Page 14 - ITPS-6-2

INNOSC Theranostics and
Pharmacological Sciences Theranostics in neurosurgery

which would automate and adapt treatment to the needs of patients with CP, particularly when coupled with some
each patient. form of interactive medium such as a video game . This
[79]
mode of diagnostics provides a self-metric, which allows
5.1. Functional electrical stimulation subjects and patients to adapt and adjust dynamically.
Functional electrical stimulation is currently being studied In addition, motion in the upper extremities can be
in relation to its efficacy among patients with CP. Through improved when robotic feedback therapy is utilized before
this ongoing research, scientists and clinicians have found conventional therapeutic methods; self-contained robotic
evidence of use-dependent muscle plasticity in patients systems are being developed to achieve this goal [80-82] . These
with CP . In many cases, this resulted in permanent cases highlight that modern therapies are not necessarily
[73]
improvements in voluntary ankle control after repetitive intended to replace conventional therapies, but instead to
stimulation, implying a lasting therapeutic effect of FES, augment them or address special cases or gaps in previous
and providing a measurable metric of real-time efficacy. methods. The current research has found that gait training
Trials conducted by Pool et al. have corroborated these is the most effective rehabilitation method for patients with
findings by showing how FES can result in an increase in CP, while strength training is negligible. Other methods,
initial contact ankle angle, maximum dorsiflexion ankle such as velocity training, electromyographic biofeedback
angle in swing, normalized time in stance, and normalized training, and whole-body vibration, have appeared
step length in pediatric unilateral patients with CP . promising in individual cases, but further research is
[74]
Further, by combining adaptive ankle assistance with needed to prove that they are as effective as stand-alone
[83]
step-length biofeedback, lower-extremity gait mechanics therapies . Gait training, among other methods, can
in patients with CP can be monitored in real-time and be further optimized for each individual with CP using
immediately improved . The expectation that this form biofeedback.
[75]
of therapy will likely be beneficial is consistent with the
understanding that an altered central drive to the ankle 5.3. Transcranial direct current stimulation
muscles and increased passive muscle stiffness may be the In a similar vein, trials are being conducted to establish
primary causes of foot drop and toe walking in patients the clinical utility of tDCS in treating CP [80,84,85] . Two
with CP . The feasibility and practical application of the such trials are currently evaluating the effects of
[76]
mainstream application of this treatment are still being combining tDCS with treadmill and mobility training on
researched and established . neuromuscular functionality in patients with CP [86,87] . In
[77]
One specific form of FES, neuromuscular electrical one of these studies, multiple non-invasive metrics were
stimulation (NMES), has shown particular promise in proposed for simultaneous tracking of the condition and
treating CP. When paired with electromyography or visual feedback was provided to the subject through a
[87]
other acute, non-invasive measurements, NMES can act gamified setup to allow for self-adjustment . While this
as a closed-loop system providing immediate feedback was not designed to generate an immediate closed loop, it
for therapeutic procedures. One specific example is should be noted that this form of feedback in training may
the combination of NMES and robotic knee extension be applicable to the general case of stimulation therapy.
assistance as a theranostic modality. The combination of Ultimately, even in its current form, gait training was
NMES and electromechanical feedback positively affects found to be more effective when using combined therapy.
knee extension during stance with reliable, customized, Scientific interest in tDCS seems to be leaning more toward
and low-latency electrical stimulation . Similarly, the hybrid applications than stand-alone therapy for CP. For
[7]
knee-extension metric can be utilized as a prognostic instance, researchers are also currently investigating the
metric to measure, recover, or diagnose the severity of CP combination of tDCS with hydrotherapy as a treatment
[88]
symptoms. Continued work toward the use of diagnostics for CP . In this format, buoyancy would act as a form of
to synchronize NMES to gait cycles for improved effects is instant adjustment and biofeedback in a corrective sense
a current goal in the scope of rehabilitation medicine and rather than a diagnostic sense. Conclusions on efficacy
medical research. Within that scope, the consideration of and function cannot yet be assumed, since this study is
[78]
pathogenic physiology is still being explored . ongoing through December 2023, and there are no results
as of yet. Safety standards will likely be discussed in the
5.2. Electromyography resulting paper.
Within neurosurgery, real-time biofeedback systems Researchers have also found that anodal tDCS can
have garnered recent attention. Studies have shown that result in an immediate improvement in the unimanual
electromyography with high-quality biofeedback can gross motor dexterity of the hemiplegic hand . Under
[89]
encourage and support home-based therapy for pediatric observation, this lasted for a minimum of 90 min,

Volume 6 Issue 2 (2023) 8 https://doi.org/10.36922/itps.417