Eric Leuthardt, MD, Neurosurgeon, Washington University School of Medicine & Neurolutions Inc, talks about stroke recovery for the arm.
I’ve done a lot of stroke stories and I think one of the hardest things is for people to lose their mobility, especially in their hands, because we take them for granted but you use them for everything. Is that what you find?
LEUTHARDT: Certainly, when people have a stroke one of the most common problems that they deal with after stroke chronically meaning what are the aftereffects of stroke that lasts you know greater than six months? It’s a loss of hand function. And that fundamentally impacts people’s independence in really unexpected ways. Meaning we commonly think about you know turning a key or turning a doorknob but the little things whether it be buttoning buttons, putting clothes on and really the added emotional dimension. For instance, people sometimes can’t hold their loved one’s hands. They can’t hold a grandchild. All these things kind of cumulatively not only affect your independence but they impact your emotional connection to the world around you.
And it feels like when I do talk to stroke patients you know they kind of top off after a while like maybe a couple of years with O.T. and physical therapy and you know everything that they’re supposed to do they get so much back and then it just kind of …
LEUTHARDT: That’s right it plateaus. So, after a stroke the classic understanding is that there’s the acute phase of stroke which is usually approximately three to six months after the injury has occurred from the stroke. But usually after six months we really see a substantial plateau of the benefit that people gain. And a lot of the gains that you see after that are less to do with the neurologic functions coming back but more it’s that they’ve developed compensation techniques to deal with that disability. But yeah. So, after six months really what you have is what you have.
And so now you’ve developed a one of a kind of exoskeleton.
LEUTHARDT: Actually, more than an exoskeleton it’s a brain computer interface where it really has three parts to it. There’s the headset that’s recording brain signals. There’s the exoskeleton – it’s a wearable robotic that a stroke patient can put on or take off by themself. Same with the headset and then a tablet that basically walks the patient through how to use the system. And it’s a system that’s taking signals from the uninjured side of their brain to control their paralyzed hand so that as they use it over time their brain remodels so that they gain function of their hand again in the future.
Now I just have done stories with exoskeletons. So, forget about the whole reading of the brainwaves.
LEUTHARDT: Right.
But they’re almost too unattainable to get for a normal person because they cost almost a half a million dollars. You know they’re very bulky and everything; this is something that…
LEUTHARDT: You’re absolutely right. So, this wearable exoskeleton is attainable. Patients can eventually acquire this without having to sell their home. It’s easily deployable meaning that it quite literally is something that they can pull out of a box. They can put it on their forearm and hand, and they can control you know their limb and that it can open and close it with again in our system is controlled by their brain.
Now how does it work?
LEUTHARDT: So, the way that the IPSY hand system works is it is a brain computer interface. And really over more than a decade’s worth of science we came to discover that there are signals on the uninjured side of the brain that are associated with movement of the paralyzed limb. So really boiling it down to kind of the human experience if you have a patient who’s had a stroke and they can’t move their hand they can still think about moving their hand. They can imagine moving their hand. They can try to move their hand. They just can’t actually move that limb. As it turns out, some of those brain signals, for instance if I injured the right side of my brain and I can’t move my left hand, there are still some signals on the uninjured side of the brain associated with that intent to move. And so, what the system does is it connects those brain signals with the intention to move with actual movement of their hand. And so, their brain essentially relearned how to use a different part of the brain to effect control of that paralyzed hand.
And how does it read the signal?
LEUTHARDT: Electrically, it’s a noninvasive headset that is picking up brain signals through the scalp.
And when you see these stroke patients put this on and try it out for the first time, is it a learning curve? Is it oh, my gosh, I can open my hand?
LEUTHARDT: There’s an element of a learning curve because we want to see them get better over time. But certainly, there’s those initial moments where they think about moving their hand and it actually moves I think is really one of the most compelling things for why they want to continue to use this. Because they’re certainly seeing that content, that imagination of moving their hand actually translates to a movement of their limb. And then it becomes this positive feed forward cycle that is the more they think about it the more their hand moves the more their brain learns how to actually control it without the exoskeleton.
