Author: Stroke Connection Magazine

Slowing activity on the side of the brain undamaged in a stroke may safely restore lasting motor function, according to a small study in “Stroke: Journal of The American Heart Association”.

Researchers found that decreasing neural activity on the unaffected brain hemisphere with a session of repetitive transcranial magnetic stimulation (rTMS) significantly improved stroke survivors’ motor function for a short time. The mechanism of this brain stimulation might work similarly to that of constraint-induced therapy in which a survivor’s healthy limb is restrained to force the stroke-affected limb to function.

Here rTMS decreases neural activity on the healthy hemisphere of the brain, which forces the stroke-affected hemisphere to be more active. Thus, this treatment might be considered a kind of constraint-induced therapy for the brain. Of 15 stroke patients (11 men, average age 56) who’d had a stroke at least a year earlier, 10 were randomly assigned to receive active rTMS and five to receive inactive (sham) rTMS. Stimulation to relax neural activity was applied to the primary motor cortex area in the hemisphere unaffected by stroke. Researchers evaluated movement in patients’ affected and unaffected arms with a series of simple movement and reaction tests. They found that the active rTMS improved motor function only in the affected hand. For instance, in a reaction-time task, patients averaged 30 percent faster than baseline after five days of treatment, and that effect lasted for two weeks.

Interestingly, the improvement was cumulative: Patients were on average 10 percent, 20 percent, 27 percent and 30 percent faster on days two, three, four and five, respectively.

Researchers speculate that this therapy may help overcome “learned non-use” of the stroke-affected limb. The daily inhibition of the unaffected, healthy brain hemisphere for five consecutive days may mimic the effects of prolonged constraint-induced therapy and induce similar changes in the brain. They also suggest that combining constraint-induced therapy and rTMS stimulation may further enhance motor function recovery.

To learn more about rTMS request the StrokeConnection Magazine July/August 2006 issue for “New Directions in Rehab”

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Author: Medical News Today

For the first time in the United States, a stroke patient has been intravenously injected with his own bone marrow stem cells as part of a research trial at The University of Texas Medical School at Houston.

Roland “Bud” Henrich, 61, was transferred to Memorial Hermann – Texas Medical Center on March 25 after suffering a stroke while working on his farm in Liberty. He arrived too late to receive tissue plasminogen activator (tPA), the only treatment for ischemic strokes. He became the first patient in the trial.

The Phase I safety trial, funded with a pilot grant from The National Institutes of Health and support from the Notsew Orm Sands Foundation, will enroll nine more patients who have suffered a stroke and can be treated with the stem cell procedure within 24 to 72 hours of initial symptoms.

Stroke occurs when blood flow to the brain is interrupted by a blockage or a rupture in an artery, depriving brain tissue of oxygen. It is the third-leading cause of death behind heart disease and cancer. According to the American Stroke Association, nearly 800,000 Americans suffer a stroke each year – one every 40 seconds. On average, someone dies of stroke every three to four minutes.

“It’s still very early in this safety study, but this could be an exciting new therapeutic approach for people who have just suffered a stroke,” said Sean Savitz, M.D., assistant professor of neurology at the medical school and the study’s lead investigator. “Animal studies have shown that when you administer stem cells after stroke, the cells enhance the healing. We know that stem cells have some kind of guidance system and migrate to the area of injury. They’re not making new brain cells but they may be enhancing the repair processes and reducing inflammatory damage.”

Savitz said animal studies have shown that the healing effects of stem cells can occur as early as a week but cautioned it is too early to attribute Henrich’s improvement to the stem cell treatment. “I’m hoping he will get better and it will be because of the cells, but it’s just hope at this point,” Savitz said.

The stem cells were harvested from the bone marrow in the iliac crest of his leg, then separated and returned to Henrich several hours later. Because they are his own stem cells, rejection is not expected to be an issue.

When he arrived at the hospital, Henrich could not speak and had significant weakness on his right side. When he was released after nearly two weeks of hospitalization and rehabilitation, he was able to walk and climb stairs unassisted and said his first words.

His wife, Reba Henrich, said she believes the stem cells have helped. He has spoken a few times with a single word or a phrase since his return home. “Too crowded,” he told her at a megastore as they shopped for Easter gifts for their grandchildren and “senior” meal he told a waitress at a local restaurant. He also has fed the cows by himself, she said. They are hopeful he will eventually be able to return to his job as a painter.

