Research
Research in the Geronimo Lab integrates technology into the lives of people with neurological disease. We work primarily with people diagnosed amyotrophic lateral sclerosis (ALS), a devestating neuromuscular disorder which robs the affected of all volitional motor function.
Brain-computer interfaces for communication in ALS
ALS leads to eventual loss of voluntary limb movement, inability to speak or eat, and respiratory failure. At some point, 80-95% of ALS patients are unable to use their own speech to communicate.
Brain-computer interfaces are one type of alternative communication technology that could restore speech for those living with advanced ALS. Many intrinsic factors (sensory function, cognition, motivation) and extrinsic factors (technical support, environment, interaction with other devices) contribute to the real-world success of these systems.
The lab uses EEG recording as well as eye tracking to facilitate communication between user and computer. We explore the use of different paradigms based on evoked potentials and cortical oscillations reflecting user-generated intent.
Brain-computer interfaces in the Epilepsy Monitoring Unit
BCIs are a powerful tool for studying and interacting with the brain, beyond their potential role in assitive communication. Recording from within the brain, as opposed to with scalp-based EEG, allows for superior spatial sensitivity to study brain processes.
Within the Epilepsy Monitoring Unit, patients undergoing invasive stereo EEG (sEEG) for the purpose of seizure localization are presented with a series of mental imageries. We are studying whether and how different types of intent — from motor, to emotion, to navigation, language, and memory — are represented in the brain.
Digital Health Monitoring in ALS
ALS care is multifaceted, and requires long visits with multiple providers. Between this and the associated travel to a tertiary medical center for treatment, the ALS care model can place a significant burden on patients and caregivers. Telemedicine programs
have been viewed favorably by patients, caregivers, and clinicians, although providers of physical, occupational, respiratory, and speech therapy are less likely to have a favorable impression of telehealth. To meet the need for conducting “hands-on” therapy at a distance, our group is developing remote monitoring interventions that utilize mobile health technologies. The goal is to develop tools that effectively track clinically-relevant biomarkers to support clinical decision making, clinical trial participation, and personalized care services.
We showed that patients can self-administer pulmonary function testing that results in forced vital capacity (FVC) and maximal inspiratory pressure (MIP) values that are very highly correlated with those acquired by the respiratory therapist in clinic. A longitudinal study is underway by our group to assess the impact home respiratory monitoring on the initiation of non-invasive ventilation.
Pulmonary function tests are the most convenient surrogate for monitoring respiratory health, and often used as an endpoint in clinical trials. However, early signs of breathing difficulty can appear during sleep, where they often go unrecognized by patients and physicians alike. Identifying early breathing changes in ALS may improve access to life-sustaining therapies. We aim to show how use of a skin sensor for measuring CO2 at night can identify breathing problems before the standard daytime respiratory measurements taken in an ALS clinic.
We have demonstrated that stride length, duration, and walking speed estimated from short recordings of free walking while wearing a shoe-fixed accelerometer are sensitive to different stages of physical function and the presence of ambulatory support. In an ongoing study by our group, a smartphone application that interfaces with an accelerometer captures longitudinal changes in these gait parameters over time in order to develop a model for predicting fall risk. In another study, we are monitoring changes in activity, handwriting, and speech using tablet-based assessments.
Most individuals with ALS experience bulbar (related to speech and swallowing) deterioration over the course of the disease which impacts their quality of life significantly. In some patients, these are the initial presenting symptoms. We have partnered with scientists in the Department of Communication Sciences and Disorders to identify and track bulbar progression via a smartphone-based, self-administered remote speech and swallow assessment.