UC Irvine experts address recovery, stem cells at International Stroke Conference

Use of robotics, telerehabilitation and stem cell therapies show promise

February 19, 2016

Stroke remains a major cause of adult disability, and there is a great need for new therapies that improve recovery and are accessible to a majority of patents. Promising UCI Health research toward achieving those goals is among the highlights at the 2016 International Stroke Conference, Feb. 17 – 19 in Los Angeles.

The International Stroke Conference is the world’s largest meeting dedicated to the science and treatment of cerebrovascular disease. This year, more than 3,000 professionals, including physicians, nurses, pharmacists, therapists, dieticians, paramedics and research scientists will attend the conference and more than 1,500 presentations will address stroke diagnosis, treatment and recovery.

“The International Stroke Conference is a tremendous opportunity for our researchers to share their findings and gain insights from colleagues,” said Dr. Steven C. Cramer, professor, UC Irvine Department of Neurology. “The findings presented at this conference highlight the advances being made that will benefit stroke survivors around the world.”

Research includes findings from a robotic device designed and developed by the UC Irvine Biorobotics Laboratory to retrain finger movements after stroke.

Stroke neurologist Cramer, an expert in the use of technology in rehabilitation, was invited to share his expertise involving the role that in-home telerehabilitation plays in recovery.

Cramer, who is also clinical director, Sue & Bill Gross Stem Cell Research Center at UC Irvine, will participate in a discussion regarding the promise of stem cell therapy to safely replace damaged brain tissue after stroke.

Robotic retraining of finger movements after stroke

Research led by Cramer and David Reinkensmeyer, PhD, evaluated how robotic assistance during finger movement training helped improve proprioception function, or the ability to know where one's finger is in space. Robots have been used to aid motor rehabilitation, but the recovery of finger movements has received little attention, Cramer said.

The 30 study participants each received a functional MRI scan at baseline. They then received therapy for three hours a week for three weeks, using FINGER – Finger Individuating Grasp Exercise Robot. They moved their stroke-damaged index and middle fingers to play a game similar to a popular video game that simulates guitar playing.

Through a special algorithm, FINGER assists the participants’ movements, which increases sensory feedback to the brain without altering voluntary motor output. The trial found significant motor improvements, and enhanced spatial awareness of the stroke affected fingers, and that features of brain function at baseline helped predict degree of improvement.

Design and early lessons learned implementing a telerehabilitation trial

Cramer will discuss the challenges encountered in starting a research study for an Internet-based approach to arm motor rehabilitation, such as integrating in-home rehab technology with human therapists.

“Technology will never replace the need for the human touch in rehabilitation,” Cramer said. “Therapists are vital to patient recovery, from determining device settings to monitoring progress and measuring results.”

In a recently opened trial, patients receive 36 therapy sessions, randomly assigned to be in the clinic vs. in-home via telerehabilitation. During the in-home sessions, therapists initiate a videoconference over the Internet to discuss progress, resolve issues and revise treatment plans as needed. Designed as a tool to assist physical therapists, this novel approach has enormous potential to meet the unmet needs of the growing population of stroke survivors.

Clinical trials for stem cell therapy against stroke

Stem cell therapy shows promise for treating disease in a new way, by replacing or regenerating damaged tissues and organs rather than managing symptoms. Previous stem cell trials on animal models have consistently shown improved multiple outcome measures, laying the foundation for further studies on their use in the treatment of ischemic stroke patients.

“Current stroke treatments target the clot, not the brain, and must be administered within a three to six hour window,” Cramer said. “New therapies are needed, and the results of animal studies have been strongly positive for certain types of stem cells. In some cases, these cells are ready to be studied in human patients.”

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