Stroke patients are starting a trial of a new electronic device to recover movement and control of their hand.
Neuroscientists at Newcastle University have developed the device,
the size of a mobile phone, which delivers a series of small electrical
shocks followed by an audible click to strengthen brain and spinal
connections.
The experts believe this could revolutionise treatment for patients, providing a wearable solution to the effects of stroke.
Following successful work in primates and healthy human subjects, the
Newcastle University team are now working with colleagues at the
prestigious Institute of Neurosciences, Kolkata, India, to start the
clinical trial. Involving 150 stroke patients, the aim of the study is
to see whether it leads to improved hand and arm control.
Stuart Baker, Professor of Movement Neuroscience at Newcastle
University who has led the work said: "We were astonished to find that a
small electric shock and the sound of a click had the potential to
change the brain's connections. However, our previous research in
primates changed our thinking about how we could activate these
pathways, leading to our study in humans."
Recovering hand control
Publishing today in the
Journal of Neuroscience, the team
report on the development of the miniaturised device and its success in
healthy patients at strengthening connections in the reticulospinal
tract, one of the signal pathways between the brain and spinal cord.
This is important for patients as when people have a stroke they
often lose the major pathway found in all mammals connecting the brain
to spinal cord. The team's previous work in primates showed that after a
stroke they can adapt and use a different, more primitive pathway, the
reticulospinal tract, to recover.
However, their recovery tends to be imbalanced with more connections
made to flexors, the muscles that close the hand, than extensors, those
that open the hand. This imbalance is also seen in stroke patients as
typically, even after a period of recuperation, they find that they
still have weakness of the extensor muscles preventing them opening
their fist which leads to the distinctive curled hand.
Partial paralysis of the arms, typically on just one side, is common
after stroke, and can affect someone's ability to wash, dress or feed
themselves. Only about 15% of stroke patients spontaneously recover the
use of their hand and arm, with many people left facing the rest of
their lives with a severe level of disability.
Senior author of the paper, Professor Baker added: "We have developed
a miniaturised device which delivers an audible click followed by a
weak electric shock to the arm muscle to strengthen the brain's
connections. This means the stroke patients in the trial are wearing an
earpiece and a pad on the arm, each linked by wires to the device so
that the click and shock can be continually delivered to them.
"We think that if they wear this for 4 hours a day we will be able to
see a permanent improvement in their extensor muscle connections which
will help them gain control on their hand."
Improving connections
The techniques to strengthen brain connections using paired stimuli
are well documented, but until now this has needed bulky equipment, with
a mains electric supply.
The research published today is a proof of concept in human subjects
and comes directly out of the team's work on primates. In the paper they
report how they pair a click in a headphone with an electric shock to a
muscle to induce the changes in connections either strengthening or
weakening reflexes depending on the sequence selected. They demonstrated
that wearing the portable electronic device for seven hours
strengthened the signal pathway in more than half of the subjects (15
out of 25).
Professor Stuart Baker added: "We would never have thought of using
audible clicks unless we had the recordings from primates to show us
that this might work. Furthermore, it is our earlier work in primates
which shows that the connections we are changing are definitely involved
in stroke recovery."
The work has been funded through a Milstein Award from the Medical Research Council and the Wellcome Trust.
The clinical trial is just starting at the Institute of
Neurosciences, Kolkata, India. The country has a higher rate of stroke
than Western countries which can affect people at a younger age meaning
there is a large number of patients. The Institute has strong
collaborative links with Newcastle University enabling a carefully
controlled clinical trial with results expected at the end of this year.
A patient's perspective
Chris Blower, 30, is a third year Biomedical Sciences student at
Newcastle University and he had a stroke when he was a child after open
heart surgery. He describes his thoughts on the research:
I had a stroke at the age of seven. The immediate effect was
paralysis of the right-hand side of my body, which caused slurred
speech, loss of bowel control and an inability to move unaided. Though I
have recovered from these immediate effects, I am now feeling the
longer term effects of stroke; slow, limited and difficult movement of
my right arm and leg.
My situation is not unique and many stroke survivors have similar
long-term effects to mine. Professor Baker's work may be able to help
people in my position regain some, if not all, motor control of their
arm and hand. His research shows that, in stroke, the brains motor
pathway to the spinal cord is damaged and that an evolutionarily older
signal pathway could be 'piggybacked' and used instead. With electrical
stimulation, exercise and an audible cue the brain can be taught to use
this older pathway instead.
This gives me a lot of hope for stroke survivors. My wrist and
fingers pull in, closing my hand into a fist, but with the device
Professor Baker is proposing my brain could be re-taught to use my
muscles and pull back, opening my hand out. The options presented to me
so far, by doctors, have been Botox injections and surgery; Botox in my
arm would weaken the muscles closing my hand and allow my fingers to
spread, surgery would do the same thing by moving the tendons in my arm.
Professor Baker's electrical stimulations is certainly a more appealing
option, to me, as it seems to be a permanent solution that would not
require an operation on my arm.
I was invited to look around the animal house and observe a macaque
monkey undergoing a test and this has made me think about my own stroke
and the effect it has had on my life.
I have never seen anything like this before and I didn't know what to
expect. The macaque monkey that I observed was calmly carrying out
finger manipulation tests while electrodes monitored the cells of her
spinal cord.
Although this procedure requires electrodes to be placed into the
brain and spine of the animal, Professor Baker explained how the monkey
had been practicing and learning this test for two years before the
monitoring equipment was attached. In this way the testing has become
routine before it had even started and the animal was in no pain or
distress, even at the sight of a stranger (me).
The animals' calm, placid temperaments carry over to their living
spaces; with lots of windows, natural light and high up spaces the
macaques are able to see all around them and along the corridors. This
means that they aren't feeling threatened when people approach and are
comfortable enough that even a stranger (me, again) can approach and say
'hello'.
From my tour of the animal house at the Institute of Neuroscience I
saw animals in calm, healthy conditions, to which the tests were just a
part of their daily routine. Animal testing is controversial but I think
that the work of Professor Baker and his team is important in helping
people who have suffered stroke and other life-changing trauma to regain
their independence and, often, their lives.
Source:
Newcastle University
Article Info
Thomas Goetz
