Past Studies
Our Past Research Studies
FLuoxetine to Open the critical period time Window to improve motor recovery after stroke
Improving lower extremity mobility following a stroke event is one of the top priorities agreed upon by stroke survivors, caregivers, and health professionals. Improvements in lower extremity mobility reduce the likelihood of being discharged to long term care nursing homes and increase the probability of improved quality of life post-stroke. Findings over the past 15 years suggest that in the first weeks following a stroke or similar injury the brain enters a recovery period characterized by rapid neuronal growth which leads to increased neuroplasticity. Previous animal and human studies have demonstrated that rehabilitation of stroke survivors is most effective during this relatively short time period.
Recent studies suggest that it may be possible to re-open and extend this critical time period for the rehabilitation and increase the overall recovery outcomes of stroke survivors. The primary objective of the FLOW Trial is to keep, re-open, and extend this optimal recovery window for those affected by stroke through a combination of fluoxetine (Prozac) and intensive exercise. Other recent studies in stroke have shown that an increase in exercise intensity can lead to greater improvements in motor and neurologic function; by combining increased activity with fluoxetine, there may be potential in increase the rate at which people improve and level to which they improve even further. Using preliminary evidence that Selective Serotonin Re-uptake Inhibitors (SSRI’s) such as fluoxetine have potential to optimally enhance motor function when combined with exercise, the FLOW trail aims to improve the recovery prognosis and fundamental outcomes of Canadians living with stroke.
Collaborators:
- Dr. Mark Bayley (Principal Investigator, Toronto ON)
- Dr. Janice Eng ( Principal Investigator, Vancouver BC)
- Dr. Sandra Black (Co-Investigator, Toronto ON)
- Dr. Bradley MacIntosh (Co-Investigator, Toronto ON)
- Dr. Marilyn Mackay-Lyons (Co-Investigator, Halifax NS)
- Dr. Michelle Ploughman (Co-Investigator, St. John's NFLD)
- Dr. Courtney Pollock (Co-Investigator, Vancouver BC)
- Dr. Sepideh Pooyania (Co-Investigator, Winnipeg MB)
- Dr. Robert Teasell (Co-Investigator, London ON)
Efficacy of Virtual Reality Exercises using Wii gaming technology in STroke Rehabilitation
The Dukelow Neuro Robot Lab was a participant in the EVREST multicentre study examining the efficiency of virtual reality gaming using the Nintendo Wii then compared to recreational therapy activities (various card and board games). The EVREST study was a large multicentre study with sites across Canada, headed by Dr. Gustavo Saposnik from the University of Toronto.
The EVREST study was developed to help inpatient rehabilitation specifically with improving motor function that has been impaired after a stroke. About 85% of stroke patients experience a hemiparesis (weakness on one side of the body) after their stroke. Use of the virtual reality gaming system has several advantages for improving motor function in rehabilitation therapy which are being explored in the study. There are several centres around the world involved in the EVREST multi centre study.
Determining Optimal post-Stroke Exercise
In stroke recovery and rehabilitation, one of the top priorities is to determine what is the ideal time frame, and the ideal treatment intensity for someone to have the most optimal recovery. Currently not is a lot is known about when the best time to start rehabilitation after a stroke. Much of the research done in stroke occurs in individuals with chronic impairments. The DOSE study is a multi-centre Canadian study that focuses on examining the response to an intensive rehabilitation program that begins in the first month post-stroke. The goal for this study is to determine if starting a more intensive rehabilitation program earlier can yield a quicker recovery, as well as a greater degree of recovery after stroke. The DOSE study focuses on ambulation (walking and balance) training, as well as strength training in the lower extremities. Previous research has shown that greater repetition and higher aerobic activity training leads to a greater recovery. There has also been a growing recognition between the relationship of aerobic exercise and brain health. If there is increased aerobic workout and endurance training, it may help improve some of cognitive impairments that can be caused after a stroke as well.
The Dukelow Neuro Robot Lab at Foothills Medical Centre is one of three sites in Canada involved in this trial. The DOSE trial is also being conducted by Dr. Janice Eng from the University of British Columbia in Vancouver, and Dr. Mark Bailey from the University of Toronto.
Pressure ulcers are more commonly referred to as bedsores, which are not uncommon in patients that have reduced mobility. A pressure ulcer develops when pressure is applied to the soft tissue, which results in partially or completed obstructed blood flow to the surrounding soft tissue. As a result of the constant pressure and decreased blood flow the surrounding tissue will start to die and a pressure ulcer will form. Pressure ulcers do not only form from pressure or compression of tissue, they may also form due to a shearing force; where a patient stays in a fixed position, and the deep fascia and skeletal muscle slide down with the force of gravity. This can also cause compression of blood vessels which will can reduce blood flow to the surrounding tissue, and eventually form a pressure ulcer. If a pressure ulcer forms and is left untreated the ulcer can become very deep, to the point where muscle, tendon, and eventually the bone are exposed from the affected area. Typically pressure ulcers can be quite painful for the patient, they can increase the risk of infection, increase mortality, and generally mean a longer stay in the hospital.
In association with Project SMART, led by Dr. Vivian Mushahwar, the Dukelow Neuro Robot Lab is examining pressure ulcers in a hospital environment. A healthy individual may work at a desk for several hours, and has a low chance of developing a pressure ulcer, because even when a healthy individual sits and works at a desk all day they will regularly fidget and make small adjustments, shifting there body weight. These regular small movements and contractions of the muscle relive the pressure applied to the soft tissue are typically enough to prevent the formation of a pressure ulcer.
Smart-e-Pants are a device that uses an Intermittent Electric Stimulation (IES) to cause muscle contractions of the gluteals to reduce pressure and restore bloodflow. The Smart-e-pants device looks like a pair of shorts with the IES electrodes inside the fabric. The prostheses is set up to be put on and removed like any regular garment; but for any patient that is immobile in bed, wearing the device would cause small regular muscle contractions around the gluteal muscles, which is one of the most common places that a pressure ulcer can develop.
The Dukelow Neuro Robot Lab has been tested this device on participants with spinal cord injury and stroke, as well as individuals admitted to the Intensive Care Unit. The Project SMART team has also tested the device at the Allen Gray Long term care centre, and at the Glenrose Rehabilitation Hospital on the elderly and individuals who are in wheelchairs, who have reduced mobility and have a greater risk of developing pressure ulcers.