HYPERMED STROKE

LATEST STORY - Marco Borzini 'Stroke Recovery' Dec 2011

Oxygen therapy improves energy metabolism in focal cerebral ischemia

Oxygen therapy (OT) with hyperbaric oxygen (HBO) or normobaric hyperoxia (NBO) improves the oxygenation of penumbral tissue in experimental ischemic stroke

www.wndu.com/Mishawaka_woman_tries_experimental_therapy_after_surviving_massive_stroke

"August 9 will mark the one year anniversary of a very dark day for a young Michiana family.

That is when their young, athletic wife and mother had a massive stroke, that she miraculously survived, but was left with lasting disabilities.

Julie McNamee of Mishawaka spent weeks in the hospital and outpatient rehab, and while she made huge strides, her improvement hit a wall.

That is when she and her family decided to look into a treatment not yet approved by the FDA for stroke patients, but is showing promise.

It is called hyperbaric oxygen therapy.

After suffering a massive stroke on August 9, 2010 at just 47 years old, Julie had come a long way in 9 months, but still had some paralysis on her left side and needed the use of a wheel chair or cane and had seizures.

"You know I had a very significant stroke and the whole left side of my body was paralyzed so I did have some improvement before the dives started, my eye was drooping and my mouth was drooling,” she said.

In May, they travelled to Rockford, Illinois to the Rockford Hyperbaric Healing Center.

President Joe Sharp said they see varying improvements depending on the patient.

"We see anything from subtle improvements to quality of life to just miraculous where people were talking and they start talking, but for most people it is a gradual process,” Sharp said.

Hyperbaric oxygen therapy involves breathing pure oxygen in a pressurized room and is most commonly used to treat infections and wounds that will not heal.

But Sharp said more studies are underway involving its use for stroke patients.

Since hyperbaric therapy is not being used for strokes in our area, the McNamee family decided to pay for 40 dives every other day at a total cost of $7,000. And while that may sound like a lot out of pocket, when hyperbaric is covered by insurance for approved use, like treating wounds, hospitals often get $2,000 "per dive."

Julie said there was a definite improvement, but her left arm is still paralyzed.

With two daughters in college and two sons at St. Joseph High School, Julie and Mark said the hardest part of the treatment was having to leave town.

Julie said the treatment itself was a breeze.

And Julie, who has a special exercise bike for rehab, says she has more strength and had ridden her stationary wheels 25 miles the day before our interview.

Mark says in addition to Julie's strength, they also believe the hyperbaric therapy may have stopped his wife’s seizures.

"We talk about the fact that she hasn't had a seizure since May 22, so overall a lot more stable,” Mark said. "Julie was having them about every five weeks, so you know close to two months now."

Still, Mark admits Julie's recovery is like a journey and hyperbaric is just part of their hope for a full recovery.

“Julie is on a path, that's the way I look at this and the path doesn't necessarily have any guarantee's for us, but there's also no real end to the path after hyper I mean there's other therapy we can look at like stem cell, which right now is not done in this country but done in Germany and Japan,” Mark said.

The McNamee family is hopeful enough with the treatment that this week they are back in Rockford and Julie is going through ten more dives.

Her last dive is on their 29th wedding anniversary, and beforehand, Julie, Mark and their kids will celebrate.

"We're going to the Cubs game the day before,” she said.

Since it can take months for the full effects of hyperbaric therapy to show results, NewsCenter16 will check back in with the McNamee family in a few months to see how Julie and the rest of the family are doing."

Hyperbaric oxygen in the treatment of patients with cerebral stroke, brain trauma, and neurologic disease

Al-Waili NS, Butler GJ, Beale J, Abdullah MS, Hamilton RW, Lee BY, Lucus P, Allen MW, Petrillo RL, Carrey Z, Finkelstein M.

Source

Life Support Technologies, Inc., and NewTechnologies, Inc., The Mount Vernon Hospital, Westchester Medical Center, New York Medical College, New York, USA.

