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VA RESEARCH: RECOVERING WITH ROBOTICS -- "Patients

recovered 15 percent of the use of their limbs. That 15

percent makes the difference in being able to dress

yourself or needing someone to dress you."

For more about robots and robotics, use the VA Watchdog search engine...click here... http://www.yourv
abenefits.org/sessearch.php?q=robot+robotic&op=or

For more about VA research, use the VA Watchdog search engine...click here... http://www.your
vabenefits.org/sessearch.php?q=va+research&op=ph

Story here... http://www.newstimes.com/ci_7554788?source=most_emailed

Story below:

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-------------------------

Recovering with robotics

Cutting-edge technology may help stroke victims

News-Times Staff

The accepted knowledge for stroke victims is this: If, after a couple of months of physical therapy, you are still disabled by the stroke, learn to live with it.

"They thought 'Your brain was dead and you didn't recover,'" said Dr. Daniel Federman, a Newtown internist who works at the Veteran's Administration Hospital in West Haven.

Using cutting-edge robotic technology designed by the Massachusetts Institute of Technology, Federman is now trying to learn if that's true. He's the principal investigator at the West Haven VA Hospital to see if stroke victims -- even those who have had chronic disability for years -- can teach their muscles and mind to learn how to move again. VA hospitals in Baltimore, Seattle and Gainsville, Fla. are doing the same work.

The implications of the study are enormous. With the Baby Boom generation getting older, it's likely that stroke disabilities -- now numbering about 700,000 per year -- will increase as well. If people want to overcome the debilitating effects of stroke, doctors will have to find new ways of doing it.

It's important. Strokes -- which do to the brain what heart attacks do to the heart -- can leave people with severely weakened limbs. Simple things -- taking a walk, buttoning a shirt, eating a meal -- become impossible to do.

"When you talk to people who have had a stroke, they know exactly the day, the hour it happened," Federman said. "They know what they were doing when they had the stroke. It's a line of demarcation
in their lives. When they talk about the event, they get angry and their spouses start to cry.

"They talk about stroke in terms of depression and despair," he said. "Doctors had told them 'This is the most you can ever expect.' "

Now, however, there are signs of hope that even in chronic stroke victims, damaged limbs can learn how to move again. Federman said one recent study -- the EXCITE Investigation -- was a breakthrough in showing the old thinking about strokes was wrong.

The study -- published in the prestigious Journal of the American Medical Association in November 2006 -- looked at 222 stroke victims with disabled arms. They had all suffered a stroke within three to nine months before they joined the study.

Of those patients, doctors gave 106 patients conventional care. But the other 116 wore a mitt that prevented them from using their good hand and arm while getting training to use their disabled limb. The study found that those who got the intensive training had significant improvements in the use of their disabled arm -- improvements that lasted for at least a year.

At MIT, a team led by principal research scientist Hermano Igo Krebs has been seeing the same results.

Krebs isn't a doctor. He's a mechanical engineer. He's been working since 1989 to design rehabilitative equipment to help doctors and patients.

"Our goal is to let technology help clinicians develop better therapies,'' Krebs said.

Knowing that most people who suffer strokes are 65 years old or older, and that the Baby Boom is about to create a flood of senior citizens, Krebs said he and others at MIT began to develop robotic machines to help stroke victims.

But rather than just building machines that work a set of muscles without variety, Krebs and MIT wanted to create a new set of robotic devices that respond to each patient and provide a visual stimulation to the brain as well. Their mantra is "Nerves that fire together, wire together."

"We're trying to get damaged nerves to develop new roots," Krebs said.

One study of 100 patients that used the MIT equipment found that the stroke patients who used the equipment had twice the improvement in recovery compared to patients who didn't use it. Those improvements lasted three years, Krebs said. Another study found that patients could recover some use of disabled limbs even six years after a stroke.

