Posts tagged stroke
Articles and news from the latest research reports.
Your eyes may hold clues to stroke risk
Your eyes may be a window to your stroke risk.
In a study reported in the American Heart Association journal Hypertension, researchers said retinal imaging may someday help assess if you’re more likely to develop a stroke — the nation’s No. 4 killer and a leading cause of disability.
“The retina provides information on the status of blood vessels in the brain,” said Mohammad Kamran Ikram, M.D., Ph.D., lead author of the study and assistant professor in the Singapore Eye Research Institute, the Department of Ophthalmology and Memory Aging & Cognition Centre, at the National University of Singapore. “Retinal imaging is a non-invasive and cheap way of examining the blood vessels of the retina.”
Worldwide, high blood pressure is the single most important risk factor for stroke. However, it’s still not possible to predict which high blood pressure patients are most likely to develop a stroke.
Researchers tracked stroke occurrence for an average 13 years in 2,907 patients with high blood pressure who had not previously experienced a stroke. At baseline, each had photographs taken of the retina, the light-sensitive layer of cells at the back of the eyeball. Damage to the retinal blood vessels attributed to hypertension — called hypertensive retinopathy — evident on the photographs was scored as none, mild or moderate/severe.
During the follow-up, 146 participants experienced a stroke caused by a blood clot and 15 by bleeding in the brain.
Researchers adjusted for several stroke risk factors such as age, sex, race, cholesterol levels, blood sugar, body mass index, smoking and blood pressure readings. They found the risk of stroke was 35 percent higher in those with mild hypertensive retinopathy and 137 percent higher in those with moderate or severe hypertensive retinopathy.
Even in patients on medication and achieving good blood pressure control, the risk of a blood clot was 96 percent higher in those with mild hypertensive retinopathy and 198 percent higher in those with moderate or severe hypertensive retinopathy.
“It is too early to recommend changes in clinical practice,” Ikram said. “Other studies need to confirm our findings and examine whether retinal imaging can be useful in providing additional information about stroke risk in people with high blood pressure.”
Second known case of patient developing synesthesia after brain injury
About nine months after suffering a stroke, the patient noticed that words written in a certain shade of blue evoked a strong feeling of disgust. Yellow was only slightly better. Raspberries, which he never used to eat very often, now tasted like blue – and blue tasted like raspberries.
High-pitched brass instruments—specifically the brass theme from James Bond movies—elicited feelings of ecstasy and light blue flashes in his peripheral vision and caused large parts of his brain to light up on an MRI. Music played by a euphonium, a tenor-pitched brass instrument, shut down those sensations.
The patient said he was initially frightened by the mixed messages his brain was sending him and the conflicting senses he was experiencing. He was so worried that something was seriously wrong with him that he raised it with a nurse only as he was leaving an appointment at St. Michael’s Hospital in downtown Toronto.
Physicians and researchers immediately recognized he had synesthesia, a neurological condition in which people experience more than one sense at the same time. They may “see” words or numbers as colours, hear sounds in response to smells or feel something in response to sight.
Most synesthetes are born with the condition, and include some of the world’s most famous authors and artists, including author Vladimir Nabakov, composer Franz Liszt, painter Vasily Kandinsky and singer-songwriter Billy Joel.
The Toronto patient is only the second known person to have acquired synesthesia as a result of a brain injury, in this case a stroke. His case was described in the August issue of the journal Neurology by Dr. Tom Schweizer, a neuroscientist and director of the Neuroscience Research Program at St. Michael’s Li Ka Shing Knowledge Institute.
Dr. Schweizer examined the patient’s brain activity in a functional MRI and compared it to six men of similar age (45) and education (18 years) as each listened to the James Bond Theme and a euphonium solo.
When the James Bond Theme was played, large areas of the patient’s brain lit up including the thalamus (the brain’s information switchboard), the hippocampus (which deals with memory and spatial navigation) and the auditory cortex (which processes sound).
"The areas of the brain that lit up when he heard the James Bond Theme are completely different from the areas we would expect to see light up when people listen to music," Dr. Schweizer said. "Huge areas on both sides of the brain were activated that were not activated when he listened to other music or other auditory stimuli and were not activated in the control group."
The patient and members of the control group also viewed 10-second blocks of words presented in black (which elicits no emotional response in the patient), yellow (mild disgust response) and blue (intense disgust response).
