Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, February 21, 2023

Spinal Stimulation Opens Door to Treating Stroke Survivors With Partial Paralysis

Is your doctor and hospital following this and preparing for its' use? NO? Then you don't have a functioning stroke doctor or hospital!  Fire them and find someone better that actually knows how to get you 100% recovered. 

Spinal Stimulation Opens Door to Treating Stroke Survivors With Partial Paralysis

Recovery of strength, functional movements seen in pilot study

A computer rendering of a transparent body with the cervical spinal cord highlighted.

With epidural electrical stimulation (EES) of the cervical spine, researchers successfully improved arm and hand mobility in two stroke patients who otherwise had no treatment available for their chronic hemiparesis.

Continuous spinal cord stimulation (SCS), provided through two surgically implanted leads, improved strength, speed, and functional movements in the first two patients of this ongoing study, reported Marco Capogrosso, PhD, a biomedical engineer at the University of Pittsburgh, and colleagues.

The two stroke patients attempted movements from day 1 without training. Within 30 days, they were able to fully open and close their fist, lift their arm above their head, and use a fork and knife to cut food for the first time in years, Capogrosso and team noted in Nature Medicineopens in a new tab or window.

"We discovered that electrical stimulation of specific spinal cord regions enables patients to move their arm in ways that they are not able to do without the stimulation. Perhaps even more interesting, we found that after a few weeks of use, some of these improvements endure when the stimulation is switched off, indicating exciting avenues for the future of stroke therapies," said Capogrosso in a press release.

The group's goal is for a permanent implant to be continuously switched on except for battery replacement every couple of years or so, according to co-author Elvira Pirondini, PhD, also a bioengineer at the University of Pittsburgh, during a media briefing.

Capogrosso said that a new culture is needed in which it is accepted that stroke patients have a stimulation system permanently with them. This will take convincing national stakeholders that chronic stroke patients should get long-term rehabilitation for their motor deficits.

It is well established that stroke is a leading cause of long-term disability,opens in a new tab or window with the majority of patients having lasting deficits in arm and hand mobility. There are currently no treatments for chronic upper-limb paresis in stroke survivors.

To address this unmet need, Capogrosso's group tested an EES protocol adapting existing FDA-approved clinical technologies. Similar to an existing technique for analgesia, a minimally invasive device with an electric array is placed percutaneously through the person's back to enter the spinal canal and rests on top of the spinal cord. There, stimulation of sensory nerves from the arm and hand amplifies the activity of muscles that have been weakened by stroke.

Engineers are currently working on fine-tuning the intensity and location of EES to produce more fluid movements of the arm and hand, noted Douglas Weber, PhD, a biomedical engineer at Carnegie Mellon University in Pittsburgh, at the press conference.

"Clinical adoption of SCS for stroke will require the application of simple and standardized parameter optimization protocols," the investigators wrote. "Additionally, in this study we focused on the immediate assistive effects of SCS with temporary implants; future studies should focus on demonstrating the long-term safety and efficacy of a fully implanted SCS system combined with protocol-based upper-limb rehabilitation in larger randomized controlled studies."

Nevertheless, the promise of EES continues to grow, as it has previously been shown to be successful in patients with spinal cord injuryopens in a new tab or window and complete sensorimotor paralysisopens in a new tab or window. Capogrosso suggested that there are many diseases involving paralysis that may be targeted with this therapy.

The current study detailed the progress of the first two participants of an ongoing studyopens in a new tab or window aiming for 15 stroke patients.

The first, a 31-year-old woman, had suffered a right thalamic hemorrhagic stroke secondary to a cavernous malformation 9 years before participation in the study. The second, a 47-year-old woman, had had a right ischemic middle cerebral artery (MCA) stroke secondary to a right carotid dissection resulting in a large MCA territory infarct 3 years before enrollment.

Both underwent surgery to implant a device for EES of the cervical spinal cord and had the implant removed within 30 days.

"Despite large differences between the two participants in terms of severity, age and time since the stroke, during SCS, both participants showed a significant improvement in strength, arm kinematics and functional task performance compared to their baselines without SCS," Capogrosso and colleagues wrote.

Chief among the limitations of the study were the very small sample and short duration of the intervention.

No serious adverse events were observed with EES, though the researchers acknowledged that their preliminary report prevents them from drawing conclusions about the safety and efficacy of EES in stroke.

  • author['full_name']

    Nicole Lou is a reporter for MedPage Today, where she covers cardiology news and other developments in medicine. Follow

Disclosures

The project was supported by the NIH BRAIN Initiative and institutional funds.

Capogrosso, Gerszten, and Pirondini have financial interests in Reach Neuro, the startup founded to put this therapy to clinical use.

Primary Source

Nature Medicine

Source Reference: opens in a new tab or windowPowell MP, et al "Epidural stimulation of the cervical spinal cord for post-stroke upper-limb paresis" Nat Med 2023; DOI: 10.1038/s41591-022-02202-6.

No comments:

Post a Comment