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The Catalyst

The changing image of stroke recovery

$10.8M COBRE/NIH grant funds stroke recovery center

By Mikie Hayes
Public Relations

Stroke survivor Patricio Gombs checks out his gait while in MUSC’s locomotor rehabilitation laboratory that houses a ZeroG mobile body weight support system (only the 6th one installed nationally) designed to retrain walking ability using a split-belt treadmill. photo by Sarah Pack, Public Relations

You lived through the stroke. That’s the good news. When you woke up that morning you had no idea you would be in for the fight of your life. Fortunately, a loved one recognized the warning signs and got you to MUSC’s Comprehensive Stroke Center where the Brain Activation Team was able to administer a thrombolytic agent to bust the clot or rushed you to surgery to undergo a thrombectomy to remove it.

But now you are in for a different fight. In terms of hoping to resume a good or even reasonable quality of life, what comes next can be nearly as important as making it through the stroke: rehabilitation and recovery.

The lifetime risk of stroke is 1 in 6. That amounts to 795,000 Americans suffering a new or recurrent stroke every year (See SC Research Center for Recovery from Stroke graphic and related graphics at http://academicdepartments.musc.edu/pr/newscenter/2014/stroke-recovery-infographic.html).

South Carolina falls into an area known as the “stroke belt,” a name given by public health officials to a region of the southeastern U.S. that has an unusually high incidence of strokes. The state also has the distinction of being included in the “buckle” of the belt as 16,000 South Carolinians suffer a stroke each year. The state also has a couple of other disadvantages: It has one of the highest incidences of stroke mortality in the nation and the age at stroke onset is younger here than the national average.

Stroke is one of the most disabling conditions in the U.S. and one of the main causes of long-term disability. When a person lives through a stroke, often the effects of the stroke will negatively impact quality of life. In the U.S., 50 percent of stroke patients will have a resultant deficit (weakness of one side), 30 percent will be unable to walk without assistance, 26 percent will be dependent in activities of daily living, and up to 38 percent will have aphasia. According to the National Center on Biotechnology Information, aphasia, which is defined as an impaired ability to communicate, is at the top of the list of symptoms people fear most about stroke.

 

Today, there are more than 7 million people in the United States who have survived a stroke and are living with the aftereffects. With these types of serious residual effects, stroke can hinder a person’s ability to reintegrate into society. Even the simplest tasks that typically get taken for granted: walking to the kitchen, talking to loved ones, lifting a glass, remembering a grandchild’s name can become virtually impossible.

Steven Kautz, Ph.D., chairman of the Department of Health Sciences Research and co-director of the Center for Rehabilitation Research in Neurological Conditions (CRRNC), has dedicated his career to making stroke rehabilitation more effective and developing interventions that will help these individuals regain their independence and return to their lives and careers. That goal —  improving the recovery of stroke victims — became the basis for the submission of a Center Of Biomedical Research Excellence (COBRE) grant application aimed at establishing a center for the study of stroke recovery that would bring together experts from MUSC’s front lines of stroke rehabilitation research to work together in an interactive, collaborative setting.

The goal of a COBRE grant is to strengthen an institution’s biomedical research infrastructure through the establishment of a thematic multi-disciplinary center — in this case, the theme being stroke recovery. COBRE awards are supported through the National Institutes of Health’s Institutional Development Award program. The IDeA program fosters health-related research by increasing the competitiveness of investigators at institutions located in states, such as South Carolina, that historically have had low success rates for NIH grant awards. Through this program,  a critical mass of investigators will be developed, through a mentoring program for junior investigators, to allow them to establish themselves and their work and enable them to obtain major funding in the future. In addition, several science cores will be established to support the work of the junior investigators and other investigators studying stroke recovery to further strengthen the MUSC research program.

Potential Impact
In early July, the MUSC College of Health Professions received news that it was the recipient of a $10.8 million COBRE grant from NIH — the largest such grant awarded to MUSC to date. The grant established the South Carolina Research Center for Recovery from Stroke from which important developments are expected. MUSC President David Cole, M.D., FACS, said of the award, “This COBRE grant award reflects a significant collective expertise on the forefront of stroke rehabilitation research at MUSC. We are very excited about the potential impact that the South Carolina Research Center for Recovery from Stroke will be able to make in the field of stroke rehabilitation because of this award. The MUSC College of Health Professions and the outstanding team involved in the grant deserve high praise — this level of investment from the NIH is a strong statement to the state and nation of the potential impact this research center will unquestionably have.”

Rehabilitation is the most critical part of recovering from a stroke, and in many cases, patients can relearn basic skills such as talking, gripping, eating, dressing, and walking as well as improve their strength, flexibility and endurance. The goal is to help them regain as much confidence and independence as possible.

According to Kautz, the center will invest substantially in advancing the fields of neural plasticity, rehabilitation and brain stimulation. This combination will best position the team to make a substantive impact on the practice of stroke recovery. “We believe that the future for stroke recovery will be pairing great new physical experience–based interventions with treatments to enhance the brain’s plasticity, be those treatments cell–based, like stem cells, or new drugs or other nervous system manipulations like harnessing electrical or magnetic brain stimulation.”

