
| James (0:10) | You are listening to a podcast from the HealthTech Research Centre in Brain and Spinal Injury. Thanks for tuning in. I am chatting to researchers and innovators and clinicians and patients and carers and anybody else who will spare the moment or two to have a talk to me about the work that they are doing around brain injury.
And today I'm delighted to be joined by Ian Howard from the University of Plymouth. And Ian, your research is about rehabilitation and recovery, is that right? |
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| Ian(0:37) | Well, my research actually covers a large range of aspects of sensor motor control. So one aspect of what I do is looking at motor learning and what can you learn, what can't you learn, what constitutes things that help us learn. This particular project is very much to do with how can we actually assess how well you're moving and apply it to situations where people have got some sort of problem with their movement due to brain injury.So my overall area of research is a bit broader than this particular project, but this project is using, if you like, the expertise that we get when we analyse movement and can say something about it. | |
| James(1:18) | Sure, that's good. I'm really interested in you used that word learn and by learning, do we mean neuroplasticity, the brain sort of rewiring itself and teaching itself to do things after injury? We talk a lot about people relearning how to do stuff.What do we actually mean by that word? | |
| Ian(1:34) | So a lot of research which is actually done in sensor motor control is I guess you could probably more say it's more like an adaptation to something, right? So we change properties of objects, for example, in the virtual world. So if I pick up something, let's say, which is really light, I move with a certain expectation of how much it's actually going to weigh.But if then I grab something really heavy, in advance, I can recall the necessary control to move something really heavy. We think we've all come across this when you pick up a cup and you think it's full and it's actually empty and you go, you know, lift it up a bit too much. So that's really adaptation.
I'm also interested in, you know, how can we learn much more novel things? So controlling things in a way that we don't normally control it. So actually tool use is one example, but also more complicated things would constitute things like, you know, how do you learn to drive? You know, you've got to learn a different kind of mapping from your arms to actually move the vehicle or the application I like the most at the moment is how would you learn to control an excavator? Now, you've got two levers and you've got to move them in a certain way, which don't really correspond to what you normally do. And I think in that kind of task, there is going to be some more structural learning in terms of remapping what you're already doing. But yeah, I think it is to do with neural plasticity in as much as this information has got to be represented somewhere in your brain. And the only way it can be represented really long term is in connections. And that's what this some of these learning mechanisms will result in. |
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| James(3:10) | It's fascinating this stuff. Some people might have seen the thing where a guy learned to ride a bicycle where the steering goes the wrong way, turn it left and the wheel turns right. And it's really difficult and you fall off a lot.But eventually you do learn how to do that, right? You get used to the way things work. | |
| Ian(3:26) | You do. | |
| James(3:27) | And I guess it's a similar sort of process then after a brain injury. So the way that you can control perhaps the movement of your right arm is now not the same as it was before. You're not getting the response and feedback from that limb that you were before.
So you're kind of finding some way to accommodate so that you can adapt. |
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| Ian(3:44) | Yeah, I think the jury's out a bit exactly what goes on. But, you know, there's various ideas that maybe we're using. We're recruiting other areas of the brain that do still operate because sometimes obviously you've got a stroke or something or an injury.You can actually lose parts of your brain tissue that do a lot of the processing. And so how exactly then we recruit new areas is a very interesting question. But certainly, you know, it's something which is of great interest.
And how can we actually maybe increase the way that it actually adopts using these new areas? And that's kind of where rehabilitation, I guess, comes into these things. |
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| James(4:24 ) | Certainly we know that in rehabilitation, you just need to keep at it, right? You keep working, you keep repeating, you try to increase the demand so it doesn't get too easy and keep yourselves working. And I guess the theory is that by doing that, you're kind of teaching your brain these new ways of working and reinforcing those connections. | |
| Ian(4:42) | Yes, I mean, you certainly do need to practise. So even when we're doing simple adaptation movements, for example, you know, we just basically get people to move between a middle point, let's say, and an outer point around the circle. So sort of a centre-out task.That's a typical paradigm that we use a lot in in motor control research to investigate what improves movement in that way or how do we quantify movement in that way? But obviously, if you get participants who aren't making any effort and not really caring about what they're moving, they don't learn anything. Right.
