Magnesium sulfate, more commonly known as Epsom salt, is already an established treatment for women with preeclampsia, a type of pregnancy-induced high blood pressure that threatens the life of both mother and child. Today physicians at UNC-CH, Wake Forest and 18 other medical centers across the country said it may also be a powerful weapon against cerebral palsy, or brain damage that can profoundly affect a person's movement and speech.

Women in preterm labor who received infusions of magnesium sulfate just before delivery were about half as likely to have babies with moderate to severe cerebral palsy, compared with women who did not receive the infusions.

Cerebral palsy occurs in two to three of every 1,000 babies. Preterm infants are particularly prone to the condition. Preemies account for about one third of all cases of cerebral palsy.

Just 1.9 percent of babies born to women in the treatment group had moderate to severe cerebral palsy, compared with 3.5 percent of the children born to women who received an inactive solution.

The findings were presented today in Dallas at the annual meeting of the Society for Maternal-Fetal Medicine.

Five-year-old Ethan Edmonson raised his hands over his head and grinned.

He is one of several children served by United Cerebral Palsy of West Alabama who has ridden a cycle made by Steve Shepard's Mechanical Engineering Design I class, and the memory of riding the vehicle still brings a flush of excitement to his face.

The cycles are not the bicycles ridden by most children.

"Many times, individuals with CP have abnormal muscle movement and tone, and would be unable to isolate muscle groups to do something like ride a bike," said Paula Peacock, special projects coordinator for UCP.

Cerebral palsy is a disease of the motor control centers of the brain with no known cure.

The cycles created by the engineering students have three or four wheels, and instead of using two small pedals in a circular motion, the rider puts his feet on a large pedal in front of him and uses his legs to push forward. All of the cycles also have a handle on the back for an adult to use to help steer.

There are similar cycles on the market retailing for thousands of dollars. The students could not exceed $1,000 in making the cycles.

Jacque Smith-Edwards, the coordinator of Children Adult Respite Education, an after-school program at UCP, recalls being impressed by a presentation about the more expensive cycles at a conference not long ago.

"I think it's a wonderful idea to have something that a child with multiple disabilities would be able to operate with assistance," Smith-Edwards said.

"When I compared those to what the students did for us, I was blown away," she said.

She said the children also enjoyed them.

"They didn't want to get off the bikes," she said.

"All of them will be able to use them, which is exciting," she said. "We just have some that will require more assistance."

The students manufactured the cycles to meet the individual needs of children in the CARE program. They met with their young clients and their parents to gain an understanding of the children's mobility range and to address concerns of safety.

Keith Lange's nine-year-old son, Zachary, was one of the children for whom the cycles were made.

"He watches all the kids running around him, and he wants to be like them, and when he can't, he gets frustrated," Lange said.

Lange said the physical challenge of moving himself forward coupled with the opportunity to control the motions is beneficial to his son.

"As far as building muscles and motivation, they're great," he said of the cycles. "I just have to work with him. Once he gets the motion in mind, he can go."

Charlotte New said she was surprised when she learned what the class was doing for the children.

Her 13-year-old daughter, Carrie, has mitochondrial disease, which she said presents challenges similar to CP.

"I think she's happy just being her, but she likes being more involved now and being around other kids," New said.

New said she is happy her daughter can have the experience of riding a cycle, but she sees more to the cycles than recreation.

"Strengthening. The more you use your muscles, the more you're able to do," she said. "When the weather's good, I do want to see her riding them."

UCP Executive Director Toni Franklin said the cycles could be used for physical therapy.

While some of the bikes might be more difficult for some children, Franklin and Smith-Edwards said the difficulties they present are not insurmountable and can positively affect the young riders.

 "I see a lot of benefits, even for the children who can't use them alone, in improving motor skills," she said. "I think they're fabulous." 

"I really believe that one of the uses will be to increase and maintain range of motion. I see them being very helpful in physical therapy and occupational therapy in addition to the recreation aspect," Peacock said.

A third benefit of the cycles is perhaps the most precious of all to both parents and children.

"Independence," Lange said. "I want him to be independent. Of course, battle scars happen."

Four of the cycles have taken up residence indefinitely at UCP in Northport, and will be moved outside to an adjacent playground in warmer months.

Anderson Renaud, a senior majoring in mechanical engineering, said the work he did reached far beyond the classroom.

"[Working with the children] was the most rewarding part of it," Renaud said. "We were doing something that wasn't just a project - it had actual benefit."

Grant Pace, a senior majoring in mechanical engineering, shared similar sentiments.

"It was really exciting to see the smiles come across their faces," Pace said, referring to the day they tested out their products at UCP. "It's a really good feeling."

Source: http://media.www.cw.ua.edu/media/storage/paper959/news/2008/01/14/Infocus/Mechanics.Of.A.Smile-3150613.shtml

Two young inventors are perfecting a device that gives back the power of speech to people who suffer from diseases or disabilities that have taken away their ability to talk.                                                                  

The device, called the Audeo, translates thoughts -- or, more precisely, brain signals sent to the vocal cords -- into synthesized speech. Using the same technology, inventors Michael Callahan and Thomas Coleman also have created a mechanized wheelchair that moves, turns and stops in response to intercepted brain signals.

The first commercially available speech device "is slated for the middle of 2008, designed specifically for people with ALS or diseases that have similar types of effects," Callahan said in an interview from his office in Champaign, Illinois, where he and Coleman co-founded the Ambient Corporation three years ago to research and market the Audeo. Both men are now 25.

"If development goes well, it should give them a full vocabulary, their ability to speak,"  Callahan said.

ALS -- amyotrophic lateral sclerosis, or Lou Gehrig's disease -- can rob people of their physical motor control and ability to produce speech. So can some other diseases, as well as traumatic brain injury, cerebral palsy, stroke and certain spinal cord injuries. Callahan and Coleman are anxious to help people with such conditions.

In fact, Callahan said, "our goal is to make [the Audeo] affordable to people who may or may not have health insurance, because we want the technology to get to everyone -- so it will be priced accordingly."

"The technology is not finished, so the communication we can give them is limited but extremely useful where there are no other options," he said.

The Audeo uses sensors located in a neckband worn by the user to detect electrical impulses in the vocal cords and relay them to a nearby computer that converts the signals to speech. But users need not fear that the device can read their minds, Callahan said.

"It's a step above thinking and a step below actually speaking, so you have to want to say it," he explained. "If you don't want to say it, we have no signal to detect and nothing is able to be communicated. But if person does actually want to say it, we're able to capture the instruction signal that your brain sends."

Existing communication devices for severely disabled people generally require them to select a button or word on a computer screen, or use a head-tracking or eye-tracking system to move a cursor on the screen. Some people are unable to do even these things, said Callahan, "so we're trying to provide a more efficient way to input thoughts into a computer."

He estimates that some 3 million people in the United States and 60 million people worldwide could benefit from this technology. "We've gotten a large amount of interest from countries all over the world, from people who have different diseases and disabilities," Callahan said. "Our first roll-out will be targeted toward English speakers, but we have the technology to cross the language barrier and to enable people to speak in other languages."

One goal, he said, is to "build a community of people; we want to connect all the people that need these types of devices, so they can talk with each other."

He and Coleman started investigating the technology as engineering students at the University of Illinois Champaign-Urbana, and they have won numerous awards for their work. Testing is being done at the Rehabilitation Institute of Chicago and other institutions. They also hope to find mainstream commercial uses for the technology such as silent cell-phone communication. Their work has been self-financed to date, but now they are planning to seek venture capital.

Callahan recalled one man with cerebral palsy who communicated by touching a computer screen with a pointer mounted to his head. Callahan fitted him with an Audeo speech device and urged him to say the word "yes." On the computer screen, the man said he never had spoken before. "In a short amount of time, we had him saying single words and then moving into phrases, and that was the first time he had had a seminatural experience of actually speaking," said Callahan. The man, who had been born with cerebral palsy, was in his mid-60s.

"It doesn't take a big stretch of the imagination to see why we're doing this -- if you think what your life would be like if you couldn't say anything for the rest of it," Callahan said. "Knowing that any one of us could be in that situation and that there are already people in that situation, that's just a huge motivation."

No date has been set for the commercial production of the wheelchair, Callahan said, but he hopes to license it to a wheelchair manufacturer in the future.

Source: http://www.scoop.co.nz/stories/WO0712/S01165.htm

Champion greyhound Wot Price Harold has delivered a $3000 bonus and the promise of more winnings to Glen Waverley’s Cerebral Palsy Education Centre after winning the Great Chase Final.

 “The Cerebral Palsy Education Centre is a holistic provider of education and rehabilitation services for children, the only one of its kind in Australia,” Deputy Premier and Minister for Racing Rob Hulls said.

 “This organisation is a deserving winner and will use the initial $3000 to buy walking frames for a couple of the children who have worked so hard to learn to stand, and then to walk.”

 He said the Cerebral Palsy Education Centre (CPEC) would also receive 10 per cent of the greyhound’s winnings in the next 12 months as part of Greyhound Racing Victoria’s innovative fund-raiser for intellectual and physical disability groups.

 Wot Price Harold beat seven other competitors at yesterday’s series final at Melbourne’s The Meadows greyhound racing track. Community groups from Warrnambool, Cranbourne, Ballarat, Geelong and Warragul were all cheering their dogs to a win.

