Dario Martelli, PhD

Funded by an R21 grant from the National Institutes of Health, our research examines the validity of a virtual reality floor maze test that could help identify early signs of Alzheimer’s disease.   Getting lost in familiar spaces can be one of the earliest and most alarming indications of Alzheimer’s disease. With the help of virtual reality technology, this warning sign could soon be used as an opportunity for early diagnosis, too.  Funded by the National Institutes of Health, our study of a virtual reality floor maze test could identify an accessible, non-invasive opportunity to identify Alzheimer’s disease early in the preclinical phase, when treatment is most effective. A progressive brain disorder caused by damage to nerve cells, Alzheimer’s disease is a type of dementia and one of the leading causes of death in the U.S. About 6.9 million people in the U.S. lived with the condition in 2020. The U.S. Centers for Disease Control and Prevention estimates that number will double to nearly 14 million by 2060. Existing tests for Alzheimer’s disease, including PET scans and biomarker tests of cerebrospinal fluid, tend to be invasive, expensive, and difficult to access, especially for patients in rural areas. Symptoms of Alzheimer’s disease can include problems with cognition, including memory loss, difficulty completing familiar tasks, and trouble with spatial navigation. People may get lost in their environment even before they have other signs of cognitive decline. Our study explores the validity of a virtual reality floor maze that could help spot spatial navigation symptoms of Alzheimer’s disease when irreversible nerve damage has just begun, giving patients the best chance at effective treatment.   Spatial navigation is a complex skill that integrates visual perception, spatial orientation, learning, and memory information. These processes occur in the brain’s medial temporal lobe, where Alzheimer’s disease first causes damage.   Existing spatial navigation tests that use mazes have limitations.    Paper and pencil and computer-based tests don’t engage the multisensory process involved in spatial navigation. Plus, they can be limited by educational and cultural factors, such as being limited to one language, which can reduce their effectiveness.    Active navigation tests, in which a patient navigates a maze on the floor, provide better results. They integrate brain signals as patients physically move through the maze, and performance on these tests has been shown to predict future risk of developing cognitive impairment. Yet because patients can see the exit (called vista navigation), these tests don’t accurately simulate the full experience of navigating through space (known as environmental navigation). Plus, they’re time-consuming to lay out and challenging to change. We think virtual reality technology can help. We’ve used a commercially available VR headset and free software to create virtual floor mazes that can be easily changed, and they can include virtual walls so patients can’t always see the exit. This allows us great flexibility to present new maze challenges to patients and precisely track their movements within a safe 33-foot by 33-foot room outfitted with cameras. We’re studying this method to determine whether the VR maze tests can be effective and non-invasive and whether further testing is necessary to diagnose Alzheimer’s disease. Related reading: Research: Spine-inspired Exosuit Could Help Relieve Low Back Pain. In this study, we’re enrolling participants over age 65, including people with mild cognitive impairment. They will navigate four mazes representing two types of navigation (vista and environmental)) and two types of exploration (walking and keyboard): Environmental navigation: VR  maze with walls Vista navigation: VR maze without walls Walking exploration: Completing the VR maze while walking in real space Keyboard exploration: Completing the VR maze while seated using a keyboard Before each maze, participants will see the course and plan their route. After completing each maze, participants will be asked to wait 10 minutes before trying again without a chance to prepare. We’ll monitor how long each maze takes to finish neurological tests to learn about their brain function. We’ll observe how their brain works using functional near-infrared spectroscopy while they’re at rest and navigating the maze, and we’ll analyze their gait using trackers attached to their ankles and hips. With all this data, we’ll seek to learn: If the virtual reality floor maze test exposes differences in navigation performance with or without walls and with and without walking If the test can help differentiate between levels of risk of cognitive decline How floor maze test results relate to participants’ performance on neurological tests If the VR maze test proves valid, it could help patients with early Alzheimer’s better understand their cognitive future, and it could have benefits in detecting other conditions, too, including traumatic brain injury, Parkinson’s disease, and autism. We’re enrolling participants with mild cognitive impairment at MedStar Franklin Square Medical Center in partnership with Dr. Gary Volkell. Participating in clinical trials can allow patients to get advanced care before it’s available to the public, and your involvement can help shape science and healthcare for future generations.  To learn more or enroll, contact Clinical Research Coordinator Cynthia Yashinski. We believe the virtual reality floor maze test can help more people get essential information about potential cognitive decline. Critically, these tests may be able to show evidence of decline earlier, allowing more patients an opportunity for effective treatment that can slow the progression of Alzheimer’s disease.

