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A Russian revolution in neuro tech

Russian neurotechnology developers visited the UK recently to forge new ties with neuro-rehab professionals. Andrew Mernin reports on their innovations and intentions.

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“People on the ground don’t care about the political situation between the UK and Russia,” says Alesya Chichinkina, PR director of Russian tech firm NeuroChat.

“Everyone has these barriers in their heads but they are not the reality. The politics is just for the politicians.”

We’re chatting midway through her enthusiastic demonstration of NeuroChat’s impressive communication system. Certainly here at the the NEC in Birmingham, there is no hint of the frosty British/Russian relationship.

NeuroChat is one of several Russian parties showing off their wares at a large exhibition stand at the European Neuro Convention.

The Russian delegation is eager to work with neuro-rehab professionals, patients and care providers in the UK.

NeuroChat enables users to type messages with their mind without any movement or speech. Target users include those with MS, motor neurone disease and brain and spinal injuries.

The headset looks like a sleek cross between a GoPro action camera and a call centre operator’s headset. It comes neatly presented in branded packaging straight from style book of Apple.

Its backstory, as told by Alesya, is perhaps a microcosm of Russia’s growing prowess in neurotechnology for people with disabilities. Investment, sophisticated science and a growing awareness of the power of rehabilitation are conspiring to put Russia at the forefront of the development of new technologies for people with brain and  spinal conditions.

“Russia was always famous for our mathematics and software developers. We have a lot of good software engineers and we also started to build really good hardware.

“NeuroChat started in 2016 as a project for people with severe speech and movement disabilities, perhaps after stroke or neural trauma. We received about £1.8m in investment, about 40 per cent from the government and the rest privately.

“Our scientific supervisor is the world-famous Alexander Kaplan, head of the laboratory of neural interfaces at Moscow State University. So the science was perfect in the project from the very beginning.

“The common problem with this type of product, however, is that scientists generally struggle to make products for the market. They have no commercial thinking.

“So the bigger challenge with NeuroChat was not how we are able to type with the power of thought; instead it was about building the product as a communicator for people with disabilities.”

The technology converts brainwaves into on-screen and electronically verbalised text. A special gel is applied to the user’s head, before the headset is put on. A five to 10-minute “calibration process” follows, in which the user is urged to concentrate on certain letters or words highlighted on screen.

The system, which runs for eight hours on one charge, gauges the brain’s reaction to each letter or word rather than tracking eye movements, as is increasingly common in rehab technology.

Alesya says: “A really important aspect is the integration with social networks and messengers. People who may have returned home from hospital after a stroke, for example, of course need to be able to communicate with their family and tell them what they want. But they must also reconnect with society. A big part of the rehabilitation process is socialising, which is why we’re putting users online.”

Users can converse on messenger platforms, via SMS or on social networks; although Facebook is not yet available as it prohibits certain types of digital integration. Other additions have been shaped by the findings of patient surveys.

“We found that users really wanted a journal function, which would enable them to make notes and keep a diary. This was super easy to do but the people working in the laboratories had no idea this is what people with disabilities wanted until they asked them.”

A news feed which keeps users updated on the latest happenings of the day was also added.  The next stage is to continue developing the system’s integration with other devices and apps, including smart home appliances.

“NeuroChat won’t just be a communication device, it will also be a remote controller.”

English is one of several compatible languages, with NeuroChat now looking to establish a foothold in the UK and other markets.

“We are interested in distribution and selling partners in the UK. In Russia we work with private clients and hospitals to teach them how to use the system and we can’t do this for UK users from Moscow so we need people here to work with us.”

Currently the system is used by around 150 patients in Russian rehab centres and 100 home-based users. Efforts to raise funds for a large-scale study into the rehabilitative effect of the technology are now underway.

NeuroChat’s progress has been aided by its involvement in the Neuronet Industry Union. This is a non-commercial partnership uniting developers, manufacturers and researchers across Russia covering neuroscience and neurotechnology.

Key areas of interest include AI, augmented reality, robotics and virtual reality, with involved partners spanning science labs, corporations and clinical settings.

It encourages collaboration across various defined market segments such as ‘neuroassistance’, ‘neuroeducation’. ‘neuromarketing’ and ‘neuroentertainment’.

The overarching aim is to drive the development of neuronet technology itself – which it defines as the ‘next generation of information exchange’. The Russian government is on board too.

A ‘neuronet roadmap’ has been approved by the Presidium of the Presidential Council for Economic Modernisation and Innovative Development of Russia. It sets out growth plans for the neuronet market, with Russian firms leading the way.

