New Dynamic Neck Brace May Improve Head, Neck Range of Motion for ALS Patients, Study Says

A newly developed robotic neck brace may improve quality of life for people with amyotrophic lateral sclerosis (ALS) and allow researchers a more detailed assessment of head and neck movements, as well as disease progression, for people with this condition.

The brace was described in a pilot study, titled “A robotic neck brace to characterize head‐neck motion and muscle electromyography in subjects with amyotrophic lateral sclerosis” and recently published in the Annals of Clinical and Translational Neurology.

In ALS, the muscles around the head and neck grow weaker, leading to a perpetual head “droop” with the chin resting on the chest. This can affect the use of the mouth, leading to breathing, swallowing, and speech problems. Currently available neck braces are often uncomfortable and become ineffective as the disease progresses because they are static, meaning they cannot move to accommodate the needs of the wearer.

Developed by Columbia University engineers, the new brace is more dynamic, with a range of motion that’s around 70% that of the human head. Furthermore, the brace can be moved via a joystick interface — not unlike what Stephen Hawking used in his wheelchair — allowing for movement that isn’t at all reliant on weakened muscles.

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“Although we cannot cure the disease at this time, we can improve the patient’s quality of life by easing the difficult symptoms with the robotic neck brace,” Hiroshi Mitsumoto, MD, a study co-author and professor at Columbia, said in a press release.

The researchers had 11 ALS patients and 10 unaffected people used as controls wear the brace and move their head through a few ranges of motion (forward and back, side to side, etc.). Participants considered the brace wearable and comfortable, with an average self‐evaluation score of 7.18 out of 8.

In the study itself, the researchers didn’t actually examine the brace as a supportive aid; rather, they used it to help measure muscle activity. They found that, even early on in disease, people with ALS used their muscles differently than those without the disease.

Essentially, those with ALS had to compensate for muscle weakness that was already present.

“During flexion-extension [a nodding motion], the head of ALS patients falls forward quicker and requires early activation of the extensor muscles to decelerate the head to the fully flexed position. These findings suggest that the nature of head‐neck movements may have been altered even when the ALS patients still have relatively large range of motion and strength in the neck,” the researchers wrote.

Moreover, they found that the brace measures in ALS patients correlated with clinical scores, such as the ALS Functional Rating Scale revised and forced vital capacity.

“Hence, this procedure can be adopted in a clinic to complement self‐reporting,” the researchers wrote.

Thus, in addition to improving motility (and, by extension, quality of life) in people with ALS, this brace may be beneficial for further studies of this disease — and the possible applications don’t stop there.

“The brace would also be useful to modulate rehabilitation for those who have suffered whiplash neck injuries from car accidents or have from poor neck control because of neurological diseases such as cerebral palsy,” said Sunil Agrawal, PhD, a professor at Columbia University and another co-author of the study.

The researchers are already planning further studies to assess and improve the brace.

“In the next phase of our research, we will characterize how active assistance from the neck brace will impact ALS subjects with severe head drop to perform activities of daily life,” Agrawal said. “For example, they can use their eyes as a joystick to move the head-neck to look at loved ones or objects around them.”