Over 1200 clinicians and therapists from 56 countries attended the 9th World Congress for Neurorehabilitation (WCNR 2016) in the Convention and Exhibition Centre, Philadelphia, USA. Held in conjunction with the American Society of Neurorehabilitation, WCNR 2016 highlighted a plethora of neurorehabilitation innovations and focused on their societal impacts.
“Neurotechnology is the new kid on the block” said John Donoghue, Henry Merritt Wriston Professor of Neuroscience and Director of the Brown Institute for Brain Science at Brown University, USA in his introduction to the 4th Michael P Barnes Lecture. “We’re putting technology to work to help the nervous system in two ways – using neurostimulation and sensory replacement to improve peoples’ lives after brain injury. New devices will come together and provide a way to effect function. This is an important approach for managing rehabilitation and optimising the nervous system. An exciting set of tools are coming our way.”
Dr Donoghue and his ‘BrainGate’ research team are developing technologies to restore communication, mobility and the independence of people with neurological disease, injury or limb loss. Using a baby aspirin-sized array of electrodes implanted into the brain, early research from the BrainGate team showed that neural signals associated with the intent to move a limb can be ‘decoded’ by a computer in real-time and used to operate external devices. This has allowed people with spinal cord injury, brainstem stroke and Amyotrophic Lateral Sclerosis (ALS) to control a computer cursor simply by thinking about the movement of their own paralysed hand.
Current research is focused on not only improving the ability to operate a computer, but also on providing individuals with neurological conditions with a reliable and constant control over their environment. The technology may ultimately provide ‘natural’ control over advanced prosthetic limbs, provide people with paralysis easy control over powerful assistive movement and communication devices, and eventually, enable naturally-controlled movements of paralysed limbs.
Jean Bennett, Professor of Ophthalmology at the University of Pennsylvania, USA and her team have established the scientific underpinnings which made it possible to test the first potential definitive retinal gene therapy treatment for patients with blinding retinal degenerations. Mutations in retinal pigment epithelium-specific 65 kDa protein (RPE65) are associated with recessive blinding disease. Therapeutic RPE65 has been developed and is delivered into the cells that the patient has left (there have to be cells left in order for the procedure to work). The necessary ‘wiring’ remains in the visual pathway despite the individual being blind, which can activate the visual cortex, so retinal function can be reactivated and/or restored. A Phase III trial for Leber Congenital Amaurosis has been conducted and could lead shortly to the approval of the first ocular gene therapy drug. “The results are very exciting and have been submitted to the FDA. If successful this will be the 1st approved gene therapy in the USA and the 1st approved blind therapy in the world” concluded Dr Bennett.
Walter Koroshetz, Director of the National Institute of Neurological Disorders and Stroke in the USA who discussed the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative which was originally launched in 2014 by President Obama, with the aim of revolutionising the understanding of the human brain. It is a collaborative research endeavour that will map out neural circuits in the brain, track patterns for electrical and chemical activity within those circuits and determine how that activity is translated into cognitive functions and behaviour.
Armin Schnider discussed orbitofrontal reality filtering and the control of behaviour. Dr Schnider’s research team is part of the Division of Rehabilitation at the Department for Clinical Neurosciences, University Hospital of Geneva and is looking at the mechanisms and rehabilitation of memory disorders in spontaneous confabulation (reality confusion). Patients with spontaneous confabulation confuse time and place and act according to memories which may have guided their behaviour in the past, but are inappropriate for ongoing reality. Spontaneous confabulation can be considered a lesion model for how the healthy brain adapts thought to ongoing reality. Dr Schnider’s team has found that this ability depends on the anterior limbic system, particularly the posterior medial orbitofrontal cortex, which adapts (filters) the cortical representation of upcoming memories, even before their content is (consciously) recognised and again encoded. His team is currently exploring the fine functioning of this filter, its potential link with the so-called ‘reward’ system and ways to treat patients with spontaneous confabulation.
Lynne Turner-Stokes, Director Regional Rehabilitation Unit and Dunhill Chair of Rehabilitation, King’s College London presented data from the UK Rehabilitation Outcomes Collaborative (UKROC) which reinforced the cost-efficiency of specialist rehabilitation. The study looked at functional outcomes, care needs and the cost-efficiency of specialist rehabilitation for a multicentre cohort of inpatients with complex neurological disability and compared different diagnostic groups across three levels of dependency. Clinical data from 62 specialist (Levels 1 and 2) rehabilitation services in England was collected from the UKROC national database from 2010–2015. The patients were working-aged adults (16–65 years) with complex neurological disability; 4182 with Acquired Brain Injury, 506 had spinal cord injury, 282 had peripheral neurological conditions and 769 had progressive conditions. Outcome measures were recorded on admission and discharge and all received specialist inpatient multidisciplinary rehabilitation. All groups showed significant reduction in dependency between admission and discharge on all measures. There was also a mean reduction in ‘weekly care costs’ which was greatest in the high-dependency group at £760/week, compared with the medium-dependency at £408/week and low-dependency at £130/week.
Other key note speakers included Catherine Mercier of Laval University, Québec, Canada who discussed the effect of pain on motor learning. Jianen Li, who in addition to serving as Chief Medical Officer for the Beijing United Family Rehabilitation Hospital, is the Chair of the World Health Organisation’s (WHO) International Disaster Relief Committee, looked at the issues associated with disaster rehabilitation. Dr Marta Imamura, the WHO Medical Officer for Disability and Rehabilitation gave the closing lecture and focussed on rehabilitation services in resilient health systems.
The 10th World Congress for Neurorehabilitation will take place from the 7th -10th February 2018 in Mumbai, India, with the theme ‘from neurotechnologies to community care’. For further information, please contact traceymole@wfnr.co.uk