Source: Media-Newswire.com

The marriage between technology and medical science has benefited victims of even rare medical conditions. The 29th of June, 2007 happened to be a memorable day in the life of Anthony, a fourteen year old, in the throes of a grave medical condition called cerebral palsy. Post surgery, Anthony is able to WALK, like most his age. 



Motion Analysis, is the latest among the diagnostic tools to assist medical specialists in gauging the outcome of surgical intervention in the treatment of cerebral palsy. This technique was employed in Anthony’s case to ascertain the best approach to surgery, in order that he gets the maximum benefit from the procedure. This might be a promise of good times to the estimated 500,000 victims of cerebral palsy in America alone, who are left with little option other than surgery for relief.

Dr. Scher who took an active interest in Anthony’s case said, “Think of motion analysis as having 15 pairs of eyes focused on a moving body part. Motion analysis imaging shows all three planes – front, side and top down all at once. While other imaging options can show these views one by one, they can’t show them simultaneously and in motion.” 



Today, thanks to this medical feat, Anthony is able to walk. He can let his aspirations soar, notwithstanding cerebral palsy. Cerebral palsy is preventable. The silver lining is, it can also be treated effectively. 



Cerebral Palsy – Understanding the Condition 



This is Cerebral Palsy Awareness Week (24th – 30th August 2007). Cerebral Palsy is the name given to a medical condition that arises due to a permanent injury to the brain. This injury normally occurs when the woman is expecting, or during the course of delivery, or soon after birth. Diagnosis of the condition is normally made soon after birth or in some cases in early childhood. 



Research has explained the definitive link between the health conditions of the mother during pregnancy which has a bearing on the health of the child. The predominant reason for cerebral palsy is due to the inadequate supply of oxygen to the fetal brain which results in permanent damage to that part of the brain which received insufficient oxygen. Insufficient oxygen supply arises due to a number of reasons - inappropriate birth position, prolonged labor, or a problem in the umbilical cord. Premature birth of the child could also lead to this condition. 



Some of the preventable illnesses behind cerebral palsy are, jaundice, rubella, Rh incongruity during pregnancy, and even lead poisoning. 



Cerebral Palsy - Types



Spastic Cerebral Palsy, which afflicts more than 50% of cerebral palsy patients, denotes extremely rigid muscle tone. Therefore, its victims demonstrate jerky and shaky movements. 



Athetoid Cerebral Palsy, known to afflict nearly 25% of cerebral palsy victims, is characterized by a mix of low and high muscle tone. Patients are seen grappling with changes in muscle tone which influences their posture. They also exhibit some involuntary movements in the upper body. For such patients, even reaching out to objects poses a huge challenge.

Ataxic Cerebral Palsy is characterized by poor muscle tone and improper coordination. Victims suffer problems in balance, are shaky and unsteady in their gait.

Ineffective muscle control negatively impacts clarity of speech in CP patients. Some experience difficulty in chewing and swallowing food. 



Consequences of Cerebral Palsy



Cerebral palsy victims experience a number of problems, like seizures, problems with vision, hearing deficiencies, hyperactivity, spasms and even learning disorders.

Almost 50% of victims suffer some form of learning disorder. In certain cases, mental retardation cannot be ruled out. Some sufferers show a preference for certain subjects, while some others are found to be deficient in overall grasping capabilities. Some children with CP are slow learners in all subjects. Depending upon the intensity of the learning disorder, children can be supported adequately at the special school meant for such children. 



Another common consequence of CP is seizures. Seizures seem to arise from the same injured region that caused CP. 



Therapy for Cerebral Palsy



Children with cerebral palsy usually avail the support of a special school or see a therapist who helps them with better ways to handle day to day activities. Acquiring new skills and practicing them to enhance their quality of life is the main objective of the therapy sessions. 



There are different types of therapists. For example, Physical Therapiststeach children to walk and balance themselves. Children are also taught important skills like riding a bike, playing with a ball, which are part of the therapy to enhance their muscle co-ordination. 



Speech and Language Therapists assist children with speech problems. Communication aids are also used to help children communicate better. Objects and even computers are commonly used as communication aids. 



Occupational Therapists are professionals endowed with the knowledge to help children learn better ways to make use of their hands. For example, the simple act of brushing ones teeth may be child’s play for normal people, but children with CP might find this a herculean task. At such sessions, CP children are taught to practice easier ways of dressing, eating and other routine activities, so that their quality of life improves. 



Suffering cerebral palsy does not mean one cannot have fun. This is whereRecreational therapists come in to help. They introduce fun activities like swimming, playing games, and sometimes even horse riding. Victims are encouraged to look at life beyond their illness. 



Though cerebral palsy cannot be cured, there are several effective treatment options available in the present day. With the highly evolved treatments, victims can learn to cope with the problem and still live life without giving up on it.

Sufferers of brain and spinal diseases could get a boost from a developing technology that could allow them to regain the ability to communicate with computers or wheelchairs, or to other people through a synthesized voice.

Known as The Audeo, the new technology uses an electromyographic-type sensor to detect electrical signals on the throats of people who are attempting to speak, and then processes those signals into text, synthesized words or commands for an electrically activated wheelchair. Ambient Corp., developers of the new system, said that it hopes to use it to help individuals disabled by such diseases as ALS (amyotrophic lateral sclerosis, also known as Lou Gehrig’s Disease), cerebral palsy, and traumatic brain or spinal cord injury.

“Our mission is to give back communication to those who have lost it through disease or diability,” said Thomas Coleman, chief technical officer of Ambient Corp. Coleman and Ambient CEO Michael Callahan demonstrated the technology to an audience of about 2,000 engineers during a keynote speech at NIWeek here yesterday. During the demonstration, Coleman controlled a motor-powered wheelchair by giving it silent commands on stage.

“When you speak, your brain sends a signal to the muscles in your throat,” Coleman explained. “We detect the electrical activity at the throat, convert it, and then use it for communication.”

Ambient’s electromyographic-type sensor, which fits around the user’s neck like a tiny scarf, picks up the electrical signals from the nerves near the surface of the skin. It then uses an A/D converter and an on-board 16-bit Texas Instruments microcontroller, along with software algorithms in a separate PC-based microcontroller, to process and understand the incoming signals, and then send them to an output.

“Once you convert the signals to words, you could do a transcription, or create a synthesized voice, or send commands to a wheelchair,” Coleman said.

Coleman, who co-founded the company while studying engineering at the University of Illinois, said that he was aided in his product development effort by the use of National Instruments LabView software. Although he started school as a computer science major, he was initially overwhelmed by the task of implementing the control algorithms in hardware, and needed LabView’s graphical techniques to help him through that process.

“Without LabView, I probably wouldn’t have finished this,” he said. “It would have taken too long.” Even with LabView, he said, the product development took approximately three years.

Coleman noted that the ALS and cerebral palsy sufferers, in particular, could benefit from the new technology. Many such patients can still use their throat muscles but cannot squeeze enough air out of their lungs to generate audible speech. As such, some ALS patients are ultimately forced to communicate by blinking their eyes.

By reading the signals from the appropriate throat muscles, however, The Audeo could enable such patients to communicate in an audible fashion.

“We’ve worked with patients from a number of different medical categories, and this helps them,” Coleman said.

Source:http://www.designnews.com/article/CA6466925.html?industryid=43652

At fourteen, cerebral palsy hampered Anthony’s ability to walk. He and his mother feared that within the next few years, he would be confined to a wheelchair. 



As is the case with more than 500,000 Americans with this crippling disorder, Anthony was left with few options and his family turned to Hospital for Special Surgery with the hope of finding answers to effectively address his condition. 



They were introduced to David M. Scher, M.D., a pediatric orthopedic surgeon at Special Surgery, who also serves as co-medical director of the Leon Root, M.D. Motion Analysis Laboratory at the hospital. Dr. Scher believed that motion analysis could be used as an additional imaging tool to figure out the best approach to surgery to prevent Anthony from losing his ability to walk. 



“We evaluated Anthony’s functional limitations during walking, a process known as gait analysis,” said Dr. Scher. “We discovered Anthony had severe deformities, specifically in his knee that prevented his ability to walk and the analysis allowed our team to quantify some of the problems with his gait that we saw qualitatively.” 



Dr. Scher values motion analysis as both a diagnostic as well as a monitoring tool since it allows clinicians to objectively measure the gains that are achieved following proper medical or surgical intervention. 



With the help of gait analysis, Dr. Scher determined which surgical approach was the best option. The surgery entailed cutting the end of the thigh bones to straighten the legs and moving the patellar tendon further down the leg to give it more leverage. Next, Dr. Scher cut the right heel bone to move it in line with his leg and fused a deformed joint in the foot at the bottom of the big toe that prevented Anthony from being able to push off with each step.



Now 16, Anthony’s ability to walk efficiently has been restored. What’s more, Anthony can expect that he will maintain the ability to walk and remain mobile and productive throughout his lifetime. 



Measurement philosophy and laboratory design 



“The central theme of the lab is to study the relationships between lower and upper extremity structure and function,” said Howard Hillstrom, Ph.D., director of the Leon Root, M.D., Motion Analysis Laboratory. “We believe that the key to understanding many of the biomechanically related diseases and injury mechanisms is identifying those relationships.”



“Think of motion analysis as having 15 pairs of eyes focused on a moving body part,” said Dr. Scher. “Motion analysis imaging shows all three planes – front, side and top down all at once. While other imaging options can show these views one by one, they can’t show them simultaneously and in motion.”



