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Dr. Joel Stein
Published By Beth Lueders on October 29, 2018

After a stroke, about two-thirds of patients will receive some type of rehabilitation therapy whether through an inpatient or outpatient care facility or through home-based therapy. With the prevalence of stroke-related disability worldwide, a number of research trials are underway on novel therapies to help improve stroke rehabilitative care and recovery.

Dr. Joel Stein, Chair of the Department of Rehabilitation and Regenerative Medicine at Columbia University in New York City, discusses a number of these forward-looking stroke therapies. Dr. Stein is also Chair of the Department of Rehabilitation Medicine at Weill Cornell Medical College and Physiatrist-in-Chief at New York-Presbyterian hospital.

Therapy Advances After Stroke

“Our understanding of the process of stroke recovery has improved considerably,” Dr. Stein said. “It’s become quite clear that people are capable of improving and are seeing considerable improvement after a stroke. What has also become clear is that there is no time window after which the door closes on the recovery process. There is an opportunity to improve even late after a stroke to some degree.”

While exercise therapy or intentional movement therapy remains the core of post-stroke rehabilitation, Dr. Stein points out the following supporting therapies, many of which are still in the research testing phase:

  • Medications — In particular, selective serotonin reuptake inhibitors (SSRIs), such as the widely used antidepressant Prozac, are showing promise with stroke patients. “Because post-stroke depression is so common,” Dr. Stein explains, “a lot of people end up on these medications, and it’s reassuring to know that these medications may also help with overall stroke recovery.”
  • Noninvasive brain stimulation — This category includes the use of transcranial magnetic stimulation, which employs powerful magnetic pulses that are delivered through a wand held over the head. Another technique is transcranial direct current stimulation that applies electrodes on the scalp to send a mild electrical current to the brain. “Brain stimulation seems to prime the brain to recover better,” Dr. Stein said. “It doesn’t fix things by itself, but when you combine it with exercise, you may potentiate the effect of the exercise therapy.”
  • Robotic technology — For the past two decades, researchers have improved on a number of robotic devices that help impaired limbs with repetitive motions to regain strength and function. “We live in an age of technology and the idea that developing machines to help with exercise just makes good sense,” Dr. Stein elaborates. “It’s where we’re headed. At some point, the physical therapist or occupational therapist can’t be there, so these devices are helpful. And there’s interest in trying to develop devices for home use, which is an important strategy.”
  • Virtual reality and gaming exercises — Some computer-based programs adapted for exercise therapy use commercially available systems like Xbox KinectTM to allow stroke patients to interact with a simulated real-world environment. On the horizon are virtual reality headsets like Oculus Rift® for medical applications and development of specific software to help stroke patients.
  • Telerehabilitation — There is growing interest in remote therapy via the internet or telecommunication networks for stroke patients. “For people with aphasia language difficulties post-stroke, there’s good evidence showing that you can do effective speech therapy remotely,” Dr. Stein said. “Because in a rural area, for example, it’s hard for the therapist to meet face-to-face with the patient. So that’s an exciting area of research, and I think we’re going to see more of that.”

While many of these therapies are still on the cusp of clinical application with stroke patients, medical experts like Dr. Stein keep pressing forward with their research and testing to improve stroke rehabilitation for every stroke patient.

“It’s an exciting time in stroke rehabilitation, and it’s important that people understand that it’s not a static field,” Dr. Stein adds. “Things are changing, and there is a lot of hope for future advances.”

Author Beth Lueders

About the Author

An award-winning journalist who has documented stories in nearly 20 countries, Beth Lueders is an author, writer and speaker who frequently reports on diverse topics, including aging and health issues for both U.S. and international corporations.

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