Close Loop Decision Aiding Framework for Rehabilitation of Neurological Disorders based on Neurotransmission Cognitive Theory

Abstract

Rehabilitation is important to the management of individuals with chronic neurological diseases. Cerebral Palsy(CP) is one of the major neurological diseases that affects ability to move and affects balance and posture as well. CP occurs in early childhood and is life long illness and rehabilitation of such patients are important to lighten the burden of patients and their families. Along with major problems, CP has many associated problems and Dysarthria is one of those associated problems. Dysarthria is speech disorder that causes slurred or slow speech and is the result of weakness of tongue or throat muscles. Many pharmacological and non pharmacological treatments are proposed for the treatment of the patients having CP but very less work is done for dysarthria linked with CP. Based on the techniques proposed in the literature, we proposed Neurotransmission Cognitive Theory(NCT). NCT Proposes therapeutic and interventional noninvasive brain stimulation method that applies mechanical vibrations to different nerve points of the body to activate the stimuli. These stimuli reach and activate dead parts of the brain which will eventually help in neurorehabilitation of neurological patients. We selected dysarthria linked with CP to test our hypothesis for novel NCT and later on it can be extended for other neurological disorders. For the application of therapy proposed by NCT, we designed a vibro tactile medical device capable of emitting mechanical vibrations at different frequencies with supportive softwares using system and software engineering techniques and methods. We proposed Enhanced Agile V Model(EAV model) for system engineering of complex medical devices and then used it as system development life cycle approach for the development of our products proposed. For our hypothesis, we designed a Prospective Longitudinal observational clinical study and parents’ response assessment questionnaires to investigate therapy’s effect in terms of efficacy and safety on CP children having dysarthria. For that, Twelve participants (Mean age=6.2, SD=1.3, 16% females, and 84% males) were enrolled and the therapy continued for six months (5 days weekly initial 2 months; 10 days a month next 2 months and once in last two months). The assessments were taken using tests for assessment of articulation and phonology in the Urdu language(TAAPU) scale at three different intervals (pre, mid, and post-intervention) along with safety and adversity scores. For Parents assessment, questionnaires are designed which are filled by the parents at different intervals. For clinical data, using paired TTest with 95% confidence interval (CI), our hypothesis is analyzed. Results showed low p-values (pre to post intervention) and reported no adversity during or after therapy. Similarly, for the parent’s response, the Chi-Square test (95% CI) showed low p-values for selected parameters (pre to post intervention). Both clinical and parents’ responses reject our null hypothesis and accepts our alternative hypothesis that NCT effects dysarthria in CP children. To Prove that the effect observed in the clinical trial and parents assessment is due to the therapy applied and not due to the other influencing factors, we performed EEG signal recording and analysis. The purpose was to check whether there is any activity on different parts of the brain when vibration stimulus is received and which parts of the brain are affected in particular. For that, we enrolled 11 healthy subjects who were passed through sham procedure first and then through intervention procedure. Data is collected for i both the groups at different intervals based on defined protocol in the form of EEG signals. After data cleaning and preprocessing, we observed changes in different frequency bands by representing different bands in the form of topographical maps and proved through statistical analysis that NCT can affect different parts of the brain and dysarthria related areas of the brain because of which improvement is observed in the population. These findings of clinical trials and EEG experiments suggest that NCT can improve dysarthria in CP children and has no safety concerns. Large sample Randomized controlled trials along with neuroscience techniques should be carried out to make this therapy evidence based treatment for different neurological disorders.