Activities supported by Neuronet include the development of new products and services, advanced training of specialists in using neuronet technology and providing new education, health and social innovations.

Dmitriy Orlov, (pictured left) Neuronet’s partnership relationship manager, is here at the NEC and keen to spread the word about the impending neuronet revolution.

“This is the big market of the future and we need to get many technologies, scientific researchers and businesses involved. This is just the beginning. Our members want to export to other countries and think internationally because this will affect societies the world over – and the UK is a really important market.”

Another member of Neuronet represented in Birmingham is Neurobotics, which makes equipment for “scientific research in neuroscience, physiology and behaviour”.

It has a range of robotic products and also develops anthropomorphic robots – including frighteningly realistic versions of Alan Turing and the Russian poet A.S. Pushkin.

At the NEC, the Moscow-based company is showing delegates products covering various fields including TMS (transcranial magnetic stimulation), FES (functional electronic stimulation) and a system used to teach patients about motor imagery. The headline technology, however, is its home-based stroke rehab invention.

The Neurobotics Neurotrainer  brings together robotics, electromyography (EMG) signalling and motor imagery. Users place their hand in a robotic glove, while a screen shows a virtual rendering of their hand.

The patient’s brain activity in mimicking movements, such as a five-fingered grab, triggers the glove to mechanically support the movement.

CEO Vladimir Konishev (pictured above) says: “Here in the UK, as in Russia, it is very costly for society to offer stroke survivors months of rehabilitation. If a patient trains for one hour a day for a month, for example, they may improve and regain some motor functions. A therapist might only be able to conduct around eight of these [one-to-one] sessions per day, however. Meanwhile, stroke survival rates are increasing, meaning more people need rehabilitation.

“It’s very hard to provide rehabilitation at home. We are trying to provide a new direction in home-based stroke rehabilitation, using robotics to replace human therapists.

“You don’t need to stay in hospital to take a pill, so our question is why do you need to do rehabilitation in hospital? You can do it at home, where it’s more comfortable and less costly to society.”

While neuro-technology can be prohibitively expensive for patients, Neurobotics is hoping to spread access to its device via a rental model. “When the patient is in hospital we can train them about motor imagery and when they go home, they can rent this for around 100 Euros per day,” says Vladimir.

The Neurotrainer is not currently available commercially – but work is underway to gain the appropriate certifications and it is expected to launch soon.

“We’ll have this as a commercial product next year when we return to this exhibition. We need to build a network of partners in the UK. I would like to see the opinion of end users and practitioners and to [introduce it] to rehabilitation hospitals and businesses”.

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Brain injury case study: Simon’s story

Simon’s story demonstrates that consistent support from a small, specialist team can maximize quality of life and reduce barriers to discharge home.

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In August 2019, Simon was admitted to the Coach House in Northampton, a specialist residential care home for adults with acquired brain injury. He was the first service user in a brand new service from experienced care provider, Richardson Care.

He had sustained a hypoxic brain injury in 2015 following cardiac arrest, and had resided in a number of care environments following his discharge from acute rehabilitation.

He was referred to Richardson Care due to an increase in unsettled and challenging behaviours and as his current placement was no longer best-placed to meet his needs.

Simon had been increasingly isolating himself from the rest of the care home and would only engage in very limited activity with 1:1 support. He would frequently make complaints about his placement.

Goal for Placement

On admission to the Coach House, the overarching goal was to enable a safe discharge home for Simon. To enable this, further exposure to more independence would be required to appropriately risk assess and inform future care provision once at home.

This would provide information as to whether his previous environmental restrictions within care homes were preventing his progression or whether his needs were more enduring.

Intervention and Support

Following an initial assessment of his needs it was evident that Simon struggled with flexibility of thinking and that unsettled behaviours would present when his expectations were not met.  This could then manifest itself in paranoid behaviours, which he would then perseverate and allow to dictate his day.

Simon was provided with a structured programme to assist him in managing his expectations: a programme which he devised with the support of his Keyworker, Gareth.

By adopting a person-centred approach to the formulation of his programme, Simon felt in control of his day and less reliant on others to initiate activity for him. Simon was able to manage his own expectations of how his day would look.

He became increasingly able to manage deviations from this if he was informed of the purpose of these changes. Whilst Simon still presented with some agitation on such occasions, the structure and the relationship he had built with his key staff enabled him to become more receptive to feedback.

Simon became more flexible in other ways and was more willing to take on new challenges. His initial engagement in food preparation was short lived, but his willingness to at least ‘have a go’ was a marked difference from his previous compliance. He started to eat different meals at lunch time and take interest in his nutritional intake.

