- Title: Stroke device could allow self-rehabilitation
- Date: 10th January 2017
- Summary: SCREEN SHOWING ARM MOVEMENT
- Embargoed: 25th January 2017 10:06
- Keywords: stroke aneurysm brain macaque monkey Newcastle University Stuart Baker brain pathway
- Location: NEWCASTLE, ENGLAND, UK / ANIMATION
- City: NEWCASTLE, ENGLAND, UK / ANIMATION
- Country: United Kingdom
- Topics: Science
- Reuters ID: LVA0035YI03MJ
- Aspect Ratio: 16:9
- Story Text: Neuroscientists at Newcastle University believe their new portable device could revolutionise treatment for stroke patients.
The wearable device, the size of a mobile phone, delivers a series of small electrical shocks accompanied by an audible click, which together act to strengthen brain and spinal connections.
Stuart Baker, Professor of Movement Neuroscience at Newcastle University, has already carried out successful laboratory tests on both macaque monkeys and healthy human subjects, using the pain-free technique.
"What we found out is that there was this parallel pathway operating along the major pathway in primates, which could contribute to recovery and we showed that in primates," Baker told Reuters. "The second thing the primates allowed us to do was to realise that these loud clicks could access that pathway. That was quite counter-intuitive, we wouldn't have expected that and it was a key finding for the primate research. As soon as we found that it enabled us to go along this line of a wearable device giving paired clicks and shocks."
In research published in the Journal of Neuroscience, the team reported that their device successfully strengthened connections in healthy patients in the reticulospinal tract. The tract is one of the signal pathways between the brain and spinal cord.
When people suffer a stroke they often lose the major pathway that connects the brain to spinal cord. Previous work in primates showed that after a stroke they can adapt and use the more primitive reticulospinal tract pathway to recover.
However the reticulospinal tract usually fails to recover extensor muscles that help open the hand. This often leaves recovering patients, such as 30-year-old Newcastle University student Chris Blower, with a curled hand, as they find opening their fist difficult. Blower suffered a stroke at the age of seven after open-heart surgery, causing paralysis of the right-hand side of his body. Although he recovered from the most serious effects, Blower still endures minor difficulties walking and opening his right fist.
Before the test begins, patients are strapped into a chair and their arm placed on a movable metal lever. As the lever jerked, the patient's reticulospinal pathway was measured. The test was repeated after six hours wearing the portable device. Tests showed that people's reflex responses could get larger or smaller, depending on how the clicks and shocks were paired.
In Baker's trial volunteers wore an earpiece that delivered audible clicks, followed by a weak electric shock to the arm muscle via a pad on the arm. Both earpiece and pad are linked by wires to the device, so that the click and shock can be continually delivered, and the timing between them precisely controlled. Baker believes this can provide better results than previous methods that also involved so-called 'paired stimuli'.
"Typically when people have used this approach of pairing stimuli in the past it's been about large pieces of equipment where the pairing is delivered in a laboratory setting," he said. "The limitation of that, of course, is the time that you can pair stimuli for. It's typically twenty minutes or half an hour pairing in all the studies published to date. What we're doing here is because we can wear the device and take it out of the laboratory environment we can pair for much longer periods of time, and we hope that might lead to stronger and more long-lasting changes in neural connections."
Tests on healthy human volunteers showed that wearing the portable device for seven hours strengthened the signal pathway in 15 out of 25 subjects.
Placing the muscle stimulus 10 milliseconds (ms) before the click strengthened the pathway, whereas a click 25 ms before muscle stimulus weakened it, emphasising the importance of precise timing.
Baker believes that if stroke patients wore the device for at least four hours a day they could see a permanent improvement in their extensor muscle connections and regain full control of their hand.
In addition, as a wearable device that the patient controls themselves, it would be an improvement on traditional rehabilitation techniques, which are limited in duration and can require substantial organisation and travel, while also reducing the cost to healthcare providers.
Baker thinks regulatory approval shouldn't be difficult.
He said: "On the approval side it should be a straightforward thing to get approved. For the auditory clicks it's not doing anything more than something like an iPod or any other media player would be doing; it's playing a click into a headphone, and the shocks it's providing to the muscle are very weak and very safe. So we wouldn't anticipate any difficulty getting this approved and we're currently talking to a device company in the region here, in the north east of England, about moving this towards manufacture if the clinical trial is successful."
Chris Blower said the treatment could be invaluable to other stroke survivors, although he believes it might be too late to help improve his own condition.
According to Blower, "I'm quite mobile, I can walk around. But there are people who are in wheelchairs and don't have as much control as I do and if those people can be helped, especially in things that I have problems with, like opening their hand, if his research can help with that then that's fantastic."
The next stage of research is a clinical trial involving 150 stroke patients in India, in conjunction with scientists at the Institute of Neurosciences, Kolkata (INK).
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