So it's one of those things that you do need to be focused and applying your your, if you like, your attention to these tasks. Some things you do actually learn a lot more subconsciously. It has to be said some there are subconscious things. But generally speaking, if you don't care about what you're doing, you won't learn as much as fast. |
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| James(5:37) | Yeah. And there's a real challenge there, I guess, because it's enormously frustrating. You know, we see young children when they learn to walk, they fall over a lot.You can imagine that, you know, if you're 50 years old, you walkign all your life and now you can't. You just get bored, right? Because it's really frustrating that you can't do something that you've been able to do your whole life.
And now it's really challenging and difficult. |
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| Ian(5:58) | Yeah. I mean, I think I mean, this is actually one of the reasons people say, you know, you know, children can learn things really quickly. I think there's probably a few reasons for that.I mean, I do recall my nephew learning to walk, actually, this is going back quite a long time now. But it was just the incredible motivation to actually do it and move. And, you know, first of all, he was crawling along and we could see he was really making a huge effort.
And I think probably what happens when we get a bit older is we don't make as much effort. And certainly in another aspect of learning, actually, which I've also experienced is learning another language. So as a child, you're very good at picking things up. And I think part of the reason is you try a lot harder and you don't care if you make mistakes. You haven't got this embarrassment. Whereas an adult, certainly I've noticed this learning languages, which is also a motor task in a large to a large degree, people are frightened of saying the wrong thing and looking silly. So I think I think the motivation aspect of this is a really key, you know, and the intensity that you do things in is really, really key to these things. And I think as children, you know, we are not so bothered about making mistakes and doing things wrong and prepared to fall over. Whereas probably we're not quite so prepared. Another thing, of course, being smaller and closer to the ground. If you're a child, you know, not as much damage can take place if something goes wrong. So, you know, you're learning, if you like, lots of things at an age where it's much more difficult to do anything, you know, which is potentially damaging to yourself as well. |
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| James(7:33) | I think, yeah, I guess when you're really little, you don't know it's going to hurt because you haven't done it as many times. Right. And we've all fallen over loads and it's horrible.So we're a bit more cautious. | |
| Ian(7:43) | Absolutely. Yes. | |
| James(7:44) | So in your latest project, then what you're trying to do is to kind of quantify some of these exercises and get some measurements and testing. I saw you showed a sort of robot device.
Measure kind of movement of arms. |
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| Ian(7:59) | That's exactly right. So a lot of the work that we do in the lab is with what we call a robotic manipulandum, sort of rather a long word. It's basically it's like a think about a mouse on a computer screen that you can move around in two dimensions.OK, and it will measure your position so we can do that quite easily. But the difference between these robotic devices is they can actually push back on you. Right.
So it'd be a mouse with force feedback. So that's the first aspect of it. So we can actually quantify movement very well using these devices, but we can also change the nature of the task in an online fashion. So you could be moving something which is just basically like a like an empty cup. And then we could simulate lots of mass, for example, and you'd be moving this very heavy cup around full of full of a liquid or something. Or we can do other simulations. We could actually change the way you look at the world by rotating it slightly. Or we can do things like put in some, if you like, less natural dynamics, like a classic one is like a curl field. So it's like moving in a viscous field, like moving underwater, but it pushes you at 90 degrees. And then we can look at how you learn on these things. So all of these techniques have been heavily developed and used in the scientific research in motor control. And the idea of this project is, you know, we've got these big systems that we've got in the laboratory. Wouldn't it be nice if you had a little tiny one you could put in a suitcase and take to a clinic or to take to the patients? In fact, we're planning on doing that kind of thing for events. So it's really an application of this technology, which has been developed a lot for scientific measurement, to actually then get it out there a bit more in the field. And the idea is to use a small, tiny little robot, which is the thing that this project, my project is all about with my colleagues, which is then relatively cheap to produce. It's all 3D printed. And of course, rather than being in a two dimensional space, we've actually built a three dimensional one as well, which is also fairly novel in this field. So the idea is you've got this portable system which you can take out to people, which isn't too expensive, and hopefully quantify their movement, not just in two but three dimensions. And the idea is also to let you change some of the qualities of what you're actually doing with the movement by giving force feedback as well. |
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| James(10:27) | So is it something that would be used to sort of measure and monitor recovery or is it an exercise device to help recover? Or is it both of those things? | |
| Ian(10:36) | It can be both of those things. And interestingly, at the meeting we had in London recently, it was pointed out to me by quite a few people that actually the rehabilitation side of it is actually also very important. And having something like that, that you can programme the level of resistance into and adapt it to the particular person could also be very helpful, because currently what we do is, you know, you'd get people, I guess you get people to make movements and then you get them to move things like weights around and stuff like that.The advantage of this system is we could do that by simulating things, but at the same time, we're actually measuring them. So that the real starting point for this project came from how do we quantify how people are? So one of my colleagues, Ellie, she's a she's a neurosurgeon.