“This study is the critical first step in translating laboratory work with stem cells into benefit for patients. If effective, this treatment could be helpful to a huge segment of stroke patients to reduce their disability,” said James C. Grotta, M.D., Roy M. and Phyllis Gough Huffington Distinguished Professor of Neurology and chair of the Department of Neurology at the medical school. “We are fortunate here at UT Houston and the Texas Medical Center to have the resources needed to carry out this work, and to have attracted someone of Dr. Savitz’s caliber to lead this study.”

Notes:

The study is only open to patients who are admitted to the Emergency Center at Memorial Hermann – TMC or through the UT Stroke Team with symptoms of an immediate stroke.

Source:
Deborah Lake
University of Texas Health Science Center at Houston
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Article URL: www.medicalnewstoday.com/articles/146294.php

Author: University of Pittsburgh Medical Center

PITTSBURGH, February 14, 2006 — Physicians at the University of Pittsburgh Medical Center are participating in a multicenter study that may help stroke survivors gain greater use of their arms and hands by electrically stimulating the brain during physical rehabilitation. Previous pilot studies have shown that such a combination is safe and enhances motor function more than rehabilitation alone. The electrical stimulation is provided by the temporary surgical placement of an electrode on the covering of the brain.

“ The most common neurological deficit among stroke survivors, and a substantial contributor to post-stroke disability, is motor weakness on one side of the body. Presently, the only treatment available for patients with such deficits is rehabilitative therapy. However, many patients are not responsive to standard therapy or they achieve a less than satisfactory improvement in function,” said Douglas Kondziolka, M.D., Peter J. Jannetta Professor of Neurological Surgery and Radiation Oncology and Vice Chairman of Education, department of neurological surgery, at the University of Pittsburgh School of Medicine.

Following a stroke, many patients show some spontaneous neurologic improvement. Restoration of function may be the consequence of the brain’s neuroplasticity, which is a mechanism in which new areas of the brain take over the function of stroke-damaged areas. The brain’s cerebral cortex, with its extensive network of interconnected neurons, is thought to be an important site for neuroplasticity. This area of the brain will be stimulated during the study.

Participants in the study will have an electrode surgically placed on the membrane, called the dura, which covers the brain. A wire from the electrode will be tunneled under the skin to a stimulating device about the size of a pacemaker that will be placed under the skin near the collarbone. The stimulator will be turned on just before the start of the daily rehab session and will be turned off when the session is over. The electrode and stimulator will be removed about eight weeks after the completion of the rehab period. Participants will be followed closely for signs of improvement for six months and will be compared to a control group, which will undergo rehabilitation only. The rehab portion of the study will take place at the Institute for Rehabilitation and Research at UPMC South Side and will last for six weeks.

To read the full article and contact information for this study, click on UPMC.

Author: Medical News Today

An individual suffers a stroke and doctors and nurses in the hospital swoop in to intervene in the immediate life-threatening medical problems. But what happens after stroke survivors battle back to health and can go home? Often, they and their families are still left with problems and questions.

Some of the daily life problems left after a stroke such as paralysis on one side of the body, or difficulty with swallowing are easy to see and address. But more insidious barriers can remain. Stroke survivors may be left with damage to their brain that makes it hard for them to interpret the environment around them.

“Difficulty eating, dressing, and navigating in complex environments occurs due to a ‘hidden disability’ affecting functional vision. Although a stroke survivor’s eyes may be healthy, he or she may have trouble ’seeing with the brain,’” said Dr. Anna Barrett, an associate professor of Physical Medicine and Rehabilitation, and Neurology and Neurosciences, at the UMDNJ-New Jersey Medical School. “A person may become unable to perceive and act while eating, getting dressed, or moving around in the home or other very familiar surroundings. Worse, people with this visual-spatial disability usually don’t know why they are making mistakes. They don’t realize they have problems with functional vision, and so they can’t tell others.”

Barrett’s research involves studies that target diagnostic and treatment strategies for this devastating but under diagnosed condition. “Our mission in our research studies is to make these “hidden disabilities” visible so they can be treated,” she said.

According to Barrett, more than half of stroke survivors also have memory difficulties that make it hard to manage appointments, medications, and to dual-task at home or in work environments. These problems can limit independence, and are embarrassing and confusing to survivors and the people who care about them. Memory problems related to stroke often go undiagnosed, and so survivors may not know why they are having trouble resuming independence and returning to work.

