Demand your doctor get the protocol.
http://www.northjersey.com/news/health-news/wayne-hospital-in-a-study-of-virtual-reality-stroke-rehab-1.1139527
Gerald Fluet is in the business of mind games. Manipulation.
Illusion. Not as a con or scam, but as a way to help the injured heal
and get even stronger.
Using a robotic arm and virtual-reality technology, Fluet, an
assistant professor in the physical therapy program at Rutgers
University, is working with patients at St. Joseph's Wayne Hospital to
regain arm, wrist and hand function impaired by a recent stroke.
The patient straps on the robotic arm and is given various "tasks"
to perform, images to manipulate or games to play at various levels of
difficulty. Moving their real arms to point and aim the robotic device,
patients use their onscreen avatar arms to "pick up," say, a virtual
ball, move it to the other side of the virtual room and then "drop" it
into a virtual bucket.
"Virtual movements basically produce the same reaching patterns as real-world reaching movements do," Fluet said.
But why not just toss a real ball across the room, and save all
this time and expense on researching the technology? "It's more
time-efficient," Fluet said. "It's more space-efficient. I can play
catch with you without ever dropping the ball and it rolling across the
room and under the table. Plus, I can adjust the level of difficulty.
... I have this incredible, fine-tuning control, that is very
convenient."
The concept of using "virtual rehabilitation" and robotic arms to
relearn cognitive and physical tasks has been around for about eight
years now, and has been implemented as part of overall physical therapy
programs at such major institutions as Kessler Institute, according to
Fluet. But it is not more widely available for several reasons, he said.
"The big knock on it is it's expensive, and it doesn't do anything that
you couldn't do in a normal therapy setting without the robots or
computers. Our response to that is, the technology is becoming much less
expensive. By the time we know how to use it, it will be
cost-effective."
Fluet is conducting the current study at St. Joseph's – one of
four sites worldwide participating — in conjunction with the biomedical
engineering program at New Jersey Institute of Technology. The robots,
at about $65,000 each, were purchased by NJIT and the simulations were
developed by NJIT students and staff. The NJIT team is headed by Sergei
Adamovich, associate professor of biomedical engineering, whose prior
research on the use of technology for rehabilitation of arm and hand
function after stroke has received a $1.2 million grant from the
National Institutes of Health.
Adamovich said that because there is no data out there now on how
virtual rehabilitation works on patients within days or weeks after
their strokes, the information collected in the current study will be
invaluable. He also noted that the technology allows the patient to
train more, and for longer periods of time, without assistance. In an
age where insurance will pay for physical therapists only for a matter
of weeks, he said, this aspect of the virtual therapy is important. Now
it's just a matter of making the technology more affordable. "We're
moving in the right direction," he said.
But the technology — and its place in modern-day physical therapy regimens — is still developing.
What makes the current research project at St. Joseph's Wayne
unique, Fluet said, is that it's the first to actually use patients
fresh from their strokes. Each patient must be about seven days into
their recovery when beginning virtual rehabilitation with the robotic
arm. This period is important — and often elusive in terms of finding
people to study, he said.
He explained that as part of "neuroplasticity," the brain rewires
itself in response to experiences like strokes. "Let's say you need to
learn to brush your hair with your left hand. If you practice it enough,
your brain cells make new connections with each other and the body part
you are using in order to perform those skills efficiently."
Thus, getting patients to use their arms soon after their strokes,
when the brain is at its busiest trying to figure out how to adapt, is
crucial. "The recruiting is the most arduous and challenging part,"
Fluet said. "St. Joe's was rare as a hospital in the U.S. to come
forward and be comfortable with us working with a patient a week after
having a stroke," he said.
He started working one-on-one with patients in July. So far he has
worked with about 25 people, and the goal is between 40 and 50. No one –
patients, researchers or the hospital — is being charged anything for
their involvement. The data collected will, it's hoped, help secure
grants to fund more research, all with the goal of making the technology
more accessible and effective.
Dr. Supriya Massood, medical director of the In-patient Acute
Rehabilitation Unit at St. Joseph's Wayne Hospital, said she welcomed
the opportunity to provide patients for the study. "Stroke is the number
one leading cause of institutionalization in our country and the number
three cause of death," she said. "Because the impact on health care
dollars is so great, this just seemed like a no-brainer."
She said rehabilitating patients virtually works the mind and body
in a whole other way than traditional physical therapy. "The brain is
targeting the goal, and increasing impulses in a more coordinated and
desired outcome," she said of the tasks patients perform. "The second
part is, they [researchers] take this data and then use 'brain mapping,'
a hot field in stroke recovery, to determine whether damaged nerve
cells should be targeted for repair, or do we just abandon them
altogether and use a different part of the brain to perform the same
functions. That can all be measured, and it can significantly change the
scope with how we intervene with rehabilitation."
Marcia Harris of Clifton, who was part of the study at St. Joe's,
said it seemed not only helpful but fun. "Six weeks ago I had a stroke
and my left side was weakened," she explained. She was admitted into
acute rehabilitation at St. Joe's. Harris had no hesitation about trying
the unconventional-sounding therapy. "I said, 'As long as there's no
pain, OK.' "
She said much of what she did was performed while she wore a cap
that measured her brain waves. "It requires great focus. And it is
tiring. You're concentrating very hard and it requires a lot of hand-eye
coordination," she said.
She still has some work ahead of her, she said. But her
improvement, using the technology, is significant. "I'm doing great
now," she said.
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