June 22, 2008

New Technology Helps Stroke Patients: Therapists Say Patients Making More, Faster Progress

By Tammie Smith, Richmond Times-Dispatch, Va.

Jun. 22--Jamaal Williams looks like he's playing a video game as he manipulates the joystick, guiding a cursor along lines that fan out from a target on a screen.

Each time the cursor meets the target, there is a low bleep. He repeats the movements as occupational therapist Natalie Smyk hovers.

"Jamaal has good strength. Now, we are working on his ability to control his movements," said Smyk, at the Sheltering Arms rehabilitation hospital in Mechanicsville.

The machine Williams is on is called a REO. Used in rehabilitation therapy, it can help patients like Williams, 32, regain function after neurological injury. In Williams' case, the injury was caused by a stroke in February 2007 that affected his right side.

Initially unable to walk or talk, Williams, a former Virginia Union football player, has regained much function. But there are some lingering problems. You have to grab his right hand to shake it. He walks slower than he did before the stroke. He sometimes struggles to get words out.

Recovery from stroke, which affects an estimated 700,000 Americans annually, is unpredictable. But patients like Williams are benefiting from new technology that therapists say helps some patients get better sooner or make gains they might not have made with traditional therapy.

In the U.S., death rates from strokes are declining, but cases of stroke are not. Stroke rates are higher in the so-called stroke belt, a stretch across the southeastern and southern U.S.

"The incidence is continuing to climb," said Timothy J. Shephard, head of the neurosciences institute for Bon Secours Richmond. "That's a function of the baby boomers getting older. Stroke, while not always a function of people over the age of 55 to 60, a large majority of it is."

Risks include smoking and high blood pressure. Things that put younger folks at risk include the postpartum period of pregnancy, clotting problems, smoking, blood vessel abnormalities, use of hormonal contraceptives and sports injuries.

Stroke rehabilitation accounts for about 16 percent of the costs of having a stroke, Shephard said. Along with the economic costs, there are costs in terms of lives lost and disability.

"I have many patients who say that their arm is just dead. It is useless and they should just cut it off, those kinds of comments," Smyk said.

The newer technology includes devices that use electrical currents to stimulate movement, such as opening or closing the hand. There also are devices such as the REO that have robotic capabilities, so that patients unable to move an arm are automatically guided through exercises.

Some places are even trying virtual reality therapy. One study had stroke patients do movements, such as knee lifts, and superimposed those images onto a computer-generated image of the person climbing stairs.

The underlying theory in most of these efforts is that with enough repetition, the brain can reorganize and learn to work around damaged areas.

"It was previously believed that pretty much after six months to a year, you had gotten all that you were going to get back after your stroke -- that any functional recovery that takes place in the first year is pretty much it," Shephard said. "We are seeing that with some new techniques and some new research, that some level of functional recovery can be gained multiple years after your stroke."

Daisy Williams, Jamaal's mother, is betting on that as she pushes her son to keep working to get his strength and function back. Two years before the stroke, he had a flu-like virus that affected his heart, she said.

He was taking medication for his heart, she said, when in February 2007 his blood pressure spiked. He was in the hospital when he started complaining about not being able to remember things. He was sent for imaging studies. Daisy Williams said she got a call that night that he'd had a stroke.

"He couldn't do anything," Daisy Williams said. "I prayed a lot. I never felt he would not get better. I pushed him. He pushed back."

Smyk said not all patients do as well as Williams. For many, the technology is a motivator.

"You put them on the Bioness or the REO, and they see they still have some movement going, which motivates them a little bit more," Smyk said. Bioness devices use electrical impulses to stimulate movement.

Researchers also are studying brain stimulation for paralysis from stroke and other neurological damage. In such cases, thin electrode wires are inserted in the brain or electrodes are placed on the skull. As the patient imagines performing a task, a computer connected to the electrodes analyzes brain waves. That patient is fitted with an orthotic arm or leg.

"Whenever the computer detects that pattern of brain waves, then it will activate the hand orthosis," said Dr. Leonardo G. Cohen of the National Institute of Neurological Disorders and Stroke. His lab, the Human Cortical Physiology Section at the National Institutes of Health, is studying the use of brain stimulation to enhance the effects of physical therapy.

In his research, electrodes are placed on the skull.

"You stimulate the brain at the time the person is going through physical therapy," Cohen said. "The idea is to apply it at the time they are learning something. So once something is learned, it's learned, and it stays there.

"In these patients, the problem is that . . . the cable that connects that intact brain that can imagine something to the hand has been severed by the stroke," he said. "So if one could bypass that 'broken cable,' then one could potentially replace the lost function by the brain-computer interface."

Contact staff writer Tammie Smith at or (804) 649-6572.


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