Barrett suggests the following warning signs might identify a “hidden disability” of functional vision in an individual who is recovering from stroke:

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Author: Advance Web

By doing a set of vigorous visual exercises on a computer every day for several months, patients who had gone partially blind as a result of suffering a stroke were able to regain some vision, according to scientists at the University of Rochester Eye Institute [Journal of Neuroscience, 29: 3981-3991].
Such rigorous visual retraining is not common for people who suffer blindness after a stroke. That’s in contrast to other consequences of stroke, such as speech or movement difficulties, where rehabilitation is common and successful.
“We were very surprised when we saw the results from our first patients,” said Krystel Huxlin, PhD, the neuroscientist and associate professor who led the study of seven patients. “This is a type of brain damage that clinicians and scientists have long believed you simply can’t recover from. It’s devastating, and patients are usually sent home to somehow deal with it the best they can.”
The results are a cause for hope for patients with vision damage from stroke or other causes, said Dr. Huxlin. The work also shows a remarkable capacity for “plasticity” in damaged, adult brains. It shows that the brain can change a great deal in older adults and that some brain regions are capable of covering for other areas that have been damaged.

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Author: National Aphasia Association

This article highlights national and international developments in aphasia therapy research over the past two years. We will focus on three areas: 1 ) the emergence of nontraditional treatments for aphasia, 2) the need to place aphasia treatment within the context of the complex brain mechanisms involved in the recovery process as well as the need for clinicians to apply theoretical frameworks in deciding the course of patient treatment, and 3) developments in the frontiers of neuroscience.

The National Aphasia Association .

Author: Medical News Today

University of Queensland research is set to unlock the regions of the brain central to successful language treatment following a stroke.

Speech pathologist Dr David Copland, from UQ’s Centre for Clinical Research, hopes to launch the first large-scale study of its type in the world.

“This knowledge can improve treatment by increasing understanding of which treatment types work best for particular individuals and so maximising recovery for patients,” Dr Copland said.

“Usually speech-language therapy is conducted treating the brain like a ‘black box’ – we conduct the therapy, but we don’t consider the brain function in the patient or the parts of the brain typically involved in the therapy.

“This is because we don’t really know the brain mechanisms underlying successful treatment and recovery,” he said.

“The brain somehow achieves this amazing feat, where someone can suffer a significant brain injury and lose the ability to speak or understand language and then amazingly the brain manages to recover a significant amount of language, both spontaneously and with the help of therapy. A range of different language treatments are available, but it is still not clear which treatment should be used for a particular individual.”

Dr Copland also aims to further his collaboration with UQ neuroimaging experts Dr Katie McMahon and Dr Greig de Zubicaray. Along with his team of researchers in UQ’s Language Neuroscience Laboratory, they will look directly at what area of the brain is critical for different language treatments to be successful.

Australians suffer from around 50,000 strokes each year, with language impairment (aphasia), common in those that require rehabilitation. A year after their stroke, up to 60 percent of people with aphasia continue to have difficulties with communication.

To read, print or email this article, Click Here .
Recruitment of volunteers for the new study will begin soon.

The University of Queensland, Brisbane Australia
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Author: Medical News Today

Among stroke survivors and patients suffering from other neurological or muscular disorders, one common difficulty they face is foot drop, a partial leg paralysis that prevents the foot from lifting. Foot drop causes instability and difficulty walking. Now, Rush University Medical Center is offering a high-tech device to help brain injury patients regain the ability to walk more naturally and improve mobility.

The unique, lightweight device called the NESS L300™ neuro-rehabilitation system is a noninvasive, wireless leg brace worn on the lower leg. Small sensors placed by the heel of the foot detect whether the patient’s foot is in the air or on the ground.

Electrodes transmit painless electronic stimulation to the peroneal nerve to activate the calf muscle and correct a patient’s gait. When weight is taken off the patient’s foot, the brace sends a signal to contract muscles inside the calf allowing the foot to swing forward.

“Foot drop is a condition where the muscles in the foot are too weak to properly lift the foot, heel and toes while walking,” said Dr. James Young, medical director of physical medicine and rehabilitation at Rush. “It is often present in patients who have suffered a stroke, traumatic brain injury, incomplete spinal cord injury, multiple sclerosis and cerebral palsy.”

The device has proved beneficial not only in patient who recently suffered traumatic brain injuries, but also patients who have suffered from several years of immobility or from strokes several years ago.

“The device has helped our patients retrain and regain control of their bodies and achieve greater mobility and independence,” said Young. “We have seen vast improvements in patients such as walking coordination, speed and blood flow and a decrease in the effort required during walking while wearing the device.”

