44.3. Demands of neurorehabilitation

A deficiency in multiple functional networks in brain injury presents as a wide spectrum of symptoms. In acquired brain injury, the brain may be injured not only in one specific location, but many small injuries may be diffused throughout the brain. It is this indefinite nature of brain injury that makes the pattern of injury and the consequent presentation unique for each individual.

Symptoms of a TBI can be mild, moderate, or severe, depending on the extent of the damage to the brain. Some symptoms are evident immediately, while others do not surface until several days or even weeks after the initial injury. Typical symptoms of mild TBI include headache, confusion, lightheadedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, a change in sleep patterns, behavioral or mood changes, and trouble with memory, concentration, attention, or thinking.

A person with a moderate or severe TBI may show these same symptoms, but may also have a headache that gets worse or does not go away, repeated vomiting or nausea, convulsions or seizures, inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness, numbness in the extremities, loss of coordination, and/or increased confusion, restlessness, or agitation.

If a brain injury results in blindness, deafness, loss of balance or limb control, in the best of circumstances, the neurology is defined, the site of damage specified by imaging, and rehabilitative strategies pursued to restore, substitute, or boost function, and the impaired individual taught to adapt, compensate, and survive.

Less well known is that the remnant sensory cortex can be induced to learn new things, providing that not too much volume—circuits and connectivity—have been lost. For example, the somatosensory cortex can learn to process information from a prosthetic “eye” (Bach-y-Rita, 1969b, 1972, 1983, 2003) long after vision has been lost. People with a damaged vestibular system can improve their moment-to-moment posture, balance, and bipedal movement (Danilov, 2004; Wildenberg et al., 2010) using the sensory circuitry of the tongue.

Even with the knowledge that TBI can result in a plethora of symptoms, neurorehabilitation of brain injury is arguably the field in medicine with one of the greatest number of unmet needs. In response to this demand, we have developed CN-NINM. The objective of our research is to develop and demonstrate an innovative and integrated therapeutic regimen for treating the multiple symptoms of TBI.

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44.4. Brief history of cn-ninm technology

To understand how we arrived at our current technology, it is helpful to know a brief history of our research.

44.4.1. Sensory Substitution

The TCNL at the University of Wisconsin-Madison was established in 1992 by the late Paul Bach-y-Rita. The laboratory’s original mission was to advance the development of tactile displays for sensory substitution initiated by Bach-y-Rita (1969a, 1983; Danilov et al., 2007). The research program has evolved from pioneering studies beginning in 1963 that resulted in the development of the Tactile Vision Substitution System (TVSS). The TVSS delivered information from a TV camera to arrays of mechanical stimulators in contact with the skin of one of several parts of the body, including the abdomen, back, thigh, forehead, and fingertip. After sufficient training with the TVSS, blind subjects reported experiencing the images in space, instead of on the skin. They learned to make perceptual judgments using visual means of analysis, such as perspective, parallax, looming and zooming, and depth judgments. The TVSS was sufficient to allow users to perform complex perception and eye-hand coordination tasks. These included facial recognition, accurate judgment of speed and direction of a rolling ball with more than 95% accuracy in batting the ball as it rolls over a table edge, and complex inspection-assembly tasks (Bach-y-Rita, 1969b, 1983; Lambert et al., 2004; Sampaio et al., 2001; Segond et al., 2005, 2013).