Neuro-rehabilitation to aid recovery of COVID-19 intensive care patients
A revolutionary approach to neuro-rehabilitation developed by EU-funded researchers could help intensive care patients to recover, including survivors of the COVID-19 pandemic.
© sompong_tom #312921254, source:stock.adobe.com 2020
The EUs CDAC project, funded by the European Research Council, contributed to the development and clinical validation of innovative technologies that have already been used for the rehabilitation of over 3 000 stroke patients across Europe. The same solutions could now be deployed to support the cognitive recovery of people discharged from intensive care units. More than 30 % of intensive care patients suffer delirium and cognitive impairment, a figure that rises to 80 % among mechanically ventilated patients such as the thousands treated for COVID-19.
We know that patients in intensive care often leave with significant brain damage: about 30 % to 50 % will not return to work within three years. These people need neuro-rehabilitation but most healthcare systems do not provide it due to the lack of cost-effective solutions. COVID-19 is driving up the number of people in intensive care, so we can expect there will be a huge number of patients with neurological deficits who will need treatment, says CDAC coordinator Paul Verschure, a research professor with the Catalan Institute of Advanced Studies in Spain.
During the project, Verschure and his team conducted groundbreaking empirical and computational neuroscience and robotics research exploring the functional role of consciousness in adaptive behaviour. This led to the development of a theory of mind and brain in the form of an artificial intelligence-based consciousness architecture called distributed adaptive control (DAC). The team also developed a deeper understanding of the role of key brain structures involved in conscious and subconscious behaviour, adaptive learning and contextual memory.
Applied clinically, the DAC theory enabled the development of a unique neurobiological model of motor and cognitive function in stroke patients, while supporting ongoing work to treat other neurological conditions such as cerebral palsy, Alzheimer disease and post-intensive care syndrome.
Eodyne, a spin-off company founded by Verschure, has since disseminated the CDAC research findings as part of a unique neuro-rehabilitation solution. The Rehabilitation Gaming System (RGS) is currently used daily in hospitals across Europe to treat stroke patients.
AI-based rehabilitation at home
The DAC-based and AI enhanced RGS technology provides gamified and engaging exercises for patients that can be performed via a home computer. This is coupled with sensors and data analytics to provide doctors with real-time health-monitoring information and diagnostic tools.
Clinical trials have shown that training with RGS increases recovery in the acute, subacute and chronic phases of stroke across motor deficits, cognitive deficits and affective deficits. All of this will be equally relevant for intensive care patients recovering from COVID-19, Verschure says.
The work conducted in CDAC, which is being continued in a follow-up project called cRGS, enhanced the technology with a new layer of insights into rehabilitation protocols. For the first time, these take into account the importance of volition, the conscious willingness of patients to perform a task, and the fundamental role it plays in memory and memory recall.
You may have come across the philosophical argument that free will is an illusion, which of course has all sorts of pretty damaging implications for our behaviour and how we organise our society. But our research shows that conscious volition is enormously important. We have shown that if we want to teach the brain or rehabilitate the brain, we must do it under conditions of volition or the brain will not fully integrate the information, Verschure explains.
The research also suggests that cognitive deficits in stroke patients do not necessarily result directly from damage to the brain but can come from affective state disorders such as depression. That, in turn, opens up new avenues to assess mental health and cognitive problems from the starting point of memory and consciousness.
Linking science to society
In that sense, CDAC and cRGS are generating incredible insights because previously all these domains had been treated independently. The crossover between them had never really been considered, but in so doing we have opened up a new window on cognitive rehabilitation, Verschure says.
That window is due to be expanded further in light of the COVID-19 pandemic, with the CDAC/cRGS team seeking funding for follow-up initiatives to be able to rapidly roll out scalable neuro-rehabilitation solutions for people emerging from intensive care.
Unless action is taken now, COVID-19 patients will suffer the same fate as most stroke patients who are sent home without access to rehabilitation because healthcare systems are not providing solutions, Verschure concludes. We have been up against clinical habits that are hard to change and the cost constraints of healthcare systems. This pandemic is a very urgent invitation to rethink how we approach healthcare and healthcare economics as well as how we link science to society.