New Stroke Therapy Shows Promise on Kids

Using non-invasive electronic stimulation, coupled with occupational therapy, researchers say they are hoping kids can increase hand function.

Is it possible to experience elation putting in your own ponytail or firmly shaking hands with a stranger?

Just look at Maddy Evans' beaming face for the answer. Maddy, 16, completed a study at the University of Minnesota and Gillette Children's Specialty Healthcare, using a combination of brain stimulation and occupational therapy to help children who have had a stroke increase their hand function. Maddy now buttons her coat with both hands, can put in her own ponytail and, yes, reaches for a stranger's hand with her right one. She never used to use her right hand.

"It helped. If anything, it helped with my confidence," the 16-year-old from Lakeville said in an interview last week. "I'm using it a lot more than I used to."

The new stimulation therapy uses a noninvasive magnetic field on the healthy side of the brain. Gillette, with 2010 revenue of $164 million, has a long history of innovation in pediatric medicine.

But what the folks who ran the study cannot say yet is whether the therapy is boosting gains children achieve from occupational therapy. They need 30 children between the ages of 8 and 16 to complete the study. Seventeen children have completed it; 13 more are needed by August 2012, when funding runs out.

Bernadette Gillick of the Brain Plasticity Lab at the University of Minnesota said so far researchers have seen "statistically significant" gains, with no adverse effects.

The study, funded by a $1 million challenge grant from the National Institutes of Health, is on the frontier of medical technology -- using physical therapy and new stimulation therapy in concert. A successful trial may lead to greater use of technology in the treatment of strokes in children.

The combination therapy works like this: Children who have suffered a stroke that has limited function on one side of their body receive therapy for 13 days -- alternating between the electronic stimulation one day and something called constraint-induced therapy the next. Basically, they have a cast placed on their unaffected arm to force them to use their stroke-affected arm. Children wear the cast all 13 days while occupational therapists work with them to increase strength, flexibility and hand function in their stroke-affected side.

That type of therapy has been used for several years now, study officials said. The difference is in the electronic stimulation, which uses a tool to create a magnetic field over the unaffected hemisphere of the child's brain.

As Gillick explains it, children who suffer strokes as babies become adept at using their healthy side for most everything -- to the point of inhibiting what their less-able side could accomplish. What the transcranial magnetic stimulation does is inhibit those inhibitions, opening the door for the stroke-affected side of the brain to take on even more work.

The U-Gillette study uses two groups of children. One group got the electronic stimulation plus occupational therapy. The other group got pretend stimulation -- the machine clicked but didn't actually do anything -- and occupational therapy.

George Wust, 10, got both. He's pretty sure it helped him. But it was hard, too, he said. After all, with a cast on his strong arm, brushing his teeth was hard. So was doing his schoolwork.

But after the cast came off, the Brooklyn Park boy found out a couple of things: He now can climb the monkey bars and he can throw a baseball with his right hand. "Now, I know if I ever get into a situation where I can't use my left arm, I can always use my right one," George said.

Looking ahead

One night last week at Gillette Children's Burnsville clinic, Maddy was reunited with occupational therapists Tonya Rich and Kelly Moberg. She brought along the cast she'd worn on her left arm, along with the cloth cap she'd worn on her head for the electronic stimulation.

Moberg said Maddy, and all the other children in the study, showed terrific courage. Many had become used to hiding their disability. Wearing a cast for two weeks took that away.

"They were frustrated and were scared. But some were incredibly brave to go through this," she said.

Therapists used games, activities and lots of praise.

"When you see that spark in a kid's eye, you know you've got them," Rich said.

Maddy admitted she was nervous at first. But, she said, "I kind of had the mind-set that it's not going to hurt me. It's going to help me."

Now researchers need to find more children. Gillick said they must meet specific criteria. They must have had the kind of stroke affecting one side of their body. They must be able to follow two-step commands. They must have a certain amount offinger extension in their affected hand.

Eventually, she said, she would like to apply low-level electronic stimulation at the same time as the occupational therapy. Gillick already is working on getting funding for more extensive study.

"We're just cutting through the ice of all the things that could happen," she said.

(Source: startribune.com)