Besides using our muscles, we move our body under the command of the brain, or more specifically, the sensory-motor cortex. Wherever location of the injury in the central nervous system, it will affect this part of the brain, in one way or another. Over time, lack of movement and sensation may result in so many changes in the brain that it might cause chronic (neuropathic) pain. Neurorehabilitation aims to restore functions of the brain, including sensory-motor cortex, utilizing the natural ability of the brain to change its anatomy and function due to various factors. This phenomenon is called brain plasticity.
We carried out an interview with a researcher at the University of Glasgow who studies and develops neurorehabilitation procedures using brain-machine interface and aims to produce a dedicated software for neurorehabilitation devices based on brain-computer interface technology.
An interview with Dr. Aleksandra Vučković, Senior Lecturer in Rehabilitation Engineering
Could you tell us about the products that are currently under your research and development?
Aleksandra Vukovic: We are currently developing and doing verification test of a device for rehabilitation using EEG neurofeedback to treat neuropathic pain. In order to make it possible for patients to use it at home, we try to develop a software for portable and cheap EEG headset and tablet. Most recently, we carried out a verification test to see whether patients(there were 20 of them) can learn to use the device at home and whether the device is effective for treating pain.
How do you carry out a rehabilitation using the device?
Aleksandra Vučković: First, we measure the activity of motor cortex by using a portable EEG headset. More specifically, brain wave at C4 is measured. Then spectral density of theta wave (4-8 Hz), alpha wave(9-12 Hz), and high beta wave(20-30 Hz) are calculated and shown on the screen simultaneously. For theta and beta wave have a positive correlation with central neuropathic pain, they should be lessened. Waves with the frequency of 8-12 Hz are called sensory motor rhythm, and these waves should be increased during training. Patients control their brain waves in order to change the height of bar chart on the screen and adjust the strength of waves. In the experiment, many of the patients say that their pain diminished and we have also confirmed that this effect did not disappear one month after the experiment.
We have trained caregivers (professional or family members) who take care of patients and have started to train therapists who work at the hospital to make them familiar with this technology. We have made an instruction video which demonstrates how to use the device in order that caregivers and therapists can treat the patients without us.
Can I try it？
Aleksandra Vučković: Sure. We received money to buy the tablets and EEG headsets for this research from Inspire Foundation, UK. They provide funding for research in spinal cord injuries.
So how it works? First of all, put the EEG headset on. At home, patients can do it themselves or if their hands are paralyzed, their family can do it instead. Then, type in the degree of your pain, which goes from o to 10. After that, listen to a relaxing music for several minutes. You do not have to, but we recommend that you do that, as it helps you to relax. After that, baseline brain wave is measured for 2 minutes. Stay calm and relax.
Now let us begin the session. Bars are shown on the screen, so please try to make the bar at the center longer, and those on the sides shorter.
(After 5 minutes)
5 minutes have passed. This is the standard time that we recommend.
It was difficult for me.
Aleksandra Vučković: You would get used to it after several times. Waves on the screen are from your own brain, and so you will surely make it.
What is the advantage of this research?
Aleksandra Vučković: Our EEG protocol is based on that which uses medical-grade devices at a hospital. Its effect has already been verified as a remedy for pain due to paralysis from spinal cord injury. A thesis related to this has already been published and several research papers came out of it.
However, it is stressful and tiring for patients to come to hospital or laboratory. It also requires time and money. Therefore, our mission is to develop rehabilitation that patients can do at home using cheap EEG device and tablet. In this way, patients can receive treatment easily, and it is likely to enhance the effect of medications which most patients take. Ideally, it should be used instead of pain medications. Emotiv Epoch headset is used in our current research, but we also try to use OpenBCI in producing a device to make it cheaper.
Also, it is possible to do remote support using Skype as tablet computer has a camera, or update the software remotely.
There exists a method called mirror therapy to treat phantom pain. Which is better?
Aleksandra Vučković: We recognize that there is a mirror therapy using motor imagery to treat phantom pain. It is effective for those who have a mobile arm or leg, depending on where you feel pain. Mirror therapy cannot be used for the patients without at least one functional arm or leg, and EEG neurofeedback is also efficient for those patients.
Are there other similar ongoing research？
Aleksandra Vučković: There is a researcher at the University of Washington. He is famous for pain research. He said he used a slightly different neurofeedback protocol compared to ours and did not get a good result. He however also uses hypnosis instead of neurofeedback.
In addition, Dr. Siegfried and Dr. Susan Othmer, who are well recognized neurofeedback practitioner in the USA, treat pain using different neurofeedback. They own “EEG institute”, and they cure patients who come there.
Do you know Dr. Talma Hendler at the University of Tel Aviv in Israel?
Aleksandra Vučković: I have seen neurofeedback video from Tel Aviv group. It was showing a waiting room with people walking around. If a person doing neurofeedback is stressed, virtual people in the waiting room walk around, and when he is calm down, they sat down.
What do you think about commercializing of this research?
Aleksandra Vučković: I have never started any business. If we try to establish a company, we would have to spend time and money. Once the research goes well, we would then consider leaving our business in charge of a company and let them do the development of products. I am also thinking of providing a license to the company because doing research as a main job takes lots of time.
It is said that 50% of patients with spinal cord injury, 80% of patients with amputated limbs, and 8% of patients with stroke have a neuropathic pain. Many of the sufferers of multiple sclerosis also have similar pain, and complex regional pain syndrome might also have some common causes. I have not tested our system for back pain yet, but if common EEG “markers” of chronic pain really exist, as some researchers believe, we are eager to verify this. There is a huge potential market, in my opinion.
Thank you for today.
Aleksandra Vučković: Thank you.
After the interview
Treatment of neuropathic pain using EEG neurofeedback is a brand new technology, which only a few hospitals have adopted as a part of experimental treatment.
Today’s story was about an ambitious researcher that tries to make it possible for the patients to use the new technology at home. We felt from her a strong will to help those who suffer.
In her laboratory, along with treatment for neuropathic pain using EEG neurofeedback, they study a rehabilitation of hands using brain-computer interface and functional electrical stimulation.
I am looking forward to seeing researches like this go beyond the laboratory or thesis, and come in useful for patients.
- Muhammad Abul Hassan, Matthew Fraser, Bernard A. Conway, David B. Allan and Aleksandra Vuckovic. The mechanism of neurofeedback training for treatment of central neuropathic pain in paraplegia: a pilot study. BMC Neurology201515:200
- Hasan MA, Fraser M, Conway BA, Allan DB, Vučković A.Reversed cortical over-activity during movement imagination following neurofeedback treatment for central neuropathic pain. Clin Neurophysiol. 2016 Sep;127(9):3118-3127. doi: 10.1016/j.clinph.2016.06.012
- Manaf K. Al -Taleb, Aleksandra Vuckovic. Home-Based Rehabilitation System Using Portable Brain-Computer Interface and Functional Electrical Stimulation. Proceedings of the 6th International Brain-Computer Interface Meeting. (doi:3217/978-3-85125-533-1-93)
- Cohen A, Keynan JN, Jackont G, Green N, Rashap I, Shani O, Charles F, Cavazza M, Hendler T and Raz G (2016) Multi-modal Virtual Scenario Enhances Neurofeedback Learning. Front. Robot. AI 3:52. doi: 10.3389/frobt.2016.00052