does anybody know what's going  on with this study?

rayilynlee <[log in to unmask]> wrote:  Could this EST be what Randy is taking part in?

Hope arises for gains long after stroke
Stimulation, therapy tested
By Carey Goldberg, Globe Staff | December 21, 2006
It has been nearly 10 years since a stroke left Jim Porter with an
all-but-useless left hand and a weakened left arm. In the old days, he would
have had no options: conventional wisdom long held that after a few months
of recovery, stroke survivors never get any better.
But in recent years, the stroke rehabilitation field has junked what some
called its "nihilism " as research has increasingly shown that the brain
continues to change all through life -- suggesting that under the right
conditions, the nation's 5 million stroke survivors may be able to improve
even years later.
That shift of thinking brought Porter, now 70, from his Nashua home to
Spaulding Rehabilitation Hospital in Boston this week. He hoped to qualify
for a study just getting underway there. Researchers will implant electrical
stimulators just inside the skulls of stroke survivors, aiming to help their
brain rewire enough to restore movement to their arms and hands.
"I'd go through anything to get my left hand back," Porter said.
Electrical stimulation is one of many methods that researchers are exploring
as ways to induce these later gains. They include new forms of physical
therapy and intensive exercise tailored for long standing weakness, drugs,
devices, and even futuristic methods using stem cells or gene therapy.
In general, "we're still limited in how much we can influence the recovery
process," said Dr. Joel Stein , chief medical officer at Spaulding, who is
overseeing the electrical stimulation study. "But in the last 10 or 15
years, we've recognized that there is recovery of the brain to a meaningful
degree, and, equally important, we can influence that recovery."
Just last month, the Journal of the American Medical Association published a
rigorous study of 220 stroke survivors that found that even months after a
stroke, intensive, guided exercise could help restore some hand and arm
function in patients with poorly functioning limbs. Called
"constraint-induced movement therapy," or "forced use," the method involved
restraining the patient's "good" arm in a sling, forcing the "bad" arm to
work more during intense, repetitive exercises.
An editorial in the journal noted that despite decades of research, it
remains unclear how far stroke survivors can improve with such
"interventions that harness the learning powers of the human brain." But, it
said, "a little more excitement in the lives of stroke survivors can only be
good."
The significance of that study is not the specific method used, but its
demonstration that "intensive, repetitive practice improves recovery," said
Pamela Duncan , a professor of physical therapy about to start work at Duke
University.
Ultimately, said Duncan, an expert on stroke rehabilitation, late recovery
from stroke is likely to entail "a cocktail of therapies," one that will
inevitably still entail a great deal of work by the patient.
One hurdle to pursuing these later-stage therapies is that most insurance
currently does not cover rehabilitation after a patient's recovery plateaus.
Typically, once progress stalls, the "recovery" period is officially over,
and reimbursement for rehabilitation ends.
As research shows ever more convincingly that it is worthwhile for stroke
survivors to keep trying, insurance companies may be persuaded to cover more
treatment. But more likely, a new system will be required to get stroke
survivors the help they need, perhaps through programs based in communities,
Duncan said.
And even if all the conditions are perfect, she warned, it is important for
patients to realize that there may be limits to their recovery: "If patients
could get up and be totally normal again, we would already have known this,"
she said.
When their brains falter, stroke survivors may someday have the option of
drugs that enhance learning to help improve their recovery, said Dr. Lee
Schwamm , director of acute stroke services at Massachusetts General
Hospital. Perhaps in a decade or so, he said, drugs could accomplish what
the implant does, boosting the brain's ability to rewire.
Other distant prospects include the use of stem cells and gene therapy to
promote new pathways in the brain, he said.
Researchers are hoping to learn how to implant stem cells in stroke
survivors' brains and coax them to grow into replacement neurons. But trying
to grow new tissue in the brain carries the risks of causing seizures --
already a danger for stroke survivors -- or brain tumors, Schwamm said.
Jim Porter volunteered for the first major national study of the electrical
stimulation device after hearing it advertised on a Boston radio station.
During the study, the device is turned on while the stroke survivor
intensively exercises a disabled limb. After about two months, the implant
is removed, but any improvements are expected to remain.
The theory is that low levels of electrical stimulation, when applied during
exercise, can boost brain activity over a necessary threshold in an area
next to a damaged area, helping it take over lost functions, Stein said.
Results in rats, monkeys, and some human patients have been promising,
though they brought partial improvement rather than a cure.
Porter said he was excited about signing up for the brain implant study,
known by the code-name EVEREST. "I've never been in a study before," he
said.
"Better later than never," Stein replied.
But when Richard Hughes , the lead physical therapist on the study, put
Porter through a standardized test of arm and hand movements to score his
level of disability, Porter made it only to 21, despite his best efforts.
He had needed to score 28 to qualify for the study, because people with
intermediate levels of weakness are believed to have better potential to
improve than those with more severe impairments. A 28 is about comparable to
the level of movement required to pick up and drop a washcloth.
After his rejection, Porter did not hide his disappointment and anxiety:
"It's been 10 years," he said. "I don't know if I'll ever get this arm back.
I was so confident I'd pass this -- overconfident."
But it took him only about a minute to bounce back. "I'm not going to give
up," he said. "I'm not a quitter."
For more information about the study, call 617-726-9143.
Carey Goldberg is reachable at [log in to unmask]

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