He joined the gym and set goals around his personal fitness. Whilst Simon was still largely dependent on others for some activities of daily living, he had developed new interests which significantly and positively impacted on his quality of life and mood.

Whilst Simon remained resistive to face-to-face therapy, he benefitted from oversight from the clinical team who would assess and inform future interventions and support. Simon gained some insight into the limitations imposed on him by his brain injury and focused on realistic goals, rather than shutting down at the suggestion of anything new. In brief, Simon started to enjoy his life.

Discharge Planning

Simon’s placement, in part, was to assess whether plans for future independent living were a viable option. During the year of his placement, on-going risk assessments were completed and observations made to inform future care needs on discharge home.

Close liaison with his case manager enabled remote planning during the Covid-19 pandemic, using technology to ensure that Simon could make decisions and choices regarding his future adaptations and environment. An occupational therapist from the team assessed Simon’s future home and made recommendations.

The team at Richardson Care also made recommendations on how a care package should look and Simon was involved in drawing up a person specification for the role of his personal assistant. In August 2020, almost a year since his admission, Simon discharged to his own home.

What did Simon say about the Coach House?

He felt that the staff treated him with dignity and respect and listened to him.

Simon said: “I like the room at the Coach House, I can’t complain.”

“I was only disappointed once during my stay.”

What did his case manager say about the Coach House?

Five weeks after admission:

“It was really lovely to visit yesterday and to see how well Simon is doing at the Coach House. It was particularly encouraging to hear that he is engaging with eating at the Coach House and not spending fortunes on going to a restaurant every day anymore! It was genuinely heart-warming to see the enthusiasm and satisfaction on his face, describing the steak lunch he had just bought, helped prepare and eaten.

Simon seems a great deal more relaxed in his new surroundings and it is abundantly clear that he has a great team around him, who understand his needs and are pro-active with him. He has not experienced that before, so it is all very pleasing! Many thanks.

After Simon’s discharge

“Could not have managed yesterday (or the past year!) without yours and especially Gareth’s support. He was an absolute legend yesterday – he really is a credit to himself and the Coach House. He did not relent in his efforts to help Simon settle in. He even put a ton of DVDs away on shelves after driving down and unloading the van in that heat. The man is a tank!

“I will make sure our paths cross again the next time I have a suitable candidate – I’ve really enjoyed working with you and your team too. You helped transform Simon’s life!

Chris Dindar RGN, Associate Case Manager at Brain Injury Services Ltd

Richardson Care is an independent family business and has a proven track record over more than 30 years. It has six specialist residential care homes in Northampton, three of which provide care for adults with acquired brain injury. The remaining specialise in supporting adults with learning disabilities. Its focus is on providing an inclusive family environment in which service users develop daily living skills, increasing their independence and well-being.

www.richardsoncares.co.uk.

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Expanding the horizon of neuro patients

With AlterG Anti-Gravity Treadmills.

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A wide range of patients are now benefiting from the use of AlterG Anti-Gravity Treadmills throughout clinics across the UK.

Patients with a wide range of neurological conditions are gaining confidence within a fall-safe environment which allows for high intensity repetitions along with increasing motor learning early on in the rehabilitation stage.

Originally designed for NASA, the AlterG uses patented Differential Air Pressure Technology to unweight patients from 100% down to 20% of their bodyweight in precise 1% increments.

AlterG started in Professional Sport assisting with rehabilitation from ACL and Ankle injuries, moving onto MSK Physiotherapy Clinics. However multiple research papers and case studies have now been carried out to show the benefits of use with multiple neurological conditions including Stroke, Multiple Sclerosis, Parkinson’s, Functional neurological disorder, Brain Injuries & Incomplete Spinal Cord Injuries.

Developing the technology further, along with a precise partial weight bearing environment, AlterG has liaised with multiple Neurological Physiotherapists and Surgeons and added new features to enhance the experience on the machine and enable patients to gain as much as possible from each session.

The machines are now available with basic Gait Analytics (Stance Time, Step Length and Weight Bearing Symmetries and Cadence), Pain scales, pre- programmed exercises and camera for live video monitoring allowing patients to see their feet whilst walking.

Multiple case studies have been carried out, one of which is Brainstem Cerebrovascular Accidents (CVA) or Strokes. In conjunction with AlterG, Kate Haugen from Great Moves Physical Therapy (Colorado, USA) wrote a great case study with regards to a 42-year-old runner and university tennis coach. The individual presented two strokes resulting in right sided weakness and significant balance deficits from the first stroke and almost complete paralysis on his left side for 8 days following a second CVA.

