Notes From Our Neuropsychologist

Dave Demarest, Ph.D.
Clinical Neuropsychologist

NEURAL PROSTHETICS

On November 2nd, 2008, the CBS News program, 60 Minutes, ran a fascinating 15’ segment, called “Brain Power,” in an area of study and now clinical trials that fits in the general category of what is often called Neural Prosthetics. It has also been called Neural Engineering.

In the 60 Minutes segment, research is discussed regarding the use of BCIs, Brain-Computer Interfaces, in animals and in two individuals. Monkeys are shown learning to use their thinking - just their thoughts! - to activate a robotic arm. Two persons are shown, one gentleman with ALS (Lou Gehrig’s Disease), who uses a cap with electrodes, hooked up to a computer, and he has learned to write, send emails, text, and therefore communicate, using nothing but his thoughts. The other individual, a woman who sustained a severe stroke years earlier, leaving her unable to communicate and paralyzed, has had electrodes implanted in her brain which also allow her to complete such things as picking from a computer menu to do things in her environment (e.g., play music from a computer list), or operating a wheelchair.

Neural Prosthetics is a discipline related to neuroscience and biomedical engineering concerned with developing neural prostheses, artificial devices to replace or improve the function of an impaired nervous system. Prominent in this area is the restoration and augmentation of human function via direct interactions between the nervous system and artificial devices. The neuroprosthetic seeing the most widespread use is the cochlear implant, with approximately 100,000 in use worldwide as of 2006. A cochlear implant is a small, complex electronic device that can help to provide a sense of sound to a person who is profoundly deaf or severely hard-of-hearing. The implant consists of an external portion that sits behind the ear and a second portion that is surgically placed under the skin. As Ken Ross, OWL’s Information Technology Specialist observed, “The day may not as far away as we think that our brains (via BCIs) can be connected to our computers.”

For example, work is being done (The Western Canada Regeneration Initiative) trying to “marry nerve cells to microchip technology.” This team’s research is aimed at creating a tube-shaped microchip designed to send out electrical signals to encourage nerve fibers to grow together and connect to one another. “If we generate electrical signals on a microchip, we can guide nerve cells sitting on that chip to grow and connect along specific pathways. Our dream is to bypass scar tissue and put nerve communication back on track. That would mean a new life for people with brain or spinal cord injuries.” (Naweed Syed, Ph.D., Head of Cell Biology and Anatomy and Research Director, Hotchkiss Brain Institute, University of Calgary Faculty of Medicine)

To capture electrical signals from the brain, scientists have developed microelectrode arrays smaller than a square centimeter that can be implanted in the skull to record electrical activity, transducing recorded information through a thin cable. The technology behind neuroprostheses is still in its infancy, but the ability to communicate, to move with the aid of equipment, and to operate equipment in one’s world may be just a start as to the ability of the mind, through the brain, to overcome the devastating effects of brain injury and spinal cord injury, and other central nervous system dysfunction.

You can access the 60 Minutes segment referenced above at: Click Here

“WOMEN’S ISSUES IN BRAIN INJURY”

The long-term health of women with brain injuries, and disabilities in general, is not as researched as well as might be thought. There has been more research in traumatic brain injury (TBI) involving men than women. There are more questions than answers in helping women specifically, in dealing with a brain injury.

Women constitute only about 20% of person with TBI (here at OWL, 45% of our Persons Served in 2007-2008 were women). Women with TBI tend to be older and are less likely to have private insurance, an arrest history, or pre- and post-injury employment. Women are more likely than men to receive a brain injury as the result of domestic violence. For women who are battered, assault is not a one-time occurrence, and the cumulative effect of even mild injuries can result in more significant impairment over time.

An organization called “Women Living with the Consequences of Brain Injury” have led discussion as to the particular issues that women face post-brain injury and the research that needs to be done to determine the relative impact of brain injury on women specifically.

We need information on how to handle the emotional lability that often accompanies TBI. Are women’s moods more volatile? Are depression and anxieties harsher as the result of TBI and its interactions with naturally fluctuating hormones?

Women are more likely the axis around which a family revolves. What is beneficial and what isn’t in helping women cope with the role changes that occur when an individual has sustained an injury? Divorce rates are high post-injury, particularly among couples in which the wife sustained the injury. What is happening to women post-injury? How do women resume their roles as mothers? Women are more likely than men to assume the role of caregiver for individuals who have sustained a TBI – what are the effects of caregiver stress for women?

Women’s sexuality has been an issue where rehabilitation professionals tread lightly. More discussion of sexuality post-injury has been on men’s sexual functioning than women’s. The issues of sexuality that women deal with post-injury include:

Women are more likely than men to be victims of sexual abuse in general. We need to be very mindful, even more mindful than with men, as to sexual abuse post-injury.

In menopause, how do women cope with hormonal changes and their interaction with an already compromised system? What is the course of menopause in women with TBI?

Are women more prone than men post-injury to arthritis and osteoporosis?

Do women respond differently to medication after injury?

A recent consensus panel on TBI convened by The National Institutes of Health (NIH) clearly indicated that women with TBI need more attention. While women constitute a smaller percentage of those with TBI, the issues facing women need to be researched more thoroughly, and optimal care given to these specific issues that women with TBI deal with.