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
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.
- 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.