devices may be applicable to more than one area.

• Neuromodulation works by using electrical stimulation to improve control of an existing part of the nervous system. Some examples include the spinal cord stimulation systems used for chronic pain management that blocks pain signals to the brain and gastric stimulation systems, which are used to block the signals of hunger.
• Neural Prostheses and Neural Rehabilitation is used in conjunction of a planned training program to replace or improve function of an impaired nervous system. For instance, FES systems can restore some hand function for those with upper extremity impairments while drop foot stimulators can aid walking. Robotics may be used for repetitive therapy or suspension treadmill training systems can improve function of voluntary movement.
• NeuroPharmaceutical is an emerging field of therapy, applied through the use of devices combined with pharmaceuticals, particularly for cognition and emotional treatments. Examples include pumps for baclofen to treat spasticity or morphine for chronic pain.
• NeuroSensing and Diagnostics are tools to improve monitoring of activity in the nervous system, brain state activity or improve diagnosis of a condition. A peripheral nerve sensing test system that detects sensory impairments due to carpal tunnel syndrome is an example of a neurosensing system in practice. Another example is EMG devices utilized to communicate with a computer system.

These four segments make up the innovative field of neurotechnology. This is an emerging field; it is essential that the consumer carefully consider each device, therapy or treatment protocol before choosing to participate.

Important Considerations of Use

Below are some important considerations to review prior to participating in a therapy, treatment or device use.

• It must be recognized that all neurotechnology programs may not be appropriate for all levels or people with brain injury. Researchers and clinicians currently working in this area understand the existing criteria and are developing new guidelines to determine for whom neurotechnology devices and therapies will be most beneficial and successful. Some levels of injury are more adaptable to some treatments than others.
• Systems are implanted, external or are a combination (hybrid) of both.
  • Implanted systems tend to be more “invasive” and therefore require a surgical or other procedure to install the system into the body of a potential user.
  • External systems are applied outside the body or on the surface of the skin.
  • Hybrid systems have components that are both implanted and external.
• The cost of the use of various systems is a very important consideration. In many cases, insurance does not reimburse for devices and therapies, especially if they are considered research or experimental. Review your insurance policy very carefully. Do Not Agree to participate in a protocol, therapy or research project until you have thoroughly explored the reimbursement options, out of pocket expenses and know the cost to you. You should be aware of your own health care policy coverage whether it is Medicare, Medicaid or a private insurance provider that may provide reimbursement.
• Be aware that such treatments, therapies or devices are potentially dangerous if not used correctly.
• Not all people with brain injury are appropriate for particular neurotechnologies. Your specific case should be reviewed by a medical professional prior to using any technology.
• Several neurotechnology devices and systems are still in a research phase and not available by prescription or purchase. Such devices might be available to participants in clinical trials. For more information about accessing clinical trials, as well as the risks involved, please visit www.clinicaltrials.gov.
• Listings of currently available devices and systems are maintained by the Neurotech Network (www.neurotechnetwork.org). As mentioned above, you should carefully review your insurance policy to establish whether these technologies are covered and what your out-of-pocket expenses might be. You should also discuss your interest in these devices with the treating doctors, including the neurologist, physiatrist, and other specialists.

Individuals interested in neurotechnology treatments, therapies or devices should consider the time commitment and financial requirements and be evaluated and supervised by a clinician specializing in brain injury.

What Is Neuroplasticity?

It was formerly an article of faith among scientists that damage to the brain was permanent, and neurons, once destroyed by trauma, could not regenerate. Decades of research into the brain have shown otherwise. There is a growing wave of scientific evidence for regenerative processes in the brain, and proof for the brain's innate plasticity — the natural capacity of the brain to “rewire” itself, to form new connections and re-model existing ones.

Cortical maps of the brain have shown the ability to modify bodily areas by sensory input and experience. Such studies about spatial navigation areas in the brains of taxi-drivers or areas corresponding to the motor maps of fingers in Braille readers demonstrate such capabilities of the brain. Axons, the projections that connect different cortical zones, continue to develop well into adulthood. Therapies guided by principles of neuroplasticity can encourage axonal regrowth, compensating for damaged neural tissue instead of re-growing it. There are neuronal assemblies, such as the hippocampus, which appear to possess limited regenerative properties, but research into this phenomenon is in its infancy. Nonetheless, as young as it is, the field of neuroplasticity is cause for cautious optimism among persons with brain injury and their families.

This research has obvious therapeutic implications for the treatment of brain injury. Doctors who specialize in the physical rehabilitation of patients with stroke have drawn on neuroplasticity research in devising therapies such as constraint-induced therapy, which forces use of the side of the body affected by stroke, by restricting use of the unaffected side. Forced to use the affected arm intensively and repetitively for weeks, stroke survivors will often see gains in their ability to use the impaired limb. Other more “low-tech” therapies drawing on the concept of neuroplasticity include compensatory therapies. The person with brain injury is trained to use a reminder system such as a notebook or calendar to compensate for memory or cognitive deficits. The continued use of such systems is hoped to encourage the growth of new habits, and, it is assumed, new axonal connections between regions of cortex spared by brain injury.

One of the most exciting realms of therapeutic technology, guided by the principles of research, is neurotechnology. This fact sheet outlines some of the current research areas in this field and offers practical guidelines for taking advantage of these advances. Families and persons with brain injury should be aware of these findings, and discuss them with their doctors. The inherent limitations in recovery caused by the loss of neural tissue can be balanced with the capacity for recovery offered by therapy and technology.

There are no “quick-fix-its” for brain injury just as there is no cure-all for any chronic health condition. We do not intend to offer false hope or make promises beyond what qualified medical professionals can make. Nonetheless, research into the regenerative properties of the brain can serve as a “silver lining” in the cloud of trauma and impairment caused by brain injury.

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