I can't find anything on chaos theory for stroke. All because we have fucking failures of stroke associations that can't even create a simple database of stroke research and protocols.
BGU’s( Ben-Gurion University) Negev Lab is bringing stroke rehab into the future
Stroke is tricky. While its effects are well known, the best course of rehabilitation to return to functionality is still very much a mystery. This rehab lab turns translational science for answers.
Dr. Simona Bar-Haim and Dr. Lior Shmuelof in the Negev Lab at ADI Negev
(photo credit: DANI MACHLIS/BGU)
Bar-Haim
is not your typical academic. She has one foot firmly in the field, and
one foot firmly in the academy as a member of the department of
physical therapy in the Faculty of Health Sciences at Ben-Gurion
University of the Negev (BGU). She also founded a start-up based on
chaos theory to help people walk after suffering a stroke.
“Many people do not recover enough to return to work or to their regular lives,” she says.
What
is more, as the population ages and lives longer, there are more and
more people suffering strokes and then recovering only partial
functionality. In Israel, 17,000-20,000 people a year suffer a stroke.
Stroke
is tricky. While its effects are well known, the best course of
rehabilitation to return to functionality is still very much a mystery,
to which Bar-Haim and Dr. Lior Shmuelof, also of BGU, have devoted
themselves to help solve.
Driven
by that impetus to help and by her out-of-the-box way of thinking,
Bar-Haim recently set up a translational rehabilitation lab at the
rehabilitation village. Translational science tries to find solutions
for real-world problems. At ADI Negev, the problems arise from the
patients themselves, their doctors and caregivers, and the solutions are
tested in conjunction with the patients.
There are several theories why stroke recovery has not progressed since the 1970s and the Negev Lab has been working to test them.
“We
believe there is a critical period of three to six months after the
stroke where recovery is most achievable because of the brain’s
plasticity during that time,” says Shmuelof of the Negev Lab, the
department of brain and cognitive sciences and the Zlotowski Center for
Neuroscience at BGU. “If an animal suffers a stroke, it recovers fully.
Why do animals recover, while people do not? One possibility is that an
animal is active from the moment it happens. Now, if a person suffers a
stroke, they spend the first week to 10 days lying in bed in the
hospital, and then they spend a couple of hours a day doing physical
therapy that does not translate to the real world.”
To
confirm these hypotheses, Shmuelof is partnering with the MRI Imaging
Center at Soroka-University Medical Center and researchers Profs. Alon
Friedman, Ilan Shelef, Anat Horev and Gal Ben-Arie, with the aim of
identifying the neural components associated with brain plasticity after
injury.
Shmuelof will then take what he learns from MRI imaging and bring it back to the Negev Lab.
ADI
NEGEV-Nahalat Eran is a fully equipped facility in a village setting,
with residential care for people with multiple disabilities and complex
medical conditions, an intensive care hospital wing for babies and
adults, a paramedical center, hydrotherapy pool, special education
school, green care farm, and a therapeutic horse stable and petting zoo.
It
is set in an ideal and idyllic location. Winding paths run alongside
the residents’ cottages. A stable for therapeutic riding anchors one
side, while the Negev Lab anchors the other. The atmosphere is calm,
quiet, happy and optimistic – a far cry from rehabilitation wards in
large hospitals.
The
ADI Negev-Nahalat Eran Rehabilitation Village was named in memory of
Eran Almog, the late son of Didi and Maj.-Gen. (ret.) Doron Almog.
Fueled
by his love for Eran, who was born with severe autism and intellectual
disabilities, Doron Almog guided the creation of a residential and
rehabilitative complex in Israel’s south, which has since become a home
and family for more than 150 children and young adults with severe
disabilities and complex medical conditions and provides a host of
rehabilitative solutions for individuals from all backgrounds and levels
of need.
While
care is important, the vision is to provide cutting-edge treatment as
well. The first step was the creation of the Negev Lab. Not far in the
future, the village will also boast a rehabilitation hospital, which
will be the biggest in southern Israel.
“ADI
Negev is the ideal place to see what happens when people spend many
more hours rehabilitating,” says Shmuelof. “What if they spend three
hours a day or five hours a day? Would they recover faster and better?
These are the kinds of questions we ask ourselves and have the ability
to answer because of this unique lab.”
Existing
movement tracking methods are not advanced enough to meet Shmuelof’s
needs. Therefore, to track patients’ motion over the course of the day,
the Negev Lab is developing methods to track not just walking but also
arm movements.
“One
of the things we noticed is that arm motion might not be completely
impaired, but weakness causes people to compensate in other ways rather
than moving their arms to regain functionality,” says Shmuelof.
“Putting
a research lab in a rehabilitation village makes a lot of sense,” says
Bar-Haim. “There, we can go directly to the residents and ask them what
their needs are. We can also test out our technologies, which we make
sure are fun and pleasant, on the residents and get their feedback.”
A stroke patient walks (photographer: Negev Lab)
THAT
IMMEDIATE feedback appealed to Prof. Ilana Nisky of BGU’s department of
biomedical engineering, who has joined Bar-Haim in developing a belt
that helps stroke patients improve their walking. She is an expert in
haptics, which is the body’s sense of touch. Their project is being
funded by the Israel Innovation Authority.
“When
you design medical devices, you need to think beyond engineering and
understand how they [the patients] will be using the devices,” says
Nisky.
