I don't recall posoting this at all, Ray
----- Original Message -----
From: "Douglas Way" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, May 14, 2007 3:48 PM
Subject: Re: Electrical Stimulation Therapy


> 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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