man standing in front of video screen
Resembling a giant video game, the M-Gait Lab is an immersive way to measure human gait in patients with neurological disorders. (Photo: UHN)

From the moment Hugh Johnston first stepped into UHN's gait analysis lab he couldn't help but feel like he'd been transported into a giant video game.

After strapping into a safety harness secured to the ceiling, and climbing atop a split-belt treadmill surrounded by an elaborate motion capture system, Hugh was intrigued as a series of projection lights vividly recreated the streets of lower Manhattan on a floor-to-ceiling screen.

"It's really the closest you can get to walking on those streets, without physically being there," says Hugh, a research volunteer, Parkinson's advocate and patient at Toronto Western Hospital. "I've been told that it's enough to trick your brain that you're outside, and your stride becomes more natural."

Introducing M-Gait

This relatively new facility at Toronto Western (TW) – which is officially called M-Gait – is an immersive rehabilitation research space designed to study gait by recording how people walk in a variety of simulated environments.

"Patients with Parkinson's act differently when they are in the hospital compared to other settings," says Dr. Alfonso Fasano, a neurologist and movement disorders specialist at the Krembil Brain Institute at TW.

"Gait analysis is an effective and standardized way to measure and analyze, in detail, human locomotion."

Milos Popovic
Dr. Milos Popovic, Co-Director of CRANIA and Institute Director at KITE, says this week's conference is intended to offer participants “a highly-interactive environment” on neuromodulation. (Photo: UHN)

M-Gait is one of the first research ventures to spring out of the CenteR for Advancing Neurotechnological Innovation to Application (CRANIA) project, which was established in 2018 by UHN and the University of Toronto.

CRANIA's mission is to study and seek treatments for a variety of neurological conditions, including Parkinson's, epilepsy, chronic pain and Alzheimer's – and assist the estimated one in three Canadians who will be affected by a brain disease, disorder of injury in their lifetime.

While CRANIA is relatively new on the scene, it's already helping to foster collaboration between researchers at Krembil, The KITE Research Institute at Toronto Rehab and beyond.

Those collaboration efforts have the potential to expand further next week when leaders in engineering and neuroscience gather for the inaugural CRANIA Conference at the MARS Discovery District on Monday, Sept. 16.

"The goal of this conference is to provide a highly-interactive environment, which will foster learning and networking for all those who are currently working in the field, or have an interest in, neuromodulation," said Milos Popovic, CRANIA co-director and Institute Director at KITE.

"Neuromodulation uses sophisticated devices implanted in a patient's brain, spinal cord or peripheral nerves to deliver targeted stimulus."

Alfonso Fasano
Dr. Alfonso Fasano, a neurologist and movement disorders specialist at the Krembil Brain Institute at Toronto Western Hospital, says establishment of the new gait lab through CRANIA is key to better understanding human locomotion and its interplay with cognition. (Photo: UHN)

Topics of discussion at the conference include the future of neuromodulation, deep brain stimulation technologies and the future of the industry. Organizers hope the event will spark discussions about the future of these technologies and potential clinical applications.

Dr. Popovic, who leads CRANIA along with Krembil neurosurgeon Dr. Taufik Valiante, says he hopes the conference becomes an important forum for students, scientists, clinicians, engineers, neurosurgeons, mathematicians, psychologists and others involved in the development of neuromodulation procedures and device creation.

Back in the M-Gait space, researchers are hard at work measuring the generated forces at play when patients walk as well as the range of motion of different joints and limbs and their displacement in the space and time.

In addition to recording locomotion, gate analysis records data from electrodes embedded in the brain or spinal cord, allowing researchers to measure the impact of new drugs or surgical procedures with better accuracy, and provide rehabilitation for gait abnormalities, including improving asymmetry with split-belt walking.

"Gait and balance disorders are – along with speech problems, constipation and pain – major determinants of poor quality of life for people living with Parkinson's, well beyond classical symptoms such as tremor and rigidity," says Dr. Fasano.

"We have good treatments for many of these problems but gait and balance are often resistant. We need a better understanding of human locomotion, including its interplay with cognition, and effective treatments now.

"Establishing this new gait lab through CRANIA is the first step we need to take in order to tackle these challenges."

Dr. Alfonso Fasano explains how M-Gait Lab works. (Video: UHN)

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