Emerging technologies for management of patients with amyotrophic lateral sclerosis: from telehealth to assistive robotics and neural interfaces

Abstract

Amyotrophic lateral sclerosis (ALS), also known as motor neuron disease, is characterized by the degeneration of both upper and lower motor neurons, which leads to muscle weakness and subsequently paralysis. It begins subtly with focal weakness but spreads relentlessly to involve most muscles, thus proving to be effectively incurable. Typically, death due to respiratory paralysis occurs in 3-5 years. To date, it has been shown that the management of ALS patients is best achieved with a multidisciplinary approach, and with the help of emerging technologies ranging from multidisciplinary teleconsults (for monitoring the dysphagia, respiratory function, and nutritional status) to brain-computer interfaces and eye tracking for alternative augmentative communication, until robotics, it may increase effectiveness. The COVID-19 pandemic created a spasmodic need to accelerate the development and implementation of such technologies in clinical practice, to improve the daily lives of both ALS patients and caregivers. However, despite the remarkable strides that have been made in the field, there are still issues to be addressed. This review will be discussed on the eureka moment of emerging technologies for ALS, used as a blueprint not only for neurodegenerative diseases, examining the current technologies already in place or being evaluated, highlighting the pros and cons for future clinical applications.

Progressive Irreversible Proprioceptive Piezo2 Channelopathy-Induced Lost Forced Peripheral Oscillatory Synchronization to the Hippocampal Oscillator May Explain the Onset of Amyotrophic Lateral Sclerosis Pathomechanism

“…Finally, an inert proton-based long-range ultrafast signaled proprioceptive skeletal system is emerging that is suggested to be gradually lost in ALS due to the theorized progressive irreversible Piezo2 channelopathy. This may explain how soft and exoskeletal robotic-assisted therapeutic exercises show preventive or even positive results in ALS [ 106 , 107 , 108 , 109 ]. Correspondingly, the author proposes that the dying mechanism in ALS is backwards if it is looked at from a somatosensory angle.…”

A systematic review of digital technology to evaluate motor function and disease progression in motor neuron disease

“…The body region to be assessed, ease of use, frequency and sensitivity of sampling, reliability, cost to purchase, battery life and storage capacity of devices must be evaluated. The shift towards telemedicine in clinical care may offer valuable insights into delivering effecting remote research opportunities for people with MND [ 46 ].…”

Time for optimism in amyotrophic lateral sclerosis

“…We are now able to monitor patients living far from any ALS centers. Moreover, technological progress enables compensation for disturbances in communication due to phonatory disturbances and loss of motricity that makes it impossible for the patient to correspond in writing; eye‐tracking and assistant virtual speakers offer hope by giving the opportunity to maintain social relationships despite the loss of communication abilities [42]. Communication abilities may be maintained beyond the patient's natural abilities.…”