“Weightbearing exercises caused medial tibiofemoral joint line pain and swelling. The patient was unsuccessful with a stationary bike and elliptical trainer. AlterG allowed for more controlled loading progression for returning to Full Weight Bearing.”

After multiple weeks of rehabilitation, the patient can now step over objects and change direction quickly. In addition, there are no limitations with the distance the patient is able to walk, and they are not limited by fatigue.

Along with a range of case studies, various research papers are available online showing how the treadmill can be an effective intervention for those who have experienced a stroke or other neurological conditions.

“The AlterG enables Neuro patients to experience what they thought they could never do again – be it walking, jogging or running. We have had some very encouraging results – even with clients who had trialled some of others rehabilitation technologies, including a conventional partial-weightbearing treadmill. Any neuro patient who can achieve an assisted step to transfer into the AlterG can benefit.

The AlterG allows a physio to challenge neurological patients in a safe manner and in a cost-efficient manner without the need for an additional therapist or assistant”.
– Jon Graham, Physiofunction.

Trevor Donald, Managing Director of SportsMed Products Ltd (the UK distributor) stated “it is great to see research coming through about the huge benefits the AlterG can have for individuals suffering with neurological conditions. The patient stories emerging from our customers at neurological physiotherapy clinics has been incredible”

Not only does the AlterG aid walking but it can be used simply in a partial weight bearing environment to carry out exercises such as single hand throwing and catching, squats and hopping.

If you would like further information on the papers and case studies carried out along with clinical protocols please feel free to contact AlterG’s UK distributor, SportsMed Products Ltd.

https://sports-medical.co.uk/case-studies/

sales@sports-medical.co.uk

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The family experience of brain injury

After a person acquires a brain injury, the impact on the whole family can often be life changing as they adjust to a new reality and relationships come under intense pressure…

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Karen Ledger (KL): When brain injury occurs, it’s like a bomb going off in the family. Life will never be the same again for any of the members of that family.

People will be shocked, bewildered and overwhelmed, and they then have to go through a complicated process of adjustment, and people reach that adjustment at different stages.

The person with the brain injury will generally have a neuropsychologist assigned to support them. Most will pay attention to people’s feelings and emotions, but the rest of the family may not have any psychological support.

This situation doesn’t get better of itself without professional input, it can get worse and people’s mental health can and often does spiral down.

Louise Jenkins (LJ): It’s a particular challenge if you’ve got someone with little or no insight. They often won’t recognise the need for or be willing to engage with neuropsychological treatment until much further down the line, by which stage, the family may have entered a more advanced stage of crisis and their whole family unit may be at risk of breakdown. There are complex emotions involved in the adjustment process following trauma which include shock, guilt and loss.

KL: That’s a scenario we see a lot. The client’s relationships may get to an advanced stage of deterioration and as Louise says, crisis, before they’re able to accept help. This is often because there is an immense amount to absorb from their new world of injury, rehabilitation and the medico-legal process and clients do not have the psychological space to consider how they are, never mind undertake the rehabilitation.

LJ: That’s where some of the challenges come in from the legal perspective. The compensation claim process is quite rigid in that generally speaking, only the injured person can claim for financial losses and for professional support, but we maintain that as the underpinning principle for compensation claims is to restore someone to their former lifestyle, you have to consider them both as an individual and as part of the family unit. We try to build into the claim some therapy sessions not only for the injured person but also for their spouse and their children.

Some defendants (compensators) say they’re happy to support that because, if the family unit breaks down and the uninjured spouse has been providing a lot of the day-to-day support, prompting and encouragement that the injured person needs, the cost of commercial care to replace that support is significantly more expensive than the amounts you can recover in a claim for support provided by a family member. It is also about embracing the spirit of the Rehabilitation Code and Serious Injury Guide in looking at the wider family need.

KL: Often, people can’t work anymore; they feel their work is taken away from them. People get their sense of identity out of work, as well as from being a spouse or a partner, a father or a mother. And if they lose their ability to earn and their relationships start to deteriorate these are often perceived as more failure and thereby serve to reduce a client’s confidence and self-worth.

LJ: It is akin to a bereavement process for the uninjured partner, yet the person is still there with you.

