After months of traditional physical therapy, and still partly paralyzed, Mr. Tannenbaum turned to a videogame for help. He used a device at NYU Langone Medical Center in which an interactive, on-screen canoe trip retrains the paralyzed hand and brain in basic movements.
New therapeutic devices for stroke recovery, made possible by advances in hardware and software, are transforming the typically low-tech world of stroke rehabilitation. Though the tools are still in the early stages, doctors say that they can be more motivating and engaging for patients than current standard therapies, and that they hold promise for stroke survivors who are too injured for traditional therapy.
“We’re entering a very exciting era,” says Dr. David Putrino, director of telemedicine at the Burke Medical Research Institute in White Plains, N.Y. “All of these new tools can really help us do our jobs much better.”
Strokes, which cause brain damage, are a major cause of death and disability in the U.S. Most survivors have some type of disability, and at least half are affected severely enough to require special care or a long-term facility.
While existing stroke therapies are useful, patients typically don’t get as much of these therapies as their doctors would like, both in the hospital and after they leave. It’s especially difficult to get patients to follow through on therapy routines in the long term, in part because the routines are often repetitive and tedious. The new methods, in contrast, are more engaging for the patients, and some can be done at home.
What’s more, while most stroke therapy works by exercising the part of the body associated with the injured portion of the brain, some of the new therapies take a different approach.
For instance, the simulated canoeing device at NYU Langone—which is undergoing clinical trials—engages both arms simultaneously in an effort to retrain the paralyzed hand and the affected portion of the brain. The design is based on research findings by its inventors that using an uninjured arm can help in retraining the injured one.
Their research suggests that both sides of the brain are involved in one arm’s movement, says Preeti Raghavan, a doctor at New York-based NYU Langone who, along with Dr. Donald Weisz, a former professor at Mount Sinai Medical Center, developed the therapeutic device through their company, Mirrored Motion Works Inc.
Mr. Tannenbaum’s experience speaks to the device’s effectiveness at getting him to stick with his therapy. “Two minutes in, you forget you’re doing exercise and you feel like you’re playing a game,” he says. Mr. Tannenbaum says that since his stroke he has regained some abilities, including the ability to walk and move his right arm up and down.
Among the newest therapeutic tools used for stroke victims, those most commercially available are robotic exoskeletons, which attach directly to the affected part of the body to facilitate or enable movement.
Robotic exoskeletons are well suited to therapy, since the support can be taken away gradually as patients improve, says Karen Nolan, a senior research scientist at the nonprofit Kessler Foundation, a West Orange, N.J., research and charitable institution for people with disabilities. Exoskeletons also may relieve physical therapists of having to manually move the patients, so they can focus on the quality of the movements instead, says Dr. Nolan.
Another approach, called telerehabilitation, aims to increase the amount of therapy stroke patients get by making supervised rehabilitation available at home—and making it fun at the same time. One system, developed by Steven Cramer, a University of California, Irvine, professor, and his team, integrates low-cost electronic videogame plug-ins, such as a Nintendo Wii remote-controlled gun. Users’ movements control the games, with remote supervision by a therapist.
“People get all freaky jazzed when they shoot the little ducky on the screen,” Dr. Cramer says. The system is in clinical trials to test its effectiveness compared with in-person physical therapy.
Benefits of VR
Videogame technology used in stroke therapy also includes virtual-reality systems, with some that render scenes and objects in 3-D. Some games with immersive environments may offer the greatest promise to stroke patients because they address cognitive problems along with sensory and motor problems, says Dr. Mindy Levin, a professor at McGill University in Montreal and president of the International Society for Virtual Rehabilitation.
While stroke patients often have physical difficulty with such basic tasks as shopping, everyday environments such as malls can leave them feeling overwhelmed as well. A simulation developed by Israeli researcher and occupational therapist Dr. Debbie Rand, called VMall, can help reintroduce patients to such environments in a low-stakes way by capturing the patient’s image and movements and placing them in an on-screen virtual mall, where they look for items on a shopping list.
The future of these technologies likely lies in a multifaceted approach that combines exercise, therapy and medication, says Lee Schwamm, director of stroke services at Massachusetts General Hospital in Boston and a professor at Harvard Medical School.
In addition to exploring the value of videogame devices such as the Wii and Microsoft’s Kinect for rehabilitative purposes, Dr. Schwamm says he would like to see what can be achieved using more everyday consumer technology, such as Fitbits, the wearable devices that encourage users to be active by monitoring their movements and vital signs. Users also can make the data available online to compare numbers and compete with others.
Researchers are still determining how to match each patient with the technology he or she would benefit most from, depending on the nature and severity of the injury. Canadian clinical guidelines, for instance, recommend robotic exoskeletons for the shoulder and elbow but not for the wrist and hand, based on patient outcomes seen in a review of research.
There’s also a question about how insurers will cover treatments in this burgeoning field. Not all of these new products are available for patient in-home use, and some concerns remain about the effectiveness of those that are.
“If it helps, it helps, but it’s a young field,” Dr. Cramer says. “Most of these devices have yet to publish solid, well-powered, persuasive clinical studies that establish these things do something reliably, in a consistent way.”
It’s possible that using all the new approaches together could provide maximal effect, says Leonardo Cohen, chief of neuroplasticity and neurorehabilitation at the National Institute of Neurological Disorders and Stroke at the National Institutes of Health.
“It’s conceivable, if each of them improves learning by 5%, maybe when one administers them all together, it has an additive effect,” Dr. Cohen says. “I don’t know that, but it would be interesting to explore.”
Ms. Court is a reporter for MarketWatch in New York. She can be reached at firstname.lastname@example.org.