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  The Nation's #1 Independent Veterans Web Site Click here to make VA Watchdog dot Org your homepage VA NEWS FLASH from Larry Scott at VA Watchdog dot Org -- 07-07-2008 |
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The Nation's #1 Independent Veterans Web Site Click here to make VA Watchdog dot Org your homepage VA NEWS FLASH from Larry Scott at VA Watchdog dot Org -- 07-07-2008 |
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VICTIMS' ARMS -- After about three months of exercising with the electronic therapist, he's mowing his lawn again, pulling weeds in his garden and taking target practice at the local sportsman's club.
For more about veterans and strokes, use the VA
Watchdog search engine...click here... Story here...
http://www.courant.com/news/h Story below:
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VA Studies Robot Therapy To 'Recharge' Stroke
Victims' Arms
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If it works, the
study could turn conventional thinking about stroke treatment on its ear
by showing that you actually can teach damaged brain tissue new tricks.
"I was basically taught that once a person has had a stroke in the last
one to two years, they weren't going to gain very much [mobility]," said
Dr. Albert Lo, chairman of the $5 million U.S. Department of Veterans
Affairs robotics study. "People who have had strokes didn't have much hope
for any recovery."
Since the study began about a year ago, Lo said he has seen patients who
had strokes 25 years ago find renewed mobility in their arms. Once the
study is complete, next summer, researchers expect to know for sure
whether performing thousands of repetitive
movements
with the help of a smart electronic therapist can indeed restore function
in limbs that were thought to be dormant.
"We're going to give this the best test possible," Lo said. "If it works,
wonderful, but if it's wishful thinking, we want to know that as well."
Thinking About Moving
The robots are being
tested in West Haven and VA hospitals in Seattle, Gainesville, Fla., and
Baltimore. The study is open to veterans with arm or hand weakness caused
by a stroke.
Half of the study participants receive intensive physical therapy with a
human therapist three times a week for 12 weeks.
The other half are assigned to the robot group. This is less exciting than
it sounds. The robot looks more like a garden-variety brace or splint that
is strapped to the wrist, elbow or shoulder, depending on which joint is
being used.
A flat-screen computer monitor displays colorful dancing dots a la 1980s
video games. Using a joystick, the patient is challenged to hit moving
targets on the screen, using the stroke-weakened arm. If the patient
cannot move the arm, the machine helps. If the machine senses any movement
by the patient, it backs off, letting the injured arm do more of the work.
Even if the patient at first cannot accomplish the task, the very act of
thinking that the arm should move, then having it touch the correct target
propelled by the robot, starts to restore or rebuild circuits in the
brain, said Hermano Igo Krebs, a Massachusetts Institute of
Technology-trained mechanical engineer who developed the device known as
MIT-Manus.
"The person sees a target asking them to extend the elbow. If they could
move, they would," Krebs said. "The machine helps to make the movement;
the impulse goes back to the brain so [the brain and the arm] are firing
together."
Although the study data have not yet been analyzed, Drs. Noshene Ranjbar
and Daniel Federman, who are running the study in West Haven, said
patients in both the robot and the conventional therapy group seem to be
showing improvement.
What they hope to show is that the robot offers a cheaper, more effective
and more reliable approach to physical therapy for stroke patients. And
they would like to convince insurance companies that it is never too late
to give stroke patients hope for regaining mobility.
Reawakening Synapses
The robot is not
designed to replace humans as physical therapists. But it has advantages.
A human physical therapist can engage a patient's arm 60 to 80 times in an
hour, Krebs said. During that same period, the robot can initiate 1,024
repetitive arm movements without getting bored or tired, Krebs said.
But repetitive movement alone is not enough. In early trials of robotic
therapy, scientists strapped a patient's crippled arm to a repetitive
movement machine that simply moved the limb while the patient watched TV.
There was no improvement. The key to reawakening brain synapses — the
little messengers that run back and forth between nerve cells, keeping the
lines of communication open — is to think about moving, then have the
movement occur. It's the ultimate mind-body connection.
If the theory holds up, the robot-assisted therapy could become another
breakthrough in the field of stroke treatment that has only recently been
able to offer hope to the estimated 700,000 people in the United States
who have strokes every year.
For decades, patients were sent home from the hospital a few days after a
stroke with a handshake and a pile of prescriptions to treat the
conditions that most frequently lead to strokes — diabetes, high blood
pressure, high cholesterol and smoking.
Sometimes, they were sent for physical therapy. But if movement did not
return after about three months, they were often told to use the other arm
and be grateful for what they could do.
"Patients say the loss of arm or hand function is the most disabling
aspect of a stroke," said Lo, a neurologist who has moved to Brown
University in Providence, but continues to oversee the VA study.
Combined with improvements in emergency care, patients for the first time
can begin to hope that a stroke — which can be caused by a blood clot or a
burst blood vessel in the brain — may not be devastating.
When a stroke occurs, blood flow to the surrounding tissue is interrupted,
causing cell death or damage. The key to recovery, said Dr. Isaac
Silverman, co-medical director of the Stroke Center at Hartford Hospital,
is to restore blood flow as quickly as possible.
Several promising techniques for protecting the brain are emerging. These
include medication, catheterization, medically cooling the body to
preserve injured tissue and surgery to relieve pressure on the brain
caused by swelling.
But the most fundamental component to better stroke treatment rests in the
hands of patients and their families.
"The area that's most lacking is public awareness," Silverman said. At
most community hospitals around the country, only 1 percent to 5 percent
of patients arrive at the emergency room within three hours of a stroke —
the time window for receiving the only FDA-approved clot-busting drug,
t-PA. At regional stroke centers such as Hartford Hospital, 30 percent to
40 percent of patients arrive in time to receive the life-improving drug.
But even that's not enough, Silverman said.
"Until it's on par with a heart attack, patients are going to get here
late," he said. Patients and families, he said, must realize that stroke
symptoms — which can include numbness, dizziness, and trouble speaking —
are an emergency and they should call 911.
Ideally, Lo said, he'd like to treat stroke patients in the emergency room
and send them home with a prescription for robot-assisted physical therapy
that would be covered by insurance, just like the blood thinners the
patient also must have.
At the same time, he hopes to have evidence that robot therapy can offer
hope to patients such as Walter Spring, whose stroke damage seems more
permanent.
Home Use
Because the robots
are still in their infancy, they are expensive and available only in
clinical settings. But if the experiments show they work, Krebs said he
envisions them becoming available for home use. He even imagines that
stroke patients may be able to interact in cyberspace by competing against
one another, playing therapeutic computer games while their arms are
getting stronger.
At Gaylord Hospital in Wallingford, a robot-controlled portable sling is
being used to help stroke patients practice activities of daily living
such as folding towels, or taking groceries off a store shelf, and other
devices are quickly being developed.
Although the VA study will not be completed for more than a year, Barbara
Spring said she is already amazed by her husband's progress.
"I was hoping for the slightest little movement to be gained, just opening
his fingers in the beginning," she said. "I never dreamed ... " her voice
trailed off. "The other day he was holding a sandwich with both hands."
The VA stroke study is open to veterans with moderate to severe arm or
hand weakness from stroke. For more information, call 203-932-5711, Ext.
3826 or Ext. 4146.
Contact Hilary Waldman at
hwaldman@courant.com.
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posted by Larry
Scott
Founder and Editor
VA Watchdog dot Org
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