In addition to seeing how the different parts of the body are moving simultaneously, we are able to monitor how and when the muscles turn on and off during the act of walking. This all translates into a thorough understanding of how we can properly and accurately treat a patient who suffers from mobility issues, Dr. Scher noted.



By focusing on the trunk, pelvis, hips, knees and ankles, digital video cameras take images of a patient’s movement and process the data through a high-tech computer system that analyzes the movement and reveals precisely where muscles and joints are and are not functioning properly.



One design feature of the Leon Root, M.D. Motion Analysis lab is the mechanical isolation of the data collection zone. The laboratory floor is completely detached from the structure of the building it resides in, explained Dr. Hillstrom. Constructing the floor in this fashion was purposefully done to ensure that measurements during motion analysis had a negligible error due to vibrations that occur in most buildings. The use of high resolution digital video cameras also helps obtain a highly accurate description of each patient’s movement patterns for both clinical and research applications. The air-bearing assemblies beneath each force plate allow them to be adjustably repositioned, further adding to the versatility of the lab. From the gait of a toddler to a seven-foot basketball player, a wide range of neuromusculoskeletal activities may be studied.



Other uses for the motion analysis 



The lab plays a critical role in the care of young patients with conditions such as cerebral palsy and spina bifida, and adult patients with neurological diseases and stroke. Tests may be performed to evaluate a patient’s functional limitations when performing purposeful movements, such as walking. Analysis of a patient’s structure and alignment enables staff to better understand the cause of impaired movement and determine an effective treatment.



The research goals of the lab, according to Dr. Hillstrom, include developing methods of tracking upper extremity motions; studying the effect of foot orthotics in patients with knee osteoarthritis; examining the influence of shoe design on feet; and identifying improved methods of evaluating cerebral palsy.



Further, Frank Cordasco, M.D., co-medical director of the Motion Analysis Laboratory, leads an effort with Hospital for Special Surgery’s nationally recognized Sports Medicine and Shoulder Service to use motion analysis technology to determine the mechanics behind sports medicine injuries. They will also study movements of weekend and professional athletes to boost performance and correct physical habits that impede their ability to succeed. 



The future of motion analysis as a diagnostic tool



One obstacle in using motion analysis as a diagnostic tool, cautioned Dr. Scher, is insurance, as many carriers do not cover this technique. “The onus is on us to prove its importance and to advocate for our patients by insisting that this tool enhances our ability to provide optimal care,” said Dr. Scher.



“The Leon Root Motion Analysis Laboratory is a center of excellence that is doing important research and clinical work for the betterment of patients who have musculoskeletal disorders,” concluded Dr. Scher. “The applications for motion analysis as a tool to identify problems and provide accurate treatment are limitless and we encourage colleagues within and outside of Hospital for Special Surgery to use us as a resource in helping all patients achieve proper mobility.”

Source: http://www.newswise.com/articles/view/531197/

Ahmedabad, January 24: It’s like any ordinary wristband that people would sport but a closer look at the prototype shows an embedded system that does tasks like switching on a computer or a television.

Aimed at making life a little easier for patients suffering from cerebral palsy, the device has been designed by two students of the Dhirubhai Ambani Institute of Information and Communication Technology (DA-IICT).

The wristband is part of the design project of Pallavi Daggumati and Ramya Reddy, B Tech students in their fourth semester. The device, a wristband for the patients will be low cost, light weight and portable so that the patient is comfortable while operating the same.

The wristband will have an embedded system within it which will take into account the slight movement of the hands made by the patients. The device will operate according to the angle made by the hand, giving a signal to a computer or a television to get switched on or off. It will have some components of another device designed by DA-IICT students called a ‘wireless mouse’.

The mouse is so designed that a computer can be operated without the person having to be near it. The mouse has a sensor and is connected to a USB port which has a receiver. The mouse helps to change slides of a presentation depending on angles made by the hand.

Prabhat Ranjan, professor at DA-IICT under whom the project is being done. says, “One needs to decipher the correct angles of the hand of the patient suffering from cerebral palsy if the device is to be tried out.

The reason for this is the lack of movements of their fingers because of which any fine movement needs to be measured.” Talking on her project, Daggumati says, “I and my friend visited several rehabilitation homes for patients suffering from cerebral palsy in Hyderabad and Chennai.

However, we concentrated on the case of a 17-year-old girl in a Chennai rehabilitation home. We got the idea to design the device based on equipment used by the girl which included an infrared mouse and touch pads to operate remote-controlled devices like television.”

She adds, “However we realised that the touchpad which was like a switch could either control the programmes or the volume of the television, meaning it could only have one function. We on the other hand intend to design a device which can be used as a multiple input switch which can have several functions.”

The duo are also in the process of designing a Voice Decoder for cerebral palsy patients. Daggumati says, “With the help of this device sounds made by the patients can be recorded and catalogued. When the patient makes a sound, it can be fed into the device which recognises the sound from its database, mapping the sound into an English word.” She adds, “We intend to make this device light weight which can be put on a patient’s wheelchair to communicate with others.”

Source:http://cities.expressindia.com/fullstory.php?newsid=219289

There was something missing from the new tablet PC that Tobii Technology presented at Siggraph in Boston earlier this week.

The MyTobiiP10 is a mountable, lightweight, Bluetooth-enabled laptop, complete with integrated eye-tracking technology--and no keyboard.

The computer employs a touch screen controlled by the eye movements of its users.

Tobii, a Swedish company that specializes in eye-tracking hardware and software added this little gem to their arsenal in March. It's the latest product to come from Tobii, which produces a line of eye-tracking equipment, some of which is used for purposes of Web research.

The MyTobii has a keyboard, which is represented on the screen. Selections are made using "dwell time," which is the length of time someone looks at an object on the screen, said Tobii Executive Vice President John Elvesjo.

The eye-controlled computer is specially designed for people with disabilities such as cerebral palsy, ALS, multiple sclerosis, and brain and spinal injuries.

Unit cost $17,000 each and are sold through distributors and resellers in the U.S., Sweden, Norway, Germany and England.

Source: http://news.com.com/2061-10801_3-6102548.shtml

After his high school graduation, Ray Miller, 43, hit his head in a motorcycle accident. Miller suffered traumatic brain injury, which impaired his ability to speak.

For him, life would never be the same. Because of the accident, Miller also has memory loss and is disabled. Because of the pain, the smile on his face disappears when he sits down, stands up or walks.

Miller attends therapy sessions at the Sir Alexander Ewing Speech and Hearing Clinic at the college, which provides prevention, evaluation and treatment services for communication disorders involving speech and hearing problems.

Miller is one of the clients who relies on “augmentative and alternative communication.” This includes therapy sessions and technological devices that allow people with disabilities and speech disorders to speak.

They also develop treatment plans based on clients’ needs. The services include solving problems with articulation or speech sound, stuttering, voice, language, accents and hearing. The clinic also offers assistive technology for voice.

Since the accident, Miller has communicated with people through a speech-generating device produced by DynaVox Systems. There are different types of DynaVox devices for different needs. Miller’s DynaVox is considered “high tech” and is made up of a small portable computer with a black and white screen and a keyboard.

When he types words on his keyboard, a male voice is generated. The price of these speech-generating devices ranges from $3,500 to $8,000. They are usually paid for by the clients’ insurance companies.

While Miller’s speech loss was a result of an accident, others have no voice as a result of an injury at birth, cerebral palsy or a stroke. Cerebral palsy is the loss of voluntary muscular control and coordination. There is no cure for the disorder, and the treatment consists of speech, physical and occupational therapy.

Anna Orak, 72, was born with cerebral palsy and has been coming to the clinic for more than 15 years. When Lindsay Pendergast, her clinician and graduate student at the college, asks Orak to show her angry face to the other group members, she can only keep it for a few seconds. Then she moves her head to the side and starts laughing loudly.

“[Orak] is known as the most fun and popular client,” Pendergast said.

Because Orak doesn’t know how to read, her device has folders with pictures. All she needs to do to say what she wants is touch the screen.

Liz Begley, clinical assistant professor in the department of speech language pathology and audiology and a supervisor at the clinic, said the clinic’s goal is to teach clients how to program devices, so they can speak fluently.

“These speech-generating devices allow these individuals to have equal access to communication,” Begley said. “Having no voice doesn’t mean they aren’t bright.”

During the individual therapy sessions, clients work on specific needs such as remembering specific labels for words or using the speech-generating device to make phone calls.

These clinic sessions also create a challenge for undergraduate and graduate students who experiment with therapy techniques and help clients find their direction, Begley said.

“Students’ responsibility to the clients creates such a great training ground and experience for the students,” Begley said. Most clinicians will work in hospitals, schools and large practices, Begley said.

Sarah Bognar, another graduate clinician, said, in the beginning, she was anxious and nervous when she started to work with a client.

Bognar said one of her clients, 43-year-old Jim Severino, makes her job easier because he always has something to say. She said she talks about many topics with Severino, who has cerebral palsy.

“It’s amazing that without even using his device, he quickly finds a way to explain what he wants,” Bognar said.

Hearing assessments or speech language and hearing evaluations are available to students, employees, faculty, staff and administration without charge, said Christine Cecconi, clinical associate professor and director at the clinic.

Speech pathology and audiology students also work at the college’s Voice and Swallowing Clinic, located adjacent to the Cayuga Ear, Nose, Throat and Allergy Associates in Ithaca. The clinic uses a model where graduate students observe medical procedures used to diagnose disorders.