Reading blue letters produced extensive activity in the parts of the patient’s brain responsible for sensory information and processing emotional stimuli and similar but less intense responses for yellow letters. Control groups showed no heightened brain activity in response to the different coloured letters.
Dr. Schweizer said the fact that the patient had very targeted and specific responses to certain stimuli – and that these responses were not experienced by the control group – suggests that his synesthesia was caused as his brain tried to repair itself after his stroke and got cross-wired.
The patient’s stroke occurred in the thalamus, the brain’s central relay station. That’s the same part of the brain affected by the only other reported case of acquired synesthesia.
(Source: eurekalert.org)
Key target responsible for triggering detrimental effects in brain trauma identified
Researchers studying a type of cell found in the trillions in our brain have made an important discovery as to how it responds to brain injury and disease such as stroke. A University of Bristol team has identified proteins which trigger the processes that underlie how astrocyte cells respond to neurological trauma.
The star-shaped astrocytes, which outnumber neurons in humans, are a type of glial cell that comprise one of two main categories of cell found in the brain along with neurons. The cells, which have branched extensions that reach synapses (the connections between neurons) blood vessels, and neighbouring astrocytes, play a pivotal role in almost all aspects of brain function by supplying physical and nutritional support for neurons. They also contribute to the communication between neurons and the response to injury.
However, the cells are also known to trigger both beneficial and detrimental effects in response to neurological trauma. When the brain is subjected to injury or disease, the cells react in a number of ways, including a change in shape. In severe cases, the altered cells form a scar, which is thought to have beneficial, as well as detrimental effects by allowing prompt repair of the blood-brain barrier, and limiting cell death, but also impairing the regeneration of nerve fibres and the effective incorporation of neuronal grafts - where additional neuronal cells are added to the injured site.
The cells change shape via the regulation of a structural component of the cell called the actin cytoskeleton, which is made up of filaments that shrink and grow to physically manoeuvre parts of the cell. In the lab, the team cultured astrocytes in a dish and were able to make them change shape by chemically or genetically manipulating proteins that control actin, and also by mimicking the environment that the cells would be exposed to during a stroke.
By doing so the team found that very dramatic changes in cell shape were caused by controlling the actin cytoskeleton in the in vitro stroke model. The team also identified additional protein molecules that control this process, suggesting that a complex mechanism is involved.
Dr Jonathan Hanley from the University’s School of Biochemistry said: “Our findings are crucial to our understanding of how the brain responds to many disorders that affect millions of people every year. Until now, the details of the actin-based mechanisms that control astrocyte morphology were unknown, so we anticipate that our work will lead to future discoveries about this important process.”
(Source: eurekalert.org)
UC Davis stem cell study uncovers the brain-protective powers of astrocytes
One of regenerative medicine’s greatest goals is to develop new treatments for stroke. So far, stem cell research for the disease has focused on developing therapeutic neurons — the primary movers of electrical impulses in the brain — to repair tissue damaged when oxygen to the brain is limited by a blood clot or break in a vessel. New UC Davis research, however, shows that other cells may be better suited for the task.
Published today in the journal Nature Communications, the large, collaborative study found that astrocytes — neural cells that transport key nutrients and form the blood-brain barrier — can protect brain tissue and reduce disability due to stroke and other ischemic brain disorders.
“Astrocytes are often considered just ‘housekeeping’ cells because of their supportive roles to neurons, but they’re actually much more sophisticated,” said Wenbin Deng, associate professor of biochemistry and molecular medicine at UC Davis and senior author of the study. “They are critical to several brain functions and are believed to protect neurons from injury and death. They are not excitable cells like neurons and are easier to harness. We wanted to explore their potential in treating neurological disorders, beginning with stroke.”
Deng added that the therapeutic potential of astrocytes has not been investigated in this context, since making them at the purity levels necessary for stem cell therapies is challenging. In addition, the specific types of astrocytes linked with protecting and repairing brain injuries were not well understood.
The team began by using a transcription factor (a protein that turns on genes) known as Olig2 to differentiate human embryonic stem cells into astrocytes. This approach generated a previously undiscovered type of astrocyte called Olig2PC-Astros. More importantly, it produced those astrocytes at almost 100 percent purity.
