Journal of Neurologic Physical Therapy:
As a graduate student 15 years ago, I was extremely interested in regional brain contributions to motor learning. Magnetic resonance imaging scanners were not common, and to address my research questions, I was forced to recruit subjects with focal brain lesions. This was a tedious and inexact process that certainly extended my doctoral studies by a year. How times change. In my research laboratory today, we can induce temporary, virtual lesions with just a few minutes of noninvasive brain stimulation. Coupled with a stereotaxic system that employs the research participant's own magnetic resonance imaging–based anatomy, we can target any location and easily increase or decrease cortical excitability. Pairing noninvasive brain stimulation with practice of novel tasks has rapidly become a primary research tool for scientists who study motor learning and recovery of function after brain damage. This is just one small example; overall, rehabilitation-related technology has rapidly advanced to a point where I believe we are on the verge of major changes in how we both capture and stimulate change in individuals with neurological injury. Thus, I am very excited to share with the readers of JNPT the articles in this special issue on Technology in Rehabilitation.
For this issue I selected papers on technology spanning a range from those that may immediately impact rehabilitation to others that appear futuristic, but that I am confident we will employ within our careers. Already in our cars, phones, and watches, global positioning systems are common; in this issue Evans et al illustrate how they may be used to index community mobility following discharge from stroke rehabilitation. Tracking amounts of activity outside of the clinic can add valuable information to our understanding of disease progression; Cavanaugh et al show declines in community activity in people with Parkinson's disease. However, activity count data may be hard to interpret in the absence of an understanding of what movements were performed. Fulk et al have designed an in-shoe sensor that couples with a neural net to decipher whether an individual was walking, standing, or even running. Each of these technologies is already available and inexpensive and provides important information regarding community function and mobility that could be easily incorporated into rehabilitation interventions.
Other technologies are on the verge of becoming common. A major issue in neurological rehabilitation is the need for high amounts of practice1; the numbers of repetitions that stimulate neuroplastic change may exceed what a therapist in the clinic can realistically deliver. Here robotics offer an exciting future where practice can be customized to the client's particular interests (Fluet et al) or tailored to address specific sensorimotor deficits (Debert et al).
Finally, two articles highlight approaches that appear to be straight from science fiction but are rapidly being developed, tested, and refined and will be employed in the clinic in the near future. Noninvasive brain stimulation seemed impossible not long ago, but in her article, Harris-Love provides an excellent overview of how this technology may be used either to map or to stimulate brain function. Velk et al consider ethical issues surrounding the use of brain-computer interface in individuals with catastrophic neural damage. Because brain stimulation in isolation does not appear to facilitate learning or changes in function,2 the utility of both of these approaches will rely on pairing them with appropriate physical rehabilitation. Each of the technologies highlighted here offers an amazing opportunity for physical therapists to refine practice, enhance science, and most importantly become even better at restoring the function and quality of life of our clients.
The “cutting edge” is defined as follows: “The state of the art, the highest level of development of a device, technique, or scientific field.”3 The contributors to this special issue illustrate how technology can and will advance both the practice and the science of rehabilitation. With these technologies we are indeed on the cutting edge—well, at least for now. Who knows what tomorrow will bring.
1. Lang CE, Macdonald JR, Reisman DS, et al. Observation of amounts of movement practice provided during stroke rehabilitation. Arch Phys Med Rehabil. 2009;90(10):1692–1698.
2. Fregni F, Boggio PS, Valle AC, et al. A sham-controlled trial of a 5-day course of repetitive transcranial magnetic stimulation of the unaffected hemisphere in stroke patients. Stroke. 2006;37(8):2115–2122.