FOR IMMEDIATE RELEASE: October 19, 2004
Contact: Bill Seiler firstname.lastname@example.org (University of Maryland School of Medicine) 410-328-8919
Monica Smith email@example.com (Baltimore Veterans Affairs Medical Center) 410-605-7098
Findings suggest that new avenues of therapy may help disabled stroke patients
A new study led by investigators at the University of Maryland School of Medicine shows that a rehabilitation program for stroke patients, which involves repetitive, simultaneous movement of both arms, activates new pathways in the brain. This indicates that parts of the brain can be trained to take over the function of damaged areas. Two-thirds of the patients in the study who had this type of therapy, called Bilateral Arm Training with Rhythmic Auditory Cueing (BATRAC), also showed functional improvement, even though their strokes occurred an average of four years earlier. Results of the study are published in the Oct. 20, 2004, issue of the Journal of the American Medical Association.
“This study provides evidence that in stroke patients, the brain can be trained to use new neuromuscular pathways in response to a training regimen,” says Jill Whitall, Ph.D., a professor in the Department of Physical Therapy and Rehabilitation Science at the University of Maryland School of Medicine, and principal investigator of the study. “These findings provide hope that with specific training, more people can regain function even years after a stroke.”
The randomized, controlled clinical trial included 21 people who were paralyzed on one side of the body. Nine of the participants received BATRAC, a therapy that involves rhythmic reaching and retrieving actions with both arms (including the disabled arm) moving to the beat of a metronome. The rest of the participants were in an alternative therapy group, which performed a set of different exercises with just the disabled arm. Both therapies were conducted for one hour, three times a week, for six weeks.
The researchers used functional Magnetic Resonance Imaging (fMRI) to examine the impact of the exercises on brain function. The imaging tests were performed both before and after the six weeks of therapy.
“Six out of the nine patients who received BATRAC training showed increased and new sites of activation in the brain, mostly on the undamaged side, as if new pathways were created,” says Dr. Whitall, a co-inventor of BATRAC and a research investigator at the Geriatric Research, Education and Clinical Center (GRECC) at the Baltimore VA Medical Center. She adds that no new sites of activation were seen on the imaging tests in the group that received therapy on just the disabled arm.
However, the researchers observed that overall, following the study, most patients in both therapy groups were better able to move their affected arm, even though they were well past the usual three- to six-month time frame following a stroke when therapy is stopped and spontaneous recovery is complete.
The training portion of the study was conducted at the Baltimore VA GRECC. The University of Maryland investigators collaborated with researchers from the Johns Hopkins Brain Injury Outcomes Division, the Kennedy Krieger Brain Imaging Center and the University of Tubingen, Germany.
“This study leads us to believe that the brain may have a functional reserve capacity for rejuvenation after a stroke,” says Andrew P. Goldberg, M.D., professor of medicine and director of the National Institute of Aging Claude D. Pepper Older Americans Independence Center at the University of Maryland School of Medicine. “If we learn to harness that reserve through specific rehabilitation regimens, we may be able to help many patients restore function and vastly improve their quality of life,” adds Dr. Goldberg, who is a co-author of the study and director of the Baltimore VA GRECC.
One unresolved question is why three of the participants who had the BATRAC training did not show any improvement in motor function changes or new brain pathways. Dr. Whitall says that may be related to the slow speed chosen for the BATRAC training in this study. “Perhaps a higher level of intensity in the training would have helped the remaining three patients in that group,” she says, adding that in a future study, researchers will increase the frequency of arm movements and the amount of exertion required of patients during the exercises.
The senior author of the study, Daniel F. Hanley, M.D., Jeffery and Harriett Legum Professor of Neurology and director of the Division of Brain Injury Outcomes at Johns Hopkins, says the results of this trial may open new avenues of treatment and research.
“With further study that would involve larger groups of patients, we may conclude that we have, in the past, underestimated the amount of recovery that is possible after a stroke,” says Dr. Hanley.
Additional investigators in the study include BATRAC co-inventor Sandy McCombe-Waller, P.T., Ph.D., Larry W. Forrester, Ph.D., Richard Macko, M.D., and John D. Sorkin, M.D., Ph.D., all from the University of Maryland School of Medicine. Andreas R. Luft, M.D., lead author, who was responsible for the analysis and interpretation of the fMRI imaging data, and co-investigator Jorg B. Schulz, M.D., are both from the University of Tubingen, Germany.
Funding for the study came from the National Institute on Aging Pepper Center at the University of Maryland, the National Institute on Disability and Rehabilitation Research, and the National Institute of Neurological Disorders and Stroke. Funding was also provided by the Baltimore VA GRECC, the France-Merrick Foundation, the Johns Hopkins GCRC and the Eleanor Naylor Dana Charitable Trust, Deutsche Forchungsgemeinschaft.
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