Therapeutic Human Neuroscience

Limited recovery of function after stroke remains a major problem for millions. Disability persists in many, especially when hand function is limited. Existing therapies are limited and many have difficulties with activities of daily living, even after rehabilitation. Electrical stimulation of the brain has been proposed and used in early studies to try and aid recovery. In animals, stimulation delivered to the brain at precise times may improve the effect of stimulation.

Project Summary Blindness in the United States is a large and increasing problem. Any significant vision loss is debilitating, but profound blindness is devastating to an individual’s ability to be independent and to perform everyday tasks and activities. Hundreds of thousands of people in the United States suffer from profound blindness, and most of these currently have no hope of vision recovery. Recently, a retinal prosthesis has become available in Europe, U.S., and Canada for people with profound vision loss from Retinitis Pigmentosa, a degenerative retinal disease.

PROJECT SUMMARY / ABSTRACT Recent advances in design and actuation have led to important improvements in prosthetic limbs. However, these devices lack a means for providing direct sensory feedback, requiring users to infer information about limb state from pressure on the residual limb. Lack of sensation limits their ability to control the prosthesis and leads to slow gait and increased risk of falling. There is also evidence that lack of sensory feedback contributes to phantom limb pain (PLP), and that electrical stimulation at the dorsal root ganglia (DRG) can reduce PLP.

Abstract DBS therapy for Parkinson's disease is now the primary surgical approach for Parkinson's disease, recently FDA approved at 4 years after onset of disease. However, this therapy is still limited to treatment of a subset of motor symptoms (ie, tremor, rigidity, bradykinesia and dyskinesias) and requires considerable postoperative clinical adjustment to program and maintain function. A number of improvements to DBS for PD are being tested, including changes in patterns of stimulation and specific targets.

ABSTRACT The public health burden of Treatment Resistant Depression (TRD) has prompted clinical trials of deep brain stimulation (DBS) that have, unfortunately, produced inconsistent outcomes. Potential gaps and opportunities include a need: (1) to better understand the neurocircuitry of the disease; (2) for precision DBS devices that can target brain networks in a clinically and physiologically validated manner; and (3) for greater insight into stimulation dose-response relationships.

PROJECT SUMMARY Deep brain stimulation (DBS) of the subcallosal cingulate (SCC) white matter is an emerging new treatment strategy for treatment resistant depression (TRD) with published studies demonstrating sustained long-term antidepressant effects in 40-60% of implanted patients.

PROJECT SUMMARY Cervical spinal cord injury results in the loss of arm and hand function, which significantly limits independence and results in costs over the person’s lifespan. A brain-computer interface (BCI) can be used to bypass the injured tissue to enable control of a robotic arm and to provide somatosensory feedback. Two primary limitations of current state-of-the-art BCIs for arm and hand control are: (1) the inability to control the forces exerted by the prosthetic hand and (2) the lack of somatosensory feedback from the hand.

Project Abstract Background/Description. Given our mutual interest in direct brain stimulation as an effective treatment for non-adherent eating disorders associated with refractory obesity, our multidisciplinary team at Stanford University has developed a collaboration with NeuroPace, Inc, a company that recently received FDA approval for a responsive neurostimulator. We previously found that electrically stimulating the nucleus accumbens (NAc) of mice attenuates binge-like eating.

ABSTRACT The proposed project will build and evaluate the safety and design needs of a new type of intracranial auditory prosthesis that targets the auditory nerve between the cochlea and the brainstem (auditory nerve implant, ANI) in order to substantially improve hearing performance over the current standard of care, the cochlear implant (CI). Current CIs provide crucial speech information to many recipients, but do not restore normal hearing, and are particularly challenged in noisy or complex acoustic environments.

ABSTRACT The goal of this U44 proposal is to develop and test CranialProgrammer, an image-guided programming tool for 2D/3D mapping of disease-related neural signals over patient and device data for more efficient and effective programming of directional deep brain stimulation (DBS) systems. DBS is an established treatment for advanced, refractory movement disorders used in over 150,000 patients.