Electric headband to help stroke patients use their hands again
AFTer the initial shock of having a stroke and becoming paralysed on one side, Jan Morgan was desperate to regain movement and make life easier for her young daughter.
Jan was just 50 when she had the stroke in September 2010 and her daughter Imogen 12. It left Jan completely paralysed down her left side, unable even to dress herself, let alone scratch an itch.
While daily physiotherapy had helped restore movement to her left leg, after around 18 months Jan’s arm was still immobile and she was largely dependent on Imogen.
‘The physiotherapist’s priority was to get me upright and focused on my lower limbs,’ says Jan, now 56. ‘I can see why, but I needed to find something to help my arm, too.’
So Jan, who lives with Imogen, in Fulham, London, scoured the internet for treatments. In March 2012, she came across a new trial at Oxford University, which was looking at electrical stimulation of the brain to improve movement in stroke patients.
The thinking is that electrical stimulation increases connections in the areas damaged by stroke. Jan emailed the researchers and managed to get on to their trial — which has had life-changing results.
Strokes are caused by a blood clot or burst blood vessel restricting the supply of oxygen and nutrients to the brain. electrical stimulation is thought to alter levels of chemicals and enhance the brain’s plasticity — its ability to adapt and rewire itself around damage.
Jan, who worked as a management consultant, had no symptoms before the stroke. ‘One minute, I was chatting on the phone, and the next I was flat on the floor,’ she recalls.
She had suffered a stroke caused by a burst blood vessel. Jan spent the next three months in a rehabilitation hospital. At first, she couldn’t even sit or keep her head upright.
Doctors said she was unlikely to recover enough movement to sit up in a wheelchair for an hour a day, and would need 24-hour care for life.
‘I was devastated, especially for Imogen — she had already lost her father in 2007 and seeing her mother like this was very difficult for her,’ says Jan.
More than 150,000 people a year suffer a stroke in the UK. Around a third die, a third make a full recovery and the rest survive, but with limited movement, says Jane Burridge, a professor of restorative neuroscience at the University of Southampton.
Which brain area is affected, how extensive the damage is and how quickly a patient is treated can help determine the chances of recovery.
The part of the brain called the motor cortex is often affected, meaning patients lose some ability to move. Stroke rehabilitation, to help the patient recover movement or to compensate for lost movement, may be offered, and can include learning to use a walking aid or to do things one-handed.
But increasingly, research is suggesting the brain can rewire itself, so that different areas of it can take over from those that were damaged by the stroke. This means that, with intensive therapy, patients can recover much more movement than previously thought. This has led to the development of technologies such as electrical or magnetic stimulation to enhance this plasticity.
Jan left hospital in December 2010 and had intensive physiotherapy twice a week. This helped her get out of the wheelchair, but little attention was paid to her arm, which she could raise only around half-aninch outwards from her side.
‘I could walk, but couldn’t dress or feed myself, nor travel alone or meet clients, so I had to give up work,’ says Jan.
The problem is that because rehabilitation is expensive, many stroke patients do not receive enough to help them reach their full recovery potential, says heidi JohansenBerg, a professor of cognitive neuroscience at John radcliffe hospital in Oxford, who led the electrical stimulation study.
In the trial, 24 stroke patients were given two weeks of daily one-hour sessions of intensive hand exercises. For the first 20 minutes, they also received electrical stimulation or a dummy treatment. For the stimulation part, patients wore a headband to secure two sponges which had electrodes attached to them — the headband was connected to a box which emitted electric current.
The placebo group received an electrical pulse for a few seconds before the current was turned off.
‘I could feel a slight sudden tingling — like the mild electric shock you get when you touch metal in shops,’ recalls Jan, who did not know which treatment she was receiving at the time.
The hand exercises became more complex as patients’ conditions improved. For example, they might start by turning over cards, and move on to picking up paper clips and attaching them to paper.
The exercises were ‘hell’, says Jan, as they were so exhausting and frustrating. however, the study’s results, published in the journal Science Translational Medicine last month, showed that patients who received elec- trical stimulation with hand exercises had more improvement in their motor skills than those who just did exercises.
Brain scans also suggested that electrical stimulation led to greater increases in grey matter — the part of the brain that contains nerve cells — in the damaged brain areas, and had more activity than before.
These improvements to their movement were still apparent three months later, suggesting a long-term benefit, too, adds Professor Johansen-Berg.
The study has provided very strong evidence for the efficacy of transcranial direct current stimulation (tDCS), albeit with a small sample of patients, says Professor Burridge.
‘Importantly, this is one of the first studies to show that functional recovery was related to an increase in active brain areas that control movement, too,’ she adds. ‘This supports the idea of plasticity in the brain and suggests that tDCS can change the structure and connections in the brain — and improve movement.’
Some studies suggest this kind of electrical stimulation — given through the scalp — may also help Parkinson’s disease, Alzheimer’s, depression and chronic pain.
electrical stimulation appears to slightly increase the brain’s responsiveness and may improve learning, explains Dr richard Greenwood, a consultant neurologist with an interest in stroke rehabilitation at the national hospital for neurology and neurosurgery, London. ‘In terms of everyday functioning, the benefits were not dramatic, but are higher than some other studies that have tested this treatment have shown.’
For Jan, the improvement has been significant. ‘Before, I could hardly move my arm; now I can lift it parallel to my body and nudge cupboard doors shut. I can also put my arm through sleeves and get dressed.’
She can’t grab things, but she hopes continued physiotherapy will help, and would be keen to try more stimulation, given the opportunity. ‘Although I still need help, the treatment has made me feel much more in control of my life,’ she says. ‘If I get an itch on my nose, I can rub it — little things like that make a huge difference.
‘It has given Imogen her mum back and me my life back.’