Grant Establishes Prestigious Claude D. Pepper Older Americans Independence Center
The University of Maryland School of Medicine has received a $7.5 million grant from the National Institutes of Health (NIH) to conduct promising new research on stroke, the leading cause of disability in older Americans. The research, focusing on a rehabilitation technique designed to "rewire" the brain and restore mobility through the repetitive exercise of paralyzed limbs, is being conducted at the Baltimore Veterans Affairs (VA) Geriatrics Research, Education and Clinical Center (GRECC).
"Based on preliminary results, we believe our studies will lead to a new era in stroke rehabilitation," says Andrew P. Goldberg, M.D., professor of medicine and director of the Claude D. Pepper Older Americans Independence Center, which is located in the GRECC. "We hope this new approach will give more stroke patients a chance to resume their normal daily activities in their own homes." In addition to establishing the Pepper Center at the School of Medicine and the Baltimore VA Medical Center, the five-year grant will fund pioneering rehabilitation and aging research. Only ten university medical centers in the country have the prestigious Pepper Center designation.
In contrast to standard therapy that focuses on the limbs unaffected by a stroke, the new rehabilitation technique uses special exercise machines and treadmills to move paralyzed arms or legs in a continuous and repetitive motion. In one aspect of the research, stroke patients train on a machine that mimics the reciprocal motion of the arms. When the "good" arm is pushed down, the paralyzed arm comes up. When the "good" arm is pulled up, the paralyzed arm goes down. At the same time, rhythmic sounds help patients to keep the "beat." The study, led by Jill Whithall, Ph.D., associate professor of physical therapy, uses brain-imaging technology to determine whether the movement affects brain activity.
"Physical therapy is an important component in the rehabilitation process, but traditional physical therapy techniques are not enough," says Richard Macko, M.D., associate professor of neurology at the University of Maryland School of Medicine and director of the stroke program at the VA and the GRECC. The human brain is divided into left and right hemispheres. When a stroke occurs on one side of the brain, partial or complete paralysis may occur on opposite side of the body. Brain imaging technology has shown that the brain has the potential to "rewire" itself after a stroke. Activity increases in the uninjured region of the brain as it takes over for the region injured by stroke.
"Our research suggests that persistent repetitive motion helps to trigger that "rewiring" and restore mobility in paralyzed arms and legs," says Dr. Macko. The Pepper Center grant will be used to study the effectiveness of this new approach in a large population of stroke patients with paralysis on one side of the body. Standard stroke rehabilitation involves physical therapy and retraining so that functional areas of the body can take over tasks that were performed by paralyzed limbs. For example, a stroke patient whose right hand is paralyzed is taught to perform more tasks with the left hand.
In many cases, physical therapy can help restore varying degrees of mobility in disabled limbs. But the success rate is unpredictable, and too often, improvements are short-lived and difficult for the patient to sustain. Dr. Goldberg says the Pepper Center research will examine whether new models for rehabilitation can help stroke patients maintain functional improvements over a longer period of time, and help patients who have not responded well to other forms of therapy. "The conventional wisdom says that rehabilitation is only effective within a few months of the stroke. But we believe the window for "rewiring" the brain may actually be as long as six years," says Dr. Goldberg.
Researchers in gerontology and primary care providers throughout the University of Maryland and VA Maryland Healthcare System will contribute to the Pepper Center research on stroke and other disabling conditions affecting older people, such as hip fracture, diabetes, and vascular disease.
"We will integrate all of our clinical and research resources to help improve the quality of life for those recovering from stroke and age-related disabilities," says Jay Magaziner, Ph.D, professor and director of the division of gerontology in the Department of Epidemiology and Preventive Medicine, and co-director of the Pepper Center.
Other research partners include the Department of Medicine's division of gerontology, the Departments of Neurology and Physical Therapy in the School of Medicine, the University of Maryland Schools of Nursing and Pharmacy, and the Kirby Imaging center at Johns Hopkins.
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