The researchers then compared the effects of Olig2PC-Astros, another type of astrocyte called NPC-Astros and no treatment whatsoever on three groups of rats with ischemic brain injuries. The rats transplanted with Olig2PC-Astros experienced superior neuroprotection together with higher levels of brain-derived neurotrophic factor (BDNF), a protein associated with nerve growth and survival. The rats transplanted with NPC-Astros or that received no treatment showed much higher levels of neuronal loss.
To determine whether the astrocytes impacted behavior, the researchers used a water maze to measure the rats’ learning and memory. In the maze, the rats were required to use memory rather than vision to reach a destination. When tested 14 days after transplantation, the rats receiving Olig2PC-Astros navigated the maze in significantly less time than the rats that received NPC-Astros or no treatment.
The investigators used cell culture experiments to determine whether the astrocytes could protect neurons from oxidative stress, which plays a significant role in brain injury following stroke. They exposed neurons co-cultured with both types of astrocytes to hydrogen peroxide to replicate oxidative stress. They found that, while both types of astrocytes provided protection, the Olig2PC-Astros had greater antioxidant effects. Further investigation showed that the Olig2PC-Astros had higher levels of the protein Nrf2, which increased antioxidant activity in the mouse neurons.
“We were surprised and delighted to find that the Olig2PC-Astros protected neurons from oxidative stress in addition to rebuilding the neural circuits that improved learning and memory,” said Deng.
The investigators also investigated the genetic qualities of the newly identified astrocytes. Global microarray studies showed they were genetically similar to the standard NPC-Astros. The Olig2PC-Astros, however, expressed more genes (such as BDNF and vasoactive endothelial growth factor, or VEGF) associated with neuroprotection. Many of these genes help regulate the formation and function of synapses, which carry signals between neurons.
Additional experiments showed that both the Olig2PC-Astros and NPC-Astros accelerated synapse development in mouse neurons. The Olig2PC-Astros, however, had significantly greater protective effects over the NPC-Astros.
In addition to being therapeutically helpful, the Olig2PC-Astros showed no tumor formation, remained in brain areas where they were transplanted and did not differentiate into other cell types, such as neurons.
“Dr. Deng’s team has shown that this new method for deriving astrocytes from embryonic stem cells creates a cell population that is more pure and functionally superior to the standard method for astrocyte derivation,” said Jan Nolta, director of the UC Davis Institute for Regenerative Cures. “The functional improvement seen in the brain injury models is impressive, as are the higher levels of BDNF. I will be excited to see this work extended to other brain disease models such as Huntington’s disease and others, where it is known that BDNF has a positive effect.”
Deng added that the results could lead to stem cell treatments for many neurodegenerative diseases.
“By creating a highly purified population of astrocytes and showing both their therapeutic benefits and safety, we open up the possibility of using these cells to restore brain function for conditions such as Alzheimer’s disease, epilepsy, traumatic brain disorder, cerebral palsy and spinal cord injury,” said Deng.
Stroke Recovery Theories Challenged By New Studies Looking at Brain Lesions, Bionic Arms
Stroke survivors left weakened or partially paralyzed may be able to regain more arm and hand movement than their doctors realize, say experts at The Ohio State University Wexner Medical Center who have just published two new studies evaluating stroke outcomes.
One study analyzed the correlation between long-term arm impairment after stroke and the size of brain lesions caused by patients’ strokes – a visual measure often used by doctors to determine rehabilitation therapy type and duration. The other study compared the efficacy of a portable robotics-assisted therapy program with a traditional program to improve arm function in patients who had experienced a stroke as long as six years ago.
“These studies were looking at two entirely different aspects of a stroke, yet they both suggest that stroke patients can indeed regain function years and years after the initial event,” said Stephen Page, PhD, OTR/L, author of both studies and associate professor of Health and Rehabilitation Sciences in Ohio State’s College of Medicine. “Unfortunately, we know that this is not a message that many patients and especially their clinicians may be getting, so the patients may not be reaching their true potential for recovery.”
Size doesn’t matter
Clinicians frequently tell patients that the bigger the size of the area of their brains affected by their strokes, the worse that their outcomes will be. However, in a lead article in the Archives of Physical Medicine and Rehabilitation, Page’s research team found that there was no relationship between the size of stroke lesions and recovery of arm function in 139 stroke survivors. On average, study participants had experienced a stroke five years earlier.
