NASHVILLE, Tenn. ( Ivanhoe Newswire) - From brush strokes, to stroke - how a robot's helping this artist get his function, and confidence back.
While you read this story, someone in the U.S. will have a stroke. For many, it can disable limbs, making even simple tasks next to impossible. Now a unique trial is helping these patients get back what they've lost.
Though he's only 23, Spencer Telligman has made his mark as an artist.
"You're putting paint on canvas and it feels great, it's just awesome," he said.
Last January, a stroke took away the use of his right hand--the one he uses to paint.
"It kinda killed it. I've been worrying since, since it happened that I wouldn't be able to do anything anymore," Tilligman said.
A unique clinical trial is restoring Spencer's confidence, and much more. Patients do repetitive exercises and play games wearing this motorized robotic arm, to help retrain their brain…and make their own arm's Function Dr. Andrew Butler professor in the department of rehabilitation medicine Emory University.
"Let's say the patient can do ten percent then the robot will do 90 percent and as you get better if you can do 50 percent, the robot will do 50 percent," said Dr. Butler. There's one more key element to this trial - a drug that helps the brain re-learn by targeting the learning and memory system. After a lot of hard work, Spencer's arm function is improving.
Didi Heagerty, Spencer's mom, said," I'm totally amazed everyday by the things he's capable of doing.' Today, he started drawing again. Spencer told Ivanhoe, "it's not at the level it used to be at but like, I can draw. I feel like in the future like I can do anything." A portrait of a young artist who's getting his life back…one day at a time.
The robotic arm used in the Emory university study, electronically measures strength and range of motion to monitor patients' progress on a daily basis.
Studies in Taiwan have shown that robot-assisted therapy has measurable benefits for patients whose arms are weakened by a stroke.
STATS: Stroke is the third leading cause of death and one of the leading causes of serious, long-term disability in the U.S. Each year more than 700,000 Americans suffer from stroke, and approximately 85% of stroke survivors experience partial paralysis on one side of the body. (whsc.emory.edu)
BACKGROUND: A stroke occurs when blood supply to the brain is interrupted or severely reduced. Within minutes, brain cells begin to die causing permanent damage. There are two major types of stroke: is chemic stroke and hemorrhagic stroke. A stroke is a medical emergency. Prompt treatment is crucial. Early action can minimize brain damage and potential complications. The good news is that strokes can be treated and prevented, and fewer Americans now die of stroke. Better control of major risk factors, high blood pressure, smoking and high cholesterol, is likely responsible for the decline. (www.mayoclinic.com,www.ncbi.nlm.nih.gov)
ROBOTICS: Robotic technology uses robotic devices to assist impaired limbs with performing repetitive motions, helping them regain strength and function. Robotics is one area of technology that has seen robust growth in rehabilitation applications, so much so that the presence of robotic devices in rehabilitation centers has become an expectation among patients, their caregivers, and therapists. Although rehabilitation robotic devices afford the opportunity to provide high doses of repetitive movement in a reliable and controllable manner, the role they play in the continuum of clinical care remains uncertain. Robotic-assisted therapy may be an effective alternative to enhance hand function recovery in patients with stroke. (www.mayoclinic.com,www.ncbi.nlm.nih.gov)
EMORY'S STROKE CENTER: In 2002, MBNA America Bank made a significant contribution to the stroke program with a $7.5 million gift establishing the Emory-MBNA Stroke Center at the Emory Clinic. In 2005, Emory-affiliated Grady Memorial Hospital was the first public safety-net hospital in the country to be certified as a Primary Stroke Center by the Joint Commission on Accreditation of Healthcare organizations (JCAHO). Emory University Hospital joined Grady as a Primary Stroke Center in 2006. From 2005 to 2007, stroke and related cerebrovascular disease research funding at Emory increased 25 percent, from $7.5 to $9.4 million, and includes genetics, physiology, neuroimaging, rehabilitation, endovascular surgery and neurosurgery. From 2003 to 2007, the number of patients treated at Emory for stroke and related conditions increased by 36 percent, to nearly 1,700.
Dr. Andrew Butler, an Associate Professor of Rehabilitation Medicine at Emory University discusses a clinical trial that is using a new robotic arm in combination with drug therapy to help stroke survivors regain movement in the upper limb.
For patients who have strokes what are the challenges that you are trying to address in new ways?
Dr. Butler: Some of the biggest challenges that effect people who have stroke are their movement limitations. There are over seven hundred and fifty thousand people who have strokes every year and a large percentage of them, maybe ten percent of them, have movement limitations. Specifically we're interested in upper limb movement limitations, the ability to reach and grasp and shake hands and use utensils and things like that. So impairment of the arm and hand is one of the things that's most affected by stroke and we're interested in improving.
