Tailored Therapies

Project leads: Hubertus van Hedel, Prof., Andreas Meyer-Heim, PD MD, University Children's Hospital Zurich

Our hypothesis is that a combined training of upper and lower limbs might prove beneficial compared to the
selective
training, as it allows patients to train realistic complex tasks involving multiple sub-tasks. Although
multiple-tasking is
a prerequisite for successful accomplishment of activities in regular daily life, it has rarely
been studied as a training
intervention. Accordingly, it was recently shown that adult patients with
Parkinson’s disease improved walking ability
in both trained and untrained conditions, showing ameliorated
generalizability (Yogev-Seligmann et al. 2012).
Within
this project, we are developing a system for children with acquired, but also with congenital neurological
disorders
to train upper and lower limb movements simultaneously. The driven gait orthosis Lokomat is being
combined with
(i) a glove system and (ii) a webcam which can detect the movements of a "magic wand" to include upper extremity
tasks during Lokomat walking. In addition, new software was
developed, which enables a communication between
these systems, and new virtual reality serious game scenarios
were designed ensuring a high-quality graphical
display to enhance motivation of our young patients to
participate actively during combined upper and lower extremity
robot-assisted training. Evaluation will occur by
various measures reflecting active participation during training (e.g.
surface electromyography of upper and lower
extremity muscles, heart rate, sympathetic skin response, and
questionnaires) and a battery of clinical capacity and performance measures.

Another goal is to use advanced fMRI methods to provide a comprehensive evaluation of brain morphology and

function during rehabilitation and functional improvements. Importantly, these methods might lead to the identification
of biomarkers for recovery. A recent study showed a relationship between white matter integrity and
motor functioning
in children with traumatic brain injury (Caeyenberghs et al. 2011). However, it is unclear how these alterations 
respond
to therapy. Within this KFSP project,a collaboration with Dr. Ruth O’Gorman (MRI Research at Kispi) has
been started.
In a prospective multicenter study we are performing MRI imaging sessions in children, who recently had an acquired
brain injury, to identify biomarkers with respect to their functional and neurological
outcome after rehabilitation.
Additionally, with the same aim, we are retrospectively screening suitable data sets out of our database.



References

  • Caeyenberghs K, Leemans A, Geurts M, Linden CV, Smits-Engelsman BC, Sunaert S, et al. Correlations
    between white matter integrity and motor function in traumatic brain injury patients. Neurorehabil Neural
    Repair. 
2011; 25: 492-502.
  • Yogev-Seligmann G, Giladi N, Brozgol M, Hausdorff JM. A training program to improve gait while dual tasking
    in
patients with Parkinson's disease: a pilot study. Arch Phys Med Rehabil 2012; 93: 176-81.