Kessler Stroke Rehabilitation Hospital is interested in telling us about them and their Stroke Rehabilitation Hospital. You may be aware that this is the hospital which provided Rehabilitation for Christopher Reeve.

In the Stroke Rehabilitation Research Laboratory at KMRREC, Program Director Anna M. Barrett, MD and her staff explore new means of helping people improve post-stroke cognition. The Stroke Laboratory’s studies attempt to apply principles derived from experimental psychology, psychobiology, and cognitive neuroscience to unlock the brain’s lost visual-spatial, and communication potential.

Spatial neglect is a failure to respond, report, attend, or orient to stimuli presented to the side of space opposite a brain lesion associated with functional disability. It occurs more commonly in patients with right hemisphere brain damage than in those with left hemisphere damage. For example, after a stroke on the right side of the brain, individuals may not detect objects on their left, or may asymmetrically represent or act on their environment. Spatial neglect may be a problem with coordinating perception, representation, and action. While the severity of spatial neglect usually lessens over time, it is still a major predictor of long-term disability, and thus may play a role in regaining independence in the chronic phase of post-stroke recovery.

Unfortunately, chronic spatial deficits might be difficult to detect reliably. In a study funded by the National Institutes of Health-National Institute of Neurological Disorders and Stroke, the Stroke Laboratory is working to standardize systematic detection of mild deficits, using a video testing method sensitive to small errors. A client might try to mark the center of a line while viewing his hand and a stimulus he is acting upon on a video screen. A video mixer can be used to right-left reverse the image, so that leftward movement appears on the screen to be moving to the right, and vice versa. As people with visual-spatial problems monitor their own bodies in this mirror-reversed manner, we can calculate whether errors may be primarily attributed to deficient perceptual awareness (“seeing or knowing where”) or intentional action (“aiming”). These two error types may originate from problems in different systems, mediated by different brain regions.

Safe and adaptive movement in complex environments is the basis for functional independence and daily life competence. Spatial function is clinically assessed only in near space, although we are often required to distribute attention over large spatial areas beyond arms’ reach (sports, navigating in a mall or an airport, driving). Dr. Barrett and her collaborators are among very few laboratories in the world examining the neuropsychological mechanisms of far bias and distractibility in brain-injured post-stroke patients. When problems are identified in far space, however, it is not clear what treatments would be most appropriate. In the current set of experiments, the group will investigate whether people with far space deficits improve while wearing an eye patch, a treatment Barrett and others have reported may benefit near space symptoms.

The long-term goal of this work is to translate spatial science to new and more effective treatments of post-stroke spatial attentional disorders. The laboratory recently proposed a follow-up group of studies in this direction, attempting to assess effects of several other available treatments. The aim is to determine if specific therapies targeted to deficits may be more effective. Although there are not known benefits to the video assessment performed as part of the NIH-funded spatial neglect studies, behavioral stimulation and visual-motor practice theoretically might improve performance. The mirror-reversal apparatus is also similar to prism and virtual-reality treatments being used at other centers for spatial neglect. Our laboratory is working to examine whether using the video apparatus may benefit performance, and if so, to adapt the video apparatus to wide use in clinical settings where prism prescriptions or virtual reality equipment may be impractical.

A second study being performed in the Stroke Laboratory, funded by UCB Pharma, Inc., focuses on the pharmacological treatment of stroke-related aphasia. Effective approaches for patients with aphasia may often be limited to management (e.g. family counseling) and vicariation (e.g. computer devices). The more than one million people with acquired speech, language and communication disorder in the United States need remediative therapies to improve their symptoms and return them to their previous activities.

Piracetam is one of the few medications reported to improve aphasia in previous studies, but is not available in the US. Dr. Barrett proposed to UCB Pharma that she perform a pilot study investigating whether levetiracetam (Keppra), currently approved for treatment of epilepsy, may improve aphasia symptoms. Levetiracetam, related to piracetam, has been associated with memory improvement in a scopolamine-induced amnesia rodent model. In an open-label, multiple-baselines prospective pilot study, the stroke laboratory will administer levetiracetam to fifty patients with chronic aphasia and serially examine their speech and language function to determine if any improvement in spontaneous speech, verbal fluency, naming, repetition, discourse and memory occurs.

Quality care is integral to the cognitive recovery process. Rehabilitation therapy is an important part of this care. Scientific treatment approaches are extremely valuable in planning care and in counseling individuals and their families about adaptation to the disabling conditions associated with stroke. Dr. Barrett and her team are working collaboratively with other scientists at KMRREC, as well as at UMDNJ-New Jersey Medical School, Montclair State University, Seton Hall University, Penn State University and other institutions to remain in the forefront of progress towards helping people maximize recovery after stroke.

The above information was provided by:

Siby Varughese, MA, RN

Research Nurse Coordinator

Stroke Rehabilitation Research

Kessler Medical Rehabilitation Research and Education Corporation

Copyright © January 2006

The Stroke Network, Inc.

P.O. Box 492 Abingdon, Maryland 21009

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