A Move in the Right Direction for Post-Stroke Therapy
Gregory Thielman, EdD, an associate professor of physical therapy at USciences, focuses on patients who are moderately impaired as the result of a stroke. Dr. Thielman worked collaboratively with researchers from Temple University and the University of Pennsylvania on a National Institutes of Health (NIH) funded project that included patients in their early 30s through 80s. Their needs are different, he said, than those who still have
fair use of the affected arm.
“The initial idea focused on forced use, where a sling was put on the uninvolved side of someone post-stroke that forced them to use their involved side,” he said of a rehab technique called constraint-induced movement therapy. “It’s really effective with people who are functioning at a high level to begin with.”
However, the goal of his research is “to help patients who don’t have use of their arm to work up to the level where constrained movement therapy will work for them.” In a recent study, he examined the effectiveness of ReoTherapy (REO) compared to real-world task-related training (TRT). REO is a technique that uses a robot to assist the patient in doing a repetitive task—for example, helping the patient reach forward and touch a target on a screen.
TRT focuses on teaching people how to do everyday tasks by “working with how people move, sometimes allowing them to move in any way they can and other times trying to force them to use just their arm,” he explained. Through the overall grant from the NIH, Dr. Thielman’s subaward studied the effectiveness of each technique and found that REO therapy was not more effective than TRT. “It’s not the answer,” he said. “But it can be used along with TRT to help patients regain motion.”
In the next part of the study, patients undergo functional magnetic resonance imaging (fMRI) before and after training to see if there are changes in the plasticity of the brain to go along with the changes in arm use that are viewed outwardly.
“[The goal is] to help patients who don’t have use of their arm to work up to the level where constrained movement therapy will work for them.”
—Dr. Gregory Thielman