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The Catalyst

Investigators involved in ground-breaking stroke research

By Mikie Hayes
Public Relations

Jim Simpson, who suffered a stroke in 2007, participates in a study using tDCS, a new technology that helps with brain recovery for stroke patients. photo by Dawn Brazell, Public Relations

His head wrapped in blue bandages attached to wires leading to a mysterious black box, Jim Simpson stares at a computer screen, trying to distinguish whether the word he hears actually matches the picture he’s looking at. His task is to press the green button if it does and red button if it doesn’t.

As random images appear and just as quickly disappear, properly identifying the object is not nearly as easy as it looks — especially considering the fact Simpson continues to battle back from a debilitating stroke. More than seven years leater, he still suffers the effects of aphasia — a speech and language disorder that resulted from the assault to his brain’s language system.

Stroke, one of the most disabling conditions in the U.S., can result in a multitude of long–term or permanent disabilities like aphasia. Simpson had his stroke on February 2, 2007, and since that time has experienced a number of residual problems that have severely impacted his quality of life, aphasia being one of the most frustrating.

The left side of Simpson’s brain was affected by the stroke, which is the reason he was left with significant problems with speech and language. His wife, Donna, explained that he knows what things are but has difficulty expressing himself. He learned to write with his left hand and is able to write basic things such as his name. He enjoys reading, especially his Bible, Donna shared, and he is able to pick out words on a menu.

Language problems, in particular, can be very upsetting to patients and their families. Aphasia, according to the National Center on Biotechnology Information, tops the list of symptoms people fear most about stroke, which is not surprising as patients often may have a great deal of difficulty with critically necessary day–to–day functions such as speaking, recalling words, and reading and writing. In more severe cases, aphasic patients may have difficulty comprehending what people are saying to them.

Sheri Davis and Dr. David Bachman review a brain image of a potential participant. photo by Mikie Hayes, Public Relations

As researchers learn more about brain recovery, they strive to find ways of improving the brain’s response to injuries such as stroke. David Bachman, M.D., a professor in the Department of Neurosciences, said, “At this time, we are more or less dependent on the natural recovery processes of the brain for improvement to occur. Speech therapy is important in recovery, but often there is still a substantial language disability.”

Patients often, though not always, improve after a stroke, but there are no medications to speed up or enhance that recovery. “We have relatively good insight into how to prevent stroke,” Bachman said. “We also have new drugs and treatments for acute stroke, especially the first five hours after symptom onset. However, aside from speech therapy, which is very important, we have no therapies to change the brain to improve its ability to recover.” Hopefully that is about to change.

Through an ongoing research study, funded by the National Institutes of Health Institute on Aging, Bachman and two other MUSC researchers, Leonardo Bonilha, M.D., Ph.D., an assistant professor in the Department of Neurosciences, and Mark George, Ph.D., Distinguished University Professor in the Department of Psychiatry and Behavioral Sciences, are investigating a new form of brain stimulation, called transcranial direct current stimulation, which could potentially improve language function in stroke patients when administered during speech therapy.

Bachman holds out great hope for this study. He explained, “We are very excited. This new technology uses a very low voltage electrical current applied directly to the scalp with electrodes for a period of about 15 to 20 minutes. Studies suggest that brain cells directly under the electrodes may be activated. Increasing the activation of these neurons potentially could allow more opportunity for the brain to ‘rewire’ itself, thus enhancing stroke recovery.”

Although many aphasic patients will recover, more than 60 percent continue to struggle even after a course of speech therapy. For patients like Simpson, who have not recovered much of their former ability to communicate, novel research, like this study, offers new hope for possible improvement.

Last year, Simpson applied to enroll in the tDCS research trial. Because he scored only two out of 80 words correctly, he was not able to participate. Last week, however, he correctly identified five words, the minimum number to participate. He is now enrolled in the study, and he and his family are hopeful he will improve.

