Dr. Mike Holmes

Learn more about Dr. Holmes

What is the focus of your research? How did you become interested in MS research?

The focus of my research program is to better understand the muscular contributions and strategies used to control our hand movements and gripping actions. How humans interact with tools and objects is one of the most fundamental aspects of human movement. For something as simple as reaching for a cup of coffee, the actions that take place at the spinal cord and brain to develop control strategies to prevent one from spilling hot coffee happen in milliseconds and are not entirely understood. The distal upper extremity is incredibly complex with many muscles capable of performing similar actions to control the hand. The muscular control required for precise hand movements and grasping actions are critical for most activities of daily living. Our lab integrates techniques from neurophysiology, biomechanics, and robotics to better understand how neuromuscular fatigue, pain, injury can influence movement quality.

Our lab has spent many years studying hand and wrist movements in healthy populations using a specialized robotic device that allows us to control the forces acting on an individual while they move. With an understanding of neuromuscular control in healthy populations, the next logical step in our research was to use the robotic device to evaluate movement in those with neurological impairments. This was always a long-term goal of my research program, and the work has progressed thanks to support from MS Society of Canada. There is little research on robotic neurorehabilitation for persons with MS, particularly for the upper limb. Most studies to investigate non-pharmacologic approaches for therapy have focused on the lower extremity, mobility, and balance. Considering upper limb disability is observed in 75% of people with MS, there is a clear and urgent need for further research. Combine our labs progression with a motivated doctoral student who has a personal connection to MS, and our work in rehabilitation robotics was born.

What inspires you to continue advancing research in this field?

The incredible population living with MS is all the inspiration we need. We have found the MS community to be unbelievably supportive of our work. Recruitment for our studies have been overwhelmingly positive. The willingness of individuals to participate in our research has been incredible. Our preliminary work in adaptive robotics, led by PhD candidate Kailynn Mannella, has allowed our team to closely interact with the MS community. We have received positive feedback from our research participants following robotic training. Hearing first-hand accounts of participants regaining independence, being able to complete activities of daily living, being able to cook and bake, and experiencing less fatigue while performing computer tasks at work, inspires and motivates us to continue this important work.

Our work is at the intersection of rehabilitation, robotics, and neurophysiology. A lack of hand function, dexterity and declining grip strength hinders an individual’s ability to perform activities of daily living such as bathing, dressing, and feeding. Upper limb impairments can translate to a loss of self-worth, inability to work, exercise or even play with your kids or grandkids. Our research aims to improve upper extremity function, which we believe is an integral part of enhancing the lives of those with MS. The potential for rehabilitation robotics is just scratching the surface and the future is exciting.

How do you hope to change the lives of people living with MS through your research?

Our work aims to improve functional impairments that result from MS, with a particular focus on the hand and wrist. Upper limb disability, including a lack of hand function and reduced grip strength is prevalent in individuals diagnosed with MS. Research has demonstrated that to promote motor learning and to increase hand/wrist function, manual therapy is required in high repetitions, multiple times per day. This can be costly for individuals with MS and time consuming for a physical or occupational therapist. We believe that rehabilitation robotics can solve these problems.

The findings from our work will inform clinicians and researchers of the value of robotic assessments and training to optimize the rehabilitation approach. Our work will generate new data in the areas of clinical assessments, adaptive robotics, individualized strength, and skill training. The knowledge generated by this work will open opportunities to advance non-pharmacological approaches to the management of MS and will provide valuable data for engineers to enhance robotic assessments.

What do you enjoy most about your research? What are some of the challenges you face?

The most exciting part of my research is getting to work with smart, creative, and highly motivated graduate students and colleagues. Building a team of researchers, with specific skills and backgrounds to address a research question or problem is stimulating. Our recent grant from the MS Society of Canada brings together expertise from 3 Canadian provinces and international colleagues from Italy. This provides a valuable learning experience for my graduate students, many of whom will continue our work in this area, well into the future.

Of course, there are always challenges associated with implementation of our research plan. Many of the experimental and technical challenges can be overcome with commitment and determination from our research team. Other challenges that we focus on include equity, diversion, and inclusion in our recruitment of participants. Our robotic device has ergonomic design considerations for inclusion and is wheelchair accessible. However, we strive to include a wide range of participants in our research across sex, age, and socioeconomic status. So, getting the word out to the MS community about recruitment for our studies is very important to us. Our research is supported by a knowledge mobilization plan. We want to do the best job possible of sharing results and key messages from our research more broadly. With the help of the MS Society of Canada, we aim to provide creative and engaging ways to promote the work outside of academic circles. This will be a challenge, but we have the supports in place to make it happen.

How important is the support from the MS Society of Canada in your research?

Support from the MS Society of Canada is critical for our research. Without this support, the work would simply not be possible. This grant will support several student researchers and will allow us to purchase important laboratory supplies. Support from the MS Society of Canada allows our lab to expand our focus. Our team can leverage everything we have learned over the past decade in healthy populations to improve the quality of rehabilitation and quality of life for those with MS.