As part of our groundbreaking research funded by the National Science Foundation, we are researching bio-inspired exosuits as a new, innovative approach to assist movement and stimulate the recovery process for people suffering from spine problems. Low back pain is a common and costly condition in the U.S. With funding from the National Science Foundation Convergence Accelerator award, we’re developing bio-inspired exosuits that may help millions of people reduce the impact of low back pain and improve rehabilitation after spine surgery. Project TANDEM, which stands for Tensegrity-based Assistive aND rehabilitation Exosuits to Complement Human BioMechanics, is not aiming for restrictive outerwear like Iron Man’s comic book super suit. Our first device, which we are developing in the TANDEM project is the Second Spine. It is inspired by the design of the human spine.  The device resembles a backpack, with straps that cross over the patient’s shoulders and around their torso. It provides structural support while allowing fluid movement to participate in daily activities. Other devices we will develop in the future will be inspired by different body parts (e.g., shoulders, knees, etc.) Almost 65 million people in the U.S. report recent back pain, and about 8% of all adults experience chronic lower back pain that limits their activities. Healthcare and other costs due to these conditions amount to more than $12 billion per year in this country and low back pain is the leading cause of lost productivity. The National Science Foundation’s Convergence Accelerator awarded grants to 15 bio-inspired projects, one of which is TANDEM. We are currently in the first year-long phase of the project. In August, we will apply to be one of the five teams selected for the three-year Phase 2. Phase 1 began with in-depth interviews with patients and providers to understand which solutions for low back pain could be impactful. We developed the first prototype of Second Spine, and we are currently testing it on healthy participants while performing lifting and leaning tasks in the lab.  During Phase 2, we will include sensors and smart motors and test the prototypes in real life settings. At the conclusion of Phase 2, we hope to be ready to go to market with a new device that changes the way we think about back pain.  We believe our device could greatly help U.S. workers in emergency services, manufacturing, agriculture, and healthcare—all fields that can result in significant numbers of workers with lower back pain.  Our device uses a proven architectural concept called tensegrity to reduce lost working days due to low back pain, giving patients back time with their families, freer movement, and faster rehabilitation after back surgery.  The spine is a remarkable piece of engineering. It comprises rigid vertebrae separated by flexible discs and supported by supple ligaments and tendons. This combination of stiff and bendable elements balances the entire body while still allowing us to bend and twist.  Engineers and architects were so taken by this design that they developed a whole new architectural concept called tensegrity (a combination of the words “tension” and “integrity”). Tensegrity has been used to create structures like buildings and bridges. Rigid portions of the structure are held and connected by a series of flexible cables under tension. The stiff portions appear to float but are in fact very stable.  With TANDEM, led by colleagues from the University of Alabama, we’re bringing it back to the spine. Our device is very light, very strong, and very flexible. Like the spine, it is composed of rigid sections and flexible elastic elements. This means it can move harmoniously with the body while reducing muscle activation at the spine, supporting movement while assisting muscles to relieve pain. Future versions could incorporate sensors and smart motors for even more impactful assistance.  Multidisciplinary projects like TANDEM are one way we’re creating solutions to some of the biggest health challenges in the U.S. Taking our inspiration from the body itself, we’re opening new frontiers that could improve the quality of life for millions of people.