It’s a challenging scenario for any parent or caregiver: a doctor delivers the news that their young child will live with a chronic disease, disorder, or delay. But what if caregivers could begin interventions for a child’s speech delay, or even a more impactful disorder like cerebral palsy, before a condition is typically diagnosed? In a pair of groundbreaking research projects, Claudio Ferre, an assistant professor of occupational therapy, explores that question.
In one study, Ferre and other BU researchers are working to improve the lives of the nearly one in ten young children in America who live with a noticeable speech delay or disorder. Ferre is using the sophisticated imaging technique called functional near-infrared spectroscopy (or fNIRS) to track the brain activity of infants who are two to six months old to “identify kids who may be at risk for language delay much earlier based on their motor profiles,” Ferre says. A child’s motor system, or their ability to move their body, is the first to develop and may be a precursor for the development of other systems.
“There is evidence to show early movement actually sets the stage for language function,” says Ferre, who, along with Jennifer Zuk, an assistant professor of speech, language, and hearing sciences, received a grant from the BU Wheelock Institute for Early Childhood Well-Being for their language research. “We’re using an imaging technique that builds a foundation of mechanistic research for our work.”
The fNIRS technology measures changes in brain areas that are active, using light to measure changes in blood. “Blood absorbs light at different frequencies, depending on whether it’s oxygenated or deoxygenated,” Ferre says. “Using sensors, which shine light into the brain, and light emitters measure how much light is absorbed, creating a marker of brain activity.” By looking at atypical brain activity, movement, and milestones early on in life, they have a chance to find important connections, Ferre says.
If we can identify infants who might be at risk for language impairments later in life, we can think of interventions for movement that can be delivered early in development—when the nervous system is very malleable.
—Claudio Ferre
Researchers will relate their observations back to language function when the infants are around a year old, Ferre adds, and follow that with appropriate interventions—typically physical and occupational therapy. “If we can identify infants who might be at risk for language impairments later in life, we can think of interventions for movement that can be delivered early in development—when the nervous system is very malleable.”
A focus on therapy
Another of Ferre’s focus areas relates to therapy’s effect on the 10,000 children born each year with cerebral palsy. Cerebral palsy is typically caused by a brain injury before birth that affects movement, he says. “Since it’s happened so early, the brain has a strong ability to adapt in response to the injury,” Ferre says, adding that with cerebral palsy there can be a large variation from child to child in terms of clinical presentation.
Ferre employs a noninvasive technology that uses magnets to stimulate the brain in order to test which parts control various muscles in older children with cerebral palsy. By delivering magnetic pulses to parts of the brain using a handheld wand, Ferre can map out the control of a child’s arm and hand muscles.
That information, he says, can show how different areas of the brain take over after a brain injury and can be used to determine whether intensive physical therapy was effective. “We can make a map at baseline and have children do intensive upper limb therapy,” he says. “We can ask questions like, did the maps expand? Did the muscles get stronger? Are they easier to activate? We can use these brain areas as additional targets for therapy. If we can identify which brain areas take over after brain injury, we ask are those areas we can potentially stimulate with noninvasive brain stimulation that is therapeutic and pair that with motor training to capitalize on neuroplasticity in the system.”
Ferre says part of the problem with current therapy for cerebral palsy—typically extensive physical, occupational, and speech therapy to help children live with the condition— is the time commitment it requires.
“If you do therapy that is intense and structured, a good portion of children with cerebral palsy will benefit,” he says. “In fact, there is a great deal of literature on the subject, and it shows doing 90 hours of therapy in a period of three weeks makes a difference.” That kind of time commitment isn’t feasible for many families, however, and Ferre says his study will look into ways to enhance the efficacy of therapy by personalizing or matching how therapy is applied to a child’s unique neurophysiological pattern.
The hope, Ferre says, is that a more targeted approach “can cut down on therapy time, which could help increase therapy access to a broader number of people.”
The evidence is still building, he says, but “it’s exciting to see how well we can understand how brain areas reorganize and, therefore, where we should be stimulating. We hope that we can make therapy more family friendly and accessible.”
Clinical research spotlight |
|
Karen Jacobs at work
Karen Jacobs, a clinical professor and associate dean for digital learning and innovation, studied people working from home at least four days a week for six months. Using their smartphones, participants contributed an estimated 60 million data points pertaining to areas such as productivity, organizational trust, and movement. “Organizations that fostered an environment of trust, allowing employees to work effectively without micromanagement, providing them with professional development opportunities, flexible hours, and locations while working remotely, tended to correlate positively with the overall happiness and life satisfaction of their workers, with higher mental and physical well-being, a stronger sense of purpose, and close social relationships,” Jacobs says. |
A vision of hope
OT Clinical Associate Professor Jennifer Kaldenberg studied whether older adults with vision impairment might benefit from devices such as iPads to complete everyday tasks, using standard accessibility functions as well as certain apps. One participant had a goal of being able to put on makeup, and was aided by an app with magnification, Kaldenberg says. “She actually put on makeup for the first time in five years. Many people think older people can’t use technology, but they can and do for multiple hours a day for a variety of activities,” Kaldenberg adds. “This can change quality of life.” |
