“Awake with a winged heart, and give thanks for another day of loving.” — Kahlil Gibran

At a recent University of Texas Medical Branch Osher Lifelong Learning seminar, Dr. David Brown, our new Dean of the School of Health Professions at the medical branch showed how biology, neuroscience, physical therapy, robotics and virtual reality can work together to help stroke patients recover functionality. He demonstrated basic and clinical science that the brain can actually create new pathways to learning and memory even after major damage like a stroke.

Strokes happen when a blood clot blocks a vessel in the brain or a vessel bursts. These are embolic or hemorrhagic strokes, respectively. That part of the brain that doesn’t get blood flow loses viability as cells are starved for oxygen.

Of course, we want to prevent strokes by taking care of our blood vessel health. This is the same as what we would do for heart health: exercise regularly, maintain a healthy weight, avoid smoking, control cholesterol, blood sugar, and blood pressure levels, eat a nutritious Mediterranean-type diet, manage stress effectively and foster positive relationships in your life.

The brain has neuroplasticity. It changes in response to learning tasks, primarily through repetition and retrieval. Active engagement can boost our ability to learn and retain new information imbedding it in our neurocircuitry, even rewiring the parts of the brain damaged by stroke.

Like someone walking a new forest path, the more times they return to the site, the more defined the path. Memory and learning work the same way.

In Dr. Brown’s research, he uses robots to keep patients with strokes or other neurological disabilities from falling by supporting them while they attempt progressively more challenging rehabilitative tasks, walking more normally, standing on a slippery surface, climbing and so on. They fail, they fail again, but like that path in the woods, the brain seems to self-correct and teach itself until the task is accomplished successfully.

Consider the pianist who must practice to perfection but needs to do it wrong, repeat, retrieve and practice to produce the desired musical piece. Or consider the baby learning to walk. Up, down, stagger, stretch, fall, get up and finally go forward one teetering step at a time. Both must be unafraid of failing so they can progress. The robotic assistant helps the stroke patients progress so they aren’t afraid of failing and falling.

Another new approach to neurological injury is offering virtual reality games that are interesting and require movement such as fending off various villains and beasts encouraging motions that might be monotonous in the usual physical therapy session. A split belt treadmill can help strengthen a leg weakened by stroke.

Such methods are called collaborative technology and will likely become routine care in the future. His robot is called the KineAssist, and it costs at least $100,000. I predict with greater usage, costs will come down and availability in hospitals will make it a standard of care for many conditions requiring improvement of locomotion, balance and movement.

In the meantime, take good care of your cardiovascular system.

Dr. Victor S. Sierpina is the WD and Laura Nell Nicholson Family Professor of Integrative Medicine and Professor of Family Medicine at UTMB.

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