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Technology horizons

A look ahead to the future of rehabilitation

April 30, 2014

During 2014, VA's Journal of Rehabilitation Research and Development is celebrating a half-century of publishing. To mark the milestone, JRRD is running a series of guest editorials that look back to the early years of rehabilitation research and discuss the progress that's occurred since.

What about the future? VA Research Currents asked experts in rehabilitation to share their perspectives on what lies ahead. Veterans and others with serious injuries are already benefiting from computerized, robotic prosthetics, and high-tech sensory and mobility aids. What will the next 10 or 20 years bring? Will technology continue to evolve at a rapid pace? Will new models of rehabilitation emerge? What about brain-computer interfaces?

The experts we queried are among the nation's top rehabilitation researchers, or they help oversee VA's scientific inquiries in this area. They all focus on restoring function and independence to injured Veterans. Here's what they had to say:

Wheelchair technology

Rory A. Cooper, Ph.D.

  • Director, Human Engineering Research Laboratories, University of Pittsburgh and VA Pittsburgh Healthcare System
  • FISA & Paralyzed Veterans of America Chair and Distinguished Professor of the Department of Rehabilitation Science and Technology, and Professor of Bioengineering, Mechanical Engineering, Physical Medicine & Rehab, and Orthopedic Surgery, University of Pittsburgh

"Wheelchairs are and will remain one of the most important means to provide mobility and to promote function for people with disabilities for many years to come. However, the wheelchairs that people use in the future will be considerably different from those in use today.

"Current research studies give us some insight into the future. In the next 5 to 10 years, some of the biggest changes will relate to cloud-based computing, smart phone technology, and alternative power sources that will permit greater software customization, be more environmentally friendly, and increase reliability at lower cost. Wearable and cloud-based computing will improve clinical practice, provide better maintenance, and facilitate more frequent and custom upgrades to software.

"Furthermore, smart applications will help to coach users to benefit more from their wheelchair and seating technology.

"In the next 10 to 20 years, robotics, flexible manufacturing, and additive-machining are going to transform wheelchair design and usage. These tools will open opportunities for greater independence for people who currently rely on human assistance. Technologies such as intelligent multiconfiguration wheelchairs, direct brain interface, and integrated robotic manipulators will be in use. All long-term wheelchair users will have their chair made to meet their individual needs."

"In the next 5 to 10 years, some of the biggest changes to occur are going to be related to cloud-based computing, smart phone technology, and alternative power sources..."

Regenerative medicine

Audrey Kusiak, Ph.D.

  • Scientific Portfolio Manager, Translational and Spinal Cord Injury and Regenerative Medicine Programs, VA

"Imagine being able to regenerate your own tissue, or at least being able to provide cells to repair tissue that has been damaged. The field of regenerative medicine is making great progress in this area of research, even being awarded a Nobel Prize in 2012 (Drs. Shinya Yamanaka and John Gurdon) for the discovery that mature cells can be reprogrammed to become 'stem cells' that can create almost every tissue in the body. Use of this technology or cell-based therapies in general, combined with task-specific rehabilitation, can be used to maximize the recovery of an individual following injury. Thus, integrative, functional neural rehabilitation is fast becoming a technology of the not-so-distant future."

"Imagine being able to regenerate your own tissue, or at least being able to provide cells to repair tissue that has been damaged."

Rehabilitation after severe brain injury

Theresa Pape, Dr.PH, M.A.

  • Deputy Associate Chief of Staff and Clinical Neuroscientist, Edward Hines, Jr. VA Hospital Research Service
  • Adjunct Associate Professor in Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine

"Neurorehabilitation of severe brain injury in the next 10 to 20 years will be a substantive departure from current standards. I believe that this shift will be enabled by evidence indicating that neurorehabilitation of severe brain injury requires the combination of traditional rehabilitation services with targeted interventions that (1) create a healthy neural environment, (2) modulate neural activity, and (3) shape modulated activity into a functional skill. This paradigm shift will likely be enabled by additional knowledge regarding optimal times after injury to provide, either individually or in combinations, the traditional services and the targeted neurotherapeutic interventions.

