Acute emergency treatment for the loss of oxygen to parts of the brain as a result of a stroke can be standardised – our brains respond in a certain way, and the same treatments will have similar effects in most patients. But the nature of stroke is that, depending on precisely where it happens and how severe it is, essentially the same kind of event in the brain can lead to very different problems afterwards.
Helping someone to recover their ability to function in the world after a stroke has to be personalised because every stroke patient is left with a different set of abilities. It is not surprising, therefore, that those who do research into new techniques and practices for rehabilitation emphasise the importance of individual patients, as Michael Regnier has been finding out.
At Newcastle University, a different approach to arm rehabilitation is close to launching a product. Janet Eyre, professor of paediatric neuroscience, leads an innovative project called Limbs Alive. Its name was inspired by a young patient who was working with Eyre and her colleagues, relearning to use his arms and hands through play.
“He said he felt his limbs were coming alive again,” Eyre recalls.
“We are trying to take that feeling of being or coming alive again, and take therapy out of the clinical setting so that patients can forget they are doing therapy and be motivated because it is fun. This has become our philosophy – patients have fun and gain skills without being consciously aware that they are trying to correct a medical problem.”
The Limbs Alive team is working with a professional gaming studio to develop a suite of bespoke computer games called ‘Circus Challenge’, specifically designed to help people after stroke. “We are using action video games not only because they are part of normal leisure activities, but also because they contain all the key elements for effective motor learning,” explains Eyre.
“Rehabilitation therapy is years behind gaming. The design of video games has been driven by evolution: only the best survive, and the best are the ones that make it easiest for people to learn complex tasks. So there is a fantastic resource in the gaming industry of people who understand how to motivate people to learn new moves and then motivate them to continue playing the game.”
Through a series of mini-games in ‘Circus Challenge’, players take part in circus acts including flying trapeze and tiger training. The actions required in the games incorporate 140 coordinated arm and hand movements that research shows form the functional bases for activities of daily living, from pouring a drink to zipping up a coat. One or more of these movements is introduced at each new level of a game, with the increasing difficulty levels systematically building up their complexity. This approach is only possible because Limbs Alive is using the next generation of commercial wireless game controllers (designed for consoles like the Nintendo Wii), which provide very precise information about hand and arm position.
“It’s been an enormous learning experience,” says Eyre. “In our team we have computer game engineers so that we can adapt the structure of the game and get the data we need. Data from selected moves are being downloaded and transferred to a server so that algorithms can be developed to provide detailed analyses of a patient’s progress during rehabilitation.”
The project’s mathematicians are also developing accurate and reliable algorithms for data analysis that translates how well someone performs the moves in the game to how much more recovery may be possible with continued practice, and how independent they could be in real life.
It is people and their real-life needs that drive the research team. Having spent her research career so far investigating the science of brain recovery after stroke, Eyre says she now wants to apply her knowledge, translate it and return the benefit to patients: “It is important that in this case, the goal is a product, not just a scientific paper.” There is currently no commercial market for games in health, but Eyre is adamant that her product should be suitable for use in the NHS and elsewhere: “We are developing a product that is based on good science, answers a real problem and is available at affordable cost.”
The team is working closely with patients and with the clinicians and therapists in the North East Stroke Research Network to ensure the product will meet their needs. The patients’ reactions to the games have been extremely positive: “The videogame idea started with young patients but older patients like the idea as well,” says Eyre. “Patients who have never played a videogame – never used a computer, even – really value and enjoy this approach. Age is not a barrier.”
The use of technology in rehabilitation has great potential, enabling stroke survivors to undertake a skilled therapy programme at home and in their own time. But, Eyre says, computers will never make therapists redundant: “Rather than replace therapists, we’re offering them a new tool to help their patients. This research will ensure that therapists can monitor their progress and provide help and advice as necessary.”
To read the full Wellcome Trust article, visit http://wellcometrust.wordpress.com/2012/05/28/focus-on-stroke-research-in-rehab/