The COBRE grant allows a team of senior investigators with different skills to all work together to train and mentor the cadre of junior scientists involved in the grant who will then become skilled in multiple areas giving them the multidisciplinary toolbox they will need to become the next leaders in the field. They will be developing and translating new, mechanism-based interventional strategies in an effort to improve functional recovery from stroke.

Kautz believes the grant represents a significant step forward in stroke recovery research and the ability to create a maximally synergistic approach, offering hope not only to the people of South Carolina but well beyond.

“Rehabilitation is critical to long-term recovery and while research related to the prevention and treatment of stroke is plentiful, research to help those left with chronic disabilities after stroke has long been underemphasized. This provides an opportunity for us to coalesce research, new clinical interventions as well as product and process development to address this critical regional and global need.”

He continued, “The combination of the high volume of stroke cases in South Carolina and our ability to care for strokes that were once deadly has pushed the need for better, more robust rehabilitation approaches past the tipping point. This research center, which is dedicated to improving the recovery of stroke patients, would ideally position MUSC to impact public health in South Carolina, as well as the nation, over the next decade,” said Kautz.

The Center’s Cores
The center is divided into four distinct scientific cores that define the work of the center as well as a fifth core that concerns administration of the grant, duties of which fall to Kautz.
Kautz also heads up the Quantitative Behavioral Assessment and Rehabilitation Core which will provide standardized experience and quantitative measurement of behavior and function.  Determining where a patient is pre- and post-rehabilitation is critical to understanding the effects of stroke and rehabilitation in order to develop the best standards of care. It also allows researchers to continue to generate new ways to quantitatively diagnose patients with the goal of providing clinicians with meaningful biomarkers of behavior.

Using sophisticated, state-of-the-art equipment that is capable of capturing extremely detailed full-body movement, researchers assess a patient’s capabilities at any specific moment in time.

The Brain Stimulation (BSTIM) Core, led by Mark George, M.D., the Layton McCurdy endowed chair, director of the Brain Stimulation Laboratory and Distinguished University Professor in the Department of Psychiatry and Behavioral Sciences, will provide a plasticity modifying tool for treatment as well as quantitative measurement of plasticity and neurophysiology. Brain stimulation methods are emerging as cutting-edge interventions for increasing the sensitivity and plasticity of underlying neural circuitry for recovery from stroke. MUSC is widely recognized as a world leader in brain stimulation methodology in other diseases and the team expects the BSTIM Core will advance current applications and pioneer novel applications for post-stroke brain stimulation, enabling collaborators to perform research that would be impossible at most institutions.

The Neuroimaging Core, under the direction of Truman Brown, Ph.D., the Stephen S. Schnabel endowed chair in radiology, and professor in the Department of Radiology and Radiological Science, will provide quantitative measurement of plasticity and structural and functional connectivity. This core will use complex imaging to create and analyze pictures of the brain and provide quantitative measurement of the plasticity and structural and functional connectivity in the brain of stroke survivors. This will help the team develop new ways to determine the damage after stroke in order to help diagnose what is the best course of treatment for a patient.

Robert Adams, M.D., SmartState biomedical endowed chair in stroke, director of the South Carolina Stroke Center for Economic Excellence, director of the South Carolina REACH Stroke Network and REACH MUSC, will direct the Clinical & Translational Tools and Resources Core which will facilitate the progression of research from experimentation into practice through development and use of unique patient resources and data tools.

Kautz looks forward to spreading the word about the center and the impact of its studies. “We have great potential to assume a national leadership role in recovery from stroke,” he said. “The complexity of research in stroke recovery necessarily includes basic, translational and clinical investigations. We will be unique in our combination of expertise in human clinical research using quantitative behavioral assessment and rehabilitation, brain stimulation and neuroimaging techniques, and basic science research related to developing interventions for recovery from stroke. Our studies will answer important questions, open new areas for further study, and result in important changes to existing interventions and development of innovative new interventions, which will have the potential to revolutionize clinical practices related to recovery from stroke.”

He continued, “MUSC will soon be in position to lead and contribute to major programmatic initiatives and clinical trials to conceptualize and test potential enhancers of plasticity such as brain stimulation and cell-based therapies.

Lisa Saladin, PT, Ph.D., dean of the College of Health Professions, agrees with those assertions and has high hopes for the future of the center.

“I congratulate the entire research team on the COBRE for their collaborative and novel translational approach for addressing stroke recovery in South Carolina. The new South Carolina Research Center for Recovery from Stroke will provide citizens of South Carolina and beyond access to innovative clinical trials that have the potential to enhance outcomes and improve recovery post-stroke. At this time, it is also my pleasure to formally announce that Dr. Steve Kautz, a leader in stroke rehabilitation research and PI for the COBRE, will be the recipient of the first endowed chair in the College of Health Professions, the Christie Family endowed chair in stroke rehabilitation research.”

The Christie family, in December 2013, contributed a personal gift that established the endowed chair which will fall under the CRRNC. On Thursday, Nov. 6, the college will host an open house to celebrate the SCRCRS, the CRRNC and the chair.

September 28, 2014

 

 
 
 

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