New technologies offer the promise of empowerment for people with spinal cord injuries, but in a recent editorial in the Journal of Spinal Cord Medicine, University of Pittsburgh professor Rory Cooper says their effectiveness is diluted by insufficient training in their use, and by "misguided changes" in medical reimbursement policies.
Mr. Cooper is director of the Human Engineering Research Laboratories, run jointly by Pitt and the U.S. Department of Veterans Affairs. He was the guest editor for a special issue on assistive technology published by the journal. Scientists, clinicians and engineers from the United States, Mexico, Japan, Britain and the Netherlands contributed articles.
"Wearable or wheelchair-mounted sensors are becoming ubiquitous," Mr. Cooper wrote in an editorial. Robotic and intelligent systems "are likely to transform the quality of life and independence of people with [spinal cord injuries] in years to come."
That so many new technologies are emerging despite declining state and federal research expenditures is a "bright spot," he said.
Science is pushing ahead, but public policy is lagging behind, Mr. Cooper said.
"Newly injured people rarely receive sufficient training in wheelchair skills and maintenance," he said, "misguided changes in reimbursement for wheelchairs and associated technologies" encourage them to buy lower quality products.
Software to adjust keyboard and mouse settings for people with physical impairments, evacuation preparedness for wheelchair users, and computer assists for rehabilitating wounded service personnel are among the featured articles in the special July issue, which can be accessed online at http://dx.doi.org/10.1179/1079026813Z.000000000197.
Using DBS to control hunger
Stimulating the "feeding center" of the brain with mild electrical pulses may be able to trigger weight loss in patients for whom all other methods -- including gastric bypass surgery -- have failed, concludes a small study conducted chiefly by Allegheny General Hospital neurosurgeon Michael Oh.
At the 11th World Congress of the International Neuromodulation Society in Berlin, Germany, in June, Dr. Oh reported on the results he and colleagues obtained by using deep brain stimulation on three morbidly obese patients. Two of the three lost significant amounts of weight within a year.
In deep brain stimulation, tiny electrodes are planted in the brain. Electrical impulses sent through them regulate portions of the brain that have been functioning abnormally. DBS was approved by the Food and Drug Administration in 1997 for treatment of essential tremor, in 2002 for treatment of Parkinson's disease and in 2003 for treatment of dystonia. DBS also has been used to treat chronic pain and depression. DBS surgery generally is considered safe, though its major risks are a chance of stroke or infection.
For his study of the effectiveness of DBS on weight loss, Dr. Oh attached the electrodes to the lateral hypothalamic area -- the area of the brain thought to control hunger.
After the three patients in the pilot study had DBS surgery, Dr. Oh, Donald Whiting, director of the center for spasticity and movement disorders at Allegheny General, and collaborators at the Pennington Biomedical Research Center in Baton Rouge, La., spent five days determining the setting for each patient that would raise his or her resting metabolic rate (the rate at which we burn calories when we're inactive) the most.
One patient lost 16.4 percent of his body weight after nine months; another lost 12.3 percent of her weight after 11 months and the third patient lost just 0.9 percent of body weight after 16 months. Further research is needed to determine what settings would be optimal to reduce appetite and food cravings, Dr. Whiting said.