Meet Elizabeth Tyler-Kabara

    

I sincerely appreciate the opportunity to submit this request to Pedal with Pete. As you will read, the goal of my research is to use technology and specialized rehabilitation sessions to help people with cerebral palsy increase muscular function and improve their quality of life.

Recently, there is new evidence that rehabilitation using magnetoencephelography (MEG) and brain computer interfaces (BCI) in patients with limited motor function has resulted in increased areas of brain activation. These studies have been done in patients that have suffered strokes. This suggests that using the brain to think about an activity with feedback from a brain computer interface can increase brain activation. This could potentially lead to improved motor function as well as new applications for new communication devices.

In patients with stroke there have been a number of studies completed to look at ways to augment or enhance the results of rehabilitation. The use of MEG is non-invasive. It is most similar to an EEG but allows for better resolution of the brain signals. In the recent studies the signals from the MEG have been used to drive a brain computer interface. The training paradigm starts with the patient attempting to perform a specific movement. The signals generated are fed to the BCI and analyzed. As the training progresses the patient moves to only visualizing the movement with feedback from a cursor on a screen. These exercises are also coupled with continued standard rehabilitation or physical therapy. In previous studies new areas of brain activation have been seen, but long term studies have not yet been conducted to evaluate for changes in function. We believe that this might be a very effective form of rehabilitation for patients with cerebral palsy.

I am currently working with a group of bioengineers from the department of physical medicine and rehabilitation. Our current research programs include using MEG to provide the input for a BCI in normal subjects. We are developing simple tasks such as cursor control as well as use of a communication device such as a Dynavox. These studies are ongoing and not yet published. We are also working with patients with epilepsy who are undergoing placement of recording grids for evaluation of their seizures. While they are in the hospital with the electrodes in place, we are using the signals from their brains to use a BCI to perform similar tasks as with the MEG patients. These studies are also just beginning and are net yet published.

The current proposal would look at 10 children with cerebral palsy who have arm dysfunction. The first step would be to perform the tasks using a joystick and then incorporate the BCI so that the tasks would be performed by visualization. The primary task would include simple cursor control where the cursor starts at the middle of the screen and is moved to a target. This is done first with the joystick, then with the joystick in combination with the BCI and finally without the joystick (by visualization).  Patients would be evaluated by occupational therapy (OT) before the training session. They would receive standard OT during the course of the training sessions. Finally, a repeat OT evaluation would be conducted at the conclusion of the training session to assess any changes in function. The initial MEG images and subsequent MEG images will be compared to look for changes in brain activation as the patient progresses through the training. The study would take approximately 3 months with 10 weekly training sessions. Each training session would be approximately 1 hour (similar to a typical therapy session).

It is anticipated that we will see changes in brain activation. We anticipate we will also see some functional improvement. We hope to be able to predict which children would most benefit from this type of therapy. We also hope to gain a better insight into which children with CP might benefit from BCI for improved function in the future. 

Elizabeth Christine Tyler-Kabara, M.D., Ph.D.
Department of Neurological Surgery
University of Pittsburgh
Children’s Hospital of Pittsburgh