Severino recently visited the clinic for a coevaluation of his swallowing. Because the roof of his mouth is deep, Severino has problems while chewing and swallowing the food.

The Sir Alexander Ewing Speech and Hearing Clinic also offers a variety of community programs including the Oral Rehabilitation Home at Kendal at Ithaca, a retirement and rehabilitation home, and the Center for Life Skills at Longview. The Oral Rehabilitation Program, for example, is for elderly people to improve their hearing. At Longview, the clinic also offers interdisciplinary programs with occupational therapy and physical therapy. Cecconi said because of the services the clinics provide, the department is equipped to help people with communication disorders.

“We can really make a huge impact on these people’s lives,” Cecconi said.

Source: http://www.ithaca.edu/ithacan/articles/0604/27/news/0getting_a.htm

When Tristan Schilling was diagnosed with cerebral palsy as a baby, doctors weren't sure he'd survive. Now at 10, he's determined to learn to stand and walk.

Vicki Schilling sees that drive in Tristan, "He has so much will and desire and spirit and the motivation to just do what he wants to do."

In a study at Shriners Hospital in Philadelphia, Tristan, and others like him, trained for four weeks on a special treadmill.

Researchers like Kyle Josephic designed the work-out to help improve their fitness, coordination and mobility, "We just really wanted to give them a jump-start and an opportunity to try walking in an environment that is safe for them, that they can trust a little bit more."

The equipment supports some of Tristan's body weight so he can practice moving his walking muscles more easily. The training is intense, but the hard work paid off.

According to Dr. Josephic there's some positive results, "In general children were able to walk faster, be up more often and are more functional."

Vicki agrees, "The biggest thing that we've seen is that he has started to crawl, and also pull himself up onto his knees, and also make attempts to pull himself even up onto his feet."

So while treadmill therapy alone hasn't gotten Tristan walking, it does get him closer. And Tristan isn't giving up, "Some kids out there just give up and don't want to walk. They stay in a wheelchair forever. But me, I'm not giving up."

That's a powerful step forward.

The project is called the Speed Supported Treadmill Training Exercise Program (or SSTTEP) and is part of ongoing treadmill studies at Shriners for children with cerebral palsy.

What Is Body Weight Supported Treadmill Training?

Body weight supported (BWS) treadmill training is a method for retraining walking. A person using BWS is supported by a harness that is suspended from a metal frame or from the ceiling. The harness and BWS provide support and reduce the weight on your feet while you walk on the treadmill. The amount of support can be gradually increased or decreased according to your particular needs. For example, if your therapist increases the treadmill speed, you might need more BWS for a short while as you try to keep your balance and posture while walking faster.

Three million Americans have disabilites so severe that they can't even say "Hello" or express simple concepts like "I need help." NBC's Tracie Potts reports on groundbreaking research that uses specially adapted computers to help young children, even infants, communicate.

Doctors describe children with severe disabilities as genies trapped in a bottle -- cognitively they are quite intelligent and able to learn like many other children their age, but their bodies won't let them communicate.

Four-year-old Augie Webster has cerebral palsy and cannot speak with his mouth.

"Like sometimes if we go to the mall, Augie will see something, and he'll make sounds, so I know he's seeing something, and I try to figure it out, and it'll be a kid from the school," said mother Kathy Webster.

Click here to find out more!

But, Augie can speak with the aid of computer. By selecting pictures and words, Augie can make sentences, answer questions and even tell a story.

"He can make selections about what toys he wants to play with," said Heather Hernandez, special education teacher. "Oftentimes they [other children] want to come around and see what he wants to press next, or they'll yell at circle time 'Pick me, pick me.'"

The ability to communicate allows Augie to build social skills and make friends with children his age. The assistive technology that makes it all possible has been around for two decades, but just within the past two years has been adapated for use by young children.

"We're able to capture them at that early stage and to provide them with a way to develop language as typically developing kids do," said professor Janice Light with Pennsylvania State University. "They're actually learning words faster than we would see with typical kids."

Light is a pioneer in the field and has found success with many of her patients.

While working with 15-month-old Jackson, who has Down syndrome, Light said he responded immediately the first time he saw the computer. Within eight months, Jackson was repeating sounds and only a year later he was choosing his own games.

Another patient, 2-year-old Gareth, who has cerebral palsy, is able to make sentences and even play a game of "Go Fish" with the computer.

"These kids now have the opportunity to communicate, to learn language, and to learn the kinds of concepts that other children are learning," said Light.

The decades-old assistive technology now being adapted for use in children is finally allowing that tiny voice trapped inside to come out and be heard.

Mirror used at the Bobath Wales Therapy Centre for cerebral palsy patients"Engineers at the New Jersey Institute of Technology in Newark recently began a five-year study of video games that can be applied to the treatment and rehabilitation of cerebral palsy patients," according to NorthJersey.com.

A $4.75 million grant will fund the study, which will have patients use a specialized glove to control in-game movements (in a piano simulator, for instance), stimulating the brain through force-feedback to hopefully "rewire" the brain and help restore hand function.

This ultimate form of brain training has also been studied with rehabilitating stroke victims. The goal here is to make therapy more efficient by requiring less professional supervision (thereby reducing costs) and also to "make therapy more fun and engaging for the patient, which in turn could make treatment more effective." It's hard to find a more noble pursuit for games than this, so we certainly wish them well.

Source: http://www.joystiq.com/2006/02/28/trial-to-study-games-in-cerebral-palsy-patient-rehab

Britt Allen sat in front of a computer, blue electrodes attached to his face and multicolored wires running from the electrodes to a small box next the machine. His eyes focused on the screen as he used his left thumb to type out a message to Maureen Gates.

She adjusted the settings on the computer, raised the screen and the 24-year-old Salt Lake City man got back to his activity -- shooting aliens with his eyes. Once the settings were right he was on target, and 10 little green men exploded one after another, each in an average time of 1.7 seconds.

Allen, a spastic quadriplegic with cerebral palsy, is the poster user for Eagle Eyes, a new technology that allows people with severe disabilities to use computer programs by moving their eyes. He demonstrated the process at Oakridge School in Springville, Nebo School District's school for children with severe disabilities.

The Opportunity Foundation of America donated two sets of equipment to Oakridge on Wednesday. The school will be a testing center for students and also will be the training school for other schools in Utah.

The technology offers a way for people with autism or other communication disorders to communicate. Using their eyes to move the mouse, they can select between food choices, activities, feelings, locations of pain or illness or, in some cases, answers to a medical college admission test. It can teach cause and effect, communication and education.

But its purpose is much simpler.

"The first is fun, first is gratification," said Gates, a project director for Eagle Eyes, which was created by Dr. James Gibbs at Boston College. "Second is gratification. Third is empowerment. Fourth is education."

The technology was created for people who can only move their eyes. The electrodes track the eye movement and act as a mouse substitute that is set to click after about half a second. Whatever the eyes are focused on, the program selects.

"It goes from fun and excitement to control over your own life," Gates said.

Oakridge Principal Richard Kay said as soon as he found out about the technology he wanted it, and after months of meeting with foundation founder Debbie Inkley and going to Jordan Valley School to see the equipment and go through training he was glad to get it.

"We're going to try every student in the school, whether they meet the physical requirement or not," he said.

Oakridge has a full-time staff member who will assess the progress of students using Eagle Eyes as well as training other administrators. The technology costs about $1,200 per unit and can be used with a regular computer with Windows XP.

Monday was an exciting day for Inkley as well, who has made the goal of her foundation to distribute the technology. She introduced Allen and the technology, visited with Oakridge staff and parents of children who'd used the program and flashed a big smile as she handed the goody bag with the equipment to Kay. She also cheered when Allen hit his final alien and led the applause when he made a big announcement through a computerized voice box.

"I am engaged," he told everyone in the room with a big smile.

"This isn't a magic wand," Inkley said, cautioning every parent that Eagle Eyes doesn't cure disorders.

But it is something.

Heidi Toth can be reached at 344-2543 or htoth@heraldextra.com.

Source: http://www.heraldextra.com/content/view/163069/4/

Scott Stephens, Plain Dealer Reporter

Avon- The printer is out of paper, and Tim Caskey is about to catch hell.

"You're out of paper, old man!" Harvey Graham snarls in mock anger. "Tim's getting old. He can't remember things anymore."

Caskey chuckles and shakes his head. He's used to the abuse.

In fact, he kind of likes it.

The good-natured banter is all part of Caskey's 4-year-old Computer Skills Development Program at Our Lady of the Wayside, a nonprofit agency that provides services to more than 180 people with developmental disabilities such as cerebral palsy and mental retardation.

The program teaches mentally disabled adults basic skills, including writing and sending e-mail and navigating the Internet. Touch-screen technology, jumbo mouses and extra-big keyboards help even the most severely disabled claim a small piece of the information superhighway.

More than two dozen adults from across Northeast Ohio travel to Avon on Tuesday or Thursday nights or Saturday afternoons to work on their typing skills, make holiday decorations for their group homes, correspond with friends and family or visit their favorite celebrity Web site.

The class represents a crack through which they can temporarily escape their disabilities and see the light of the outside world.

"We have a waiting list," says Caskey, a special-education teacher by day at Cleveland's Audubon School and the sole instructor of the computer-skills program since its inception. "It's important to them that their housemates know that they're in this class. It's got a certain cachet to it."

No one can recall a program exactly like Caskey's class - in Ohio or anywhere else. 

