Hemiplegia 

Robotic Therapy in Children with Spasticity

Studies of the efficacy of robot-aided therapy in children with spasticity, focusing on mobility recovery in the arm and wrist, in collaboration with Massachusetts Institute of Technology.

How much how often? Dosage in Robot-Assisted Therapy in Pediatrics

To systematically investigate therapy schedules differing in number of sessions and number of movements per session; to learn what combination of frequency and intensity leads to minimal and optimal outcomes.


Using Transcranial Direct Current Stimulation (tDCS) to augment the effects of robotic training on hand function in children with hemiplegic cerebral palsy

This study will investigate whether the use of Transcranial Direct Current Stimulation (tDCS) will improve the effectiveness of robotic training for children with hemiplegic cerebral palsy. These robotic Neurorehabilitation therapies were pioneered by Massachusetts Institute of Technology and have been used with great success in patients who are recovering from stroke, spinal cord injury, traumatic brain injury, as well as other neurological conditions. This study hopes to uncover whether the use of tDCS can further improve the benefits of robotic training for children with hemiplegic cerebral palsy.

Team Members:
Director: Kathleen Friel, PhD
Postdoctoral Fellow: Claudio Ferre, Ph.D.
Research Assistant: Talita Campos, B.S.
Collaborators: Kelly Au, OTR/L, Julie Knitter, OTR/L, Sue Morrow-McGinty OTR/L

Vision

Title of Study: Visual Assessment and Therapy in Children with Brain Injury

The aim of this project is to be able to accurately measure vision in children with cerebral visual impairment. The research will evaluate the ability of a new, noninvasive system, to assess smooth eye movements as a novel way to measure visual impairment in brain injured children.
Quantifying, treating, and evaluating the effectiveness of treatment of visual dysfunction in children with brain injury is a major medical challenge. These patients may not be able to follow directions and respond to questions used in traditional vision assessment. It is essential to accurately describe a patient’s visual deficits and capabilities. This not only allows for appropriate choices in treatment options, but for adaptations to the patient’s general therapeutic and educational programs as well.
Our approach requires only that subjects perform a simple task that is largely instinctive - following a moving stimulus with their eyes. E ye movements, which are detected with an eye tracking device, are assessed while visual scenes are slowly moved across a computer screen. When the system detects that the eyes are smoothly following the scene, music is played to encourage continued following. The absence or presence of smooth eye movements under conditions when the size, brightness and the speed of elements in the scenes are manipulated, can be used to quantify the way the brain processes visual information.
For information on the Clinic for Children with Low Vision Due to a Brain Injury or Disease, please click here.

Team members:
Scientific Director: Glen Prusky, Ph.D.
Technical Director: Jeremy Hill, D.Phil.
Postdoctoral Fellows: Melis Suner, M.D., Scott Mooney, Ph.D.

Cognitive Neurorehabilitation

Disorders of Consciousness/Cognitive Impairment Following Brain Injury 

Children with severe brain injury can lose connection with the outside world. This lack of responsiveness is called a disorder of consciousness. Most children recover a large amount of connections with the external world, but they are often left with impairments particularly in thinking. 
Currently, it is difficult to predict whether and when a child with brain injury will recover consciousness, and other neurological functions. This is primarily due to reliance on clinical assessments, which require response, interaction with the environment, and no concurrent assessment of the brain. This creates a critical need for tools that measure brain function in a direct, quantitative and repeatable way.
The long-term goal of this project is to predict how children will recover from brain injury and to understand the brain processes that support recovery. Our strategy to predict recovery is to reveal hidden brain processes. Presently, we know if a child can react to the outside world by how they move and react. However, we can also measure the brain directly using EEG, which is a method of recording electrical activity of the brain non-invasively with electrodes placed on the scalp. By giving the child stimulation and recording the brain’s responses, we can know how much brain function they have, even if they don’t move or otherwise react to the stimulation. 

Team Members:
Scientific Director: Sudhin A. Shah, PhD
Technical Director: Jeremy Hill, PhD
Consultant: Nicholas Schiff, MD
Tester: Melis Suner, MD
Research Associate: Kyuwan Choi, Ph.D. 
Research Technician: Sophie Nowak, B.A.
Coordinator for the TBI Core Brain Injury Group: Alison Pedowitz, B.A.

Gait

A Balance Master Intervention

The Physical Therapy Department recently completed this project which provided sequence training to improve a child’s ability to cross a busy street with a traffic signal in a safe and timely manner. 
Move Forward  - the Walk Aide through the Physical Therapy Department - This technology (the Neuro-Prothesis) combines functional electrical stimulation with movement.  Hopefully this can result in proper ankle movements with every step and may decrease the need for an ankle foot orthosis.

Other

Follow-up with 13 patients with ANDMAR Encephalitis

A function-based post discharge questionnaire was developed and information was collected and analyzed. The results from the preliminary questionnaire found significant residual problems at follow-up. Click here for a two-page summary and here to view the full e-Poster and bibliography from the 2014 American Academy of Neurology meeting, presented by Dr. Jay E. Selman, Chief of Neurology.

Using TMS and EEG to Study Hemiplegia Recovery in Children

Sensorimotor and Vision Testing in Children with and without Hemiplegia

Functional Magnetic Resonance Imaging of the Motor System in Children with Cerebral Palsy

Transcranial Direct-Current Stimulation (tCDS) and Robotics

Adaptive arm training for children with hemiplegia (BAT)

Investigating the use of the WalkAide on a child’s ability to ascend/descend stairs and curbs.

Independent Walking Speed and Crossing a City Street (Balance Master Study)

  • Linda Fieback, M.A., P.T.

Neurophysiological studies of cognitive function after severe brain injury.

Post Discharge Questionnaire for Parents of Patients with AntiNMDAR Encephalitis.

CNS Vasculitis and inflammatory brain diseases outcome study (BrainWorks)

Visual assessment and therapy in children with brain injury

Registered Nurses As Preceptors – A Qualitative Case Study

Selective Dorsal Rhizotomy Outcomes and Side Effects

Retrospective analysis of Amantadine use in Pediatric Brain Injury

Use of Low-Cost Virtual Reality and Active Video Games to Improve Balance and Perceptual Skills in Children with Cerebral Palsy and Brain Injury

Teresa Smith, P.T., M.S., N.C.S.