What is the approach you're taking and how is it different from the approaches
that have been taken in the past?
Dr. Butler: There's a lot of evidence to suggest that repetitive movements, lots of repetitive movements, and strengthening exercises with your hand and forearm will improve paralysis over time. My laboratory is using alternative devices accomplish this goal and one of the devices that we're using is a robotic arm to help a person perform many repetitive movements. The robotic arm is essentially an exoskeletal, it's something that fits over top of a person's arm and helps them move their wrist up and down. So if a person can't move their wrist and hand completely the robotic arm will help them. As the stroke survivor improves, the robot slowly decreases the amount of effort that's put in by the robot arm and increases the effort that must be put forth by the stroke survivor. The idea is that over time the stroke survivor will slowly and progressively improve in moving their hand and arm. We're also trying to decrease the amount of time the stroke survivor is using this robotic arm. There is evidence to support the use of a certain medication that helps the brain re-learn and improves memory. So we're combining robotic training with a certain pharmacological agent in hopes to improve movement in the upper limb of stroke survivors.
One of the goals is to try and speed up the recovery process. Is your clinicaltrial trying to make recovery occur in patients that might not have been able to move before? When you start out with the intervention for the patient where are you trying to take them?
Dr. Butler: We're actually trying to do both, we're trying to improve the level of movement so many people come to our clinic and they don't have movement that's similar to their non-affected hand. So we try to improve the function of that hand but we also try to decrease the time it takes to recover. One of the goals of this trial is to decrease the time that they're in the rehabilitation hospital. In the current medical realm people are in the hospital for a much shorter period of time and receiving therapy for a shorter period of time. By combining robotic therapy with pharmacological therapy we hope to improve a person's overall function as well as decrease the amount of time stroke survivors are in the rehabilitation hospital, with the goal of recovering function to pre-stroke levels.
What kind of a drug is this, what does it target?
Dr. Butler: When learning a new activity whether you're learning how to play tennis or learning to play the piano one must learn new motor movement and how to move your hands. But you must also remember those new movements from day to day. So the drug targets the learning and memory system in your brain. After a stroke there are certain parts of the brain that controlled movement and learning and memory are damaged. So the idea is that the combination of the robotic training will help people learn new movements in combination with drug, which will restore memory of those new movements.
How unusual is Spencer's case, is it surprising to see a younger person having stroke or do you see more and more of it?
Dr. Butler: Unfortunately we do see more and more young people having strokes. There are certain reasons that this is occurring in our society but yes, it is quite unusual for a young person to have a stroke. Typically we see people in their forties, fifties and sixties who are having a stroke. So when Spencer's family contacted us, we were very excited because we thought we could help him in his recovery. Again he's very motivated he has a past history as an artist and having a specific goal to draw and paint using his hands. We thought that our clinical trial would be a very good match because we offer specific training for the wrist and hand. We want to help Spencer get back to doing what he loves which is drawing, painting and sculpture.
How has rehabilitation and therapy changed for stroke survivors from what it used to be?
Dr. Butler: Today we focus on the patient's goals. It's not exactly what the therapist's goals are, but the patient's goals. One of the first questions I asked Spencer and his family is what do you want to do when you finish? He wants to be able to paint and do his sculpture. He had very specific functional goals. So that's what has changed in Rehabilitation. It's not about what my goals are as a therapist, but it's about what the patients and their family's goals are. That's really where we're trying to get, the patient centered goals.
Now there are some pretty hard and standardized measurements that will tell you if he is doing better or not correct?
Dr. Butler: Yes, that's the unique aspect of this study. We have very specific and quantifiable outcomes that we are measuring. Some are improvements in the hand and arm and those are motor goals and then we have some cognitive and memory goals that we're measuring. Therapists, occupational therapists and physical therapists do a very good job of evaluating a person's quality of movement and how that improves over time. But it is difficult for therapists to quantify every change. The robot measure's exactly the number of repetitions a person performs, and the amount of difficulty in an exercise. The robot is very quantitative and the nice thing is once Spencer achieves eighty percent of his goals in a given exercise the robot moves Spencer up to the next difficulty level; thereby challenging his brain to improve to reach the next level of difficulty. There are ten difficulty levels and he's done very well on all of them moving from a very low level, level one and two all the way up to level seven, eight and nine in some exercises.
FOR MORE INFORMATION PLEASE CONTACT:
Lance Skelly Director of Media Relations Emory Hospitals and Wesley Woods Center (404) 686-8538 firstname.lastname@example.org
Andrew J. Butler, Ph.D. PT, FAHA Emory Univeristy (404) 712-5675 Andrew.Butler@emory.edu
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