"It's not a cure," Krebs said. "But patients recovered 15 percent of the use of their limbs. That 15 percent makes the difference in being able to dress yourself or needing someone to dress you."

The West Haven VA study uses the MIT equipment to study if stroke victims can recover the use of weakened arms. Different pieces of equipment work on the shoulder, the elbow, the wrist and the hand.

Clarence Coles, 64, of Bridgeport -- a U.S. Marine who suffered a stroke in January 2005 and is now taking part in the study -- demonstrated one piece of the equipment.

"I had hypertension," Coles said. "I got up one morning, my blood pressure went up and I fell to the floor."

Although he had physical therapy and Botox treatments, he still walks with a limp on his right side and his right arm moves slowly, if at all.

Matthew Laut, an exercise physiologist at the VA hospital, strapped Coles into a seat that prevented him from using his torso in the exercise. He then fitted Coles' disabled right arm and hand into the robotic machine -- in this case, an apparatus fixed with an upright handle that slid over an even table in front of Coles.

To do the exercises, Coles watched a video screen. On it was a circle, cut into eight pieces like the wedges of a pie. Each piece has a small target at its outer edge.

As Coles moved the apparatus, a cursor on the video screen moved as well. In sort of a video game, Coles had to move the cursor from the center of the circle to each of the targets, one by one. He did this 10 times -- 80 movements in total.

The MIT machine doesn't let people do this on their own. It helps, providing some of the power needed. But it also responds to each patient. If the patient is strong, it provide less power to move the apparatus and cursor. If the patient is weak, or tires at the end of a hour, the robotics provide an extra nudge to keep things moving.

"We guarantee success," Federman said.

At the end of the test, the machine also told Coles and Laut how well Coles had done. That means that every time a patient uses the device, he and his physical therapist get a sort of report card, marking improvements.

Along with the continual feedback between patients and machine, and the visual stimulation, the MIT device also gets the patient to do a lot of work.

"A physical therapist can get a patient to do about 80 movements in an hour," Krebs said. "Our machines can get them to do 1,000 motions in an hour."

The VA study is divided into three groups. One will get standard medical care for 12 weeks. The second will get intensive physical therapy three times a week for 12 weeks. The third will get three hours of robotic therapy a week for 12 weeks.

Study coordinator Dr. Noshere Rangbar said one aspect of the study will be a cost analysis. The MIT machines are expensive -- the set the West Haven VA has cost between $250,000 and $500,000.

"We want to see if physical therapy is as good as robotics," said Rangbar, who is the study coordinator. "Robots are more expensive, but if it's working well, thousands of patients can use it."

The study will end in 2009. If it proves successful, Federman said, thousands of stroke victims who have been told to live with their weakened arms and legs may find their hopes strengthened, as well as their limbs.

"This study has been such an eye-opener for me," Federman said. "I've been a doctor for 20 years, and I never had realized the gravity or the severity of stroke. It may not seem like much but for these stroke victims, it's so important if they can say 'I can wash myself now. I can shave.'"

Contact Robert Miller
at bmiller@newstimes.com
or (203) 731-3345.

STROKE:

is a "brain attack"

causes a blockage that prevents blood from getting to the brain, or a broken blood vessel in the brain

about 700,000 Americans get a stroke each year

kills about 160,000 Americans a year

the third leading cause of mortality in the United States after heart disease and cancer

affects women more then men

higher incidence rates for African-Americans than whites

about 75 percent of strokes affect people 65 years old or older

the leading cause of disability in the United States

about 15 percent to 30 percent of stroke victims become permanently disabled

costs the United States more than $53 billion a year in medical costs and lost productivity

The Veteran's Administration Hospital in West Haven needs patients for its study on the use of robotics to treat strokes. If you are a veteran who is at least 18 years old and have had a stroke more than six months ago that's left you with upper extremity weakness and would like to participate, call Dr. Noshene Ranjbar at (203) 932-5711, ext. 4146.

-------------------------

Larry Scott  --

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