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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] ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn