Jan 8, 2012

Stroke Robot Therapy

In Depth Doctor's Interview
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 goal is to try and speed up the recovery process. Is your clinical trial 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 pharmacologic 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.

 This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.

     If you would like more information, please contact:Lance Skelly
Director of Media Relations
Emory Hospitals and Wesley Woods Center
(404) 686-8538

Andrew J. Butler, Ph.D. PT, FAHA
Emory Univeristy
(404) 712-5675

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