Can rehab robotics increase hand function and strength in people living with multiple sclerosis (MS)?
A new study is seeking to find out through use of the Wristbot, a made-to-order haptic device used to study arm and wrist biomechanics and motor control.
Two years ago, Kailynn Mannella, a then-Master’s student at Brock University, was halfway through training a group of 15 people living with MS to use the ‘Wristbot’ when the COVID-19 pandemic ground the world to a halt.
Early results were encouraging, and inspired a ‘proof of concept’ that she and her supervisor, Associate Professor of Kinesiology Michael Holmes, presented to the Multiple Sclerosis Society of Canada.
The Society subsequently awarded the team a two-year Catalyst Research Grant to pick up where they left off.
In this latest study, Mannella – now a PhD student in Health Biosciences – and her colleagues will involve at least 30 research participants living with all types of MS with “some function of their hand or wrist” in at least one limb.
At the centre of the research is the Wristbot. Housed in Brock University’s Neuromechanics and Ergonomics Lab, the equipment is the only one of its kind in a Canadian university.
In Mannella’s earlier study, when participants grasped the joystick, the machine alternated between helping them to manipulate the stick and providing resistance so that moving the stick was more difficult.
The robot used real-time feedback of the participants’ performance on a hand-tracing task to alter the muscular demands placed on the user, effectively delivering an individualised protocol to maximise performance and adaptation.
“We found that combining assistance and resistance led to participants reporting stronger muscles, reduced muscular fatigue and other positive outcomes,” says Mannella.
Besides expanding the research base to verify earlier results, the team is exploring whether the Wristbot can be used to bring about a phenomenon called ‘cross-education.’
“MS is a bilateral disease but there is often a more affected limb,” explains Holmes.
“Manual therapy and exercise for the limb that is more spastic or weak can be challenging to rehabilitate.”
He says that in addition to rehabilitating the stronger limb, the researchers hope their approach can strengthen and increase skill in the weaker (untrained) limb by stimulating neural pathways in the spinal cord and brain, known as cross-education (CE).
“Very little research has focused on the neurophysiology of CE in MS and thus the site of neural adaptation is not known,” says Holmes.
“We believe that a deeper investigation into CE using robotics could revolutionise MS therapy.”
The team’s research has three goals: develop an adaptive robotic training program for the hand and wrist; fully understand the adaptations of CE in people living with MS; and link objective data from the robot to participants’ subjective assessments of how they think Wristbot therapy is or isn’t helping them.
The team is aiming to start the research early next year.