"We're not aware of anything like it," says Terry Davis, president and chief executive of Our Lady of the Wayside. "It's unique, and we've been very pleased with the results."

Truth is, the uniqueness of the program is also a sort of disadvantage. Foundations and other potential funding sources don't know how to categorize the class.

Is it an adult special-needs program? A technology program? An education program?

"It's unusual, and that's what's made it difficult to find foundation help," Caskey says.

But with donations from the Stocker and Nordson Corp. foundations, the program has maintained and slowly grown. There are now 28 students.

The genesis of the program is as unusual as the class itself. Five years ago, Caskey was moonlighting at a Micro Center computer store, teaching a free beginners class that the retailer offered to its customers.

A man in the class looked as if he would rather be anywhere else in the world. Caskey figured the guy's wife forced him to attend.

"The guy was just bored to tears," Caskey recalls. "I thought, 'Man, I'm losing this guy.' "

But Caskey hadn't lost the guy, who turned out to be Dick Griffin, then a member of Our Lady of the Wayside's board of directors. Griffin envisioned a similar kind of class for the agency's clients, and he asked Caskey to come to his office the next week and talk.

Six months later, Caskey launched the program as a six-week pilot. It was an immediate success and has continued ever since. 

On this winter evening, Craig Breeden quietly composes an e-mail. Ron Dobrinski and Patty Culley huddle at another computer, engrossed in a spirited game of "Spin and Win." The cantankerous Graham is searching the Internet for information about commercial motor coaches, one of his many interests.

He has chosen the country and western tunes that fill the classroom this night.

"It's a balancing act," Caskey says later. "You try to keep everyone engaged."

Skill levels vary dramatically. For some, printing out a snowman or wreath for a wall decoration is a major accomplishment. For others, there are few boundaries.

One student, for instance, has apparently memorized a Web site that features home listings. Ask him what a three-bedroom, two-bath, 2,220-square-foot home on West 227th Street goes for, and he will give you a remarkably accurate quote - depending on whether it has air conditioning and a finished basement.

"You get a whole new appreciation of how this little computer works," says Caskey, pointing to his head.

What the class means in the lives of his students - and their families - has startled Caskey from time to time. Several years ago, a student named Reed died. At his funeral, Caskey was approached by Reed's younger sister, a Denver school teacher. She hugged him.

"He would e-mail his sister, and she'd e-mail him back," Caskey says. "She told me she found out more about her brother through those e-mails than she had ever known before."

Unfortunately, the woman had lost her brother's e-mails. But Caskey was able to retrieve the files, print them and send them to her.

He received a gracious thank-you note in return.

^^^^^^^^^^^^^^^^^^^^^^^^^ "It's gratifying," Caskey says. "They are exceptional people. I've learned far more from them than I could ever teach these guys."

Source:http://www.cleveland.com/news/plaindealer/index.ssf/base/lorain/113610792979670.xml&coll=2&thispage=1

By Ken G. Knott, M.D. And Christopher Grant, CHT

A person can survive a few days without water, and weeks without

food, but if the body is deprived of oxygen, biological death begins

to occur within three minutes. The same goes if you deprive just

an area of the body of oxygen, such as the brain.

When brain tissue has been damaged due to an injury, a lack of blood flow or a lack of oxygen, the cells that surround the injured area, called the penumbra, may only be receiving a fraction of the blood flow and oxygen they need for optimum health. This disruption creates impairment of cell function. The cells become dormant and may remain permanently impaired.

Hyperbaric Oxygen Therapy (HBOT) for brain injuries is based on the theory that even if brain tissue has been injured, the dormant cells surrounding the injured area can be revived. To do this, the blood supply to the dormant cells needs to be improved.

A hyperbaric oxygen chamber, in which a patient lies, is pressurized with 100 percent oxygen to greater than atmospheric pressure. While at a typical treatment pressure of 1.5 atmospheres absolute (ATA) (equal to 7.5 psig or 16.88 feet of sea water) the patient would be breathing an equivalent of 150 percent oxygen or oneand- a-half-times more oxygen molecules in each breath. This will allow the plasma to carry 10 to 15 percent more dissolved oxygen throughout the entire body including areas with decreased blood flow. This is the first step in “flipping on the switch.” When given daily, HBOT stimulates a process called angiogenesis or the formation of new blood vessels. These new blood vessels form slowly in the vicinity of the damaged tissues, providing more blood flow and oxygen to the dormant cells. This revives the dormant cells and allows them to resume their normal function. With many brain injuries, edema and hyper-perfusion can be present even for year’s later. In the initial stages, HBOT can reduce this state by vasoconstriction, which decreases blood fl ow to these areas which in turn allows them to normalize. Simultaneously, an increased percentage of oxygen is being delivered to the tissues. The result of angiogenesis and vasoconstriction is a permanent structural change in blood supply to the damaged brain tissue and an important contribution to the degree of recovery from the brain injury. We have seen brain injured patients experience various results as early as the first treatment and even more after 20 treatments. Some patients don’t see anything significant until a few weeks after their fortieth treatment. So, how many treatments should we initially do? Is some better than none? Well some is better than none and it all depends on the individual case. If a patient is treated early, within 48 hours, one can sometimes evoke a greater response with a lesser number of treatments. However, as the result of many case studies, we know that non-acute patients who have completed an initial set of 40 consecutive HBOT treatments can make positive changes in which the majority, if not all, become permanent.

The reason involves basic physiology. With the increased oxygen in the plasma, the dormant brain cells “turn on” or “awaken” from their dormant state. As function returns, we see clinical changes in the patient. The reason the cells are dormant is due to a lack of blood flow and a corresponding lack of oxygen. So, if the plasma is the only thing delivering the oxygen, and you stop HBOT, then you stop giving those cells the oxygen they need to remain functioning and they become dormant again. Many times theses patients do not regress completely but they do lose some of what they may have gained. If a patient completes the full 40 treatments, regression is typically absent and more gains continue for weeks and months after their fourtieth.

It has been shown that capillary budding (growth of blood vessels) can begin as soon as the 8th treatment. The capillary further develops by 20th treatment but it is not completely stable. By 30th to 35th treatment the capillary becomes increasingly stable and by the 40th treatment the new capillary is essentially permanent. This has been proven time and again with non-healing wounds and the salvage of grafts and flaps. HBOT has been stopped prematurely in patients who were showing signs of healing of wounds, grafts or flaps. A few days later, the wound began to deteriorate and the wound, graft or flap fails. Although the histology of the capillaries is different when comparing brain capillaries to those found in other areas of the body, a capillary basically grows the same in the foot as it does in the brain. Physiology is physiology.

Case Study I

Six year old female -

Patient with failure to thrive and resultant cerebral palsy began her

first set of hyperbaric treatments in September 2001.

Protocol: 11-HBOT session at 1.6ATA for 90-minutes and 3-HBOT

sessions at 1.6ATA for 60 minutes (Equivalent of 20.5 one-hour

treatments).

Gains: less moody, calmer, attempted to do puzzles, was able to touch

nose, ear, etc. on command.

Regression: less interest in puzzles, more excitable, less awareness. In July 2002 the patient completed an additional 20 HBOT sessions. Protocol: 20-HBOT sessions at 1.6ATA for 60 minutes. Gains: able to complete 20-piece puzzle, attempted to open/close car door, improved school performance, less disruptive, less seizures, improved ability to follow directions, walked with assistance. Regression: gradual loss of ambulatory skills, more disruptive, less attentiveness to directions or commands, limited interest in puzzles. In November 2003 she started 40 consecutive HBOT at a new

hyperbaric center.

Protocol: 40-HBOT sessions at 1.5ATA for 60 minutes. Gains: more appropriate response to commands, improved speech pattern (pronunciation), signifi cant behavior change (improved by “70 percent” according to mother), seizure activity diminished, independent play activities improved, speaking in phrases, walking with minimal or no assistance, routine eye contact and virtual completion of toilet training.

No regression.

Upon follow-up of patient 2 months post Gains - integrated into more advanced educational environment, more improvement in speech pattern, a continued ability to engage in play, and a continued ability to ambulate with minimal or no assistance.

No regression.

Upon follow-up of patient 6 months post-HBOT no regression.

Initial SPECT scan - October 2003.

Post HBO SPECT scan - January 2004.

SPECT scan difference of Brain Blood Flow (BBF) between

pre-HBOT of 40 treatments and post-HBOT: 45 percent global

increase of BBF

Impression and Comments: In retrospect, the patient appeared to benefit from the initial HBOT treatment regimen, but regression was noted. The second 20 HBOT treatment regimen also showed a positive response, however regression was again noted. When the patient was given a 40 HBOT treatment regimen, there did not appear to be any regression in any area. There are certainly no guarantees, however, based upon the results seen with this patient, but it does appear that permanent changes are more likely to occur with an isolated 40 treatment program as opposed to an isolated 20 treatment program.

Case Study II:

2-day old male -

Protocol: 5-HBOT sessions at 1.2 ATA for 60 minutes. After a full term, normal pregnancy, mother experienced a difficult vaginal delivery of a 10 pound -10 ounce boy. The infant’s left shoulder became lodged during delivery and the doctor worked for more than four minutes to dislodge the infant’s shoulder. Once delivered, the infant cried weakly and went into shock. The respiratory department was called stat and worked on the infant for more than three minutes. He subsequently began crying and fully stabilized after 20 minutes. After examination by two different pediatricians, both stated the baby was fine, but no prognosis was offered. The infant was released at 32 hours of age and began hyperbaric oxygen treatment at 40 hours of age.

