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Dr. Gail Eskes


“Repair kit” to help people regain quality of life after stroke

By Elaine Flaherty

HALIFAX_ Dr. Gail Eskes chooses a gardening metaphor to describe her research combining aerobic and cognitive therapy for stroke patients.

“Exercise would be enhancing the fertile ground – improving brain function – with the cognitive piece sowing the right flowers,’” says Dr. Eskes, a clinical neuropsychologist and professor in the Department of Psychiatry at Dalhousie University. “And then you have a beautiful garden.”

At Halifax’s Cognitive Health and Recovery Research Laboratory, Dr. Eskes and her team of students and staff members are half way through a pilot project looking at how people recovering from strokes can benefit from exercise (walking on a treadmill) and playing a specifically designed computer game.

Working with Dr. Marilyn MacKay-Lyons, Dr. Shaun Boe and Dr. Michelle Ploughman at Memorial University in Newfoundland, she’s also examining whether the order of the activities makes any difference to the outcome.

Exercise is connected to neurogenesis  – the birth of new neurons. And while exercise does seem to increase brain function in stroke patients, the big challenge is finding an aerobic activity suitable for those recovering.

“They aren’t capable of doing the intense walking or spinning on bicycles,” she says. “So what we wanted to do was enhance that by adding the cognitive part.”  The only criteria for participants are that they have the capacity to do the exercise and the language to be able to take part in the study.

This study is just part of Dr. Eskes’s five-year $2.8 million project funded by the Atlantic Innovation Fund and other agencies to build what she calls a ‘Cognitive Repair Kit.’ It will include a number of game-like software tools to address the basic problems faced by people who’ve experienced strokes: distractibility; reduced working memory, “basically your mental blackboard” she says; and difficulty with sustaining concentration to stay on task.

Now in year three, Dr. Eskes says building the kit is an iterative process of testing, tweaking and testing again. And the hope is to find further funding to continue with development of similar interventions.

But building a one-size-fits-all toolkit is out of the question, says Dr. Eskes.

“One of the biggest challenges is that everybody is different after a stroke, depending on how big and where the stroke is. Different parts of the brain do different things so everyone has their own specific challenges. So one of the biggest issues is, how do we take what we might know about enhanced recovery and how can we apply it to each individual?”

While patients may all have different needs and different goals, there is one constant. “I think of cognition as a scaffolding for people to relearn everything.”

The kit will also feature an assessment tool, “because you need to know what the issues are before you can fix them.”

There are number of researchers in Canada working on similar projects, but as far as she knows, this is the only one targeted towards stroke recovery and Parkinson’s patients, who have related problems.

Dr. Eskes and her team are testing another pilot project, again involving computer games, but this one is aimed at patients who are back at home.

Called ‘cognitive telerehabilitation,’ the therapy involves asking patients to play an online game from the Cognitive Repair Kit, called N-IGMA, fashioned and named after the infamous Second World War encryption machine. This research is part of a national telerehabilitation initiative funded by the HSF Canadian Partnership for Stroke Recovery and Heart and Stroke Foundation

“One of the big issues is, how do patients keep getting rehab after they leave the hospital?” says Dr. Eskes. That issue is compounded when patients live far away from centres where rehab is available.

“That’s what we’re trying to do – to work on a process for the Internet and the phone that would allow people to go home and continue getting rehab for their cognitive problems.”

Working with Halifax-based IT firm TeamSpace, Dr. Eskes and her researchers have designed a game that asks participants to recognize patterns. “You can gradually build up how many things you have to hold in memory to do the matching,” she says.

When the website is up and running, it will also include an educational section, a tutorial section on how to play the game and maybe even a chat room. Therapists will be able to log on, monitor patients’ progress and help them set goals.

Dr. Eskes started her career as clinician who saw the shortfalls in programs available to help stroke patients resume their daily lives.

“I want them to feel more attentive,” she says. “I want them to feel like they’re able to do things that give them back their quality of life. That’s our major goal.”