“Historically, lesion size been thought to influence recovery, but we didn’t find that to be the case when looking at regaining arm and hand movement,” said Page, who also runs Ohio State’s B.R.A.I.N Lab, a research group dedicated to developing approaches to restore function after disabling injuries and diseases. “This has important implications because we know clinicians look closely at lesion volume and may make decisions about the type and duration of therapy, and that some may communicate likelihood for recovery to patients based on this size. Many people think the window for therapy is roughly six months, but we think it’s much longer.”
Page agrees that the first six months after a stroke may represent important healing time for the brain, but that “retraining” it with occupational therapy can potentially be helpful at any time after the stroke. He says that his findings support other theories that the health of remaining brain tissue influences recovery much more than lesion size.
Although there are many studies that have identified a relationship between stroke lesion size and overall neurological function, Page’s study is the first to specifically look at lesion size and upper extremity outcomes.
Robotic arm as good as traditional therapy
In the second study, Page’s team demonstrated that stroke survivors using a portable robotic-assisted arm to perform repetitive task training showed as much motor recovery as patients who performed similar tasks in a therapist-guided outpatient setting.
“Our results are exciting not just because we showed robotics-assisted therapy can offer equal benefit. We showed that both groups got better, even among patients who had suffered strokes as long as eight years ago,” noted Page.
For the study, which was published in the June 2013 issue of Clinical Rehabilitation, patients performed repetitive exercises that focused on everyday tasks while supervised by a therapist in an outpatient setting. Half of the group was randomly assigned to use the robotic arm, a portable device that is worn over the arm like a brace. When a person tries to move a weakened arm, the device senses the electrical impulses and helps the person carry out the movement. A second group performed the same tasks without the device for the same amount of time and in the same environment. The group training with the robotic arm performed tasks as well as their counterparts.
“Therapy can be tiring, expensive, and resource-intensive. This study is important because it shows us that in patients with moderate arm impairment, similar benefits can be derived from using a robotic device to aid with arm therapy as with manually based rehabilitative approaches,” said Page. “Study participants who trained with the robotic arm also reported feeling stronger and more positive about the rehabilitation process.”
Most of the estimated 80 million stroke survivors worldwide will continue to have upper body weakness for months after a stroke, preventing them from accomplishing everyday tasks like lifting a laundry basket or drinking from a cup. Page says that more research in stroke outcomes and rehabilitation is needed, and that he hopes families and healthcare practitioners dealing with stroke will keep the door to recovery open wider and longer.
“Loss of upper extremity movement remains one of the most common and devastating stroke-induced impairments. And the fact is that more stroke survivors are expected yet studies and pathways to optimize rehabilitative therapy for these millions are not always emphasized. In particular, we know active rehabilitation programs help people regain function, but we still don’t know who will benefit the most from these types of therapy,” said Page. “Both of these studies give us insights about patients who will respond best – and most importantly, that we have to give these patients every chance possible to get better, because they can keep getting better.”
Early brain stimulation may help stroke survivors recover language function
Non-invasive brain stimulation may help stroke survivors recover speech and language function, according to new research in the American Heart Association journal Stroke.
Between 20 percent to 30 percent of stroke survivors have aphasia, a disorder that affects the ability to grasp language, read, write or speak. It’s most often caused by strokes that occur in areas of the brain that control speech and language.
“For decades, skilled speech and language therapy has been the only therapeutic option for stroke survivors with aphasia,” said Alexander Thiel, M.D., study lead author and associate professor of neurology and neurosurgery at McGill University in Montreal, Quebec, Canada. “We are entering exciting times where we might be able in the near future to combine speech and language therapy with non-invasive brain stimulation earlier in the recovery. This could result in earlier and more efficient aphasia recovery and also have an economic impact.”
In the small study, researchers treated 24 stroke survivors with several types of aphasia at the rehabilitation hospital Rehanova and the Max-Planck-Institute for neurological research in Cologne, Germany. Thirteen received transcranial magnetic stimulation (TMS) and 11 got sham stimulation.
The TMS device is a handheld magnetic coil that delivers low intensity stimulation and elicits muscle contractions when applied over the motor cortex.
During sham stimulation the coil is placed over the top of the head in the midline where there is a large venous blood vessel and not a language-related brain region. The intensity for stimulation was lower intensity so that participants still had the same sensation on the skin but no effective electrical currents were induced in the brain tissue.