During the first treatment while in the HBOT chamber, the infant became visibly more alert. After removal from the chamber, the infant exhibited a much stronger vocal response as well as cooing and was much more animated. No additional changes were noted during the next four treatments.

Upon follow-up, the patient reached 95 percent level of growth and development and started walking at 10 months of age. In addition the mother’s back pain resulting from the epidural injection decreased by 80 percent after first treatment and was gone after the second treatment.

Impression and comments: This particular case study is an example of using HBOT in an acute setting to reduce potential neurological problems resulting from oxygen deprivation. It also illustrates the safety of the use of HBOT in young children. Due to the extreme low age of the infant, a pressure of 1.2 ATA was utilized even though 1.5 ATA would have most likely been well tolerated and indicated. 

Conclusion:

Unfortunately, HBOT treatment for neurological conditions is not paid for by insurance companies. However, payment policies by insurance companies do not necessarily follow what is medically indicated. The two foregoing case studies illustrate a typical response by patients given the appropriate treatment regimen with HBOT. All patients are different and as a result, no two patients respond equally. However, the vast majority of brain injured patients, particularly those with damage due to reduced amount or lack of oxygen, responds very well to HBOT given at 1.5 ATA for 40 one-hour treatments on either a daily or twice daily basis.

Of course, the question may arise as to whether or not a lesser number of treatments would suffice. It’s easy to pick a number, but in our experience, we now know that we are seeing significantly less regression with the 40 treatment regimen as opposed to a 20 treatment program. In addition, we have seen further improvement in many patients who have undergone more HBOT after a break from their initial set of 40 treatments, but 40 seems to be the minimum starting point for non-acute patients. Remember, physiology is physiology.

Source: Cerebral Palsy Magazine Decamber 05

Ed Yeates Reporting

Santa used a special workshop, hidden away on Utah State University's campus, to build a unique tricycle for a seven-year old girl. This weekend it was under her Christmas tree with the fresh smell of paint still lingering in the air.

If Katelyn Roberts’ shiny new tricycle looks different, it is! That's because it was custom designed just for her. Katelyn has cerebral palsy. Up until this weekend, she could hear and see kids outside playing, but couldn't join them.

Tammy Roberts, Katelyn's Mom: "So I brought her out a few times, but she would just sit on the sidelines and watch."

But no more sitting on the sidelines. With special pedals to keep her feet strapped in, a wide edged seat to hold her from sliding, special handlebars, and a guide bar in back , Katelyn will soon be on her own.

If Santa ever had a tucked away workshop, it’s at Utah State University. The elves in this case are some ingenious students with faculty, creating all sorts of gadgets to help disabled people fulfill a few dreams.

Sachin Pavithran, who’s been blind since he was about six-years old, is one of those special designers. He's currently working with a professor on a robotic navigational system for blind people.

Sachin Pavithran, USU Assisted Technology Specialist: "[At airports] Go to restaurants or gift shops they have. I can check out different products there. I don't just sit around and kill time."

Here's another project on the bench. It is in its very early stages, but eventually will help a woman with cerebral palsy when she cooks.

Starting with just pictures scratched on paper, an old typewriter stand, drawer slides, and discarded lifts become a new creation. Eventually…

Amy Henningsen, USU Occupational Therapist: “She'll slide the food onto the surface, slide it back, close her oven door. Then there will be a screw mechanism that will raise this up to counter height and slide it over to the counter."

A jogger for a disabled marathon competitor, special beds, chairs, the list goes on. And all at no cost for folks like Katelyn who want to push the envelope for independence.

Source: http://www.ksl.com/?nid=148&sid=143585

Deep in the basement of Toronto's Bloorview MacMillan Children's Centre, in a converted laundry room, Dr. Tom Chau is using technology to revolutionize pediatric rehabilitation.

Physicians and therapists have traditionally focused on curing or reversing disabilities. If there was no hope for either, medicine looked on its work as a failure. Not Dr. Chau.

The 35-year-old award-winning engineer has spent six years creating new ways children with temporary or long-term disabilities can use whatever mobility they have to tackle day-to-day challenges most people take for granted.

With his devices, children can use the blink of an eye or the wiggle of a finger to trigger a computer that lets them communicate with their parents or caregivers. Dr. Chau has harnessed the ultra-low-frequency sounds of muscles to activate and control prosthetic arms. He has taken an approach used to monitor quality on assembly lines and created a lightweight neckband that sounds an alarm when a child has difficulty swallowing. A computer-driven system allows children to play tunes on a simulated piano even though their small hands may be incapable of striking a single key. He has also created a table-like sensing device that enables therapists to accurately measure a child's ability to grip a pen or pencil and exert enough pressure to progress to learning to write.

"Nobody has even looked at that since the 1950s," he says. "Yet it is essential to be able to measure a child's abilities before therapists can decide whether to abandon trying to teach the child to write."

Dr. Chau's work is breaking new ground in the way health care professionals look at disabilities, says Dr. Peter Rosenbaum, Canada Research Chair in pediatric disability at Hamilton's McMaster University and former chief of medical staff at Bloorview MacMillan.

"He is making an enormous difference in the lives of both disabled children and their parents," he says. "If the child can blink a single eye, Tom will find a way to use technology to restore some elements of normal life to that child."

The key, says Dr. Chau, who speaks in tones as soothing as silk, is to accept a child's limitations, find out what the child is able to do, and build on that.

Dr. Chau and his team of two postdoctoral fellows, 10 graduate students and half a dozen undergraduates use off-the-shelf PCs and monitors, new and existing software, advanced circuitry, tiny microphones and space-age materials to craft one-of-a-kind devices, some of which may find widespread commercial applications.

Their small laboratory operates on a modest budget of $600,000 a year. It has waist-high Formica shelving piled with electronic components, looking more like the back room of a strip mall computer repair shop than a world-class laboratory.

Yet world-class it is. Dr. Chau last year was granted a prestigious Canada Research Chair in pediatric rehabilitation, which guarantees him a five-year grant of $500,000 annually. This year he won the Ontario Professional Engineers' Young Engineer of the Year award.

The money allows him to continue with his work and the recognition may help attract private donors -- to date, his laboratory has been operated on a shoestring. When he decided to leave a lucrative job at IBM Canada six years ago, Bloorview MacMillan welcomed him -- as long as he could find his own funding.

"The first few months were spent writing grant applications," he says. "I was lucky and found one fairly quickly, enough at least to pay me a small salary."

The $44,000 a year he drew for the next five years was less than half what he had been earning at IBM. Yet the emotional and intellectual rewards more than made up for the monetary loss, says the father of two (a third child is on the way). "Besides, my wife Grace is a very understanding woman."

Dr. Chau's father Frank was an engineer, and he credits his mother Irene with his dedication to improving the life of disabled children. She worked in palliative care at the old Riverdale Hospital, focusing on lending support and comfort to Chinese patients, many of whom spoke no English and had no relatives in the city. "I could see from her work the difference she made in people's lives," he says.

"When I graduated, I got a job with IBM working with a team that was re-engineering the processes at a Milton plastics plant," he adds. "I did well, they paid me good money, they even gave me an award. But I quickly realized this was not how I wanted to spend my life."

Instead, Dr. Chau saw enormous opportunities to use existing and leading-edge technology to greatly improve the lot of children. Take the Aspirometer as an example. Children suffering from throat cancer, birth defects or a host of other conditions often can't swallow very well. Dr. Chau borrowed from industry to create a throat band with a sensor, linked wirelessly to a processor and an alarm. The sensor recognizes the physical signature that proper swallowing creates, just as industrial sensors recognize the signature of production equipment operating as it should. If the signature varies, the processor knows something is wrong and triggers an alarm, alerting caregivers.

For amputees or those with birth defects, Dr. Chau's team created a subway-token sized microphone embedded in a tiny square of hard gel. The microphone picks up the low frequency sounds muscle and bone makes when performing physical movements. Those tiny sounds can then be used to trigger movement in an artificial hand.

An Ottawa company is now looking at using the Aspirometer technology in marketable devices, and a Mississauga company is considering commercial application of the prosthetics microphone.

Dr. Chau's newest research is into how cerebral palsy affects children's ability to walk. Walking, he explains, comes from a combination of stored memory and the ability of the brain to plan ahead. Cerebral palsy creates a disconnect between the two.

"If we can identify that disconnect, we might be able to find ways to deal with it," he says.

For children with cerebral palsy, progress comes in small steps, by crawling a few inches or even by rolling over.

Ryan Rothenanger's mother is ready for a new tack to help her 7-year-old son in his lifelong quest to adapt to the condition. Last week, Sydney Rothenanger watched through a window at a center on Indianapolis' Far Southside as three children worked with aides.

The Jackson Center for Conductive Education opened in July and has drawn praise from parents who bring their children from as far away as Mooresville and Lafayette. Conductive education is not new, but the center -- started by the mother of one of its students -- is the only place in Indiana to practice it.

Rothenanger visited one morning to see if the Jackson Center could rejuvenate Ryan's training in skills that come naturally for most but take repeated effort by children with cerebral palsy.

"He's come a long way," the Carmel resident said. But the dividends are shrinking in one-on-one sessions with speech and physical therapists.

Lara DePoy, the founder, listened as Rothenanger talked about what Ryan can do -- walk, with some assistance -- and can't do -- chew and swallow food with texture.