Abstract

Hyperbaric oxygen (HBO) therapy has been used to treat patients with numerous disorders, including stroke. This treatment has been shown to decrease cerebral edema, normalize water content in the brain, decrease the severity of brain infarction, and maintain blood-brain barrier integrity. In addition, HBO therapy attenuates motor deficits, decreases the risks of sequelae, and prevents recurrent cerebral circulatory disorders, thereby leading to improved outcomes and survival. Hyperbaric oxygen also accelerates the regression of atherosclerotic lesions, promotes antioxidant defenses, and suppresses the proliferation of macrophages and foam cells in atherosclerotic lesions. Although no medical treatment is available for patients with cerebral palsy, in some studies, HBO therapy has improved the function of damaged cells, attenuated the effects of hypoxia on the neonatal brain, enhanced gross motor function and fine motor control, and alleviated spasticity. In the treatment of patients with migraine, HBO therapy has been shown to reduce intracranial pressure significantly and abort acute attacks of migraine, reduce migraine headache pain, and prevent cluster headache. In studies that investigated the effects of HBO therapy on the damaged brain, the treatment was found to inhibit neuronal death, arrest the progression of radiation-induced neurologic necrosis, improve blood flow in regions affected by chronic neurologic disease as well as aerobic metabolism in brain injury, and accelerate the resolution of clinical symptoms. Hyperbaric oxygen has also been reported to accelerate neurologic recovery after spinal cord injury by ameliorating mitochondrial dysfunction in the motor cortex and spinal cord, arresting the spread of hemorrhage, reversing hypoxia, and reducing edema. HBO has enhanced wound healing in patients with chronic osteomyelitis. The results of HBO therapy in the treatment of patients with stroke, atherosclerosis, cerebral palsy, intracranial pressure, headache, and brain and spinal cord injury are promising and warrant further investigation.


 

HyperMED Stroke Injury Protocols Are Unique - We Are About 'Driving Functional Changes'

HyperMED provides saturative blocks of Hyperbaric Oxygenation (HBOT) combined with Australian first LOKOMAT (Robotic Gait Training - Adult and Paediatric) to promote neuroplasticity - the ability of neural pathways to foster and develop new connections and ‘learn’ new functions. Other supportive modalities include MonoRail Walking, Median Nerve Stimulation, Whole Body Vibration and immune stimulating supplements

HyperMED combination protocols ‘awakens’ dormant neural pathways and provides accurate neurological repetition enhancing and re-training connections and pathways in the brain and spinal cord. Patients have the ability to ‘salvage back’ what has been damaged - the capacity to wake-up dormant pathways, rewire, retrain and reconnect function improving brain and spinal cord function.  Do Wheel Chairs Inhibit Recovery?

 

HyperMED/VNI HBO, LOKOMAT, Cerebrolysin Submission October 2009. Project Submission for Funding

HyperMED/HyperMED LOKOMAT 2009.pdf

HyperMED/LOKOMAT - Australian Experience HyperMED NeuroRecovery.pdf

 

This combined Hyperbaric LOKOMAT approach ‘awakens’ dormant neural pathways and provides accurate neurological repetition enhancing and re-training connections and pathways in the brain and spinal cord.

Patients have the ability to ‘salvage back’ what has been damaged improving brain and spinal cord function - to regain walking ability or learn to walk!

 

HyperMED Clinical Research/Clinical_Report_LS_UT LOKOMAT Southwestern_en_0904_small_en.pdf

HyperMED Clinical Research/Clinical_Report_LS_ LOKOMAT Spaulding_en_0905_small_en.pdf

HyperMED Clinical Research/LOKOMAT_Clinical_Report_ LOKOMAT Shepherd_0706_en_small_en.pdf

HyperMED Clinical Research/STROKE-2009-563247v2-Hornby.pdf  'Locomotor training improves daily stepping activity and gait efficiency in individuals post stroke who have reached a 'plateau' in recovery Prof George Hornby'

 

Controlling Patient Participation During Robot Assisted Training - Stroke Recovery

The overall goal of this paper was to investigate approaches to controlling active participation in stroke patients during robot-assisted gait therapy. Although active physical participation during gait rehabilitation after stroke was shown to improve therapy outcome, some patients can behave passively during rehabilitation, not maximally benefiting from the gait training. Up to now, there has not been an effective method for forcing patient activity to the desired level that would most benefit stroke patients with a broad variety of cognitive and biomechanical impairments.

