When a person has a stroke, some of their brain cells can suddenly die due to a lack of blood flow. This is usually caused by a rupture of an artery or a blockage of blood flow in an artery. The neuroscience of stroke recovery has not been fully explored yet. This leaves room for innovation and new developments to help people who have had a stroke recover. I mainly focused on stroke research, but the treatments for other neurological conditions maybe similar. The common symptoms of stroke can be remembered by the acronym “BEFAST”, where “B” stands for balance dysfunction, “E” stands for loss of vision, “F” stands for facial weakness, “A” stands for arm weakness, “S” stands for speech difficulty, and “T” stands for time, which is of critical importance as it is important to get medical attention quickly to stop the stroke in its tracks. I wanted to learn about stroke research because my great-grandmother recently suffered from a stroke.
A stroke can affect people in a variety of ways making it hard for scientists to find a ‘textbook’ cure. Doctors and researchers join the field of stroke research to help patients regain their strength and resume their normal activities. It’s not easy though as the brain is the most important and complicated organ, and understanding it is probably the hardest and most interesting part of stroke research.
I interviewed stroke rehabilitation experts from New York University and Johns Hopkins University to get an overview of the neuroscience of stroke recovery. The experts I interviewed were Kyle McDonald, Dr. John-Ross Rizzo, Dr. Jennifer Stone, Dr. Prin Amorapanth, and Dr. Marlis Gonzalez-Fernandez. I asked each expert the following questions:
· What inspired you to get into the field of stroke research and neuroscience?
· What types of stroke does your research focus on?
· What are you actively doing to further stroke research and help patients?
· Does your development also help people with other neurologic conditions?
· What was something surprising that you learned about stroke or the brain?
· What are the important unsolved questions in the neuroscience of stroke recovery?
The summary of each interview is below:
Kyle McDonald is a Physical Therapist who analyzes videos that depict a stroke patient’s movement before and after injections to reduce muscle stiffness. Using these videos, he draws conclusions about which muscles are critical to inject to improve movement. He went into the field of neuroscience because he felt it was a field where he could make the biggest impact from his background in therapy. He noted that there are so many different cases of stroke, that one cannot pick and choose the types of patients one gets. There is no ‘textbook’ definition or manual to cure strokes yet, but researchers are slowly getting to that point. Kyle focuses on the sub-acute stage of a stroke, where a lot more research is needed.
Dr. Prin Amorapanth was inspired to work in Neuroscience because the brain is the seat of the soul! He works with people who have traumatic brain injuries or strokes because their treatment can be similar. He spends his time in the outpatient facilities and focuses on restoring movement and function. He explained how brain doesn’t stop learning, and that people can fully recover from stroke if they try hard.
Dr. Jennifer Stone was always interested in rehabilitation and wanted to help patients who have had strokes. She worked on researching if a tool called the bimanual arm trainer can restore movement in severely affected individuals. One thing she found surprising about her research was that people affected by strokes were affected emotionally as well as physically.
Dr. John-Ross Rizzo got into neuroscience when his grandmother suffered a number of strokes towards the end of her life. He is interested in eye-hand control and thinks there is a big connection between strokes and eye-hand coordination. In general, he focuses on ischemic strokes as they are more common, and it is easier to find the artery that led to the stroke. It helps him focus on what the problem is and find a sample of patients who are similar. He has a ‘battery’ that he puts patients through, where patients are asked to ‘look and reach’ similar to the actions in a knocking game. The idea is that you use your eyes and hands to look and reach. He compares his results with patients to that of regular people. Then he varies the game to make it harder or easier for the patient depending on their abilities. He has a set of strategies to boost their eye-hand coordination and has preliminary data as proof that his game works. A lot of rehabilitation is goal setting and the idea is to get the patient back to having fun. Stroke falls under an acquired brain injury and Dr. Rizzo thinks that his technique will have use in traumatic brain injury as well. Surprisingly, he found that some individuals who have had strokes may learn to use their peripheral vision, without looking at the target directly. He thinks that there is a lot to be solved in the field of neuroscience.
Dr. Marlis Gonzalez-Fernandez works on swallowing rehabilitation after neurological conditions at Johns Hopkins University. She approaches neuroscience from a quality of life standpoint, and figured that if people can’t swallow, they would have a low quality of life. She sees patients in the clinic and gives them exercises. She is also interested in how swallowing recovers after stroke. People who have strokes are typically older, and age also affects swallowing, so she is curious about how age affects how they will recover after a stroke. She wants to get people to swallow so she uses special liquids to help. If you thicken liquids, increasing their viscosity, it helps people swallow better. However, people don’t like these foods so, it’s hard to find a way to help them. The strategies for people who have swallowing dysfunction are similar for pretty much all neurological diseases. There are many tests to understand how a patient is swallowing, because you can’t see their swallowing system like their legs or arms. Using these tests, she figures out what is wrong with their structures, and then prescribes certain exercises. There are no medications for swallowing disorders, only physical exercises. One of the most unintuitive things about swallowing is the difference between drinking and eating. When one is eating, the food that is ready to be swallowed goes automatically very deep to the back of the mouth and goes very close to the airway. When you are drinking the liquid goes you seal the into a sealed area between the tongue and your pallet before you digest it. gets digested. The human swallowing system is also different from that of other mammals, which is why humans can talk and mammals can’t. Some of the predict swallowing dysfunction based on the brain tissue damaged by a stroke, how does aging affect recovery of swallowing from a stroke? Dr. Fernandez is working towards a textbook on how to treat swallowing difficulty after strokes, as helping people recover swallowing is very important and often overlooked.
From my interviews, I can see that researchers are exploring many different aspects of stroke recovery – movement, emotions, eye-hand coordination, and swallowing. There are different strategies that can be used to aid recovery from a stroke, but it is difficult to know which is the best one for a given person. Things we take for granted such as reaching and swallowing can be very difficult for someone who has had a stroke. Stroke research is just gearing up and there are still many important unsolved questions and knowledge about the brain that has yet to be uncovered.