Patients received 20 minutes of TMS or sham stimulation followed by 45 minutes of speech and language therapy for 10 days.
The TMS groups’ improvements were on average three times greater than the non-TMS group, researchers said. They used German language aphasia tests, which are similar to those in the United States, to measure language performance of the patients.
“TMS had the biggest impact on improvement in anomia, the inability to name objects, which is one of the most debilitating aphasia symptoms,” Thiel said.
Researchers, in essence, shut down the working part of the brain so that the stroke-affected side could relearn language. “This is similar to physical rehabilitation where the unaffected limb is immobilized with a splint so that the patients must use the affected limb during the therapy session,” Thiel said.
“We believe brain stimulation should be most effective early, within about five weeks after stroke, because genes controlling the recovery process are active during this time window,” he said.
1 in 4 Stroke Patients Suffer PTSD
One in four people who survive a stroke or transient ischemic attack (TIA) suffer from symptoms of post-traumatic stress disorder (PTSD) within the first year post-event, and one in nine experience chronic PTSD more than a year later. The data suggest that each year nearly 300,000 stroke/TIA survivors will develop PTSD symptoms as a result of their health scare. The study, led by Columbia University Medical Center researchers, was published today in the online edition of PLOS ONE.
“This work builds on recent findings of ours that PTSD is common among heart attack survivors and that it contributes to a doubled risk of a future cardiac event or of dying within one to three years. Our current results show that PTSD in stroke and TIA survivors may increase their risk for recurrent stroke and other cardiovascular events,” said first author Donald Edmondson, PhD, MPH, assistant professor of behavioral medicine (Center for Behavioral Cardiovascular Health) at CUMC. “Given that each event is life-threatening and that strokes/TIAs add hundreds of millions of dollars to annual health expenditures, these findings are important to both the long-term survival and health costs of these patient populations.”
“PTSD is not just a disorder of combat veterans and sexual assault survivors, but strongly affects survivors of stroke and other potentially traumatic acute cardiovascular events as well,” said Ian M. Kronish, MD, MPH, assistant professor of medicine (Center for Behavioral Cardiovascular Health) and the study’s senior author. “Surviving a life-threatening health scare can have a debilitating psychological impact, and health care providers should make it a priority to screen for symptoms of depression, anxiety, and PTSD among these patient populations.”
Stroke is the fourth-leading cause of death and the top cause of disability in the United States. According to data from the American Stroke Association, nearly 795,000 Americans each year suffer a new or recurrent stroke, and up to an additional 500,000 suffer a TIA.
PTSD is an anxiety disorder initiated by exposure to a traumatic event. Common symptoms include nightmares, avoidance of reminders of the event, and elevated heart rate and blood pressure. Chronic PTSD is a duration of these symptoms for three months or longer (as defined by the DSM-IV).
Since only a few studies have assessed PTSD due to stroke, Drs. Edmondson and Kronish and their colleagues performed the first meta-analysis of clinical studies of stroke- or TIA-induced PTSD. The nine studies in the meta-analysis included a total of 1,138 stroke or TIA survivors.
The study found that 23 percent, or roughly one in four, of the patients developed PTSD symptoms within the first year after their stroke or TIA, with 11 percent, or roughly one in nine, experiencing chronic PTSD more than a year later.
“PTSD and other psychological disorders in stroke and TIA patients appear to be an under-recognized and undertreated problem,” said Dr. Kronish.
“Fortunately, there are good treatments for PTSD,” said Dr. Edmondson. “But first, physicians and patients have to be aware that this is a problem. Family members can also help. We know that social support is a good protective factor against PTSD due to any type of traumatic event.”
“The next step is further research to assess whether mental health treatment can reduce stroke- and TIA-induced PTSD symptoms and help these patients regain a feeling of normalcy and calm as soon as possible after their health scare,” said Dr. Edmondson.
(Source: newsroom.cumc.columbia.edu)
New Molecular-Level Understanding of Brain’s Recovery After Stroke
A specific MicroRNA, a short set of RNA (ribonuclease) sequences, naturally packaged into minute (50 nanometers) lipid containers called exosomes, are released by stem cells after a stroke and contribute to better neurological recovery according to a new animal study by Henry Ford Hospital researchers.