"While these concepts are not yet established in the literature, I think that a healthy neural environment is an environment ready and able to support repair of injured neural circuits or reassignment of functions to non-damaged neural circuits. Given current research, we can anticipate advancements in immunotherapies and neural nutrition that will help support such an environment. We can also anticipate that neuromodulatory interventions will be sufficiently robust to address the heterogeneity of severe brain injury and yet customizable to meet the needs of patients who partially respond.

"Finally, we can also anticipate advancements regarding how to shape or progressively modify neural activity induced by neuromodulatory interventions into a functional skill."

"We can anticipate advancements in immunotherapies and neural nutrition that will help support a healthy neural environment."

Brain-machine interfaces

Robert L Ruff, M.D., Ph.D.

  • Professor of Neurology, Case Western Reserve University School of Medicine
  • Neurology Service Chief, Louis B. Stokes Cleveland VA Medical Center
  • Acting National Director for Neurology, VA

"Over the next 20-plus years we will see progressive advances in brain-machine (or nervous system-machine) interface technology (BMIT) to improve people's lives.

"The technology has begun to allow output from the severed nerve stumps of amputated or severely damaged limbs to interface with and drive 'smart' prosthetic devices. Newer advances include having the prosthesis connect to surviving peripheral nerves so that the person is able get sensory feedback from the artificial limb.

"The brain, being more complex, offers more opportunities and challenges. We are working on BMIT that intelligently perceives brain waves to enable a person to drive machines. These machines are able to compensate for loss of language, among other functions. For example, in VA Cooperative Study 567 we demonstrated that a simple BMIT device could enable Veterans paralyzed due to ALS to be able to communicate with synthesized speech, printed text, and email. Other applications now in development include using BMIT to allow a person to drive mobility-enhancing devices, such as motor wheelchairs, and having thought direct a prosthetic limb, exoskeleton, robot, or avatar."

"Other applications now in development include ... having thought direct a prosthetic limb, exoskeleton, robot, or avatar."

Bioengineering

Ronald J. Triolo, Ph.D.

  • Executive Director, VA Advanced Platform Technology Center (at the Louis B. Stokes Cleveland VA Medical Center)
  • Professor of Orthopaedics and Biomedical Engineering, Case Western Reserve University

"New methods to exchange information with the nervous system and assistive or augmentative technologies made from materials that truly integrate with and match their properties to the body instead of simply being biocompatible will significantly impact the lives of people with limb loss, peripheral vascular disease, sensory-motor disorders, or cognitive impairments.

"In particular, high-resolution micro- and nano-scale systems constructed from new biomimetic materials that communicate selectively with axons in the peripheral nerves will allow sophisticated multi-jointed prosthetic devices to be controlled as naturally as the intact limb while providing natural sensations of touch, pressure, and position. These breakthroughs will enable users to better interact with the world, function in unfamiliar surroundings, and connect with their peers.

"Similar technologies will enable individuals paralyzed by spinal cord injuries, multiple sclerosis, or stroke to regain or maintain the ability to stand, balance, and walk independently through minimally invasive interventions, thus gaining access to places and life opportunities inaccessible from the wheelchair.

"But the biggest advance over the next 20 years will be a sea change in prevailing social attitudes and policies toward disability and personal restorative technology. The stigma previously associated with technology has been slowly disappearing, and devices once stared at as novelties are increasingly commonplace and publically acceptable. The trends initiated by the advent of the cellphone, mobile computing, and wearable sensors and systems will continue, and we can look forward to their widespread application in new socially acceptable assistive or augmentative technologies that significantly enhance societal participation."

"The biggest advance over the next 20 years will be a sea change in prevailing social attitudes and policies toward disability and personal restorative technology."


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