And is this something that every stroke patient can do if they’re 10 years after stroke?
LEUTHARDT: There certainly are criteria, it doesn’t matter how far out from the stroke they are. We have patients who have been many years out from their stroke, and they still can recover function. We certainly want to make sure that they have the appropriate cognitive capabilities to understand how to use the system. So, for instance things like aphagia. If they really can’t understand speech or if they had real problems with attention, those could be limitations. But generally speaking, the majority of patients who have an isolated motored deficit can use the system.
Is this something that you would use all day long? Or do you use it just when you need it?
LEUTHARDT: The way we have tested it and the way that we would recommend using it is that they just have to use it for an hour a day. And then over time they will accrue kind of continue ongoing benefit.
And would it be so that you would not have to use it then and you would keep that muscle memory going?
LEUTHARDT: Absolutely. The system is really a rehabilitation system. So, it’s used to really retrain your brain to rewire your brain, so you don’t need this system in the long run.
How long does it take?
LEUTHARDT: Well, the studies that we’ve done it takes around three months to see kind of really clear clinically significant benefit. Now, we have patients who’ve used it longer and have continued to improve function. The exact answer for how long you use it, I think it varies from patient to patient.
We’re gonna see Mark. Can you tell me a little bit about him?
LEUTHARDT: Yes. So, Mark, he had a stroke. Really you know lost function of his hand and had lost it for quite some time. And I think he’s a classic story in the sense of everybody told him it wasn’t coming back. But he’s a willful kind of individual. He wasn’t going to give up. And so, his wife found kind of this clinical trial when we were first in one of the early trials when we were testing out the system. And he got involved. And I think what was for me what is really inspiring is that he did achieve a meaningful amount of hand recovery to the point that he was able to do one of the things that he was passionate about which was fishing. And after he had a stroke, he couldn’t fish anymore. He couldn’t cast a line. And now he can, he’s gotten enough function back. Not only was he able to fish again he actually rebuilt a boat so that he could fish. And seeing that really that return of independence and passion, and really returning to life is really one of the things that inspires me, again why we do this in the first place.
So, can people get this now?
LEUTHARDT: Right now, it has been authorized and cleared. Basically, the company that’s making the system is ramping up its commercial capabilities to start selling it. So not yet. But if they go out to the website and get a log in to see if it’s appropriate for them, we’re building our list right now so that eventually we can ship it to patients.
How soon do you think going to be? Like next year in 2022?
LEUTHARDT: You know our hope is in the next six to 12 months we’ll be able to make these available to patients.
And what will the costs be like?
LEUTHARDT: So, I think it’s going to vary. You know it’s hard for me to put an exact number on depending on there’s a lot of dynamic things happening right now as it relates to reimbursement cost coverage by Medicare and Medicaid. So, I don’t know the exact cost but it’s not bank-breaking money.
So, who would be the ideal candidate and who would not be?
LEUTHARDT: Currently the ideal candidate is somebody who has a paralyzed hand or limb who has had their stroke and they’re now six months out or greater from their stroke and is otherwise cognitively intact.
And who would be bad?
LEUTHARDT: Somebody who has excessive spasticity who can’t move their hand at all or somebody who has cognitive impairment who would prohibit them from focusing their attention to actually do kind of the thought-based control of their limbs.
Is this just the start? Because I’m thinking why can’t you do a leg?
LEUTHARDT: It is absolutely the start. This is the first FDA cleared brain computer interface for motor restoration in stroke. So, there’s a whole I think number of possibilities going forward of how additionally we can use this to recover motor function, the hand, the leg and other cognitive functions as well.
And this won’t work for let’s say like for paralyzed people because it’s not about talking or?
LEUTHARDT: Right now, it is not indicated for people who have a paralyzed limb because of a spinal cord injury for instance. I think that we can certainly envision ways so that we can enhance kind of using these types of technologies for other applications but that’s further off in the future.
Interview conducted by Ivanhoe Broadcast News.
END OF INTERVIEW
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