How is the nature of neurorehabilitation research evolving? Q&A with Dr. David Reinkensmeyer

In October 2019, we are celebrating the 15th anniversary of Journal of NeuroEngineering and Rehabilitation – the leading open access journal in rehabilitation. We’d like to take the anniversary as an opportunity to discuss with JNER’s Editor-in-Chief, David Reinkensmeyer, the field of neurorehabilitation, how it has evolved in the last 15 years, and what we are expecting for the future.

Journal of NeuroEngineering and Rehabilitation was founded in 2004 as a forum to discuss how neuroscience and biomedical engineering can reshape physical medicine and rehabilitation. What are the biggest developments in the field since then?

Neurorehabilitation has become increasingly familiar with and reliant on advanced neuroscience and engineering technologies. This is also reflected in Journal of NeuroEngineering and Rehabilitation, as the highest cited and accessed papers present innovative ways to enhance rehabilitation with technology.

Can you please expand on how and why you think technology is more prominent in rehabilitation research?

A key sign is that in the U.S., the National Institutes of Health has increasingly funded rehabilitation research that incorporates advanced engineering tools. An analysis done in 2018 by NIH analysts found that “bioengineer or rehabilitation engineer” was the most frequently listed. From personal experience circulating at poster sessions at rehabilitation conferences, I have observed that physical and occupational therapist researchers now fluently use cutting-edge technologies to aid their research, including robotics, brain monitoring and stimulation, and sophisticated data analysis techniques. Use of cutting-edge technologies for research by therapists was much less common 30 years ago!

What would you say are milestones technologies in rehabilitation that have had the most impact in the last years?

The robotics revolution began in the late 1980s/early 1990s. Virtual reality in rehabilitation increased soon after. Now, we are in the age of wearability. We are also seeing an increased incorporation of artificial intelligence, and increased experimentation with adjuvant therapies (such as brain stimulation and targeted feedback) combined with rehabilitation therapy.

You mentioned that technology use is not so common in rehabilitation practice – do you see a development in the field anyway?

Uptake of new technologies into routine clinical practice is slower than uptake into research. However, most rehabilitation facilities are now experimenting with new technologies, and many are finding ways to enhance their practice. Significant barriers to translation remain. People with disabilities and clinicians must be more intimately involved in the development and testing of new technologies. We also must become more sophisticated in analyzing and addressing the factors that determine translation of rehabilitation technologies.

What do you imagine rehabilitation technology will look like in 2036?

I believe that more people, both with and without disabilities, will more frequently use rehabilitation-inspired technologies because they enhance their health and their day-to-day capabilities. Sensor-based data, computational modeling, and artificial intelligence will increasingly enhance rehabilitation science, promoting more personalized design and better outcomes.

Let’s talk about access to research – with the open access movement and JNER as the leading fully open access journal, have you seen an impact in the field?

Yes, NIH Public Access Policy was drafted in 2004, JNER’s first year, and mandated in 2008. NIH and other funding agencies across many countries now require funded research to be made publically available. With open access publications, any interested person around the world can immediately access the latest research. This is particularly important for rehabilitation, because this means that inventors, persons with a disability (who may themselves be inventors as well as consumers), and rehabilitation therapists and caregivers worldwide can make decisions based on the latest findings.

What developments are you expecting for the future of the field?

Again, we are squarely in the “wearable” age of neurorehabilitation technology development. Wearable rehabilitation will continue to mature, and does represent a new paradigm in rehabilitation. Besides enhancing our movement capabilities, wearables allow us to take a sort of “avatar” of our rehabilitation therapist with us as we move, thus helping us do “therapy on the go.”  I am also expecting to see more articles published on human augmentation, including augmentation of the movement of persons who don’t have a disability. JNER published the first study that demonstrated a metabolic reduction in unimpaired walking using an autonomous exoskeleton. This work provides the scientific basis for the goal of using an exoskeleton to help you hike farther without using as much energy. I’m excited to see how the field of movement augmentation continues to evolve and develop. And I hope that JNER can continue to be a premier place to publish papers in this emerging field!

Note: Some of these answers are adapted from David Reinkensmeyer’s commentary “JNER at 15 years: Analysis of the state of neuroengineering and rehabilitation” just published in Journal of NeuroEngineering and Rehabilitation, which you can read for a more in-depth discussion.

View the latest posts on the On Medicine homepage