The important role of a specific microRNA transferred from stem cells to brain cells via the exosomes to enhance functional recovery after a stroke was shown in lab rats. This study provides fundamental new insight into how stem cells affect injured tissue and also offers hope for developing novel treatments for stroke and neurological diseases, the leading cause of long-term disability in adult humans.
The study was published in the journal Stem Cells.
Although most stroke victims recover some ability to voluntarily use their hands and other body parts, nearly half are left with weakness on one side of their body, while a substantial number are permanently disabled.
Currently no treatment exists for improving or restoring this lost motor function in stroke patients, mainly because of mysteries about how the brain and nerves repair themselves.
“This study may have solved one of those mysteries by showing how certain stem cells play a role in the brain’s ability to heal itself to differing degrees after stroke or other trauma,” says study author Michael Chopp, Ph.D., scientific director of the Henry Ford Neuroscience Institute and vice chairman of the department of Neurology at Henry Ford Hospital.
The researchers noted that Henry Ford’s Institutional Animal Care and Use Committee approved all the experimental procedures used in the new study.
The experiment began by isolating mesenchymal stem cells (MSCs) from the bone marrow of lab rats. These MSCs are then genetically altered to release exosomes that contain specific microRNA molecules. The MSCs then become “factories” producing exosomes containing specific microRNAs. These microRNAs act as master switches that regulate biological function.
The new study showed for the first time that a specific microRNA, miR-133b, carried by these exosomes contributes to functional recovery after a stroke.
The researchers genetically raised or lowered the amount of miR-133b in MSCs and, respectively, treated the rats. When these MSCs are injected into the bloodstream 24 hours after stroke, they enter the brain and release their exosomes. When the exosomes were enriched with the miR-133b, they amplified neurological recovery, and when the exosomes were deprived of the miR-133b, the neurological recovery was substantially reduced.
Stroke was induced under anesthesia by inserting a nylon thread up the carotid artery to occlude a major artery in the brain, the middle cerebral artery. MSCs were then injected 24 hours after the induction of stroke in these animals and neurological recovery was measured.
As a measure on neurological recovery, rats were given two types of behavioral tests to measure the normal function of their front legs and paws – a “foot-fault test,” to see how well they could walk on an unevenly spaced grid; and an “adhesive removal test” to measure how long it took them to remove a piece of tape stuck to their front paws.
Researchers then separated the disabled rats into several groups and injected each group with a specific dosage of saline, MSCs and MSCs with increased or decreased miR-133b, respectively. The two behavioral tests were again given to the rats three, seven and 14 days after treatment.
The data demonstrated that the enriched miR-133b exosome package greatly promoted neurological recovery and enhanced axonal plasticity, an aspect of brain rewiring, and the diminished miR-133b exosome package failed to enhance neurological recovery
While the research team was careful to note that this was an animal study, its findings offer hope for new ways to address the single biggest concern of stroke victims as well as those with neural injury such as traumatic brain injury and spinal cord damage – regaining neurological function for a better quality of life.
(Source: henryford.com)
Study charts exercise for stroke patients’ brains
A new study has found that stroke patients’ brains show strong cortical motor activity when observing others performing physical tasks — a finding that offers new insight into stroke rehabilitation.
Using functional magnetic resonance imaging (fMRI), a team of researchers from USC monitored the brains of 24 individuals — 12 who had suffered strokes and 12 age-matched people who had not — as they watched others performing actions made using the arm and hand that would be difficult for a person who can no longer use their arm due to stroke — actions such as lifting a pencil or flipping a card.
The researchers found that while the typical brain responded to the visual stimulus with activity in cortical motor regions that are generally activated when we watch others perform actions, in the stroke-affected brain, activity was strongest in these regions of the damaged hemisphere and strongest when stroke patients viewed actions they would have the most difficulty performing.
Activating regions near the damaged portion of the brain is like exercising it, building strength that can help it recover to a degree.
“Watching others perform physical tasks leads to activations in motor areas of the damaged hemisphere of the brain after stroke, which is exactly what we’re trying to do in therapy,” said Kathleen Garrison, lead author of a paper on the research. “If we can help drive plasticity in these brain regions, we may be able to help individuals with stroke recover more of the ability to move their arm and hand.”