She was always explaining that, you know, one of the very basic things that they do quite often to quantify how good people are at moving after they've had an accident or had a stroke is watch them make a cup of tea. Right. Which involves a lot of motor skills. You know, we take it for granted, but it involves a lot of motor skill. But obviously that's a subjective measurement. So the idea really of this project was to say, can we use some of these technologies and quantify things in a way that we're doing for our scientific research? Can we use that as a metric for saying how good a particular person is maybe on a particular day? And if we can do that, then we can also look at the progress that they're making and say whether or not, you know, there is any in a quantitative way. You know, it's not a matter of opinion anymore. It's like it's, you know, the computers working out your trajectories. So that's really the that was the main driving force of this to try to quantify things in a way and get away really from sort of these subjective judgments that we've had in the past. |
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| James(12:30) | Yes. Certainly something I did quite a lot in the early days after my brain injury was just to hold my hands out in front of me and the doctor would hold his hands out and I'd have to push down or lift up. And even while I was doing it, I was thinking, but one of your arms is stronger than the other one.So can you really how fair is that as a test? Can you really tell which one is one stronger than the other or not? | |
| Ian(12:50) | Yeah. So certainly we can we can sort of estimate forces. You can put force transducers on these things as well.Making something quantitative is, I think, has got an advantage, certainly in terms of looking at, you know, like the evolution of that person's improvement over time. I think also you can also then compare against different people more to say, you know, what level of severity is this? But obviously, you know, movement is a complicated thing with multiple dimensions of quantity of qualities of movement.
So but I think just to start off with, you know, just how accurate are you? How hard can you push and how can you move around the you know, your local workspace? Can you do that with without too much trouble? You know, how jerky is your movement? This is another course. This is another issue that we we will come across a bit more since at the moment we've been we've been, you know, in the past running on fairly normal people or maybe elderly people who also volunteer and which means they're generally very good. You know, when you come across people really with with serious issues, they can't even move in a straight line without stopping a few times. So but I think all of this is a is a very useful tool for quantifying all of this kind of behaviour. I have to say, I think also it's very interesting from a scientific perspective as well, understanding what's going on more, because I think there's probably not as much done from my community, sensori-motor community on people with injuries as there could be. And always when something goes wrong in the system, it's also a good way of trying to understand how it's working. So I think it will feed back in both directions. We can do some of this thing, this kind of things, you know, and the more we understand about motor control and how the brain controls movement, obviously probably the more we can actually do to help people improve when they've something's gone wrong. |
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| James(14:44) | Yeah. And I guess you then you start to think about how do you design the rehabilitation intervention so that it matches that person, not just some huge cohort of all the people who've had a stroke ever, but that individual and the particular things that they need. And we talked about how we escalate that challenge through rehabilitation.Well, if you just press a button on a computer to make it a little bit harder each time, then we get that kind of exercise coming through. But I guess what you're saying is we just need to know the numbers. We need to understand what's happening in that process.
And also, I guess it's going to be different for everybody. So some people make quite quick progress. Other people, it's going to be much, much slower. You know, it could be years before they really start to regain function. |
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| Ian(15:28 ) | Yeah, I mean, there's huge individual differences, even when you're looking at normal people. One thing we did see, actually, is that the level of motivation is something which does affect performance quite a lot. Some of the initial tests we did, we actually had a scoring mechanism and it was feeding back how fast or how within target limits they're working at.And it was very interesting because it pushed people a bit more to their limit. So I think this is also another important issue when we're doing these kind of tasks or when we're doing rehabilitation as well. You know, you do need to somehow make it exciting and motivating for people as well.
