N-TRAINER
N-TRAINER is a new biomedical instrument for the rehabilitation of
suck dynamics in premature and term babies with oromotor dysfunction.
The brain of typically developing fetuses includes an organized set
of neurons in the brainstem and cortex that are involved in the production
of centrally patterned rhythmic motor behaviors. These neural circuits
are known as central pattern generators or CPGs. One such rhythmic
behavior that is controllecd by a CPG is the suck. Under normal circumstances,
the human infant is pecocial for suck, meaning it is a motor behavior
that is well established in utero and functional at birth. This is
logical since a good suck CPG is needed in order for the baby to thrive
and develop following birth.
Unfortunately, many babies born prematurely exhibit grossly disorganized
suck and this leads to medical complications and failure to thrive
and develop. There seem to be other ramifications as well concerning
the baby's overall sensorimotor development, perceptual capacity, and
even delays in higher cognitive function including speech, language
and other processing skills.
Another feature of CPGs is that many are modulated by sensory stimulation,
either as a result of the motor behavior itself, or by an external
stimulus which can be used to 'trigger' and regulate the rate and phase
of the suck pattern. The N-TRAINER utilizes these neurophysiologic
principles of sensormotor entrainment of CPGs to drive the human suck
pattern.
The N-Trainer consists of a unique pacifier cannula mounting receiver
that accepts a medical grade silicone pacifier (Soothie TM) which is
available in three sizes from micropremies, premies, and term infants
through the first year of life. The lumen of the pacifier is coupled
pneumatically to a hydraulic amplifier and linear motor which is under
computer control to impose rhythmic changes in the conformation (shape)
of the pacifier nipple, essentially synthesizing the patterning of
the non-nutritive suck. Premies and infants with oromotor dysfuntion
are given entrainment 'experiences' with the pulsing nipple of the
N-TRAINER a few times each day.
The pleasurable and preferred patterns of somatosensory exerience
generated by the N-TRAINER produces volleys of synchronous afferent
activity along the trigeminal leminscus (sensory pathways) which are
part of the suck CPG. This somatosensory experience has been shown
to modulate the baby's suck pattern, essentially phase-locking their
motor output to match the N-TRAINER's synthetic suck signal. In essence,
the baby's suck becomes more highly organized and functional.
From the neurophysical literature on brain plasticity, it has been
shown that neurons which fire together (synchronously as is the case
during entrainment) will wire together. Thus, the N-TRAINER represents
a new neurotherapeutic tool for increasing the probability of functional
oromotor behavioral, improvement in the mapping of perception-action
subsystems in the developing brain, and likely positive impact on later
occurring cognitive development.
Additional features include data acquisition, stimulus control, database,
and analysis software, a pheumatic bleed valve for pressure transduction.
Applications
This system has obvious application in
hosptial neonatal intensive care units (NICU), pediatric units, and
potentially home-based systems for use by parents around the world.
Benefits
The N-TRAINER represents a new neurotherapeutic tool for increasing
the probability of functional oromotor behaviroal, improvement in the
mapping of perception-action sybsystems in the developing brain, and
hypothesized positive impact on subsequent cognitive skills.
N-TRAINER provides non-invasive, objective, rapid, pleasurable stimulation
of the human orofacial apparatus to promote suck CPG development.
There is no other knonwn sysmtem like the N-TRAINER in the world.
Potential Uses/Users
Neonatologists, pediatric and NICU nurses, developmental speech physiologists.
Developmental Status
Under development for implementation at two regional
neonatal intensive care units in Kansas as part of an ongoing NIH
R01 research grant focused on sensorimotor development of the orofacial
system in human neonates at risk for intraventricular stroke, respiratory
distress syndrome, and typically developing babies.
Patent: Pending
License: Negotiable
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