Overcoming the effects of stroke

Dr. Steven S. Cramer encourages the use of a telehealth video game console to promote stroke recovery.

In recent years, improvements in the diagnosis and treatment of stroke have led to fewer deaths. Despite that progress, nearly 700,000 Americans suffer strokes each year, and the condition remains the No. 1 cause of disability and a major cause of dementia. With more people surviving strokes, the need for better rehabilitation and recovery programs has never been greater.

“There’s really strong evidence from studies that the more rehab stroke patients get, the better they do,” says Dr. Steven C.Cramer, UCI Health neurologist. “In the United States, people don’t get anywhere near the maximum doses of rehab. Some of that is just complexity, but a lot of it has to do with cost. A third reason is access: It’s hard for some people to get to their appointments, and there’s also a shortage of physical/occupational therapists.”

Through a National Institutes of Health grant, Cramer is directing a clinical trial to research whether telerehabilitation therapy can help improve patients’ access to—and frequency in attending—rehab programs.

His idea is simple: provide patients with in-home telehealth systems that use specially selected video games to improve arm movements and brain function, with an Internet video chat program so therapists can interact with patients and monitor their progress. Data so far show a 98 percent compliance rate and that study participants are improving.

Putting telehealth systems in patients’ homes makes it much easier for them to participate, Cramer says. The programs are designed to be fun, while requiring specific movements and problem-solving behaviors. “ Video poker is our mos t popular game,” he says.

The other primary goal of the program is to enhance patients’ recoveries by educating them. “One of the biggest problems for stroke patients is that they just don’t know very much about their disease,” Cramer says. “One study I like to cite is that half of the people in the hospital for stroke can’t name a single stroke symptom. So in each dail y session we incorporate stroke education in a Jeopardy format.”

In addition to promoting more effective rehabilitation, Cramer has spent years studying how stem cells can help the brain heal after a stroke. Stem cells have the potential to develop into many different cell types in the body during early life and growth.

“The brain is already galvanized for repair,” he says. “After a stroke it goes to work right away trying to rebuild the smoldering ruins left behind. Stem cells are attractive because in some animal studies these treatments have large and consistent effects.”

Of particular interest to Cramer—and the focus of a separate clinical trial—is a type of stem cell called mesenchymal cells, which are most readily found in bone marrow.

“These cells have multiple mechanisms for action,” he says. “They are attracted to sites of injury, and they start cranking out multiple growth factors for healing. They also tend to promote new blood vessels, and they strengthen the immune system.”

Whatever the approach, Cramer says prompt attention is vital to improving stroke recovery. “In the first three months after a stroke, the brain is on fire with growth activity,” he says. “You have this critical window where we can make you a lot better.”

Join our program: If you or someone you know has weakness due to a recent stroke, visit ucirvinehealth.org/stroke for information on clinical trials focusing on stroke rehabilitation.

— UCI Health Marketing & Communications
Featured in UCI Health Live Well Magazine Winter 2016