Research participant Heather Rendulic prepares to grasp and move tomato soup at the Rehab Neural Engineering Labs at the University of Pittsburgh.
Tim Betler/UPMC and University of Pittsburgh Schools of the Health Sciences
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Research participant Heather Rendulic prepares to grasp and move tomato soup at the Rehab Neural Engineering Labs at the University of Pittsburgh.
Tim Betler/UPMC and University of Pittsburgh Schools of the Health Sciences
Electrical pulses delivered to a specific location in the spinal cord have helped two stroke patients recover from paralysis of the arm and hand, the team reports in the journal. Nature Medicine.
The success should give “a lot of hope” to the hundreds of thousands of people in the US who are disabled by stroke, says Dr. Walter Koroshetz, director of the National Institute of Neurological Disorders and Stroke, who helped organize the research. .
The results will need to be replicated in a larger study, Koroshetz says, adding that it is still unclear whether stroke patients will benefit the most from the treatment.
For Heather Rendulic, 33, one of the patients in the study, it was a life-changing treatment.
A team of doctors at UPMC Presbyterian Hospital is preparing Rendulic to implant spinal cord stimulation electrodes.
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A team of doctors at UPMC Presbyterian Hospital is preparing Rendulic to implant spinal cord stimulation electrodes.
Tim Betler/UPMC and University of Pittsburgh Schools of the Health Sciences
As a teenager, Rendulic liked to run and ride. Then, starting in 2011, he had a series of ugly strokes through the blood vessels in his brain. The worst blow was the last.
“I woke up and I couldn’t move the whole side of my body,” Rendulic says.
Surgeons were able to remove the cluster of blood vessels that had caused the stroke. but the damage was done.
“For about two years it helped me to walk on my own,” said Rendulic, who wrote a book about his experience.
At last Rendulic was able to move his arm and hand a little. For example, he might close his hand, not open it. As a result, he could not tie his shoes, open a pot, or cut vegetables.
University of Pittsburgh neurosurgeon Dr. Peter Gerszten (left) and assistant professor of neurosurgery Marco Capogrosso, during an implantation procedure at UPMC Presbyterian Hospital.
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University of Pittsburgh neurosurgeon Dr. Peter Gerszten (left) and assistant professor of neurosurgery Marco Capogrosso, during an implantation procedure at UPMC Presbyterian Hospital.
Tim Betler/UPMC and University of Pittsburgh Schools of the Health Sciences
“You don’t see how much you need two hands until you only have one good one,” he says.
So, nearly a decade after Rendulic’s stroke, he was offered a scholarship to the University of Pittsburgh.
The researchers there learned that in most people with Rendulic, the brain still sends signals through the spinal cord to the muscles that control the arm and hand. Marco Capogrosso, an assistant professor in the Department of Neurosurgery, denied that the problem was that the signs were very weak.
University of Pittsburgh kinematics occupational therapist Amy Boos (left) and Carnegie Mellon University student Nikhil Verma (center) connect sensors to muscle activation in Rendulic.
Tim Betler/UPMC and University of Pittsburgh Schools of the Health Sciences
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University of Pittsburgh kinematics occupational therapist Amy Boos (left) and Carnegie Mellon University student Nikhil Verma (center) connect sensors to muscle activation in Rendulic.
Tim Betler/UPMC and University of Pittsburgh Schools of the Health Sciences
“We wanted to pick up on these weak signals and essentially turn them into functional matches that a person could automatically control with their hand,” he said.
Capogrosso and his team of researchers hoped to do this by delivering electrical impulses to nerve cells in the spine. Electricity makes these nerve cells more responsive, or excitable, which helps send signals from the brain to the muscles they control.
(Left) Close-up of the stimulating electrode containing the eight stimulation contacts. (Right) Gerszten explains the placement of moving electrodes while holding them in his hand.
Tim Betler/UPMC and University of Pittsburgh Schools of the Health Sciences
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(Left) Close-up of the stimulating electrode containing the eight stimulation contacts. (Right) Gerszten explains the placement of moving electrodes while holding them in his hand.
Tim Betler/UPMC and University of Pittsburgh Schools of the Health Sciences
When the team tested it on animals, they were able to restore arm and hand function.
“If you carefully place electrodes within the spinal cord, you can direct this excitability to the muscles you need,” Capogrosso says.
The team was pretty sure their approach would work in humans, he says. “But we didn’t expect the amount of emotional recovery that we saw.”
University of Pittsburgh graduate student Erynn Sorensen (left) observes research participant Rendulic during an isometric torque test used to measure arm strength.
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University of Pittsburgh graduate student Erynn Sorensen (left) observes research participant Rendulic during an isometric torque test used to measure arm strength.
Tim Betler/UPMC and University of Pittsburgh Schools of the Health Sciences
Rendulic was treated in the first person. The surgeon used a large needle to place electrodes on her spine. “I had threads hanging from my back,” he said.
Later in the lab, the researchers turned up the excitement. Immediate effect.
“I opened my hand in ways I haven’t in ten years, and my husband and my mother were with us and we were all in tears,” Rendulic says.
Graduate students observe the (old) system test.
Tim Betler/UPMC and University of Pittsburgh Schools of the Health Sciences
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Graduate students observe the (old) system test.
Tim Betler/UPMC and University of Pittsburgh Schools of the Health Sciences
The difference is easily seen in the background made by the investigators that shows Rendulic trying to catch the mess.
At first, “you can see that he can’t do anything with his hand,” says Elvira Pirondini, assistant research professor in medicine and physical rehabilitation. “But when he’s excited, he can reach into the mess and grab it and lift it up.”
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The electric pulse also improved something that many stroke patients lose – the ability to feel the position of the arm and hand without looking at them, which comes from a kind of sixth sense “proprioception”.
“When she was excited, it was easier to understand where her arm was in space.” Pirondini says.
Give your thumbs up while holding a fork with a piece of steak attached to your arm.
Tim Betler/UPMC and University of Pittsburgh Schools of the Health Sciences
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Give your thumbs up while holding a fork with a piece of steak attached to your arm.
Tim Betler/UPMC and University of Pittsburgh Schools of the Health Sciences
The effects of the stimulation became more dramatic during the four weeks each patient had the electrodes on their spine.
“They start to open their hands and in four weeks they can do everything,” says Capogrosso.
The effects were also reduced but did not disappear completely when the stimulation was switched off. That pulse suggests it causes changes in arm and hand control, Capogrosso says, though it’s not clear how long those changes last.
At the end of the four-week study, the electrodes were removed from both patients. But the researchers say they plan to develop a system that can be permanently implanted.
Normally, moving this kind of technology from the lab to widespread use takes many years. But the process is likely to move much faster in this case because the device used to stimulate the spine is already approved by the Food and Drug Administration to treat patients with chronic pain.
“There are thousands of patients implanted with this technique,” says Pirondini.
Spinal cord stimulation has also been used to help patients paralyzed by spinal cord injury regain the ability to walk.
“I don’t see a lot of violators getting in the way of this [stroke] patients,” says Koroshetz.
Rendulic says his experience has changed the way he looks at his future, and he hopes to be the first in line to receive a permanent stimulator.
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