Rehabilitation neurotechnology: from the laboratory to everyday life

As part of the launch of the report Neurotechnology for human well-being, the Bankinter Innovation Foundation continues with the informative work through a new webinar. The report is the result of the meeting of our think tank Future Trends Forum, where we convened more than 40 internationally renowned experts to discuss the repair and enhancement of human capabilities through neurotechnology and other innovative applications, and to analyse the opportunities and risks that arise.

In this new webinar we have brought together two leading experts in neurotechnology and rehabilitation who participated in our think tank, Ander Ramos-Murguialday and Javier Mínguez, to explore the cutting-edge crossover between artificial intelligence, robotics, smart sensors and applied neuroscience for neurological rehabilitation.

This article focuses on the intervention of Ander Ramos-Murguialday and we will soon publish another with that of Javier Mínguez.

Ander Ramos-Murguialday is a leading researcher in the field of neuroprosthetics, brain-machine interfaces, and neural interfaces, focusing primarily on the rehabilitation or restoration of motor function. Leader of Neurotechnology and Translational Science at TECNALIA and group leader at the Institute of Medical Psychology and Behavioral Neurobiology of the University of Tübingen, he also leads the RamosLab laboratory, where applied clinical research is carried out, developing innovative technologies for the rehabilitation of patients with motor disabilities through the use of non-invasive brain-machine interfaces and neuromuscular stimulation.

Throughout the webinar, Ander Ramos-Murguialday shares his experience in post-stroke motor neurorehabilitation, through non-invasive and implantable neural interfaces and their combination with robotic exoskeletons and electromagnetic stimulation.

Here you can watch the webinar with Ander Ramos-Murguialday:

Advanced Neurotechnology: From the Laboratory to the Home (Ander Ramos-Murguialday)

Below, we summarize the key ideas and progress in neurotechnology for rehabilitation after a stroke that Ander Ramos-Murguialday shared during this webinar:

What is neurotechnology?

According to Ramos-Murguialday, neurotechnology is an intersection of multiple disciplines—including engineering, neuroscience, clinical, computer science, and mathematics—with two clear goals:

• First, to deepen our understanding of the nervous system and
• second, to develop systems capable of restoring or improving functions in people with disabilities of neural origin or even enhancing existing human capacities. This personal perspective underscores the transformative potential of neurotechnology in treating and improving the human condition.

Neurotechnology: a bit of history

Neurotechnology, a fusion between neuroscience and technology, has undergone a remarkable evolution since its inception. It all began in 1770 with John Walsh, who experimented with bioelectricity through the study of the rayfish, a discovery that Luigi Galvani would expand on in 1780 by defining animal electricity as bioelectromagnetism, marking the first documented interaction with the human nervous system. This discovery laid the foundation for electrophysiology.

Between 1908 and 1930, Edmund Jacobson delved into the study of the control of neuronal oscillations through muscle relaxation, highlighting the importance of bioimpedance. However, it was Hans Berger in 1929 who revolutionized the field by inventing electroencephalography, allowing for the first time the recording of the electrical activity of the brain.

Advances continued in the 1960s, when the first attempts were made to control brain signals and neurofeedback (a technique, which involves training the brain to improve its functioning) was introduced. In 1969, the viability of brain implants in primates was demonstrated, and in 1973, the first brain-machine interface (BCI) with humans was presented, opening up new possibilities for direct interaction between the brain and electronic devices.

In the 1970s, a chance discovery by Sterman revealed a correlation between neurofeedback and the reduction of epileptic seizures, demonstrating its first significant clinical application. Since then, and despite facing skepticism and challenges, including accusations of pseudoscience, the field of neurotechnology has continued to advance thanks to serious research and practical applications.

In the new millennium, significant advances have been made, including the use of brain-machine interfaces in humans to improve neuroplasticity and treat various pathologies, such as amyotrophic lateral sclerosis (ALS), epilepsy, and stroke.

