It could prove to be a revolution in stroke recovery therapy at a time when it is badly needed.
But to Ottawa stroke patient Gordon Bryant the treatment feels like nothing at all.
“You don’t really feel anything. You just have to be silent and still.”
Seventy five-year-old Bryant had a stroke last April, leaving the left side of his body weak. During a stay at Élisabeth Bruyère Hospital for rehabilitation, he was asked whether he would like to participate in a clinical trial to test a non-invasive therapy aimed at stimulating parts of the brain. The goal was to improve outcomes by making rehabilitation exercises more effective.
He said yes.
“I thought it might be to my benefit. I was willing to try it,” he said.
For 15 sessions over three weeks, Bryant underwent transcranial magnetic stimulation performed by a technician with a device shaped like the number eight. The device is held over specific parts of a patient’s head to target the stimulation on “hot spots” in the brain. Those spots, which control parts of the body affected by stroke, are identified by an MRI image of the patient’s brain that is hooked up to the device. An advantage of the technology, researchers say, is that it can directly target areas of the brain that impact stroke recovery.
Transcranial magnetic stimulation isn’t new. But it is not approved by Health Canada for use as a medical device to treat stroke patients.
Dr. Jodi Edwards of the University of Ottawa Heart Institute would like to see the therapy overcome hurdles to get it into more widespread use, if the results of ongoing trials are positive.
Edwards, who is a scientist and director of the Brain and Heart Nexus Research Program at the Heart Institute, is the principal author of new recommendations and a checklist to improve stroke research using non-invasive brain stimulation techniques, such as the feasibility study conducted at Bruyère.
New treatments to improve the recovery of stroke patients are needed more than ever, she said.
Dramatic advances in acute care mean people who would likely have died previously can be saved. But that leaves more people with disabilities related to those strokes, and rehabilitation is both slow and having trouble keeping up with the increasing demand for these programs.
The technology works by preparing the brain for rehabilitation and therapy, which helps them get the most out of it, optimizing their rehab sessions.
“Rehab is excellent, but to make the changes in the brain you would have to do thousands of repetitions a day,” Edwards said. The non-invasive brain stimulation, she added, prepares the brain to get the most out of rehabilitation.
Bryant and other patients in the trial spent about 30 minutes with a technician while they mapped out the best areas of the brain to target and then about 30 more minutes receiving the therapy before going directly to rehabilitation.
Bryant believes it has made a difference in his recovery.
Edwards said the technology was approved for use in Canada to treat depression. But it has long been studied as a technology to help stroke survivors. While there is plenty of evidence of its benefits, she said there is a “translational” gap, meaning it has never overcome the hurdles for approval by Health Canada.
Edwards is principal investigator of the Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim). She chaired a roundtable with experts in brain stimulation to get to the bottom of what further work was needed to get definitive evidence that could lead to widespread use of brain stimulation for stroke patients.
The trials at Bruyère Hospital are part of that work. The next step is a larger Phase 2 trial. Bruyère Hospital has the region’s largest stroke unit.
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