Device helps retrain brain of stroke victims

BALTIMORE " After Norris Turner's stroke a decade ago, he would tuck his right arm into his pocket to get the nearly useless limb out of the way. Now the 68-year-old from suburban Columbia can use the arm to play catch with his grandson and hit a golf ball nearly 100 feet.

Turner's progress has made him something of a poster child for a machine called the Tailwind. It's licensed and for sale by researchers from the University of Maryland who invented it and a local entrepreneur who believed it could help patients like Turner.

"We think there is tremendous potential for this device," said Sandy McCombe Waller, who worked on the Tailwind with colleague Jill Whitall. Both are professors in the University of Maryland School of Medicine's Department of Physical Therapy and Rehabilitation Science. Turner was a test subject.

"Mr. Turner didn't start high functioning but has been able to return to recreational activities," she said. "He can grab things with his arm, drink from a cup. They sound like little things, but they are huge things."

Strokes affect about 750,000 people a year in the U.S. and are the third-largest killer behind heart disease and cancer, according to the American Stroke Association. They are the top cause of adult disabilities.

Clamped to a table at the university, the Tailwind looks a set of metal arms with handles. A stroke patient sits in front of it, grasps the handles and repeatedly runs them back and forth to a metronome, a steady, audible beat that facilitates movement.

Unlike a bicycle, the limbs move independently, so a weak arm cannot depend on a functioning arm.

According to two studies printed in Stroke and the Journal of the American Medical Association, patients who use the device begin to show progress after about six weeks.

The repetition retrains the part of the brain that controls motor skills but was damaged by a stroke. A stroke on the left side of the brain affects the right arm, and vice versa.

Like muscle strengthening, weakened motor pathways eventually become stronger and patients make smoother movements.

The machine tilts up, the arms extend and the metronome pace increases to make it more challenging. The eight-minute sets were exhausting for Turner, but the workouts have been worth it, he said one recent day as he demonstrated his routine at the university, moving his arms out and back in tandem, and then one after the other.

"Results come in spurts," said Turner, who participated in a Tailwind study two years ago and has continued working with the machine at the university and at home (researchers gave him a device).

Those involved in stroke therapy say there isn't much else available for such patients. There are even fewer options that are portable and can be taken home.

The device's success in studies was notable for showing "neuro-plasticity" " recovery of brain function years after a stroke, said R. Samuel Mayer, who did not take part in the Tailwind research. Mayer is a physician adviser for the Department of Physical Medicine and Rehabilitation at Johns Hopkins Hospital and medical director of the hospital's inpatient rehabilitation.

"Traditionally, people thought that little recovery occurs from stroke after three to six months," he said. "We now know that rehabilitation can help people even years later recover some function."

It's not clear how clinics and individuals will respond to the $2,400 price tag on the Tailwind " insurance and Medicare will not cover therapy. Formal marketing begins in the next few weeks, and none have sold yet.

Mayer said other promising therapies are being studied for low- and higher-functioning patients, some of which the Tailwind researchers are involved in testing.

"The important issue is to keep patients active after stroke," he said.

Turner plans to continue working on his Tailwind five days a week. He also plans to keep tossing a ball to his grandson.

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