Restoring movement
About 5 million people in North America (500,000 in Canada) live with the after-effects of stroke. Many of these people (about 60%) have partially paralyzed arms and hands, which can make daily tasks such as eating or getting dressed very difficult or even impossible. Dr. Arthur Prochazka has a team dedicated to developing new techniques and treatments to help patients regain some arm and hand function. This work is part of his overall research program at the Centre for Neuroscience at the University of Alberta.
Studies have shown that functional electrical stimulation (FES) in conjunction with daily hand exercises over several weeks can significantly improve hand function. FES uses electrical stimulation to produce contractions in paralyzed muscles. But this kind of intensive therapy is expensive, and patients must travel to meet with a skilled therapist. Dr. Prochazka's team began work on a better way to deliver therapy.
The team developed a rehabilitation system based on an invention of Dr. Jan Kowalczewski, now a postdoctoral fellow in the lab. Rather than having to travel to a therapist, patients are provided with a special joystick called ReJoyce (see Cool Tools) to control games on their home computer. FES is used to coordinate hand opening and closing on the joystick. Exercise sessions are supervised over the Internet by remote therapists using a teleconferencing system. The therapist can see the user and the user's screen, providing encouragement and advice, as well as choosing games and adjusting the difficulty. An added bonus is that therapists do not have to be in the office to deliver the therapy. They can sign into the web-based system from anywhere and at times that best suit the participant and themselves.
The first major clinical trial of the system was completed in 2009. Fourteen people with spinal cord injury participated from across Western Canada. Sessions ran for six weeks, with five days of one-hour guided exercise per week. After a four-week break, the same participants received six weeks of a standard exercise program, also delivered remotely by a physiotherapist. "We were hoping that our system would test out to be just as good as standard physiotherapy; instead, it exceeded our expectations," says Dr. Kowalczewski. "All participants had clinically significant improvements in their wrist and hand function using our system."
Now Natalie Ravid, a PhD student in Dr. Prochazka's lab, is following up on these findings with a clinical trial involving stroke patients who have a paralyzed hand. This trial will also use FES and the ReJoyce rehabilitation system. "The first trial showed that, if you encourage people every day, you will see improvement," says Ms. Ravid. "This trial will add an unsupervised group. We're interested in finding out whether they will also improve." The clinical trial is currently enrolling patients.
The ReJoyce rehabilitation system is a prime example of an innovation translated from basic research through commercialization into clinical practice. In 2005, Rehabtronics, a University of Alberta spin-off company, was assigned patents for several devices from Dr. Prochazka's lab. In 2006, Rehabtronics licensed these patents to a medical devices company in California. Several products, including the ReJoyce, are now in the final stages of clinical trials and regulatory approvals prior to their launch in 2010 and 2011. "It's amazing how many stages of development, testing, and documentation are required to commercialize new medical devices," says Dr. Prochazka. "Canada has very few companies that can do this and even fewer that have alliances with university labs. It's crucial that companies such as Rehabtronics succeed, so that a community of people with the right background emerges who are able to convert lab-based innovations into products that help people and build a viable industry."
Research subjects needed for study on improving hand function after stroke
Dr. Arthur Prochazka, in the Centre of Neuroscience at the University of Alberta, is conducting a research study to test whether daily exercises combined with electrical stimulation of muscles will improve hand function in people who have survived a stroke. Dr. Prochazka is recruiting subjects with partially paralyzed hands due to stroke who are at least 12 months after injury. For more information, contact Dr. Arthur Prochazka at (780) 492-3783 or (780) 492-1616 or