Researchers are taking a new approach to stroke rehabilitation: building video games that harness the brain's ability to repair itself after trauma, Karen Russell reports for the New Yorker.
Stroke is usually caused by a blood clot or plaque that chokes off oxygen to a part of the brain. As brain tissue dies, patients can be left with debilitating cognitive and physical deficits, such as reduced motor function on one or both sides of the body.
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Fewer people are dying of stroke, but that means more people are living with a long-term disability and few treatment options. "Their recovery has plateaued, their insurance has often stopped covering therapy, and they are left with a moderate to severe disability," Russell explains.
John Krakauer, a neurologist and neuroscientist with Johns Hopkins University School of Medicine, says current rehabilitation regimes are not effective.
Part of the issue is intensity. "The movement training we are delivering is occurring at such low doses that it has no discernible impact on impairment," Krakauer says. "We are providing physical therapy at homeopathic doses." Testing in animals indicates that higher-dose therapy may be a more effective way to reduce motor impairment in stroke patients.
At Johns Hopkins' Brain, Learning, Animation, and Movement lab (called BLAM!), Krakauer and a team of game designers built a video game that they hope will provide more intense therapy while also keeping patients' attention. Called "Bandit's Shark Showdown," the game lets players control a charming, free-spirited dolphin (named, you guessed it, Bandit) as it glides through the ocean eating mackerel and fighting sharks.
The idea is to make patients want to play—especially during the critical phase right after a stroke when the brain is most malleable.
"The tissue death that results from stroke appears to trigger a self-repair program in the brain," Russell writes. For one to three months, the brain adopts some of the features it had in infancy and childhood. Experts say stimulating the brain during this period is key to recovering from a stroke.
To test the game's effect on stroke rehabilitation, the Johns Hopkins team—along with researchers at Columbia University and a clinic in Zurich—will work with 72 patients who have had a stroke within five weeks.
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Robotic rehab for stroke
Some of the patients will play Bandit's Shark Showdown twice a day for three weeks, guiding the dolphin by moving their impaired limbs with the help of a motion-sensing camera and robotic arm slings. Meanwhile, a control group will receive traditional occupational therapy.
The study has not yet started, and it will be years before findings are published. But regardless of the outcome, Susan Fitzpatrick of the James S. McDonnell Foundation—which is funding the study—says the trial will reveal important insights about a key question: When is the best time to delivery rehabilitation to stroke patients?
"Success, as we define it, will be an answer to the question," she says, adding, "Of course, we are hoping for a positive result" (Russell, "Annals of Medicine," New Yorker, 11/23).
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