KL: People don’t have to have a death to experience loss, and loss can activate a bereavement process. So they’re grieving for the person they once knew, and now they’ve got this new person which makes adjustment to the injury complicated. And the thing about brain injuries is they’re hidden. The person looks the same but behaves differently to how they did before. It understandably takes a long time for clients and family members to really grasp the effects of brain injury, because they’re often traumatised, angry, discombobulated and distressed.

The family that includes somebody with a brain injury goes through a process of understanding, just as the client hopefully does.  It’s a complex situation trying to comprehend what a brain injury means whilst feeling bereaved.

Family and children’s therapy is relevant too. Children often get missed because they deal with loss and trauma in different ways to adults. Children tend to get on with their lives, as if it’s not happening, so they need particular attention. They won’t be talking about it so much, but they’ll be experiencing it. The sooner that’s managed by specialists, the better it will be for children in the longer term, giving children the best chance of allowing normal development to take place.

LJ: It’s difficult because there’s a significant investment of time and energy put into implementing a rehabilitation programme and support around the injured person. This is integral to the claims process. The spouse can feel as if all the focus is on the injured person and they’ve been left out.

From a legal perspective, we try to involve the uninjured spouse as much as possible in discussing what we’re doing and why we’re doing it. We try to weave in that therapy support for the uninjured spouse so they come along the journey with us rather than becoming a disrupter to the rehabilitation programme because they feel excluded and unsupported. If securing interim payments through the claim to fund support is challenging at an early stage, our in-house team of client liaison managers, all of whom have a healthcare background, can provide time and input in discussing the challenges and in signposting for support both for the uninjured spouse and children as well as for the injured client. There are some really valuable resources for children, for example, which explain some of the problems that can arise in a parent who has sustained a brain injury to help them to understand and come to terms with changes in the family dynamics.

KL: People affected by brain injury can feel deserted by their partner and like a single parent.  This is because they’ve lost their partner’s contribution to childcare and work in the home. The complexity and challenges of living in these circumstances should never be underestimated.

LJ: At the point of injury, they are in shock and just want to be there for the person who’s injured.  I’ve worked with a number of people where the grief and adjustment process is very substantially delayed. These delays extend to weeks, months or even years.

They’re in a fight/flight/freeze situation. They’re managing a situation that’s about life and death initially in the most serious cases. When the acute stage is over and they have some space to start thinking about themselves, rather than the person who’s injured, they can start reflecting. It’s an emerging awareness that it’s never going to be the same again, that some degree of permanence will remain with the injuries, that this is how it will be in the longer term and a realisation that you need support to adjust to the new normal.

KL: It takes a while for that realisation to come in. I am often working with partners who are in that process of adjustment and what initially attracted them to the person pre-injury has been lost post injury, for example agile thinking and intelligence.  Moreover they now find themselves in a caring role and one where many strangers are entering their home and talking to them in alien language!  It’s not surprising that for many people this is often too challenging for them to manage and why therapy is needed as soon as possible for clients to regain their own personal power as soon as possible. They will have a private listening, respectful and tender place for them when the rest of their lives are so exposed.

LJ: They don’t know where that injured person is going to land with their recovery in the longer term. There’s a natural recovery process of a minimum of two years following brain injury, often longer, and they don’t know how much recovery the person’s going to make. They’re living with that uncertainty for a long time before being able to understand and adjust to what the long term will look like, often with significant physical, cognitive and behavioural changes which place great strain on sustaining relationships. Independent family law and financial advice is often essential to protect both parties in the event that the relationship does break down.

KL: I believe that acquired head injury is usually devastating to the person and those around them.  However, in my experience, people are often amazing in how they find the strength to establish new ways of being and making their life work for them.  Therapy can often speed up that process because clients feel heard, respected and understood, a powerful combination for a restorative process particularly when they are so often feeling powerless.  This process can help families stay together or decide to go their separate ways and with support they are more likely to do this without acrimony and additional trauma.  Observing and supporting clients and their loved ones to dig deep to find the strength and commitment to establish a new life is such an amazing privilege and honour for me.

LJ : When the claims process is managed by expert serious injury lawyers, early access to specialist rehabilitation and support will enable an injured claimant to restore their life to the best possible position and allow them to maximise their potential for the long term, restoring a sense of control and positivity for the future. Working together with therapists like Karen is essential to ensure that a multi-disciplinary network of support can be put in place in order to support an injured person to achieve their goals and rebuild their life as an individual and as part of a family unit after a life changing injury.

Louise Jenkins is a partner at Irwin Mitchell and leads the serious injury team at the firm’s Sheffield office. Karen Ledger is managing director of KSL Consulting and a therapist, counsellor and supervisor with over 30 years of experience.

 

 

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