Neurotechnology is not only limited to recording brain activity and stimulating the brain; It also includes stimulation devices outside the brain, such as pacemakers, which have been a part of our lives since 1958. In addition, cochlear prostheses and deep brain stimulation devices for the treatment of Parkinson’s are examples of how neurotechnology improves lives. Recently, the first visual prosthesis has been introduced, marking another milestone. This field, backed by significant investments from prominent figures such as Elon Musk and companies such as Facebook, is showing exponential growth. With approximately 2 billion people affected by brain or nerve disorders globally, the neurotechnology market is huge and promises even more impressive future transformations in brain-machine interaction.

Neurotechnology for the rehabilitation of post-stroke patients

Regarding the clinical applications of neurotechnology, there are:

• cognitive: depression, schizophrenia, dementia, cognitive impairment, etc.
• motor: hemiplegia, traumatic brain injury, demyelination, etc., and
• organic functions: constipation, erectile dysfunction, urinary incontinence, etc.

Of all of them, Dr. Ramos-Murguialday focuses in the webinar on motor application, and specifically, applied to patients who have suffered a stroke.

Stroke, a term that many of us have heard but may not fully understand, represents one of the most significant challenges in the field of cardiovascular medicine. This phenomenon, which occurs in the brain, can manifest itself in two main ways: as a hemorrhage, resulting from the rupture of a blood vessel, or as the obstruction of blood flow in an artery (thrombosis or embolism) that prevents blood flow to a specific area of the brain, leading to cell death.

The implications of stroke

The seriousness of stroke lies in its ability to interrupt the pyramidal pathways, essential for the transmission of the will to move to our muscles. This disruption resembles a “hole in the road” of our neural signals, resulting in a loss of motor control, decreased muscle mass and tone, spasticity (a hyperflexion that leads to excessive flexion) and alterations in muscle synergies – it is as if, when trying to stretch the arm forward, it involuntarily contracts towards the chest. evidencing erroneous or poorly connected neural connections.

Neurorehabilitation: A Ray of Hope

Using principles of instrumental learning, neurorehabilitation seeks to restore motor function by stimulating neuronal plasticity. Donald Hepp, one of the pioneers in the study of neuroplasticity, taught us that “two cells or two neurons that fire at the same time end up coming together.” In this sense, neurorehabilitation focuses on reconnecting the will to move with neuronal activity, through repetition and sensory and proprioceptive feedback, hoping to reactivate or generate new neural connections.

Brain-machine interfaces: a bridge to recovery

Brain-machine interfaces make it possible to record brain activity and even residual muscle activity. Through this technology, how and where the patient wants to move is decoded, facilitating that movement and promoting neuroplasticity. This approach seeks to reactivate silent neurons and, in addition, unite those that are active simultaneously, with the ultimate goal of restoring motor function.

Stroke, with its profound implications in the lives of those who suffer from it, poses a monumental challenge. However, advances in neurorehabilitation and the implementation of brain-machine interfaces open up a horizon full of hope. Through the understanding and application of these approaches, science is aimed at restoring autonomy and improving the quality of life of thousands of people affected by this condition.

Evolution of neurorehabilitation

Perseverance, innovation, knowledge, and multidisciplinary teams intertwine to redefine the boundaries of what’s possible in modern medicine. This is demonstrated by Ander Ramos-Murguialday, who reviews the projects he has been developing from 2007 to today and how they have managed to improve the lives of patients who have suffered a stroke:

Neurorehabilitation has undergone a radical change in recent years. In 2007, Ramos-Murguialday led a project in which patients controlled a rehabilitation robot using only their brain activity. This experiment, which involved the movement of stretching the arm and opening the hand, revealed that those patients who actually controlled the robot with their mind showed significant motor improvements. This finding underscored the importance of the direct connection between the brain and physical activity in rehabilitation. The project evolved into more complex systems, where brain and muscle activity combined to guide movement, improving the synchronization between the desire to move and action. The creation of the AMoRSA project, a rehabilitation scenario that integrated video games and patient-controlled avatars, marked a milestone in making rehabilitation more interactive and enjoyable, despite the complexity of its configuration.