Garrison, who completed the research while studying at USC and is currently a postdoctoral researcher at the Yale University School of Medicine, worked with Lisa Aziz-Zadeh of the USC Brain and Creativity Institute, based at the USC Dornsife College of Letters, Arts and Sciences, and the Division of Occupational Science and Occupational Therapy; Carolee Winstein, director of the Motor Behavior and Neurorehabilitation Laboratory in the Division of Biokinesiology and Physical Therapy; and former USC doctoral student Sook-Lei Liew and postdoctoral researcher Savio Wong.
Their research was posted online ahead of publication by the journal Stroke on June 6.
Using action-observation in stroke rehabilitation has shown promise in early studies, and this study is among the first to explain why it may be effective.
“It’s like you’re priming the pump,” Winstein said. “You’re getting these circuits engaged through the action-observation before they even attempt to move.”
The process is a kind of virtual exercise program for the brain that prepares you for the real exercise that includes the brain and body.
The study also offers support for expanding action-observation as a therapeutic technique, particularly for individuals who have been screened using fMRI and have shown a strong response to it.
“We could make videos of what patients will be doing in therapy and then have them watch it as homework,” Aziz-Zadeh said. “In some cases, it could pave the way for them to do better.”
Technique Could Identify Patients at High Risk of Stroke or Brain Hemorrhage
Measuring blood flow in the brain may be an easy, noninvasive way to predict stroke or hemorrhage in children receiving cardiac or respiratory support through a machine called ECMO, according to a new study by researchers at Nationwide Children’s Hospital. Early detection would allow physicians to alter treatment and take steps to prevent these complications—the leading cause of death for patients on ECMO.
Short for extracorporeal membrane oxygenation, ECMO is used when a patient is unable to sustain enough oxygen in the blood supply due to heart failure, septic shock, or other life-threatening condition, said Nicole O’Brien, MD, a physician and scientist in critical care medicine at Nationwide Children’s and lead author of the study, which appears in a recent issue of the journal Pediatric Critical Care Medicine. The patient is connected to ECMO with tubes that carry the patient’s blood from a vein through the machine, where it is oxygenated and funneled back to the patient via an artery or vein that then distributes the oxygen-rich blood to vital organs and tissues.
The disease processes that lead someone to need ECMO are different, O’Brien noted, but it is used only after traditional therapies, such as a ventilator, fail. One of the biggest risks of ECMO is bleeding in the brain. Only 36 percent of children who suffer this complication survive, many left with permanent neurologic injury.
“Most of these patients are critically ill before they go on ECMO and often have low oxygen levels, low blood pressure and poor heart function, all of which can certainly lead to strokes,” said O’Brien, also an associate professor of clinical medicine at The Ohio State University College of Medicine. “Still, some patients develop problems and others don’t and we don’t understand why.”
To better understand the cause for these brain bleeds, O’Brien launched a pilot study to monitor cerebral blood flow using a transcranial doplar ultrasound machine, a portable, noninvasive technology that uses sound waves to measure the amount and speed of blood flowing through the brain. All patients on ECMO experience a change in cranial blood flow, but O’Brien wanted to see if those variations offered any hint as to why some patients had complications while others didn’t.
She measured cranial blood flow in 18 ECMO patients, taking the first reading within the patient’s first 24 hours on the machine, then again each day they received the treatment and one more time after ECMO therapy ended.
When she compared these measurements to normal cerebral blood flow rates for children in the same age group, she found significant differences. Thirteen of the children in the study developed no neurologic complications while on ECMO. In these children, cerebral blood flow was 40 percent to 50 percent lower than normal. But in the five patients who had either a stroke or brain hemorrhage while on ECMO, cerebral blood flow was 100 percent higher than normal.
The age of the child, length of time on ECMO or the underlying illness didn’t seem to matter. The only difference was that cerebral blood flow was dramatically increased in patients who ultimately had problems. While O’Brien found that interesting, the most intriguing finding was that the increase in blood flow occurred as long as two to six days before the patient began bleeding in the brain.
“That could give us a lot of lead time to prevent the brain bleeds or hemorrhages,” said O’Brien.
Physicians may decide to try to wean a patient off ECMO a little more quickly or change the dosage of anti-coagulant medication that all ECMO patients take.
Although O’Brien is excited about the results, she is careful to note that the findings are preliminary. She is planning a multi-center trial to see if the outcome will be the same in a larger study population.
“We still need to understand why these kids bleed and why they stroke,” said O’Brien. “This little piece of information is the very tip of the iceberg in terms of why that happens.”
(Source: nationwidechildrens.org)