Newtowner Overseeing Historic

Robotic Study On Stroke Victims

By John Voket

According to Newtown resident Dr Daniel Federman, stroke victims generally reach the full extent of their reestablished mobility in the weeks and months following their brain attack. But thanks to a revolutionary study with robots Dr Federman is overseeing for the Veterans Administration, there is new hope for stroke victims who may have previously resigned themselves to a life of frustrating new limitations.

“Within a few weeks to a few months following the stroke, one reaches a certain level of ability or disability, and that is it,” the Newtown physician and researcher said from his office at the West Haven VA CT Healthcare System. “But with this study, we’re hoping to increase their functions.”

Dr Federman calls the therapy “a novel concept.”

“We’re offering hope to those affected long after the maximum recovery is expected,” he said, adding that his passion for the study comes from “seeing the devastation and the way a stroke disrupts families and taxes caregivers.”

For more than a year, the West Haven VA facility was preparing to launch the hands-on segment of its Robotic Assisted Upper-Limb Neurorehabilitation study for stroke patients. The project, funded by a $5 million federal grant, is moving forward in West Haven as well as at similar facilities in Gainesville, Baltimore, and Seattle.

But just as the equipment was being readied for its first few patients, the former supervisor left the project, opening a door for Dr Federman, who is also a professor at Yale School of Medicine, to explore the most advanced reaches of his passion.

 “My interest in strokes came first,” Dr Federman said. “I’m an internist with an interest in vascular diseases. As an internist I deal with vascular diseases in the lower extremities, heart, and brain.”

So Dr Federman was thrilled when he was tapped to take over the lead position overseeing the study. “I came on approximately a month ago, while the study was already in progress,” he said. “And as soon as I came on, we got the machines and we started enrolling patients.”

According to a report on the study furnished by the VA, each year approximately 17,000 veterans are hospitalized for stroke. About 40 percent are left with moderate functional impairments and about 30 percent are left with severe disability.

Functional impairments from stroke can be long-lasting (“chronic”) and stroke survivors can continue to suffer significant deficits that last years after their strokes. In the majority of strokes, the hands and arms are affected and patients describe lasting problems with their hands and arms as significant sources of disability.

And until this study was launched, there were no prevailing and effective therapies to significantly restore arm and hand function for persons with chronic stroke impairments.

According to the report, neurorehabilitation is a type of therapy that focuses on treatments to help restore function. It can include therapies to improve the use of an impaired arm or leg in people with neurological disorders such as stroke, multiple sclerosis, cerebral palsy, and spinal cord injury.

New Pathways

The primary goal of neurorehabilitation is to improve a person’s ability to perform normal daily and social activities. Some theories on neurorehabilitation are based on the idea that regularly helping a patient move their impaired arm or leg may help them eventually build the strength and movement capabilities to perform in normal daily activities.

 It may also help form new cortical pathways that will assist in rehabilitation. Dr Federman likens it to weaving new neurological bridges where the old and stroke-damaged ones used to be, by using the kind of precise repetitive motion that can only be rendered by mechanical processes.

That is where Dr Federman’s stroke robot comes in.

“It really looks more like a video game than a robot,” he said. “The patient’s arm is hooked up to the machine, and their hand is manipulated to the stick which controls a cursor on the video screen.”

The robotics require the participant to target the cursor, and if the patient lacks the strength, the robot assists them, creating what the doctor calls “a visual-spatial input combined with a sensation of moving.”

“It almost develops new neurocircuitry in the brain,” he said. “We think the study will show that the robot equipments reverses the way normal human motion is processed. It combines visual input and mechanical precision, instead of physical therapy manipulation, which has too much of a range of variable because of human involvement.”

Patients who are qualifying for one of three aspects of the study may all have access to the robotics, but only one of the three qualifying groups are given priority treatment. To qualify for the VA study, an applicant must have a stroke verified by CAT scan or MRI, and they must be age 18 or older — there is no upper age limit.

Candidates must have suffered their stroke at least six months ago — also with no outside limit. They have to have moderate to severe arm or hand weakness; must be able to provide direct informed consent; must be able to process and follow a three-step command; and be an eligible veteran.

“People can go into one of three study groups — conventional therapy, intense physical therapy and the robot,” Dr Federman said. “Currently, because of the limitations of the robot, only three to five patients at a time can be assigned to the robot program.”

Those who enroll in either of the other two programs get the first opportunity with the robot therapy once all members of the dedicated study group have completed their therapy regiment. In the early stages of the hands-on segment of the study, the team already has qualified several first- and second-tier participants, including a single robot-exclusive participant.

Dr Federman, who has called Newtown his home for 14 years, believes this test study will bring new hope to those suffering the debilitating effects of stroke for many years.

“I’m very proud of this project and the care being rendered at the VA CT Healthcare System, which include facilities in Danbury and our West Haven facility among others,” he said. “We are pleased to have the opportunity to invite participants throughout the state to apply for this study. We can also accommodate vets outside the state who are interested in traveling to participate.”

For more information on the VA Robotic study for stroke victims, contact Dr Federman at 203-932-5711, extension 2346.