Introduction to special topic issue on technology in neurorehabilitation

Technology can serve several purposes in the lives of people with neurological disabilities augmenting their treatment and enhancing everyday living. It can be assistive, supplementing or supporting an individual in daily activities in a way which compensates, at least in part, for abilities which have been diminished by the effects of atypical development, injury or disease. Technology may play a therapeutic role as an alternative or complement to drug treatment, physical and occupational therapies and other conventional modalities. And some technology is evaluative, providing sensitive objective means for exposing the mechanism of a disability and assessing its severity and characteristics for clinical or research purposes. The articles in this special topic issue of NeuroRehabilitation span all of these categories, often in combination. Augmentative communication devices, as described in the article by Beth Mineo-Mollica, are primarily assistive, although their use by individuals with developmental disabilities may help advance language and social skills. The same can be said for cognitive prosthetics, i.e., computer programs custom-designed to prompt and support functional activities. The article by Elliot Cole on this topic reports surprising improvements in aspects of cognitive function in some cases where only support was intended. Will Durfee’s report on functional electrical stimulation describes, among others, applications to stroke patients which are assistive or therapeutic, offering both electro-exercise for increasing strength, and limited control of functional grasp and gait. Home health care technologies, described by Corinna Lathan, are meant to provide convenient assessment of vital health parameters as well as selfor family-administered home treatment. Virtual reality applications in cognitive rehab are almost all in the research domain, at present, but Cheryl Trepagnier’s paper on this topic suggests the promise of these innovative technologies for both assessment and remediation of syndromes such as impaired face recognition characteristic of people with autism. Telerehabilitation is defined in my paper as a battery of techniques which employ telecommunications and information technologies to deliver therapies, monitoring, assessment and coaching at a distance. The topics in technology covered in this issue were chosen to illustrate all three of these application categories. They also intentionally span topics from operational to conjectural e.g., augmentative communication to virtual reality and from mass-market high tech applied to neurorehab (computers as cognitive prostheses, for example) to highly specialized engineering for intimate interaction with human physiology (such as FES). In retrospect, however, some other commonalities and contrasts emerge to which I will call attention briefly as an introduction to this issue. While the role of modern computing technology is obvious in some of these technologies and hidden in others, it is, in fact, essential to all of them. The seamless movement of dynamic images in virtual reality displays, ideally rapid enough that delays in response to user inputs are undetectable, demands application of computers which are substantially more powerful and more expensive than garden variety PC’s. Such computing power demanded room-sized facilities until less than a decade ago and was completely unavailable another decade back. Electronic augmentative communication products ceased to be built from fixed-purposed circuits twenty years ago when the microelectronics revolution made it possible to obtain more function and infinite flexibility of function in much less space for less money by writing programs for single-chip computers. Functional electrical stimulation to overcome foot drop in individuals with strokes was first accomplished in the early sixties without computers. But coordinated stimulation of multiple muscles often using implanted electronics, integrating signals from numerous feedback sensors, and obeying control laws which learn how to optimize the quality of limb movement is a practical impossibility without the miniaturization and flexibility provided by microcomputers.