 

  

 

 
 
 
 

The economic cost of spinal cord injury and traumatic brain injury in Australia (1.31Mb)

 

What Happens With Stroke?

Most victims of stroke have years of progressive vascular insufficiency leading to a catastrophic event. Those that survive have a long road ahead. Stroke recovery is slow and many do not survive past 3-5 years due to 'secondary cascade complications'

The event of stroke causes widespread hypoxic damage which can be measured on MRI - often referred to as 'encephalomalacia' which leads to progressive 'softening and liquefaction' of the brain. Google search this term for additional information. The MRI has a typical 'watershed' that delineates the area affected by stroke. However many stroke survivors with further MRI years later demonstrate expansion of the original watershed. This is due to Hypoxic Induced Apoptosis. Hypoxia fosters progressive neurodegeneration compounded by 'learned non-use'  

The difficulty in treating stroke is the fact that 'drugs' require Oxygen as a catalyst to penetrate the target region. This is exactly how Hyperbaric Oxygenation provides benefit for stroke victims. We often describe the impact of Hyperbaric Oxygenation is like 'getting more fizz into a flat can of coke'! The objective of Hyperbaric Oxygenation is to get more Oxygen (fizz) into the hypoxic damaged nerve cell and neural tracts accelerating recovery and preventing further destructive spread due to hypoxic induced apoptosis

 

Why Does The Individual Progressively Lose Functionality?

Experiments conducted on neural impaired subjects demonstrate that neural circuitry slowly 'learn' to shut down.

Lack of appropriate and 'accurate' stimulation induces functional incapacity called the ‘learning non-use’. Simply stated if you teach the neural circuits to cease walking or to sit they will learn 'non-use disability'. Refer to the 'rat study'  Do Wheel Chairs Inhibit Recovery?

Motor cortex centers in the brain and spinal cord show signs of 'global functional loss' due to localized encephalomalacia effects. It is imperative to keep this ‘window open’

Body Weight Support Treadmill Training (BWSTT) and more recent studies on LOKOMAT (Robotic Gait Assisted Walking) demonstrate the potential of functional neuroplasticity - the ability to re-learn and re-organize function. Functional BOLD MRI measures the capacity to retrain function in both the brain and spinal cord neural pathways. The injured brain and spinal cord has capacity to 'wake-up' - salvage back tissue damage, re-activate and re-train dormant neural pathways improving functionality.

 

Breakthrough Stroke Therapy - Malay Mail - The two machines, the LOKOMAT and the Armeo, were developed by Swiss-based Hocoma - renowned leaders in robotic rehabilitation therapy for neurological ...

HyperMED Australia : Beyond Therapy - Treatment Program

HyperMED Australia : LOKOMAT NeuroRecovery

How robotics are assisting Stroke victims

Transfer of scientific concepts to clinical practice: recent robot-assisted training studies

Restoration of motor function is a priority of post-stroke rehabilitation, the aim being to facilitate the patient's reintegration into society. Innovative technologies for neurological rehabilitation must be easy to use and offer patients real benefits, and the treatments they provide must be efficacious and efficient. All these aspects must be carefully evaluated in their development. To achieve restoration of motor function after stroke, task-specific repetitive robot-assisted training of the upper and the lower extremity is currently the most promising approach. The results of clinical trials of robotic devices for upper limb (MIT-Manus, MIME, NeReBot, BiManuTrack, ARMin, ARMOR) and lower limb (LokoHelp, GangTrainer GT1, Haptic Walker, G-EO-Systems, LOKOMAT) training are here presented with the aim of highlighting the possible gains in motor function due to robotic therapy. Patients who receive robot-assisted training in combination with physiotherapy after stroke are more likely to achieve better motor function than patients trained without these devices, or only with these devices.