"That will change," DePoy said.

She has seen it in her own son, 5-year-old Jackson, for whom the center is named. She and her husband, Spencer, took him to a center near Chicago last year before raising $50,000 from family and friends to start their own in a donated business center office.

Conductive education pairs children with a "conductor," who works with them to learn how to overcome tight and restrictive muscles and posture problems.

The goal is to help the children work through each problem and movement themselves so they remember how to do it.

DePoy, 32, Mooresville, is an occupational therapist. She said being around others with the condition helps the children learn. The method originated in the 1940s in Hungary, and that country's International Peto Institute of Conductive Education still has one of the few training programs for conductors. One graduate, Zsu Zsi Borcsok, moved to Indianapolis last year from a center in Cleveland to help DePoy.

"We are more holistic," Borcsok said of conductive education. "The human can be changed, but the disability cannot.

"Those kids are capable of so much more than they're given credit for."

The Jackson Center's students attend three-hour classes three days a week for four-week sessions. During the summer, the center will expand sessions to five days a week.

Over time, they learn to sit independently, walk using a support, pull themselves up and use a toilet. Cerebral palsy often comes with mental disabilities, but the Jackson Center's students vary. The age range is 17 months to 8 years.

Conductive education, like any treatment, is not a cure.

The United Cerebral Palsy Research and Educational Foundation has not endorsed it, although Dr. Mindy Aisen, its director, sees value in intensive practice. More research still is needed on the differences between conductive education and other methods, she said.

Angela Gottlieb, 35, has seen her daughter, Karliee, 4, learn to express herself verbally and crawl at the Jackson Center. She can walk with assistance.

"It was really more just a shot in the dark," she said. Gottlieb, who lives on Indianapolis' Far Southside, said Karliee's progress has amazed her.

Count Rhoda Waiss, 39, among the devotees. She waited for her son, 5-year-old Liam, to finish class Friday before driving him back to their home on Indianapolis' Northside.

The family will move to Florida soon because of her husband's job transfer, she said. There's no question they will continue with conductive education.

"We will not be without it," Waiss said.

But their new city lacks a center. Again, she said, there is no question -- after studying the DePoys' efforts, she will start a new center there.

Researchers from the Department of Surgery and the Department of Sport and Exercise Science at The University of Auckland are collaborating to investigate a new hi-tech activity monitor that could identify ways to help improve the way children with cerebral palsy walk.

Lead investigator, Associate Professor Sue Stott,of the Faculty of Medical and Health Science’s Department of Surgery says the new device, called IDEEA, gives data about levels and types of body movement, and could be used to monitor the daily routines of children with cerebral palsy.

“This information could then help doctors and physiotherapists tailor surgery and treatments to improve their walking ability,” she says.

While the device has been used primarily with overweight adults overseas, it has not been used on children any where before, and this is the first time it has been used in New Zealand.

The two-year pilot study has been funded by a Health Research Council strategic development grant. The sophisticated devices cost $US 5000 each.

Associate Professor Stott will test the device on both those with cerebral palsy and those with no walking difficulties. She is looking for participants, aged between eight and 25, for the study.

“We will test to see how effective it is on children with cerebral palsy, and if it could be applied to other situations, such as measuring activity levels in overweight children,“ she says.

Cerebral palsy is a condition caused by damage to the motor control areas of the brain during pregnancy or immediately after birth. Children with cerebral palsy have difficulty walking, and lack of balance and co-ordination because of poor motor control and muscle weakness. These problems generally become more accentuated as they grow older and heavier.

While the condition affects less than one percent of children in the general population, it is much more prevalent among children with very low birth-weights, where incidence runs at about five percent.

Associate Professor Stott is also a paediatric orthopaedic surgeon at Starship Children’s Hospital and carries out multi-level surgery to improve the walking ability of children with cerebral palsy.

“We know that our surgeries have improved the walking speed of many children, by testing them post-operatively in the University of Auckland Gait Laboratory, but we have not previously been able to objectively test the impact of surgery on their function in the community - does it mean they can climb stairs more quickly and are they using wheelchairs less often?

“The monitor will be able to give us this type of information which means we would be able to better predict the outcome of different surgeries and tailor post operative therapies more effectively.”

The monitors are worn on a waistband with sensors attached to the body and can collect data for up to two weeks. This is then downloaded through special software to give the amount of time spent running, walking, standing, sitting, lying down and climbing stairs.

Amy Hogan, a former patient of Associate Professor Stott, has cerebral palsy and will take part in the study. The 19-year-old University of Auckland student has spastic quadriplegia, and has undergone numerous operations over the years to improve her walking ability, including a marathon 13-hour session under anaesthesia in which seven different operations were carried out to adjust her gait.

It has become increasingly difficult for her to walk as she has grown older, and she says that without the operations and ongoing physiotherapy she would be confined permanently to a wheel chair.

Source: http://www.health.auckland.ac.nz/news-events/news.shtml?id=302&from=more

Corey Hume can barely use his arms and legs and spends most of his time in a wheelchair.

Still, the second-grader from Maine Elementary School in Beavercreek rides horseback, plays soccer and swims as part of his therapy for cerebral palsy, a general term for a group of permanent brain injuries that affect an infant in the womb, during birth, or in the months following birth.

He also dives.

The 8-year-old son of Chris and Cara Hume of Beavercreek is one of five children so far to "dive" into a hyperbaric chamber at Wright-Patterson Air Force Base Medical Center as part of a study to see if pure oxygen delivered in a pressurized chamber can improve motor functions in children with cerebral palsy.

"Hyperbaric oxygen has been used all over the world," said Dr. Daniel Lacey, a pediatric neurologist with Children's Medical Center who is leading the joint study with Wright State University's Boonshoft School of Medicine and Kettering Medical Center.

"Tens of thousands of kids have been put in these chambers mostly because traditional medicine doesn't have a whole lot to offer kids with cerebral palsy. Unfortunately, there have not been many good research studies to show that it works."

Cerebral palsy afflicts about two children out of every 1,000 born in the United States, according to CerebralPalsyFacts.com. Patients may have rigid muscles and limited motor skills, speech difficulties, learning disabilities and other problems.

How it works

It's called a dive, but no actual diving, as into a water tank, is involved. Instead, children seated in a chamber about the size of a hospital room wear a plastic hood over their heads. Each is tended to by a nurse or health clinician. The atmospheric pressure inside the chamber is raised, mimicking the experience of scuba diving, and pure oxygen is delivered to the patient to stimulate damaged or dormant brain cells.

"These brain cells are sleeping or idling; they're not fully functional," Lacey said. "If you can get more oxygen deeper inside the brain, then you can awaken them. That's the hope and the theory."

The sessions last about an hour, five days a week for eight weeks. For comparison purposes, half of the children receive 100 percent oxygen; the other half receive the equivalent of room air, which is about 21 percent oxygen.

Researchers will look at each child's gross motor functions when the 40 treatments are completed and again three and six months after that.

If Lacey's study, scheduled to be completed in 2009, shows the therapy is effective, it could help convince insurance companies and the government to cover the cost, which averages about $100 per treatment, Lacey said. It could take up to 100 sessions to be effective, he said.

The treatments are free, however, to the families that participate in the study, thanks to a $1.77 million federal grant the hospitals landed with the help of U.S. Rep. Dave Hobson, R-Springfield.

But researchers still need more than 80 children to sign up, and they're looking for volunteers. The children must be 3 to 8 years old and have never received hyperbaric treatments.

Once the study is completed, the children who did not receive 100 percent oxygen will be invited back for treatment if the therapy is shown to be effective.

For the Humes and son Corey, the study was an opportunity they could not resist.

"I think it's worth the investment (of time). And for people in the Dayton area, it's never going to be any closer, it's not going to be any cheaper and it's probably not going to be any safer," Cara Hume said.

Source: http://www.daytondailynews.com/localnews/content/localnews/daily/0415hyperbaric2.shtml

Biomedical engineers at New Jersey Institute of Technology (NJIT) will use new technology to help children with cerebral palsy improve their movements, reduce stiffness in their joints and live fuller and more independent lives.

Small robots mounted on wheelchairs, interactive video games and a robotic arm that can be programmed to guide and aid human motion - these are just a few of the technologies the engineers will use to help these children improve their muscular control and movements.

"Those of us without disabilities can't really understand how much extra effort goes into doing the things of everyday life," said Richard Foulds, PhD, an associate professor in the biomedical engineering department at NJIT. "In a nation of technological riches, there is no better way for engineers to use their creative talents than to find new methods and devices that help children with cerebral palsy overcome their daily barriers."

Foulds is director of the newly formed Rehabilitation Engineering Research Center (RERC) at NJIT, funded by a $4.75 million grant from the National Institute on Disability and Rehabilitation Research, in Washington, D.C. The institute supports research for the rehabilitation of people with disabilities. The grant, awarded on Nov. 1, 2005, will run for five years.

The strength of the center, said Foulds, is the synergy it will create between NJIT and its collaborating institutions: Children's Specialized Hospital, Mountainside, the largest pediatric rehabilitation hospital in the country, which will be the clinical site for the research; Rutgers-New Brunswick, and the University of Medicine and Dentistry of New Jersey, (UMDNJ) Newark. Sergei Adamovich, PhD, assistant professor in the biomedical engineering at NJIT, and Bruno Mantilla, MD, a special lecturer in the same department, will serve as co-project directors for the center.

