To STW website

Project 10736: TORTICOLLIS



People involved:


Dr.ir. Riender Happee
Project function: Project Leader
Organisation: Technische Universiteit Delft

Prof.dr. Frans van der Helm
Project function: Co-applicant, Program Leader
Organisation: Technische Universiteit Delft

Dr. Marina de Koning-Tijssen
Project function: Co-applicant
Organisation: University Medical Center Groningen

Dr.ir. Alfred Schouten
Project function: Co-applicant
Organisation: Technische Universiteit Delft

Dr. Hans Koelman
Project function: Co-applicant
Organisation: Academisch Medisch Centrum

Patrick Forbes
Project function: PhD candidate
Organisation: Technische Universiteit Delft

Edo de Bruijn
Project function: PhD candidate
Organisation: Technische Universiteit Delft

Bas Nijmeijer
Project function: PhD candidate
Organisation: Academisch Medisch Centrum


Newsletter (2) November 2012

Three potential diagnostic methods have been developed using 1) intermuscular EMG coherence, 2) mechanical perturbation with a moving platform and 3) isometric force testing. First results comparing 10 patients to 9 controls show deviating surface EMG in isometric conditions and retained reflex modulation function during mechanical perturbations. A second test series with needle EMG is being prepared to optimize the isometric device to be used as a tool for diagnostic applications and dystonic muscle identification.

Galvanic vestibular stimulation (GVS) elicited consistent neck motion and intramuscular EMG in seated and standing subjects, revealing a broader range of vestibular function in neck muscle control not previously shown. In a subsequent experiment GVS was applied simultaneously with mechanical perturbations. Results invalidated the superposition principle since the presence and amplitude of a motion perturbation strongly enlarged the sensitivity to GVS.

The detailed neck model obtained from partner TNO has been extended with neuromuscular feedback. Isometric validation showed a lack of flexion strength in the upper neck which has been resolved by implementing muscle geometry data collected in a dissection study. Passive stiffness properties of the model have been improved and validated.

The isometric test procedure now combines two degrees of freedom being forward/rearward and lateral head force while twist is tested separately. Together with partner MOTEK advanced visual tasks for multiple isometric degrees of freedom will be developed. Additionally, MOTEK has developed drivers to connect to the Qualisys motion capture system in order to provide visual tasks during platform perturbations.
While much remains to be learned from the first 10 patients tested, we are already planning larger patient studies in 2013.
 



Newsletter (1) April 2012

Project TORTICOLLIS investigates neck stabilisation in healthy subjects and in patients suffering from cervical dystonia (also called: torticollis) a syndrome characterized by sustained involuntary muscle contractions.

Three potential diagnostic methods have been developed using 1) intermuscular EMG coherence, 2) mechanical perturbation with a moving platform and 3) isometric testing. These test methods are now evaluated using 10 patients and 10 matched controls. While 2 more patients are to be tested, first results indicate deviating intermuscular coherence in several tested conditions, and gaps in (maximum) in left/forward or right/forward isometric force generation.

Galvanic vestibular stimulation (GVS) has shown to elicit consistent neck motion and intramuscular EMG in seated and standing subjects, revealing a vestibular contribution to neck muscle control. Experiments were performed at the labs of Prof Herman Kingma (Maastricht) and Jean-Sébastien Blouin (UBC-Vancouver) and partner TMSi is developing an advanced stimulator to be used in further studies.

The detailed neck model obtained from partner TNO has been extended with neuromuscular feedback. Isometric validation showed a lack of flexion strength in the upper neck which is being resolved by implementing muscle geometry data collected in a dissection study.

The isometric test procedure now combines two degrees of freedom being forward/rearward and lateral head force while twist is tested separately. Together with partner MOTEK advanced visual tasks for multiple isometric degrees of freedom will be developed. Additionally, MOTEK has developed drivers to connect to the Qualisys motion capture system in order to provide visual tasks during platform perturbations.

While much remains to be learned from the first 10 patients tested, we are already planning larger patient studies in September 2012.


--------------------------------------------------------------------------

Introduction

 

Cervical dystonia (also called: torticollis) is a syndrome characterized by sustained involuntary muscle contractions, resulting in abnormal posture and twisting movements of the neck. The pathophysiology of dystonia is only partly understood and gives clues for both abnormalities in the cortical and subcortical areas of the brain, but also for alterations in the spinal cord and peripheral nervous system. The goal of the project is to develop new test methods and neuromuscular identification methods to capture 3D neck stabilisation, in order to diagnose and improve treatment for torticollis patients. A 6DOF motion platform will be used to apply trunk loading with subjects restrained to a rigid seat and a head loading device allowing bi-directional dynamic loading will be developed. Based on research with these setups a cost effective, diagnostic setup will be developed to facilitate deployment in medical practice. Mechanical visual and vestibular stimuli will be applied to uniquely identify the role of the applicable feedback loops in head-neck stabilisation. Patient studies will reveal the possible role of aberrant feedback and diagnostic parameters will be derived which optimally discriminate controls and patients and optimally predict the impairment level. The effect of botuline treatment will be evaluated using established and newly developed diagnostic methods.


Contact: Riender Happee, r.happee@tudelft.nl
Website: www.bmeche.tudelft.nl / www.3me.tudelft.nl/nmc / www.amc.nl
All vacancies have been fulfilled

Partners

Motek (www.motekmedical.com), Cruden (www.cruden.com), TMSi (www.tmsi.com), IPSEN (www.ipsen.com).