New Stroke Therapy Produced Significant Gains in Motor Function After a Stroke
SAN DIEGO – International Stroke Conference 2014 – Today only an average of 50% of stroke survivors recovers full use of their arm. A study from the Rehabilitation Institute of Chicago approached stroke rehabilitation through a new combination of therapies which produced significantly greater gains in patients' motor function 6 months post stroke.
The combination of non-invasive navigated transcranial stimulation (nTMS), along with occupational therapy, opened the door to improving the quality of life for stroke survivors. The study presented Thursday at the American Heart Association and the American Stroke Association's International Stroke Conference, yielded results from the active group of improved function by 13+ points in the Upper Extremity Fugl-Meyer Assessment (UEFM) score. It also showed over 80% of the active group received a clinically meaningful response rate.
About the Study
The Contrastim Stroke Study: Improving Hand and Arm Function After Stroke with Combined Non-Invasive Brain Stimulation and Task-Oriented Therapy (presentation #152)
Richard Harvey, MD, and his team at the Rehabilitation Institute of Chicago (RIC) presented their trial results that have shown improved outcomes for patients 3–9 months post stroke. The research took a look at the combination of non-invasive navigated transcranial stimulation (nTMS) along with occupational therapy (OT) in post-stroke patients. The study identified 30 patients who tested with a baseline with severe impairment based on the UEFM. Ten of the patients were assigned to the sham group.
"What we found is that there are areas of the brain usually where the lesion is that are less active than they used to be, and there are actually areas on the brain on the opposite hemisphere, the healthy area of the brain, that are more active than it used to be" recounts Lynn Rogers, PhD, Director of RIC's Neuralplasticity Laboratory.
Treatment consisted of 20 minutes of pre-functional occupational therapy, 17 minutes of nTMS, followed by 60 minutes of upper limb task-oriented OT. Patients received treatment during 3 visits per week for 6 weeks, the standard of care in the US. They then returned for follow up visits at 1 week, 1 month, and 6 months. The study found that non-invasive navigated transcranial stimulation, used as an adjunct to therapy, promoted lasting improvements in patients' motor function.
About the Technology
"We are actually able to
modulate healing, and I think this is the wave of the future" – Dr. Richard Harvey
The NBS System uses stereotactic MRI-guided transcranial magnetic stimulation (TMS) to non-invasively modulate precise areas of the motor cortex. The system's e-field based targeting tool allows the therapist to accurately locate the patients exact stimulation location using technology similar to navigating the globe with a GPS. The nTMS was used to stimulate the patient's non-injured hemisphere at a low frequency. The results regulated the excitability of the brain, which down-regulated the healthy side of the brain. Adding navigation to TMS is the key to finding the exact location and orientation of the e-field of the motor area that should be inhibited by stimulation. The stimulation is then accurately repeated in every session, assuring the dose is applied to the correct place. This targeted stimulation has been proven to correlate with Direct Cortical Stimulation in the OR.