A Critical Window for Recovery After Stroke

A Critical Window for Recovery After Stroke

The BLAM (Brain, Learning, Animation, and Movement) lab at John Hopkins University is focusing research on promoting optimal recovery for patients suffering a stroke or TBI. Their Kata Project is a collaboration between neuroscientists, robotics, computer science, and animation.

Stroke is one of the leading causes of disability in the US. Scientists at John Hopkins University have identified that there is a period of endogenous hyperplasticity that occurs directly after an ischemic brain injury. During this period, motor coordination and movement improves at a much greater rate than later in the recovery period. They found that patients typically improve during the first month following a stroke and then plateau at a new level of functioning that is only a fraction of their baseline functioning.

Motor rehabilitation is often delayed immediately following a stroke. The first two weeks after a stroke is typically spent in an inpatient hospital environment focusing on medical stabilization. During much of this time the patient is alone and immobile. Unfortunately, by delaying rehabilitation efforts, there is concern that we are not optimizing recovery by taking advantage of the hyperplasticity period following ischemia.

John Hopkins University has been experimenting by looking at the level of functioning regained by mice that suffered a stroke. Immediately following a stroke, mice were placed in one of two environments. In the control environment the mice were primarily alone and immobile (similar to an inpatient hospital environment during medical stabilization). The experimental environment was an enriched environment filled with other mice, toys, and visual and physical challenges. Mice in the enriched environment recovered much more quickly and to a higher level of functioning than those in the control environment.

A pilot study is now being undertaken to see what gains can be made by placing a stroke patient in a more enriched and challenging environment immediately following a stroke. The BLAM lab developed an immersive gaming environment including 3D exoskeletal robotics and non-invasive brain stimulation.

In the “game” the patient manipulates the robotic arm to control a 3D dolphin and complete challenges. The hope is that this type of  stimulation can be incorporated in the acute care setting immediately after a stroke and we can better take advantage of the hyperplasticity period. Per John Hopkins, pilot data has been promising. Regardless of the data on motor functioning, patients seem to be having a lot of fun playing the game. Being in a position of control seems to be very rewarding for patients after they have lost so much control through the disease process.

References:

Johns Hopkins Departments of Neurology and Neurosurgery. (2015). Funding a Lab of the Future. NeuroNow, Winter 2015, 1-4. Retrieved from http://www.hopkinsmedicine.org/news/publications/neuronow/files/sebindoc/m/r/4187BEB7CC3B446264EA2DD3CE8EBEDA.pdf.

Krakauer, J. (2015, March 7). A Critical Window for Recovery After Stroke [Video File]. Retrieved from http://tedxtalks.ted.com/video/A-Critical-Window-for-Recovery