UW-Madison OT Program - 2012 OT Matters - Innovations in Stroke Rehabilitation Provide Hope for OT Professionals

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Innovations in Stroke Rehabilitation Provide Hope for Occupational Therapy Professionals

stroke billboard photo

Stroke is the leading cause of adult disabilities in the United States.

Stroke patients often succumb to additional strokes and draw huge expenses from long-term disabilities. In 2007, at least 30% of the 4.5 million stroke survivors in the United States were permanently disabled, requiring extensive and costly care, according to a 2009 report from the Wisconsin Department of Health Services' Heart Disease and Stroke Prevention Program.

In Wisconsin, 17 percent of stroke patients were discharged to skilled nursing facilities while another five percent were discharged with organized home health services, according to the report.

"These findings suggest an urgent need for statewide efforts to reduce the recurrence of heart attack and stroke and to improve effectiveness of cardiac and stroke rehabilitation services," the report said.

Scientists in the Kinesiology Department’s occupational therapy and motor control programs are responding to this call by developing innovative interventions for stroke survivors. Kinesiology Associate Professor Andrea Mason and Occupational Therapy Professor Dorothy Farrar-Edwards concentrate on recovery of hand function.

MASON TAKES REHAB TO VIRTUAL SPACE
Andrea Mason headshotAndrea Mason has spent the majority of her career working at the intersection of engineering and human motor control, studying how people reach, grasp and manipulate objects with their hands in both real and virtual environments.

She specifically explored how characteristics of their environment influences the ways in which people plan their movements – basic scientific research that anyone interested in human-computer interaction could use for practical applications. Recently, however, Mason started applying her discoveries to the practice of stroke recovery.

The window for stroke patients to make the most improvement with intensive rehabilitation is limited both physically and logistically. The time period in which insurance covers in-patient stroke rehabilitation generally ends before patients are able to recover normal hand function. So, they rely on therapists' take-home instructions. Some therapists have recommended using video game systems that have fitness or motor control activities.

"That technology is taking off and you're seeing senior citizens who are using the Wii as a way of staying active, so we are interested in taking the idea of a game system and creating a rehabilitation tool for people to use in their homes," Mason said. 

But most of those game systems are designed for younger people, or people without disabilities. So, the idea to develop a video game specifically for stroke rehabilitation was a perfect fit for Mason's expertise. She and colleagues at UW - Oshkosh and UW - Stevens Point received a grant from UW System to develop a video game for elderly stroke survivors.

Mason has been visiting stroke support groups and senior centers to organize focus groups. Her team wants to find out what stroke survivors have problems with, what activities they would like to be able to do, what they would find engaging in a video game, and what feedback they would like out of the game that would motivate them to continue playing.

"They're out there looking for things that could potentially help them," she said. "And we think we can do it the right way because of the background that we have… we know what you're supposed to do to learn movement and we want to bring that science into the design of the game."

Mason's team is trying to take complex tasks, such as pouring something into a cup or playing cards, break them down into isolated movements, and re-apply them into a game environment. The games should allow patients to build up their ability to perform increasingly difficult tasks that they can then translate into real environments, Mason said.

The team is experimenting with ways to digitally, yet unobtrusively, capture a subject's hands and hand motions in order to represent them on a video game screen, "which actually turns out to be pretty difficult without a lot of sensors and wires," she said.

"It is really important that the game system be easy to use and not require patients to wear a lot of equipment," she said. "We feel this would be too large of a barrier for patients to actually use the game at home."

Mason and her colleagues started by trying to capture hand movements of children and healthy elderly adults and how they are different from college-age adults. But their subjects were moving so differently from the average that their sensors didn't pick up their movements. So, they have been working to overcome that challenge before applying it to the more complicated condition of paretic hands.

They also hope to incorporate a way to connect the game results to a network so that patients' therapists can access the data, monitor compliance, and give feedback to help patients get the most benefit from the system, she said.

FARRAR-EDWARDS TESTS NEW TECHNOLOGY
Dorothy Edwards headshotWhile scientists like Mason develop high-tech methods for understanding and treating stroke, Professor Dorothy Farrar-Edwards has been focusing part of her research time on assessing stroke treatments from an occupational therapy perspective.

She has partnered with colleagues in the School of Medicine and Public Health and at UW-Milwaukee on a research grant that applies brain-computer interface technology to increase recovery of hand and arm function after stroke.

But it can be a challenge to move new technologies into clinical practice, said Edwards, whose research team has been exploring the barriers to adopting new technologies for stroke recovery and patients' attitudes toward these new treatments.

So far, patients report more openness to trying new treatments than clinicians, she said.

Biomedical Engineering Associate Professor Justin Williams and his research team developed a new therapy device that combines brain activity sensors with a functional electronic stimulator (FES). The brain sensor system picks up information about the patient's activity desires and relays information to the FES which then stimulates the hand and arm muscles needed to perform a set of functional tasks. 

Neuroradiology Assistant Professor Vivek Prabhakaran and his team in the School of Medicine and Public Health have been using fMRI to measure changes in the brain associated with the treatment.

Edwards and her graduate students have been assessing treatment outcomes of this device to determine whether patients can recover upper limb function after several sessions with the device.

"This new technology-based treatment promises an increased speed of recovery," Farrar-Edwards said.

The research group's goal is to show enough positive initial results to be able to secure funding for a larger, randomized control trial, she said.

At the same time, engineers at UW-Milwaukee's Rehabilitation Research Design and Disability Center (R2D2) have been developing a robotic device for stroke recovery that is designed to interact with the stimulator device that the engineers at UW-Madison have developed.

"The next phase is to marry two technologies together," Farrar-Edwards said. 

Kira Luoma, an occupational therapy graduate student who has been working on the study, sees potential in the device for both additional research and wider use among practicing therapists.

She and the other students prepare the subjects by helping stretch them out, stabilizing their arm, helping initiate movement and generally guiding the participant through the process.

"We're really important in making the participant comfortable and initiating a therapeutic relationship in such a medically-based research intervention," Luoma said.

As a future occupational therapist and occupational therapy researcher, Luoma sees promise in the new technology, based on her experience working with the patients in the pilot study.

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