Children with cerebral palsy have limited use of their arms due to the discoordination of their neural motor control and stiffness of their joints. The stiffness results from spasticity, the involuntary muscle tightness that occurs in about two-thirds of children with cerebral palsy. These difficulties interfere with the way these children walk, play and perform the manual tasks needed for studying - writing, typing or holding a book.

NJIT researchers have been working with a robotic arm, called the Haptic Master, to help stroke patients overcome spasticity and re-learn the movements they need to live independently; and this robot will be adapted so the children can use it. A child with cerebral palsy will hold onto the robot's arm, which is programmed to perform intense, repetitive arm and finger motions. The children will do the exercises while watching virtual reality games on a computer - games that both guide their motions and make the therapy fun. They will also wear a computerized cable glove that helps them move their paralyzed fingers. The repetitive motions and exercises will eventually retrain their brains so that the children will have better manual coordination, Foulds said. The HapticMaster could eventually become a common form of physical therapy for children with cerebral palsy, he added.

Researchers at the center will create new interactive video games that can be played by children with cerebral palsy. The games will not use joysticks, which use only the hand, but will have components that involve entire body movements. These games will be customized for each child based on his or her therapist's input, and will encourage children to have fun while they improve their motion skills.

Another approach the center will use to reduce spasticity is to stimulate the balance system in the inner ear and generate neural signals that briefly cause the brain to send signals that relax the muscles. During the short period of time in which spasticity is also lowered, researchers will seek to understand how spasticity interferes with the children's movement. "It may even be possible to make therapy more effective so that their muscular coordination may be improved for the long-term," said Foulds.

Many children who use electric wheelchairs also have limited use of their arms and hands, Foulds said. Most are unable to move their arms through a full range of motion, and are thus unable to turn a door knob, get a glass of water or take a book from a shelf. The center will use two new robots that can be mounted on wheelchairs and programmed to help the children better control their movements and accomplish everyday tasks.

Children who sit all day in wheelchairs, moreover, do not receive the same mechanical forces on the long bones of their legs as children who walk. These children are thus more prone to developing osteoporosis. The center will study the bone loss in wheelchair users and develop a technology that applies mechanical forces on their long bones to help prevent osteoporosis.

In addition to research and development, the center will host a number of educational initiatives for NJIT students, children with disabilities and their families, added Foulds. These initiatives include online-information services, new graduate courses, and research projects conducted by students. Disabled students, both at the high school level and at the undergraduate level, will be invited to participate in the research projects.

Before coming to NJIT in 2000, Foulds developed and directed for 12 years the Applied Science and Engineering Laboratories at A.I. DuPont Children's Hospital in Wilmington, Del. Foulds built this laboratory into an internationally known center for pediatric rehabilitation. During his tenure there, Foulds initiated and directed three rehabilitation centers. Foulds, a former president of the Rehabilitation Engineering Society of North America, is a leader in the rehabilitation engineering community.

"New Jersey has a richness of rehabilitation resources that have been channeled into this new center," said Foulds. "We are poised to advance the understanding of pediatric disabilities and to improve the quality of new therapeutic techniques. The next five years will be both exciting and productive. Technology, backed with supporting research, offers the potential to change lives."

New Jersey Institute of Technology, the state's public technological research university, enrolls more than 8,300 students in bachelor's, master's and doctoral degrees in 100 degree programs offered by six colleges: Newark College of Engineering, New Jersey School of Architecture, College of Science and Liberal Arts, School of Management, Albert Dorman Honors College and College of Computing Sciences. NJIT is renowned for expertise in architecture, applied mathematics, wireless communications and networking, solar physics, advanced engineered particulate materials, nanotechnology, neural engineering and eLearning.

Robert Florida

florida@njit.edu

New Jersey Institute of Technology

http://www.njit.edu

Source: http://www.medicalnewstoday.com/medicalnews.php?newsid=33900

(NewsRx.com & NewsRx.net) -- Individualized interventions use new advances in assessing movement to increase mobility for people with cerebral palsy, according to Alberto Esquenazi, MD, an expert in physical medicine and rehabilitation.

"Medical science has ways to help children and adults with cerebral palsy increase their potential, improve their quality of life and function independently," said Alberto Esquenazi, MD, chair of the department of physical medicine and rehabilitation at MossRehab and Albert Einstein Medical Center and affiliated with the department of rehabilitation at Thomas Jefferson Medical College in Philadelphia. "We cannot cure their brains, but we can make their lives better."

Esquenazi spoke at an American Medical Association media briefing on advances in neurology in New York.

"We use computer technology - similar to the technology being used for computer animation, virtual reality and computer games - to help us more accurately analyze individuals' movement problems," said Esquenazi. "This technology lets us look at the complexities of each person's physiological system and helps us to see changes that we may be able to make to help improve mobility and, ultimately, improve their quality of life."

The computerized movement, or gait analysis, provides an objective measure of what needs to be corrected for each individual. A number of interventions that relax or lengthen muscles or correct muscle spasms are used to correct movement and posture problems. These therapies include drugs that relax the muscle and treat spasticity, like diazepam, which has a generalized relaxant effect on the body and brain. Other drugs, such as dantrolene, interfere with the muscle contraction process.

Another way to improve outcomes is to give injections of a drug directly into the spinal column. One such drug that has been delivered this way is baclofen, which blocks the signals to the muscles that tell it to contract. This drug is useful for treating spasticity. Delivering baclofen directly to the spinal column may make it more effective and can help avoid some of the side effects that occur when it is taken orally.

Other interventions include chemically blocking nerves, which can be done with agents such as botulinum toxins (type A or B), alcohol and phenol (a chemical agent similar to alcohol). Blocking the effects of nerves can help a muscle that has habitually been contracted to relax, providing more movement. "Chemo-denervation [blocks] should be used in the very early stages, because they often help us avoid surgery," said Esquenazi. Surgical intervention is used to lengthen tendons or muscles or to transfer tendons.

Cerebral palsy is a term used to describe the aftereffects of damage to parts of the brain that control movement and posture. This damage often occurs before birth, but usually does not progress; however, the effects on movement and posture persist. Cerebral palsy is often characterized by habitual contracture of muscles, affecting movement and posture. It is estimated that only 10-20% of children in the United States with cerebral palsy acquire the disorder after birth.

Computerized movement analysis, or gait analysis, is not only used to assess an individual's movement problems - it is also used to measure the success of treatment outcomes. "The problem is that we can't change the brain," Esquenazi noted. "We can, however, change results of the action of the brain. Having trouble walking or holding things in your hands can make people more dependent. Improving mobility increases ability to live independently in the community. Our goal is to keep people healthy, mobile and independent."

Source: http://www.intellisearchnow.com/pwrpub_view.scml?ppa=6ikplWZgljlqotZUfb%7D38%7Dbfej%5B%22

Cerebral Palsy (CP) is the general term for people suffering from lack of control of muscle and joint movements, due to injury to the brain, either during birth or as the result of a developmental “accident” caused to the embryo. Depending on the location and extent of the damage, CP can range from mild - with minor incapacitation, to severe, leading to the patient being confined to a wheelchair or bed, with practically no control of body functions and /or movement.

Recent world-wide technological advancements have improved the treatment and rehabilitation of cerebral palsy patients. The general term for the use of these methods to improve the lifestyle of CP patients is called Assistive Technology (AT).

AT devices include tools, equipment and services designed to compensate for, or enhance the function of the physical or mental capacities that are impaired in C.P. patients. These technologies are suitable for children and adults.

Augmentative Communication Devices (ACDs) help CP patients communicate with their surroundings and thus contribute to their independence. They range in complexity – from simple boards with pictures which enable a child to indicate certain needs - to sophisticated electronic speech synthesizers. This independence can result in a significant psychological boost for the patient. Speech synthesizers are connected to a portable computer with which the patient manipulates either by keyboard using their fingers or, in more severe cases, by a breathing apparatus that “translates” breadth in to speech via the synthesizer. One of the most famous individuals using this method is Stephen Hawkins who has lost virtually all of his muscle control due to amyotrophic lateral sclerosis. Yet, through various assistive devices including a computerized speech synthesizer, he is an international authority in cosmology and quantum gravity, and is the author of many books.

Manual communication boards are more reasonably priced ACD’s. They are inexpensive communication devices and are considered “manual” since they contain no mechanical parts. Communication is facilitated through photographs, symbols or words, which can represent the user’s message. A program called Boardmaker can be personalized for each individual’s needs.

BIGmack is a light, easily transportable device that uses pre-recorded messages, which the user can display to communicate his/her thoughts or needs.

Dynavox is a computer device designed for schoolchildren. With an interface that is quite similar to “folders” on a regular computer, the child selects school-topic related categories from the menu on the screen, which includes subcategories. Through this method, the child can communicate within any specific category.

In addition to communication devices, there have been technological improvements in mechanical assistance for CP patients. Many new devices have improved mobility, and include postural support, seating systems, open-front walkers, special canes and gait poles. New, improved electronic wheelchairs are granting mobility to more severely impaired patients. These advances are enabling even severely confined CP victims to reach an unimagined level of independence and communication.

On the social level, many international and national organizations are devoted to finding resources for the treatment of Cerebral Palsy and to support for victims of CP. Notable among these is the March of Dimes.

Many new breakthroughs for improving the conditions of CP patients are being achieved practically daily. Victims of CP and their families are discovering these technological breakthroughs on the internet and are benefiting directly from discoveries being made all over the world.