It has helped ski jumpers jump farther, cyclists pedal faster, and weight lifters lift heavier weights. It’s perfectly safe. And someday soon, if promising research at the University of Pittsburgh, UPMC and other institutions is successful, it may be used in rehabilitation centers around the country to help stroke survivors recover more strength and dexterity.
Stimulating but non-invasive
This new performance enhancer is called non-invasive brain stimulation (NIBS). It’s a way of waking up brain cells through electrical or electromagnetic stimulation and boosting their ability to learn new skills. For athletes, this means coaxing more performance out of muscles that are already performing at a high level. For stroke survivors, it can mean bringing inactive muscles back to life.
“Opening a fridge door, using a hair dryer; they seem like small things that we all take for granted,” says UPMC’s Amit Sethi, PhD, OTR/L, assistant professor at The University of Pittsburgh. “But if you’ve had a stroke and you can’t move your hand, you’re looking at a big disability.”
Since weakness in one hand is a common effect of stroke, appearing in about 85 percent of patients, Dr. Sethi and his team are focusing on hand rehabilitation in their ongoing study of the feasibility and efficacy of NIBS at UPMC’s Rehabilitation Institute in Pittsburgh, Pennsylvania.
Jump-starting neuroplasticity Dr. Sethi’s program blind-tests NIBS on two groups of chronic stroke patients who have passed the six-month window for recovery through conventional stroke therapy. One group is treated with occupational therapy and the other gets occupational therapy plus accompanying NIBS treatment. The NIBS is delivered in the form of externally applied electrical or electromagnetic pulse, targeted at the stroke-impaired area of the brain. “We’re working with the brain’s neuroplasticity—that is the brain’s ability to retrain nearby nerve cells to take over the function that injured nerve cells can no longer do,” says Dr. Sethi.
Why test NIBS on chronic patients as opposed to those who have just had a stroke? “We’re testing after the six-month window so that we can isolate the effect of NIBS on recovery,” he explains. “Theoretically, the brain’s own healing process is over after six months, and these patients typically have little chance of getting better. So if hand function improves, it’s because of NIBS, not the brain’s own healing process.”
So far, the patients are, in fact, getting better in both groups. More than halfway into the study, co-sponsored by UPMC, the University of Pittsburgh and the National Institutes of Health, more than 90% of the patients are showing significant results. “Some of them are improving more than others, as much as twice what we’d see in other studies,” adds Dr. Sethi. Theoretically, these overachievers will correlate with the NIBS treatments, a hypothesis that will be evaluated when the study finishes next year. Dr. Sethi also sees the 90 percent improvement in both NIBS and non-NIBS patients as an indication of an opportunity for better stroke rehab outcomes across the board. “Today, insurance support for therapy ends around six months post stroke, based on the theory that you can’t improve after that point,” he says. “This study could show that there’s potential for significant recovery beyond six months with continued therapy, even without NIBS. That in itself is a big deal.”
At the same time, strong results might also suggest that NIBS-enhanced therapy could benefit acute stroke patients by accelerating and improving recovery during the critical six-month period of natural healing. “The sooner you do intense rehab, the more gains you make,” says Dr. Sethi.
It’s all about synergy
Currently, 800,000 people in America suffer a stroke every year, a rate that’s on the rise as our population ages. Rehabilitation therapy and techniques for improving its effectiveness are gaining importance as experts consider the future of healthcare. Dr. Sethi is looking to continue his research and work with the UPMC Rehabilitation Institute at UPMC’s new Vision and Rehabilitation Hospital in Pittsburgh, to be completed in 2020. The new multimillion dollar facility will serve one of the largest rehabilitation networks in the U.S., treating nearly 5,000 inpatients and more than 70,000 outpatients a year, and its impact on research will be significant.
“It’s more than just operating in a state-of-the-art facility,” says Dr. Sethi. “We’ll have better access to patients and a great opportunity to synergistically collaborate with the therapists to influence change.” And with rehab, that’s what it’s all about.”