Post-stroke rehabilitation treatment is also being boosted by a new device developed at Northwestern University and being tested at the Shirley Ryan AbilityLab, a Chicago research hospital. It is a Band-Aid® like device which can be applied to key areas such as the throat (left above, credit AbilityLab), chest, or limbs to send back information to doctors on how a patient in treatment post-discharge, especially at home, progresses. The sensors and platform measure heart activity, muscle movement, sleep quality, swallowing ability, and patterns of speech. Especially revolutionary is the monitoring of speech communication and swallowing, which are often impaired in stroke patients but hard to track once the patient is out of a facility. The team’s research was presented last week at the American Association for the Advancement of Science (AAAS) annual meeting. New Atlas. Hat tip to Toni Bunting.
Prepare to be shocked! Can brain enhancing techniques via transcranial direct-current stimulation (tDCS) be the future of performance enhancement? Will it be the future basis of recovery from some mental illnesses, stroke and other neurological diseases? It’s a hot research area, according to this Atlantic article. Researchers at DARPA, University of New Mexico, George Mason University, Stanford University, Oxford University, University of Göttingen and this Editor’s local City College of New York (CCNY) are hot on the trail. Four areas being investigated are (more…)
Through presentations by world-class clinicians, this meeting on 24th September, will examine the wide range of ways in which telemedicine has improved patient outcomes, and reduced cost, in the field of clinical neuroscience. Older readers with long memories may recall a BT television advert from the late ’80’s featuring a neurosurgical consultant in his dressing gown and slippers studying a TV monitor in his home. A CT scan of an acute patient had been transferred in real time for a consultant decision using the ‘Intrans’ system. Since then, there have been many applications of image transfer, which has become the UK norm. This will be discussed, as well as the complexities and difficulties related to encryption.
However telemedicine has applications in a host of other clinical areas. Management of very acute neurological conditions remains the most obvious. ‘Apps’ in head injury management are now commonly used for both record and decision making and are about to be expanded further. We will also be discussing telemedicine intensive management with international experts by Skype. Acute stroke has also been transformed by thrombolytics, although the decision on who to treat must be made in local centres without recourse to neurological experts, so here again telemedicine plays a vital role.
Acute medicine is not the only field where telemedicine has a role. Long term management of disabled patients who find the distance to the specialist centre daunting is also vital. Telemedicine in neuro-rehabilitation is one of a number of areas where the techniques have found a clear place.
This is the fourth event organised by the RSM’s Telemedicine & eHealth Section this year – the previous three have all been extremely well attended; delegates have rated them highly in feedback reports. To book go here – as with all RSM events, prices are far below commercial rates as the Society is a charity dedicated to medical education and the promotion of medical advances.
RATULS, standing for Robot Assisted Training for the Upper Limb after Stroke, is a randomised controlled trial that is looking for volunteers..
The trial seeks to establish whether robot assisted training with the Inmotion robotic gym system improves upper limb function post stroke. RATULS is looking for people who have only had one stroke (between one week and five years post stroke, with moderate to severe arm weakness) to take part.
Consenting trial participants will be randomised into one of three groups
A) Robot-assisted therapy
B) Enhanced Therapy
C) Usual Care
Patients will receive therapy for 45 minutes, three days per week for 12 weeks. There is funding available for patient travel. Experience so far has shown that patients are keen to take part in the study.
For more details or to enquire about volunteering, please contact firstname.lastname@example.org
A year-long pilot program in Australia to screen for for atrial fibrillation (AF) found new, previously undiagnosed AF in 1.5% of those tested. The SEARCH-AF study used the AliveCor Heart Monitor ECG to test 1,000 customers 65 years and older through community screening in suburban Sydney pharmacies. Pharmacists used the AliveCor device, attached to an iPhone, to transmit 30-60 second ECG recordings to study cardiologists. If AF was suspected, the follow-up was a GP review and a 12-lead ECG performed. AF is the most common heart rhythm abnormality and puts an individual at five times the risk for stroke (National Stroke Association). Early diagnosis and treatment cost savings are straightforward: over $20,000 (~£12,400) for prevention of one stroke. (This Editor’s opinion–it’s an understatement.) Per the study summary:
The incremental cost-effectiveness ratio of extending iECG screening into the community, based on 55% warfarin prescription adherence, would be $AUD5,988 (€3,142; $USD4,066) per Quality Adjusted Life Year gained and $AUD30,481 (€15,993; $USD20,695) for preventing one stroke. (“Feasibility and cost effectiveness of stroke prevention through community screening for atrial fibrillation using iPhone ECG in pharmacies”, Thrombosis and Haemostasis, Ben Freedman, MD et al., 1 April online (subscription access required for full study)
15 new AF diagnoses per 1,000 may not sound high, but using the above estimate, this type of community screening using AliveCor or a similar device translates to a cost saving of over $310,425, assuming that all undiagnosed AF resulted in a stroke. Even if less, it is a nice return on investment, health and future outcomes. (This Editor invites more accurate cost analysis.) AliveCor release (San Francisco Business Times). Additional coverage CNet Australia. The George Institute for Global Health Australia project page which extends the study to GP clinics.
GE Healthcare has developed an iPad app, MIND, for patients with Alzheimer’s and other neurological disorders which presents favorite music, music videos and a virtual art gallery. The aim is to stimulate the brain, evoke emotions and promote social interaction. This extends the pioneering research from New York City’s Institute for Music and Neurologic Function‘s Music and Memory program, which provides personalized music on iPods for those with both cognitive and physical challenges in long-term care to improve quality of life and reduce anti-psychotic drug use. GE release. Website.
Another approach to brain diagnosis and therapy for Alzheimer’s, stroke and brain hemorrhage may be pioneered by Multineurons. This startup has developed a head-worn sensor device that works with an iPad app, WakeUp, for non-invasive brain diagnosis and therapy. It measures speed (connectivity of neurons), fitness (neuroplasticity) and robustness – at 10 different points in the brain. Testing is planned to start in a Swiss rehabilitation facility this summer. MedCityNews
A development that deserves more attention is the use of ‘gamification’ in rehab. In one program, it’s using a combination of incentives, brain stimulation and robotics. The popular Candy Crush Saga game uses a moving candy target, rewards (to higher levels) and reduced reaction times at the harder levels. The Manhasset, New York-based Feinstein Institute for Medical Research at North Shore-LIJ Health System is testing this notion with rehab for paralyzed limbs. Instead of concentrating on training other limbs to compensate for the paralyzed ones, the Non-Invasive Stroke Recovery Lab program focuses on gaining more movement in the affected limbs. Using robots to move the limb at first, then sensing when the patient is moving them on their own, they gradually train the brain to move the limb for whatever motion can be achieved. Therapists use these programs with patients to gain the “just-right” amount of challenge to maintain motivation and attention. According to their website, several programs are being tested using devices for the wrist, shoulder-elbow, hand and an anti-gravity one for the shoulder. A fifth one is in early development to improve gait post-stroke. Also in test is coupling this with trans-cranial direct current stimulation. mHealthNews. Feinstein Institute and researcher (Bruce Volpe) website.
Drug manufacturer Pfizer is also testing gamification for a different sort of rehabilitation–using Evo Challenge from Akili Interactive Labs in determining the status of and improving the abilities of those with cognitive impairments, Alzheimer’s disease (with and without amyloid in the brain) and ADHD. The game, which involves navigation around obstacles and rewards, is designed to improve the impaired processing of cognitive interference, a/k/a distractions. MedCityNews