“One of the
most important elements in walking is being able to feel the ground and
knowing where your legs are without looking at them. That ability,
which we take for granted, can be damaged by a stroke. So, we are
designing a belt that is worn on the person’s skin under their clothes
that will massage the person’s waist and help them with their terra
sense – the sense of where the ground is and where their legs are,” she
explains.
“What is
truly groundbreaking in our belt is that it does not need to measure
where the legs are relative to the ground. Instead, we rely on an
artificial intelligence algorithm that we train on many examples of past
walking to guess where the ground and legs should be at a given moment
in time, based on a very simple sensor that is placed on the belt and in
the center of the body. This way the only thing the person after stroke
will need is the belt itself.”
The
researchers have already developed a prototype, but in the future each
belt will be customized to the individual person’s needs.
“We
hope they will use the belt, and that the information it provides to
them will be helpful,” Nisky says. “We also hope that if they use it a
lot, then perhaps they will eventually be able to walk on their own
without it.”
To
make sure that they will indeed wear it a lot rather than buy it just to
have it collect dust in the closet, the team also works with Ofer
Canfi, a designer who graduated from the Bezalel Academy of Arts and
Design and the Royal Academy of Arts, London, to make the belt look and
feel nice, using advanced manufacturing procedures and hi-tech fabrics.
Nisky
notes that now is the ideal moment for such research. Haptic devices
have become much more pleasant to use. “It’s like a massage. What’s not
to like?” she says, while artificial intelligence has reached the point
where it can be harnessed for purposes such as physical therapy.
A future entrepreneurial hub
Another important advantage offered by the Negev Lab is its multidisciplinary nature.
“We have clinicians, clinician-researchers, engineers and programmers, all working together,” says Nisky.
Bar-Haim
also envisions the Negev Lab as an entrepreneurial hub, a space where
technologies from around the world can be tested and receive feedback
from the people who stand to benefit from them.
In
fact, this vision is already a reality. The Negev Lab collaborates with
Swiss-based Mindmaze, which designs virtual reality and computer
simulations. It sends its latest technologies to the lab, where Shmuelof
puts them through their paces with patients.
One
such program lets the patient control a dolphin on a screen by raising
or lowering their arms. It has been a big hit with patients.
“Seeing the dolphin move in response to my arm movements shows me how much I have improved,” one says.
“Using the vest gives me hope that I will return to moving my hand easily,” another says.
“At the end of a treatment session, I feel like my whole body got into it,” says a third.
“People instinctively understand how to control the dolphin, and they enjoy it,” explains Shmuelof.
“The
simulation makes me feel like I’m playing a computer game at home, and I
just want to pass level after level,” says a patient.
That is encouraging feedback, because the Negev Lab wants to develop programs that people will actually use.
The rehabilitation hospital
In
a welcome development, the ADI Negev-Nahalat Eran Neuro-Orthopedic
Rehabilitative Hospital is nearing completion. Thanks to the support of
multiple government ministries, JNF-USA and international donors, the
hospital is set for completion late this year.
It will have more than 100 beds and will provide unique research opportunities.
“It
will also be a unique research hospital, with an ethical and
information technology infrastructure that will allow us to study most
of the activities that will be carried out there,” says Bar-Haim.
“In
other words, a large proportion of what goes on in the hospital will be
able to be researched and incorporated into academic studies. That is
not the case in most hospitals around the world currently, not even in
teaching hospitals.
“Once
the hospital is completed, the Negev Lab will move into its new space
and become the largest and most advanced lab of its kind in Israel.”
Bar-Haim
and Shmuelof are excited about the opportunities to advance their
understanding of how to rehabilitate stroke patients using the knowledge
they will gain from researching at the hospital.
“How
active was the patient during the day? How well did she sleep? How long
did she sit for? Measuring patients’ activity during the day will allow
us to better understand how it affects their recovery, and to find ways
to increase their activity during rehabilitation,” explains Shmuelof.
“We are already receiving inquiries from around the world about this new lab,” he adds.
The future
While
the South has lagged behind the Center in terms of medical and
rehabilitative care, Bar-Haim and Doron Almog’s vision does not stop at
achieving parity with the Center, but, rather, aims to exceed it.
“We
believe that residents of the South deserve the same quality of care as
those in every other part of the country, and we believe that we can
set the bar higher for rehabilitative care,” says Almog.
“This
village was founded on the principle that a person is a person no
matter what, and this hospital and research lab are finally starting to
realize our full vision. In this place, all people will be provided with
the best possible care and loved beyond measure.
“In
the age of corona, the importance of the Negev Lab is clearer than ever
before. Each and every day, our rehabilitation professionals empower
people of all ages, backgrounds, and levels of need, giving them a new
lease on life and returning them to their families in good health and
renewed spirit.
“But
we can expedite this process and make it even more powerful through
collaborative translational research. There are so many people hurting
right now, and the groundbreaking research being done at the Negev Lab
can change the face of rehabilitative care across Israel and around the
world.”
“I
envision the Negev Lab and the ADI Negev-Nahalat Eran Neuro-Orthopedic
Rehabilitative Hospital as the core of the future National
Rehabilitative Institute of Israel,” declares Bar-Haim.
The writer is deputy spokesperson, international media at Ben-Gurion University.
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