 

Exercise-mediated (LOKOMAT) locomotor recovery and lower-limb neuroplasticity after stroke

 

Stroke Facts

Approximately 700,000 strokes occur annually in the United States; 50 percent of the 550,000 survivors experience residual hemiparesis affecting one side of the body and approximately 165,000 of those individuals have mobility deficits requiring assistance with walking [1-3]In this population, hemiparetic gait is a major problem that limits mobility, increases risk of falls, and imposes higher energy demands for basic daily activities [4-5]. Gait deviations due to hemiparesis are well documented, in terms of both clinical manifestation and biomechanical analyses [6-7]. Classic models of stroke recovery indicate that improvements in both upper- and lower-limb motor function plateau between 3 and 6 months poststroke [8]. Recent studies have challenged this assumption by suggesting that specific training interventions that target use of the hemiparetic limbs can improve motor control and neural plasticity. The research community now widely accepts that the central nervous system comprises inherently plastic neural networks that are continuously amenable to reorganization in the service of functional behaviors [9]. As a consequence, new therapeutic approaches seek to exploit experience-based CNS plasticity to mediate functional improvements. A common thread among most of these interventions is an adherence to the principles of motor learning, as defined by incorporating high volumes of task-oriented practice along with the added dimensions of goal setting and performance feedback [10].

Studies of therapies that improve function and induce neuroplasticity in hemiparetic upper limbs in human survivors of stroke have supported an emerging focus on developing new learning-based strategies for improving gait and balance function in individuals with lower-limb hemiparesis after stroke [11-17]. Here we review evidence that one particular mode of exercise, treadmill (TM) training as applied in a number of approaches, can be employed to improve gait function in survivors of stroke with residual hemiparesis. We will suggest that basic motor learning strategies can alter underlying neural mechanisms to improve hemiparetic function of the lower limb and may also be effective in recovery of walking ability after stroke. Following a brief overview of the rationale and early results from studies using TM training with stroke, we provide examples that illustrate the role of the CNS in lower-limb motor control and gait. Our focus then shifts to an overview of how the neurophysiology of lower-limb motor control is sensitive to short-term adaptations and rapid plasticity. Finally, we review the early evidence of central neuroplasticity underlying lower-limb function and gait using long-term TM training protocols.

Rationale For Treadmill Training After Stroke


Findings from spinalized animal models demonstrate that walking without supraspinal inputs can occur when the animal is placed on a moving TM [18]. Thus, several investigations have studied TM training as a means to improve locomotor function in subjects with incomplete
spinal cord injury and stroke. Visintin et al. first adapted the findings from spinalized animals to human experiments, reasoning that activation of
subcortical neural structures by TM walking could provide a physiological stimulus for recovery of gait function [19-20]. These studies support the rationale that TM-generated stepping patterns in neurologically injured humans can help deliver repetitive sensory inputs to the spinal cord, which in turn could mediate locomotor learning and neural plasticity through a process of sensory motor integration [21]. Additional feasibility for this idea was shown in a study of the immediate effects of the TM stimulus on hemiparetic gait patterns in naive subjects with chronic stroke [22]. While controlling for walking speed, paretic paretic /pa·ret·ic/ (pah-ret´ik) pertaining to or affected with paresis.  limb stance-swing parameters and loading impulse immediately became more symmetrical on the TM compared with usual overground

Treadmill Based Exercise Training Improves Gait Function

The initial studies with human SCI and subacute stroke subjects used TM training in conjunction with partial body-weight suspension (
PBWS PBWS Performance Based Work Statement (contracting mechanism) ). In a randomized study of more severely impaired subjects with subacute stroke, Barbeau and Visintin found TM with PBWS to be more effective than TM without PBWS for improving selected mobility outcomes in those subjects with more severe motor deficits (i.e., <0.2 m/s walking velocity and Berg Balance scores <15) [24]. By week 6 of training, 79 percent of subjects were able to train at 0 percent PBWS. In a noncontrolled 3-week study, 25 PBWS TM training sessions improved mobility scores and gait temporal-distance parameters in nine nonambulatory stroke subjects [25]. PBWS was not required after day 6 of training in seven of these nine cases. Similar results were reported in a follow-up study using the same approach in an A-B-A design [26]. These studies indicate an important role for PBWS as a bridge to full-weight-bearing TM exercise, particularly in subjects more severely affected.

Additional Review

HyperMED Australia : Clinical Research - LOKOMAT

HyperMED Australia : Clinical Research - Hyperbaric Oxygenation

HyperMED Australia : Clinical Research - Cerebrolysin