Applying NeuroTracker for Rehabilitation

New modes of rehabilitation are evolving all the time, however in recent years, some of the most promising therapy methods are being driven by neuroscience. If you aren’t familiar with NeuroTracker, this perceptual-cognitive tool is a training program which uses an immersive 3D environment and multiple object tracking to strengthen visual processing capacities and cognitive functions. The benefits of training include improvements in biological motion perception, visual information processing speed, attention, working memory, inhibition, and situational awareness, among other executive functions. Here we will cover why this neurotechnology provides some unique advantages for both physical and cognitive rehabilitation.

The Cognitive Effects of Injuries

Following injury or exposure to trauma, cognitive and visual processing systems can become affected. What most people find surprising is just how intimately the brain and body are connected.

For example, it is well known that problems or deficits with visual processing can dramatically impact balance. As such, these central cognitive systems are critical for achieving success in both physical and neurological rehabilitation programs. Here we will delve into the application of NeuroTracker, as an example of how cognitive programs can effectively assist individuals in their return to activities of daily living, and occupation.

Executive Function and Physical Rehabilitation

Physical rehabilitation programs that involve motor learning, such as learning to use a prosthesis following amputation, or gait training following spinal cord injury, place heavy demands on cognitive systems. For example, the loss of a limb has significant physical, psychological, and social impacts on a person's life. Ambulating with an above knee prosthesis requires significant cognitive effort, as the proprioceptive clues as to the position of the prosthetic limb in space are lost, and the loss of motor control at the ankle and knee affects balance strategies (Williams et al., 2006).

Activities during prosthetic rehabilitation, such as donning/doffing of the prosthesis and gait training, require both the physical skills of strength, balance, and coordination, but also the cognitive capacity to effectively learn these new skills and adapt them to complex environments. Several areas of cognition are thought to be involved in successful prosthetic use, including working memory, attention, and visuospatial function (Coffey et al., 2012). Likewise, executive control and inhibition are important for self-regulation and pain management. Executive control varies within people, and it is a non-constant resource that is prone to fatigue (Solberg et al, 2009).

Increased Cognitive Loads

Specific to spinal cord injury, spasticity, clonus, weakness, and postural instability may result in a more complex walking pattern, requiring far more information processing. These constraints prevent fluid and natural walking, and patients must generate adaptations that could affect the cognitive demands of the walking task. As attention is a limited resource, this increase in cognitive demand might be sufficient enough to decrease the patient's sense of security and ability to correctly integrate information from the environment. For motor skill in general, spinal cord injury patients have less control because of postural instability, lack of equilibrium, muscle weakness, and sensory loss.

To counterbalance those challenges, they must closely monitor their movements. As a result, more attentional resources are required to be given to sensory integration (visual, vestibular, and proprioceptive). This a key avenue where NeuroTracker fits in, providing an effective method to train executive functions to have increased stamina, as well as a higher resilience to fatigue during physical rehabilitation tasks that heavily tax cognitive systems.

NeuroTracker Training and Neuroplasticity

Neuroplasticity is essentially the brain adapting its neural pathways and synapses to respond to changes in behavior, the environment, neural processes, and injury. It can also involve neurogenesis, which is the growth of new neurons in the brain. The brain is incredibly adaptable, and changes itself to better respond to environmental demands. As injury and exposure to trauma can affect the strength and function of cognitive systems, NeuroTracker boosts brainwaves that have been associated with an increased state of neuroplasticity. It improves learning by repeatedly strengthening attention and executive functions in a way that allows the brain to rewire itself to become more efficient in performance of tasks (Faubert & Sidebottom, 2012).

For example, injuries that cause damage to the spinal cord or the loss of a limb will undoubtedly cause psychological trauma. The patient may have also experienced neurological trauma such as mild traumatic brain injury, or concussion. The emotional experience of psychological trauma can have long-term cognitive effects. The hallmark symptoms of PTSD and concussion involve alterations to cognitive processes such as memory, attention, planning, and problem solving (Hayes et al., 2012).

Strengthening Connections through Repetition

Over the course of twenty trials and each session performed, NeuroTracker elicits these cognitive systems in a way that is controlled and at the individual threshold of each user. The patented speed algorithms have been designed in such a way that they are continuously challenging the user at the upper limits of their tracking capacity, without overloading them to a point that it becomes too difficult.

Staying within this zone of proximal development allows for optimal learning and neuroplasticity to occur. This adaptation to individualized capabilities occurs on a moment to moment basis, providing a training program that is efficient, effective, and tailored to the individual.

Dual-Task Training for Gait & Motor Skill Acquisition

Not only does NeuroTracker elicit the cognitive systems required for effectively learning and mastering motor skills, but it allows for physical skills to be integrated into the training sessions. Once a user has consolidated their learning in a seated position, the next phase of learning involves incorporating proprioceptive and physical skills that progress in complexity to match the demands of the environment. The goal is to increase cognitive load capacity, which effectively prepares the brain to be increasingly adaptable to new environments.

This process conditions users to be able to perform at optimal levels on both tasks, in situations where there will be both physical challenges and demands placed on attention and situational awareness. In a physical rehabilitation setting, this can include tasks that incorporate balance, gait, strength, and coordination, all while NeuroTracking.

