Developing technology in treating stroke victims studied at St. Joseph's Wayne

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.