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Stroke Smart Magazine


September/October 2008
AMAZING BRAIN

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Rewiring the Brain
Scientists Explore the Connection


By Kari Dunning, PH.D., PT and Susan Israel

Now is an exciting time for stroke survivors because scientists are starting to figure out how to tap into the brain’s amazing ability to recover and rewire itself. Doctors and therapists now understand that recovery can occur for a much longer period of time then was previously thought. And researchers like us are testing new treatments to some old problems, such as foot drop. An inability to pick up the toes while walking, foot drop is a common problem among stroke  survivors. It often causes falls in stroke survivors because the foot catches on obstacles on  the floor.


Historically, treatment for foot drop has been a lower leg brace that fits in the shoe and  positions the foot so that the toes clear the ground. This type of brace, called an ankle foot orthosis (AFO), helps stroke survivors walk safely. Now, some people are being treated by a foot drop simulator, a new device that uses brief electrical impulses to activate the muscles that pull the toes up during walking. A major benefit of this technology is that the muscles are actively being used instead of positioned passively.


The Neuromotor Recovery and Rehabilitation Lab in Cincinnati, Ohio, is currently investigating ways that the brain can rewire itself to regain the ability to control foot movement.


  • One treatment being tested is daily use of the foot drop stimulator. Brain rewiring happens better with the repetitive, meaningful and challenging activities. So, will walking with the device be challenging enough for the brain to make new connections for controlling foot movement? Will use of this technology eventually enable stroke survivors to walk without any type of brace?
  • Due to the high cost of the device, many stroke survivors will be unable to purchase it for use at home. However, there are several clinics that use the device during outpatient treatment sessions. So, the effect of using the foot drop stimulator for just two to three hours per week during therapy is also being evaluated.
  • Another treatment for foot drop is a computer-based game system. The game is played by using sensors that detect muscle activity in the front and back of the calf. These are the muscles that pull the toes up and point them down. There are various games that involve moving the foot up and down to move the cursor and play the game. This is a challenging and entertaining way that people can exercise the muscles that move the foot. Will an increase in movement of the foot help people to walk better?

Early research confirms that the brain can somewhat recover and rewire itself after stroke.





  

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