STORY BYWhen Burt Kilmer began experimental constraint therapy only a week after having a stroke, the 55-year-old mechanic had almost no function on his left side. He had difficulty walking, and he couldn't pick up any of the colorful pegs the occupational therapist instructed him to plug in to holes on a board.
“I couldn’t grasp anything with my left hand. It was frustrating,” Kilmer said. “All I wanted to do was use my good side, but the therapist told me not to. The point of the therapy was to force me to use my bad hand so I would get better faster.”
For two weeks, under the care of researchers at The University of Texas Medical School at Houston, Kilmer endured what is known as constraint therapy. He spent 90 percent of his waking hours with his “good” right hand in a mitt that resembles a ping pong paddle.
The mitt, which consists of a splint, fabric and a little bit of elastic, isn’t exactly high-tech. It’s a simple device, but it could be the key to recovery for a portion of the 600,000 Americans who suffer ischemic strokes each year.
The mitt’s sole function is to prevent stroke patients from bending their “good” hand and fingers, thus forcing them to use the limb that was damaged during their brain attack.
Several small clinical trials have consistently shown that stroke survivors can improve motor function with constraint therapy even years after their injury.
Neurologists at UT Medical School-Houston felt these results were intriguing and wanted to investigate further. In 2002, using a grant from the National Institute of Neurological Disorders and Stroke at the Institutes of Health, they began testing a theory that recovery would be faster and more profound in patients who started constraint therapy within 14 days of their stroke.
Dr. Elizabeth Noser and the
constraint therapy mitt.
“When a patient has a stroke and one side of the body is affected, we see a phenomenon called learned non-use,” says Elizabeth Noser, M.D. “Patients learn to compensate with their good side, and essentially ignore the damaged limbs.”
Learned non-use not only hinders recovery, but also can prompt medical complications, including shoulder pain and tendonitis.
“We are researching whether we can prevent stroke patients from ever learning non-use,” she says. “If we can force them to use their weak side and do aggressive therapy soon after the stroke, we may be able to promote healing in the brain, improve motor function and prevent other medical complications.”
Previous studies prompted concern that initiating rehabilitation too early could actually cause more brain damage to the stroke patient, but Noser says the pilot study performed at UT-Houston found that constraint therapy was feasible and safe to begin within 14 days of a stroke.
To qualify for the research, patients must have at least 10 degrees of movement in the disabled hand and minimal movement in the arm and have the mental capacity to follow instructions.
At the beginning and end of the therapy, researchers use transcranial magnetic stimulation, a noninvasive technique to map out neurons that control hand movement. During the next two weeks, the patients spend three hours each day in occupational therapy. They must wear it 90 percent of their waking hours, including the three hours each day that they are in occupational therapy.
“It’s very intense,” Noser says. “It’s a lot of therapy for our patients, but they do great. We find that more neurons are being recruited after the therapy, and that means the brain is healing.”
Take Kilmer, for example. He now works out three to four times a week and has the skills he needs to care for himself. “I don’t think I could thread a needle, but my wife can’t either, and she’s never had a stroke,” Kilmer jokes. “I think it really helped me.”
The constraint therapy will continue for another two years, during which time 44 stroke survivors will be enrolled, making it the largest clinical trial of its kind.
Research participants will be tested again two years after the constraint therapy to determine if the effects are sustainable.
“Our goal is to heal people to the best of our ability so our stroke patients can be healthier and live independently,” said John Choi, M.D., director of the neurorecovery program at UT-Houston, says.
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Dr. Elizabeth Noser is Director of the Stroke Training and Recovery Program at the UT Medical School.
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Packing Bag Lunches Safely
If you pack lunches for your child to take to school, be careful that you do not accidentally expose them to foodborne illness.
Bagged lunches, especially those containing perishable foods, need to be packed and handled properly in order to keep the food safe. In general, perishable foods should not be left at room temperature for more than two hours. If left out too long, the temperature of the food can enter the danger zone where bacteria grow most rapidly, which is between 40 and 140 degrees Fahrenheit.
Below are some tips to help families pack bagged lunches safely:
Before eating lunch or snacks at school, make sure your child washes his or her hands with soap and warm water for at least 20 seconds. If your child's school does not have a handwashing program in place, encourage them to adopt a such a program, as handwashing is one of the best ways kids and parents can protect health and stop the spread of germs.