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Author: Medical News Today

The time span in which treatment should be given for acute ischaemic stroke – i.e. stroke caused by a clot or other obstruction to the blood supply – can be lengthened. This according to a study from the Swedish medical university Karolinska Institutet, the results of which can bring about more effective and safer treatments for stroke sufferers.

In the event of acute ischemic stroke, treatment with ‘clot-busting’ drugs – thrombolysis – should be administered as early as possible. Failure to do so might leave the treatment doing harm than good since it increases the danger of haemorrhage. Prevailing praxis is for thrombolysis to be given only to patients who reach hospital within three hours after the onset of stroke.

However, an international study led by Professor Nils Wahlgren at Karolinska Institutet now shows that it is safe to administer the treatment up to four and a half hours after the stroke.

The researchers compared 11,865 patients treated within three hours of stroke with 644 patients who, for various reasons, were treated within three to four and a half hours afterwards. The results show that the risk of haemorrhage complications and death was not significantly higher for the later treatment. Nor was there any difference between the two groups in the percentage of patients displaying impaired functionality in everyday activities three months after stroke.

“The data we are now publishing will make it possible for many more patients to receive thrombolysis,” says Professor Wahlgren. “This is important, because it’ll not only alleviate their suffering, but also help to reduce the costs of stroke for society.”

Possible changes to the European guidelines for the treatment of stroke will be under discussion at Karolinska Stroke Update, a conference due to be held in Stockholm on 16-18 November. Here, consideration will also be taken of the results of another, as yet unpublished, randomised study co-led by Professor Wahlgren.

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Author: Alan Aldinger

PITTSBURGH, Nov. 21, 2005 — University of Pittsburgh researchers report a high level of effectiveness in re-opening completely blocked internal carotid arteries (ICA) as late as two to three days after acute stroke symptoms by using stents. The study at the University of Pittsburgh School of Medicine Department of Neurology and University of Pittsburgh Medical Center (UPMC) Stroke Institute, is in the November issue of Stroke, a peer-reviewed publication of the American Heart Association.

“This report breaks new ground in that it contradicts the conventional wisdom that a completely blocked or occluded carotid cannot be opened,” said the study’s lead author, Tudor Jovin, M.D., assistant professor of neurology and neurosurgery at Pitt’s School of Medicine, and co-director of the Center for Endovascular Therapy at UPMC.

Dr. Jovin’s team, which consisted of members of the UPMC Stroke Institute, retrospectively studied 25 patients with acute carotid occlusion who underwent angiography with the intent to revascularize the occlusion from January 2002 to March 2005.

Researchers concluded that recanalization, or re-opening of the artery, was successful in 23 of the 25 patients, and that the procedure was done safely.

“The main finding of the report was that endovascular revascularization of occluded ICA in the setting of acute or subacute ischemic stroke carries a high-revascularization rate and is safe in selected patients,” Dr. Jovin reported.

“Management of stroke because of acute internal carotid artery occlusion continues to represent a challenge because it may result in significant disability in 40 percent and death in 20 percent of cases,” Dr. Jovin said. “Our results are significant because they offer an opportunity for patients who may need more aggressive treatment. Future prospective studies are necessary to determine which patients are most likely to benefit from this form of therapy.”

Dr. Jovin added that early restoration of flow in the occluded ICA may improve the symptoms of acute stroke, prevent worsening and reduce long-term stroke recurrence risk.

The study also demonstrated that ideal candidates for endovascular ICA revascularization would be patients with a small area of tissue irreversibly compromised and a large area of tissue that is viable but threatened to undergo infarction.

Michael B. Horowitz, M.D., associate professor of neurosurgery and radiology and director of the UPMC Center for Neuroendovascular Therapy, also participated in the study along with Rishi Gupta, M.D., fellow, department of neurology; Ken Uchino, M.D., assistant professor of neurology; Lawrence R. Wechsler, M.D., professor of neurology and director, UPMC Stroke Institute; Maxim D. Hammer, M.D., assistant professor of neurology, all from the University of Pittsburgh School of Medicine; and Charles A. Jungreis, M.D., professor of radiology and chair of radiology Temple University Hospital.

According to the American Heart Association, stroke is the third leading cause of death in the United States and is a primary cause of serious, long-term disability in adults. On average, someone in the U.S. suffers a stroke every 53 seconds, with 700,000 Americans experiencing a new or recurring stroke each year and approximately 160,000 Americans dying every year from stroke.

Read other related articles at UPMC.