Can an unassuming joystick-like robot increase hand function and strength in people living with multiple sclerosis (MS)?
Kailyn Manella is taking the next step to find out. Two years ago, the then master’s student was halfway through training a group of 15 people living with MS to use a device called “Wristbot” when COVID stopped the world.
Early results were encouraging, enough for a “proof of concept” that she and her supervisor, associate professor of kinesiology Michael Holmes, presented to the Multiple Sclerosis Society of Canada.
The society subsequently awarded the team—led by Holmes, who holds the Canada Research Chair in Neuromuscular Mechanics and Ergonomics and includes researchers from Memorial University, the University of Saskatchewan and the Italian Institute of Technology—a two-year Catalyst Research Grant to pick up where they left off.
In this latest study, Mannella and her colleagues are looking for at least 30 research participants living with all types of MS with “some hand or wrist function” in at least one limb. A similar-sized group of people who do not have MS is also needed for comparison.
Participants must be able to get to the lab at Brock University multiple times per week. Once on campus, the research team will provide free parking and compensate participants for their time spent in the study.
Anyone interested in becoming a participant is asked to contact Mannella at [email protected] for more information.
“Two years ago, I received tremendous support from the MS community,” says Manella, who is now a PhD student in health biosciences.
“I am very grateful to have this grant, which will advance research for MS patients,” she says. “I’m really excited to start this business.”
At the center of the research is the Wristbot, a custom-made haptic device used to study hand and wrist biomechanics and motor control. Located in Brock University’s Neuromechanics and Ergonomics Laboratory, the equipment is the only one of its kind at a Canadian university.
In Manella’s earlier study, when participants grasped a joystick, the machine alternately helped them manipulate the stick and provided resistance so that moving the stick was more difficult.
The robot used real-time feedback on the participant’s performance on the arm tracking task to modify the muscular demands placed on the user, effectively delivering an individualized protocol to maximize performance and adaptation.
“We found that combining assistance and resistance resulted in participants reporting stronger muscles, reduced muscle fatigue, and other positive outcomes,” says Manella.
In addition to expanding the research base to confirm earlier results, the team is investigating whether the Wristbot can be used to create a phenomenon called “cross-training.”
“MS is a bilateral disease, but there are often multiple limbs involved,” explains Holmes. “Manual therapy and exercises for limbs that are more spastic or weak can be challenging to rehabilitate.”
He says that in addition to rehabilitating the stronger limb, the researchers hope their approach can strengthen and increase the skill of the weaker (untrained) limb by stimulating neural pathways in the spinal cord and brain, known as cross-education (CE).
“Very little research has focused on the neurophysiology of CE in MS and thus the site of neural adaptation is unknown,” says Holmes. “We believe that a deeper investigation of CE using robotics could revolutionize MS therapy.”
The team’s research has three goals: develop an adaptive robotic training program for the hand and wrist; fully understand CE adaptations in people living with MS; and correlate the objective data from the robot with the participants’ subjective assessments of how they think the Wristbot therapy is helping them or not.
The team aims to start research early next year.