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Seeking to unlock muscles and joints after stroke

Stroke doesn’t only affect the brain, says University of Toronto neuroscientist Dr. George Mochizuki. Its reach is much broader.

In the first year after stroke, up to 40 per cent of people are faced with “spasticity”, a tightness and stiffness in the muscles and joints. The result can be a clenched fist, a flexed elbow, a bent wrist, or an in-turned shoulder.

“Spasticity can make it difficult to perform many tasks of daily living, like opening a hand to wash it, grabbing a cup of coffee or reaching out to open a door,” Dr. Mochizuki says.

That’s why he and his team of researchers at the Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (CPSR) are involved in a three-year study of 30 patients to determine the right mix of pharmaceuticals and targeted physiotherapy to reduce spasticity and to help people regain movement and function of their limbs. The results could bring life-changing improvements for thousands of Canadians living with the effects of spasticity.

“When we get “the mix”, we can say this is the right recipe of pharmaceutical intervention and therapy to see physical changes,” says Dr. Mochizuki, an assistant professor in the Department of Physical Therapy at the U of T. “If we see that, we can get the information out to clinics and impact the management of spasticity in Canada.”

Anne Carrier, whose husband Adrian had a major stroke in 2006, says there is a huge benefit to the research under way. Adrian, 74, a retired packaging plant supervisor, took part in the CPSR study and, after 20 weeks, had greater use of one arm and can hold a cane steady. “I am very thankful he had the opportunity to do this.”

One of the most popular therapeutic approaches for treating tightened muscles is with Botulinum toxin-A, or BOTOX® injections. BOTOX® blocks the release of a chemical signal from the nerves, which is necessary for muscle contractions to occur. While research demonstrates that BOTOX® reduces tightening and pain, there is not a lot of evidence to show it can help improve function, Dr. Mochizuki says. The purpose of the CPSR study is to better measure the impact of BOTOX® and the underlying physiological changes it promotes, and to identify the therapies that contribute to these physiological changes.

CPSR scientists are using sophisticated technology — EEG (electroencephalography), a tool that measures brain activity during the performance of different tasks, EMG (electromyography) a tool that measures activity in affected muscles, and a robot that measures movement characteristics – to uncover and quantify subtle changes in movement patterns in the treated upper limb. Understanding underlying changes in the control of movement will allow the development of targeted therapies for specific muscles and joints.

The study is funded by Investigator-initiated Trial Funding from Allergan Canada, Inc. (makers of BOTOX®), the FedDev Technology Development Program for Southern Ontario, and the Heart and Stroke Foundation Canadian Partnership for Stroke Recovery. Researchers at Sunnybrook, Toronto Rehab and Queen’s University are involved in the project.

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