Institute Activities and Advances
The National Center for Medical Rehabilitation Research (NCMRR) is the primary NICHD funding source for research on rehabilitative and assistive technology. The NCMRR is developing and supporting the application of devices to improve the human-environment interface and to restore or enhance an individual’s capacity to function in his or her environment. This type of applied research and rehabilitation technology includes, but is not limited to, prosthetics, wheelchairs, biomechanical modeling, and other devices that aim to enhance mobility, communication, cognition, and environmental control.
Specific examples of current funding areas include the following:
- Development of technologies that promote healthy, independent living for people with disabilities (PAR-11-021)
- Engineering of control devices for upper limb movement (NIH-NICHD-NCMRR-2011-15)
- Development of advanced neural prosthetics (PAR-12-053)
- Bioengineering research partnerships for basic, applied, and translational multidisciplinary research that addresses important biological, clinical, or biomedical research problems, including rehabilitation and assistance for people with disabilities (PAR-10-234)
Other current areas of support can be found at the NCMRR website.
Advances that have resulted from NCMRR funding exemplify the range of the center’s interests within rehabilitative and assistive technology. Examples are listed below.
- The NMCRR supports a project at the University of California, Irvine, that focuses on robotics for rehabilitation therapy. This project, co-funded by the National Institute of Biomedical Imaging and Bioengineering (NIBIB), included the development and testing of two robotic exoskeletons—Pneumatic Wilmington Exoskeleton (Pneu-WREX) and Biomimetic Orthosis for Neurorehabilitation of the Elbow and Shoulder (BONES)—for rehabilitation of upper extremities. Videos of these devices in action are available at http://biorobotics.eng.uci.edu/videos .
- Many rehabilitation projects aim to improve motor function outcomes of stroke patients. Some NCMRR grantees sought to identify key biological substrates needed for improvements in mobility as a way to predict and maximize treatment outcomes. They found that the degree of injury to specific motor tracts predicts gains from treatment in stroke patients. Knowing the degree of injury could help therapists to select more targeted and effective treatments for these patients.
- Researchers supported by the NCMRR and the NIBIB are studying the Robotic Upper Extremity Repetitive Therapy (RUPERT) device, a portable robotic device that helps stroke patients retrain their muscles to perform basic tasks, such as picking up a cup. As the patient’s abilities improve, the robot’s computer adjusts the assistance given to stroke patients to help retrain their muscles. The device offers multiple degrees of arm movement for the shoulder, elbow, and wrist. Studies showed that RUPERT offered a low-cost, safe, and easy-to-use robotic device to assist patients and therapists in systematic therapy at home or in a clinic.
- Physical disabilities prevent many individuals from leading independent lives. Some of these individuals however may have the capacity to drive an automobile, but are not given an opportunity. Researchers supported by the NCMRR are trying to expand driving opportunities for disabled individuals through the development of a virtual reality driving simulation. The researchers are currently examining the utility of this novel approach for evaluating the driving ability of individuals who recently experienced a concussion. The method represents a way to test individuals’ ability to drive in a safe but challenging manner.
- One project, supported by the NCMRR, the NIBIB, and the U.S. Department of Veterans Affairs, developed technology that detects brain signals and uses them to control assisted devices. This investigational system—called BrainGate2 —aims to help people with spinal cord injury, stroke, muscular dystrophy, amyotrophic lateral sclerosis, limb loss, or other conditions to restore their mobility and independence. By turning brain signals into useful commands for external devices, such as a standard computer desktop or other communication device, a powered wheelchair, or a prosthetic or robotic limb, the system components can turn thought into action. Recently reported findings related to BrainGate2 indicate that the interface provides repeatable, accurate, point-and-click control of a computer interface to an individual 1,000 days after implantation of this sensor.
- In studies of a surgical technique in which targeted muscles produce signals on the surface of the skin that can be measured and used to control prosthetic arms, NCMRR grantees reported successful results. An article on this study appeared in the Journal of the American Medical Association and follow-up studies are now under way.
- Because many patients in the intensive care unit (ICU) may be unable to communicate their needs through speech, NCMRR grantees are studying methods of augmentative and alternative communication for these patients. One study examined both high- and low-technology communication devices with voice output in patients of varying motor and cognitive abilities. The study showed positive results and has the potential to improve symptom communication and ease suffering to those in the ICU with speech limitations. The National Institute of Nursing Research is supporting a follow-up study of these results.
Other Activities and Advances
The Medical Rehabilitation Research Infrastructure Network, funded through the NCMRR with additional support from the National Institute of Neurological Disorders and Stroke and the NIBIB, builds research infrastructure in medical rehabilitation by providing investigators with access to collaborative opportunities from allied disciplines such as neuroscience, engineering, applied behavior, and the social sciences.