Saturday, October 2, 2010

Isn't there a machine for that?

I was over at dean's stroke musings a cool stroke recovery blog. He had a link to a study that showed that there were some changes in the brain when limbs are moved passively. Lets say you can't flex or extend your wrist. Will passively moving the wrist make it better? That is, if you move the "bad" wrist with your "good" hand, or have someone else move your wrist-- will that help the wrist move by itself? Will it change the part of the brain that controls the "bad" wrist? According to the study, there were brain changes. But. They didn't measure movement changes. Their bottom line: "These findings provide a potential neural substrate to account for alterations in motor and sensory function in stroke patients in response to long-term passive movement interventions." Which is a good point. Let's say you have a machine (which this study did) that moves the wrist back and forth, a half-hour per day. Would that help? Certainly those who make robotics like the Myomo (Val from our lab!) or the REO would have us believe that there are both brain changes and movement changes. There are many therapists who rely on hands-on techniques in which they "facilitate" movement by handling patients. The efficacy of those therapies remains questionable. But it may be a matter of dosage. If the machine can do it for a half hour (or 5 hours) at one joint, consistently, that's a little different than having a therapist do it for a 20 minutes at many joints. Also, robots (like the Myomo and REO) are very sensitive (using EMG or computers) to when the survivor needs help and when they don't. So that may make a big difference as well. Where does this leave the question "Does passive help?" So far as I can tell: moving the limb passively won't hurt and may help. Doing it with robotics seems to provide enough duration and specificity to provide measurable changes in movement. But the bottom line remains the same: Doing any movement yourself is always better than having someone else do it. So these options are for folks who have trouble moving the joint at all. Once you can move it with no help, it should be "all you." --

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