That seems to be quite an important issue. |
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| James(16:09) | And we're seeing quite a lot of that sort of gamification coming in through various rehab technologies. You know, can I beat my best score to give you that kind of motivation and drive you on to keep practising? | |
| Ian(16:21) | Yeah, certainly. So, you know, the idea of our system, that could also be integrated within game. There's quite a few gaming engines out there that you can interface to.Obviously, at the moment, lots of people are using these like VR headsets or these VR accelerometers in order to work out what the positions of their arms are. But the advantage of our system, again, like I said, is because it can also generate force feedback on you. You can actually start feeling what's going on in the world.
And I think another interesting aspect is, you know, we've also lots of people have done work on it now. You know, the haptic feedback is actually very important for us to operate because, first of all, it's much faster to get back to our nervous system than vision, right? So vision is actually running with quite a large latency because it's got a lot of processing stages to go through. So I think an advantage of having a system like this, as opposed to these sort of accelerometer based systems or tracking systems, is that we'll be able to actually get feedback, you know, generate haptic feedback on people by pushing back on them as well. So hopefully that will be another nice aspect of this of this little. |
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| James(17:34) | Yeah. And I guess that sort of ties in. You described it in the start of our conversation, sensori-motor.So it's not just about the movement, but it's also about that sort of tactile feedback that we get. We know what things like because we touch them. Right.
And we get some response for them. And you're saying your system can provide that, right? You can give us a bit of a pushback. |
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| Ian(17:53) | Well, it can provide pushback on you in as much as you're, you know, you're holding the handle and you can you can you can you can start feeling what you're doing. You know, you could also in terms of tactile, people normally would say that they would think in terms of a glove that can actually push your fingers in a certain pattern. I mean, that's something else you could put on the end.I do think very much that this feedback is a very useful thing. So incidentally, some of these robots initially were designed the sort of phantom robots from the US. They were, you know, haptic feedback devices.
That was the idea. And I know they're using them a lot now and they're selling them a lot for designers and stuff so they can actually even feel their designs and stuff like that. You can actually have interactions with these things. So I think it's a very useful way of interacting rather than rather than just using a mouse in two dimensions, actually having something you can actually feel as well in three. |
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| James(18:50) | Yeah, really exciting stuff. I can tell just listening to you that you're excited about it. | |
| Ian(18:55) | Yeah, I know. It's great. It is good fun. | |
| James(18:5) | So sort of early stages of this project, you've got this kind of portable device that you you can take it out and you get people in. What's the sort of next stage? Is that going to develop into something that will be out into clinics and or is it just going to be a research tool to start with? | |
| Ian(19:14) | Well, we certainly are looking into, you know, future support for this. I think there's actually also a product development possibility as well in this kind of work. Certainly, that's one aspect of what I'm looking into.You know, how can we actually get something out there? And so people can actually use it because it's all you know, it's all very well having something in the lab, but it's not going to it's not going to change millions of people's lives. But that's certainly one aspect of it.
But in fact, we're going to be meeting my colleagues shortly and have a big discussion about this. How do we move it forward? The other thing, actually, I would also be interested in doing is this is obviously one little tiny system. I'd be interesting in looking at, you know, more general systems that can actually look at both arms and both legs at the same time. Right. So you've got a complete, if you like, a body assessment kind of system. So you could actually, you know, you can get somebody basically standing there or sitting there maybe. So you can actually assess their entire body and how they coordinate that as well at the same time, not just one particular arm. And I think also underpinning a lot of this this kind of research is we do need sort of to have some very, if you like, maybe very, very reliable, bigger systems to actually support testing of the smaller ones. So, you know, you need a sort of a ground zero kind of approach that we have a really big system. We've got a really big version of this robot already in two dimensions and three dimensions, which isn't portable. So I'm kind of thinking, you know, there should be sort of a parallel development between things that you can take out into the field and really what you consider to be almost like the ultimate you can do in order to show that this is a really effective way of actually doing some recordings. And can we then see the same kind of trends using a much smaller, more portable system? |
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| James(21:13) | Wow. Really fascinating conversation, Ian. Thank you ever so much for finding the time to join us and good luck with your project as it moves forwards. | |
| Ian(21:21) | Thank you so much. | |
| James(21:22) | You've been listening to a podcast from the Healthtech Research Centre in Brain and Spinal Injury. Check out all of the others on our feed and visit the website.
And I'll put some links to some of the things that Ian's been talking about in this chat. So do check those out, too. |
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