Saturday, February 21, 2015

Technology to Increase Function after Stroke

Sharon D. Anderson
Stroke Survivors Tattler
Feb 15 / 2015

About 15 million people worldwide have a stroke yearly.  Stroke is now the 4th or 5 leading cause of death because now about 85 % survive stroke.   However, it is the leading cause of adult disability. Less than 15% of survivors recover completely.

Restoration of blood flow using clot-dissolving drugs has produced impressive benefits in some patients who receive it.   Only a small proportion (about 10%) of eligible stroke patients (ischemic stroke only) reach hospital within the 4.5 hour treatment window.  The new clot retrieval systems (MR CLEAN, ESCAPE, EXTEND-IA, SWIFT PRIME) offer additional hope.  The window time for is longer.  In the Australia/New Zealand study, treatment with a clot-retrieving device had to be initiated within six hours of the onset of stroke symptoms and completed within eight hours.  Most (90%) of those treated with an intra-arterial device were still alive 90 days later and 53% were considered functionally independent. For every 2.5 to 4 patients treated with the new clot retrieval systems, one could be expected to have an outcome better than they would have had if they received the  clot-buster,  tPA .

However, functionally independent is not the same as recovered.   Many stroke survivors will still have many of the impairments common to transient ischemic attacks, mild stroke, or those who received clot busters.  The physical impairments may be less but impairments such as fatigue, anxiety, depression, memory problems, slower cognitive processing etc.…. still make carrying on as before stroke at home or work challenging.  Yes MR CLEAN, ESCAPE, EXTEND-IA, and SWIFT PRIME clot retrieval studies will create more survivors and reduce functional impairment, but many survivors will still have impairments that require rehabilitation or adaptation.

Technology to the Rescue

More survivors will increase the demand for rehabilitation to enhance the brain’s capacity for reorganization and recovery (neuroplasticity).   Technology can assist with recovery and also, help people adapt to the impairment.

Technology offers promise for tapping into neuroplasticity after stroke.  We tap into neuroplasticity when we are interested (enriched environments) and the therapy is intensive (massed practice).  For example the cab drivers in London and youth who play video games have gains in spatial orientation, memory formation and strategic planning(2).

CBC @ Radio-Canada

Technology is another way to stimulate nerves to function.

Technology that uses Functional Electrical Stimulation (FES) stimulates peripheral nerves in your arms or legs to increase patterned movement.  The WalkAide and Bioness systems for foot drop and Bioness for hand spasticity have been available for some time.  These FES systems stimulate the weak muscles, usually the extensors, to move. Myndmove is a newer FES system that works on both flexors and extensors.  NovaVision also uses computer training  to assist people who vision impairments after stroke

Technology can help to make recovery exercises interesting and intensive.

It is well known that exercise can help to rewire brain function.  Those who exercise regularly have better outcomes than those who don’t.  The intensive exercise required to tap into neuroplasticity can be boring. Technology can make these activities interesting and in some cases tailor the activity to your skill level.  They can track your progress.  There is now good evidence that using the Wii or therapeutic activities that incorporate video games   (e.g., ReJoyce) do produce meaningful results.  When combined with regular in-patient rehabilitation—those using Virtual Reality systems had a 20 percent improvement in motor function and completion of routine tasks than those in rehab alone.   Rehab patients played 20 to 30 hours during four to six weeks of therapy on one of several computer-based technology systems: three traditional video game systems (i.e., Glasstron, IREX®, Playstation®  Eye Toy® and nine virtual reality systems (i.e., Virtual Teacher, CyberGlove, VR Motion, PneuGlove, Wii™).

Combining therapies seems to be even more effective than a single therapy for improving functional recovery(1).  Stroke survivors like Sarah Scott have made impressive gains in intensive speech therapy (Constraint when transcranial magnetic stimulation (TMS) or repetitive transcranial magnetic stimulation (rTMS) are added

  1. Corbett, D, Nguemeni, C. & Gomez-Smith, M.  (2014) How can you mend a broken brain? - Neurorestorative Approaches to Stroke Recovery. Cerebrovascular Diseases, 38 (4), 233-239.
  2. Kühn, S.,  Gleich, T., Lorenz, R. C., Lindenberger, U., & Gallinat, J. (2013).  Playing Super Mario induces structural brain plasticity: gray matter changes resulting from training with a commercial video game, Molecular Psychiatry, , DOI: 10.1038/mp.2013.120
  3. Saposnik, G., & Levin, M.  (2011). Virtual reality in stroke rehabilitation: a meta-analysis and implications for clinicians. Stroke. 42(5), 1380-6. doi: 10.1161/STROKEAHA.110.605451. Epub 2011 Apr 7.
  4. Pinter, M.M. & Brainin, M. (2013). Role of repetitive transcranial magnetic stimulation in stroke rehabilitation. Front Neurol Neurosci.  32, 112-21. doi: 10.1159/000346433. Epub 2013 Jul 8.

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