“We just want an opportunity to try and jumpstart his progress,” Donna said. “He’s plateaued, and we’d like to see some results in his speech that will allow him to communicate better.”
Because the study is double–blinded, meaning neither the subjects nor the researchers know which participants are receiving the brain stimulation, Simpson may be receiving the real or sham brain treatment while he undergoes three weeks of speech therapy, using for one, the 175–item Philadelphia Naming Test, where the patient presses the green or red button to signify yea or nay to the image. The PNT consists of high–, medium–, and low–frequency nouns that range in length from one to four syllables.

All patients involved in the study receive speech therapy which is the traditional treatment approach in the rehabilitation of aphasia. Controlled studies have shown that this approach may modestly improve naming performance. The threshold between the results a patient receives from the speech therapy alone and those resulting from the brain stimulation will ultimately determine the efficacy of the study. Until the study is completed, investigators won’t know the results.

While Simpson has his own special way of communicating with his family, using the few words he is able to speak, dealing with the reality of aphasia for the past 7–½ years, has been a major frustration for him and also for Donna who longs to be able to have “a normal conversation” with her husband.

Bachman said this situation is not unusual for stroke patients. “Aphasia is a particularly devastating symptom of a stroke since much of what we do in life is to communicate with other people. It can result in patients becoming more socially isolated or even depressed.”

Donna agreed, sharing that her husband can sometimes get frustrated when trying to do the things that were at one time simple. “Jim manages to keep a pretty positive attitude,” she said. “But sometimes he gets down when he isn’t able to do the things he would like to do. He stays optimistic because of his strong faith in God. The Lord is the only thing that keeps us going.”
Simpson, a tall, strapping 55–year–old, is described by his wife of 32 years as having a great sense of humor and having been a terrific conversationalist. As a second degree karate black–belt, Simpson was not only accustomed to being active but having precision control over his body movements. Donna said he misses it very much and hopes to get back into it one day.

The Simpsons own a local wood flooring business that is known for its radio commercials featuring Simpson, before his stroke, telling radio listeners that: “My aim is to honor God through my business.” Donna took over the day–to–day operations of the company after his stroke. She said it has been difficult for both of them, but they remain hopeful. She is grateful to the people who help her so she is able to bring her husband to MUSC to participate in the study. She said she doesn’t know what she would do without them.

Her love for her husband is clear, as is her not–so–secret hope that he is one of the participants actually receiving the tDCS.

When the study is complete in 2017, the hope is this new technique will have represented a leap forward in the treatment of aphasia. Bachman points to a computer screen that displays an image of a participant’s brain. Three distinct types of brain tissue are apparent. Bachman circles the black tissue, which represents the part of the brain that died as a result of the stroke; then the gray area, he says, is tissue hanging on by a thread, but possibly still salvageable; and finally, the white area which is viable, intact tissue that is trying to compensate for the dead and damaged areas. He hopes the tDCS, by stimulating intact brain tissue spared from the stroke, will compensate for the tissue damaged by the stroke.

“We hope that the newly stimulated brain tissue will help take over some of the language function that was lost when the stroke occurred. Giving tDCS during special speech therapy could potentially enhance language function in aphasic patients who are more than six months out from a stroke.”

Bachman expressed how important this study is to the participants and their families and the future of aphasia treatment. For Simpson, this study could mean being able to say the words “I love you” to his wife again.

Ladson residents Jim and Donna Simpson stay positive and upbeat during the testing process. photo by Dawn Brazell, Public Relations

The study was initiated by Julius Fridriksson, Ph.D., director of the Aphasia Laboratory and professor in the Department of Communication Sciences and Disorders at the University of South Carolina, who also serves as the principal investigator of the overall study.

Now, 2½ years into the five– year–trial, Bachman and the team are recruiting additional  subjects for this important study. Research volunteers should have mild to moderate aphasia due to stroke and be at least six months out from the date of their stroke onset.

For information, call Sheri Davis at 792-2845.

January 2, 2015

 

 
 
 

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