Advances in neuromodulation represented a leap towards the commercialization of these technologies, with the development of portable sensors and simpler and more effective rehabilitation systems. The goal was to make neurorehabilitation more accessible and faster, removing barriers to its implementation in patients’ daily lives. Ramos-Murguialday also explored techniques such as transcranial magnetic stimulation, where the patient’s brain waves influenced treatment without their conscious intervention. This approach opens up new ways to improve communication between the brain and muscles, enhancing motor recovery.

One of the most challenging and promising aspects of this field is the improvement of brain signal decoding and the promotion of neuronal plasticity, crucial elements for the recovery of motor functions after events such as stroke. Current non-invasive technology, although advanced, has limitations in the accuracy of decoding. This limitation also leads to exploring how more accurate and faster decoding could significantly improve brain plasticity, since plasticity, or the brain’s ability to reorganize and adapt, is critical for motor recovery. Improving the ability to decode brain signals in real time could speed up this process, making rehabilitation more effective and efficient. To overcome these limitations, the transition to invasive technologies is contemplated , which, although they present risks, offer greater fidelity in the capture and decoding of brain signals. This approach is illustrated by Ramos-Murguialday in a multidisciplinary and transcontinental project, where a small array of microelectrodes was implanted in the motor cortex of a post-stroke patient. This procedure, performed with the support of multimodal imaging, allowed direct and precise communication with the brain areas responsible for movement. In addition, progress was made towards a hybrid control system, which integrates both the direct neural activity of the brain and the residual activity of the muscles. This fusion allows for more natural and effective control of assistive devices, such as robotic exoskeletons, facilitating a wider spectrum of rehabilitative movements.

The results of using this technology for a few months are testimony to its transformative potential: patients who initially had almost no functionality in their hands and arms began to perform practical functional movements, essential for daily activities. This recovery was not only reflected at the functional level but also at the neurophysiological level, demonstrating a remarkable similarity in muscle activity between the affected limb and the healthy one.

The culmination of these efforts is to bring neurorehabilitation to patients’ homes through video games that promote motor recovery. This approach places an emphasis on patient autonomy, allowing them to manage their own treatment and facilitating the integration of rehabilitation into their daily routine. Ultimately, the work of Ramos-Murguialday and her team reflects a paradigmatic shift in neurorehabilitation: from a clinical practice focused on the specialist and the team, to one that is more personalized, empowering, and integrated into the patient’s life.

After the presentation, Ander answered questions from webinar attendees:

Q on Neurorehabilitation with Ander Ramos-Murguialday

Does the brain relearn to move after a stroke by connecting neurons to generate voluntary movement through directed muscle movements?

Although a stroke can impede movement, the brain still tries to generate the activity needed to move. This effort produces brain activity that, although blocked by damage, can be “bypassed” with technology. By decoding these signals and attempting to move the paralyzed arm with an exoskeleton, residual muscle activity is enhanced. This process strengthens neural and muscle feedback, improving motor activity.

Can motor responses, for example in Parkinson’s patients, be conditioned by emotional and rhythmic stimuli?

Theoretically, yes. There is research that uses synchronized auditory rhythms to restore certain neural rhythms, such as those affected by Parkinson’s. However, this method is indirect and complex, and its effectiveness has not yet been conclusively proven.

Are there studies that apply neural interfaces in patients with multiple sclerosis?

Although tests have been done, there is no evidence to date that these therapies have restorative effects on neurodegenerative diseases such as multiple sclerosis.

How is the intention to move in people who have suffered a stroke determined and analysed?

Movement intention is detected through neural activity, specifically by non-invasive sensorimotor rhythms, which vary in amplitude during rest and movement intention. Invasive technologies allow for more precise decoding of the speed and direction of the desired movement. In stroke patients, muscle activity may not match intention due to erroneous neural reconnections, requiring careful adjustment between brain and muscle signals for effective rehabilitation.

We recommend watching the webinar because it illustrates with various videos, the improvements and progress of real patients who have suffered a stroke:

Advanced Neurotechnology: From the Laboratory to the Home (Ander Ramos-Murguialday)

If you want to delve deeper into this field and other technologies and innovations for human well-being, be sure to check out our report.

You can also access the webinar article Neurotechnology for Human Well-being: A Look at the Future with Dr. Álvaro Pascual-Leone.