Dealing with Real-Word Needs

In a physical rehabilitation program, dual-task ability is especially important for not only mastering new skills, but for safety in executing them in busy or demanding environments. For example, being successful walking requires situational awareness, the ability to appropriately control limb movements, and the ability to navigate within complex environments to successfully reach the desired location. A pilot study by NeuroTracker's Chief Scientist, Professor Jocelyn Faubert indicates that attentional demands significantly increase the risk of ACL injury through changes in motor-skill function. With higher cognitive load on the individual, the landing mechanics of the lower limb can change (Mejane et al., 2019).

Though this is injury specific, it's logical to infer that this influence is generic to other motor-skill based injury risks, especially in individuals who are participating in a rehabilitation program to strengthen and re-train physical and neurological function. Additionally, dual-tasking has been demonstrated to severely affect gait parameters associated with fall risk in populations prone to falls, and dual-task cost has been associated with poor performance in neuropsychological tests of attention and executive function (Yogey-Seligmann et al., 2008)

Intervention and Assessment

NeuroTracker can be used as an intervention to improve the capacity to perform dual-tasking, and it can also be used as an assessment to examine the safety of performing certain dual-tasks during rehabilitation and daily activity. Simultaneous performance on two attention-demanding tasks not only causes a competition for attention, but it challenges the brain to prioritize the two tasks.

Using dual-task training can serve as a predictor of potential fall risk and injury, and it may be able to reveal deficits not seen during single task motor skills performed on their own. Typically, an individual will be able to effectively perform the tasks separately with a sufficient degree of precision and stability. When the cognitive task is introduced, performance on one of the tasks becomes significantly reduced. This means that either situational awareness and attention will be reduced, or the quality of the motor-skill itself will become compromised.

Progressive Results

As NeuroTracker is performed in a controlled setting at the individual threshold of the user, it provides the ideal method to assess the ability to safely perform a motor skill under increasing cognitive load. At the same time, the multiple object tracking paradigm also trains biological motion perception (BMP). BMP involves the visual systems' capacity to recognize complex human movements, as well as to predict the actions and intentions of others.

The relevance of biological motion perception can be seen in navigating a busy sidewalk or grocery store, competing in sport, as well as driving. This has implications for pain management and loading on the joints, soft tissue, and musculature of individuals recovering from injury. With time and training, users can develop both the cognitive and motor skills required to successfully return to day to day activities.

This matching of complex therapy needs with NeuroTracker’s flexible assessment and training allows clinicians to take their treatments to a much more advanced level. In fact, some leading neurovision specialists use NeuroTracker data to guide their whole intervention approach, utilizing insights from the results to gauge the effectiveness of other interventions, as well as to customize treatment to the individual’s needs every step of the way.

If you’re interested in learning more about the wider neurovision training approach, then also check out this blog.

What is Neurovision Training?

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References

Coffey, L., O'Keeffe, F., Gallagher, P., Desmond, D., & Lombard-Vance, R. (2012). Cognitive Functioning in Persons with Lower Limb Amputations: A Review. Journal of Disability and Rehabilitation, 34(23), 1950-1964. doi:10.3109/09638288.2012.667190

Faubert J, Sidebottom L. Perceptual-cognitive training in sports. J Clin Sports Psychol2012; 6:85–102.

Hayes, J., VanElzakker, M., & Shin, L. (2012). Emotion and cognition interactions in PTSD: a review of neurocognitive and neuroimaging studies. Frontiers in Integrative Neuroscience, 6(89), 1-14. doi:10.3389/fnint.2012.00089

Lajoie, Y., Barbeau, H., & Hamelin, M. (1999). Attentional Requirements of Walking in Spinal Cord Injured Patients Compared to Normal Subjects. Spinal Cord, 37, 245-250. doi:10.1038/sj.sc.3100810

Mejane, J., Faubert, J., Romeas, T., & Labbe, D. (2019). The combined impact of a perceptual–cognitive task and neuromuscular fatigue on knee biomechanics during landing. The Knee, 26(1), 52-60. doi: https://doi.org/10.1016/j.knee.2018.10.017

Nudo, R. (2013). Recovery after brain injury: mechanisms and principles. Frontiers in Human Neuroscience, 7(887), 1-14. doi:10.3389/fnhum.2013.00887

Nudo, R., Plautz, E., & Frost, S. (2001). Role of Adaptive Plasticity in Recovery of Function After Damage to Motor Cortex. Muscle and Nerve, 24, 1000-1019.

Phelps, L., Williams, R., Raichle, K., Turner, A., & Ehde, D. (2008). The importance of cognitive processing to adjustment in the 1st year following amputation. Journal of Rehabilitation Psychology, 53(1), 28-38. doi:10.1037/0090-5550.53.1.28

Solberg, L., Roach, A., & Segerstrom, S. (2009). Executive Functions, Self-Regulation, and Chronic Pain: A Review. Annals of Behavioral Medicine, 37, 173-183. doi:10.1007/s12160-009-9096-5

Williams, R., Turner, A., Segal, A., Klute, G., Pecoraro, J., & Czerniecki, J. (2006). Does Having a Computerized Prosthetic Knee Influence Cognitive Performance During Amputee Walking? Archives of Physical Medicine and Rehabilitation, 87(7), 989-994. doi:10.1016/j.apmr.2006.03.006

Yogev-Seligmann, G., Hausdorff, J., & Giladi, N. (2008). The Role of Executive Function and Attention in Gait. Movement Disorder Society, 23(3), 329-342. doi:10.1002/mds.21720

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