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CPSR study probes new ways to retrain the body and brain after stroke

ST. JOHN’S, NL _ A unique CPSR study that compares different combinations of mental and physical training in chronic stroke patients will help determine the optimal prescription for post-stroke recovery.

In an innovative clinical trial underway in Newfoundland’s largest rehabilitation hospital, a team of CPSR researchers led by Dr. Michelle Ploughman is studying stroke recovery in 40 people by combining different kinds of computer brain games and fitness training.

“What we do here is real-world trials,” says Dr. Ploughman, who is Canada Research Chair in Neuroplasticity, Neurorehabilitation and Brain Recovery. She is also the CPSR site leader at Memorial University of Newfoundland (MUN).

She runs the first MUN research lab embedded in a hospital.

Study participants undergo 10 weeks of intensive training, three times a week and receive follow-up at six months. They are randomized into different protocols: Some receive a CPSR-funded cognitive-training program developed by Dr. Gail Eskes at Dalhousie University; and others use an off-the-shelf computer game program.

Brain games are combined with either whole-body exercise programs or treadmill training.

Doctoral student Liam Kelly shows a visitor one of the training rooms, which has a treadmill with a harness to support participants who use a wheelchair, the NuStep recumbent cross-trainer, and a floor mat to challenge gait and balance.

Masters student Beraki Abraha demonstrates the sophisticated transcranial magnetic stimulation machine that measures brain “excitability” to determine if study participants see improvements in the speed of signals moving from the brain to hand and the foot.

As part of the trial, researchers measure the patient’s fitness, resting metabolic rate, and various blood markers before and after participation in the study.

“My focus is always on intensity – more repetitions, higher heart rate and more frequency,” Dr. Ploughman says. “In many cases, rehabilitation is not intensive enough.”

The study, which is expected to finish in May, will primarily evaluate cognitive outcomes in patients, especially the ability to problem-solve using new information.

“People think physical and cognitive are separate, but they’re not,” Dr. Ploughman says. “You need cognitive capacity to learn a new physical skill. If you don’t have the cognitive, the physical doesn’t work.”

Results from the study will lead to the development of new protocols for stroke rehabilitation.

Dr. Ploughman worked for 15 years as a physiotherapist in neurorehabilitation before doing graduate and post-graduate work in basic science, studying animal models to determine how responsive the brain is to change.

She was able to leverage CPSR funds, her Canada Research Chair and matching funds from Newfoundland’s Research and Development Corporation to fully support her current research program.

Dr. Ploughman said she sees everyday the benefits of being part of a larger network like the CPSR. “It’s all about connections to your collaborators.”

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