Tuesday 20 March 2018

Second lease of life

Dr Ken Monaghan and his team of three PhD researchers tell Sorcha Crowley about giving stroke patients fresh hope and mobility

L-R: PhD researcher Patrick Broderick, Director Clinical Health and Nutrition Centre Dr Ken Monaghan and PhD researchers Monika Ehrensberger and Daniel Simpson in their lab at IT Sligo
L-R: PhD researcher Patrick Broderick, Director Clinical Health and Nutrition Centre Dr Ken Monaghan and PhD researchers Monika Ehrensberger and Daniel Simpson in their lab at IT Sligo

A quiet miracle has been happening in homes around Sligo since 2015. A team of researchers at IT Sligo are helping stroke patients to move again - by using mirrors to trick their brains.

"If you train one side of your body in the gym for six weeks, that side of your body will get stronger, but amazingly the other untrained side gets stronger as well, by maybe 40-50 per cent," he tells The Sligo Champion in his lab.

The Rathcormac native first came into contact with mirror therapy while working as a clinical specialist musculoskeletal physiotherapist in rehab centres in Ireland and the US.

Then, when treating a friend who had a stroke, he had a light bulb moment.

"I saw some great improvements in treating him and saw the potential in it. That was my spark to wanting to do this," he says.

Now the Director of the Recognised Research Group at the IT, Ken has a team of three PhD researchers dedicated to stroke rehabilitation as he saw the room for bringing on new treatments.

The common perception of strokes are that once you hit six months post-stroke rehabilitation, that's it. You're sent on your merry way to live with whatever restrictions you're left with.

Dr Ken Monaghan and his team are changing all that, however.

Ordinarily, your brain sees that your affected limb isn't working and so effectively, 'ignores' that part of the body.

If however, you watch a reflection of your mobile limb in a mirror, something happens in your brain, as researcher and neuro-psychologist Patrick Broderick explains:

"It appears as if I'm moving my good hand, so I'm getting a positive visual feedback telling my brain that I have two fully functioning and moving hands.

"It effectively tricks the brain into believing that your hand is working again. Or it's tricking the brain into believing that I'm walking in a proper pattern again and that my weak leg is now working properly," he says.

The result is that it stimulates the motor function areas of the brain, prompting it to send energy and to activate that damaged hemisphere.

"It creates new pathways in your brain. It can re-ignite old pathways or establish new ones that help your limb function," he says.

The mirrors work for arms and legs and it's surprising how quickly - after just 30 seconds - that the brain can be fooled into thinking both limbs are functioning again.

Patrick is another Sligo native who is qualified in the assessment of head injuries or a stroke and designs interventions for them.

He was working with Acquired Brain Injury Ireland when he first became interested in the area.

"The first time I saw mirror therapy I saw instantly the effects that it had, bringing movement to limbs which had no movement whatsoever for years. For me that was startling. And the fact that very little research was being done on it," he says.

"We're seeing a lot of increases in people's overall ability to walk on a day to day basis, increases in walking speed, in their endurance and big increases in their overall motor function.

"When people have increased mobility then they can do all the other activities in their lives a lot easier. It creates a lot of independence. It's giving chronic stroke patients a second lease of life. A patient told me yesterday that for the first time since she had her stroke she felt like a normal person. She felt like she didn't have a stroke anymore, she could get on with her life. We're seeing this in all our patients. It's transforming," he says.

What this form of therapy is offering is a new approach to rehabilitation. Traditional phsyiotherapy gets people to a point. Mirror therapy comes in afterwards and brings people a step further.

"The beauty of mirror therapy is that it cuts down on expense. You don't need a therapist, you can use it yourself at home. You can put this device onto your treadmill at home and you can start walking and do it. You lead the way. That's the beauty of it," adds Patrick.

Sports Science specialist Monika Ehrensberger and Health Promotion Officer Daniel Simpson are the other two phD researchers working with Ken.

They are working on strength training in chronic stroke patients but their first obstacle turned out to be their most opportune.

"We initially tried to get all the stroke patients to come here but it's very difficult to get stroke patients to come here because they need someone to bring them and it's a big commitment to come here for four weeks of the exercises," says Ken.

As the proverb goes, "If the mountain won't come to Muhammad then Muhammad must go to the mountain", Ken and his team had to devise a way of bringing the therapy out to patients.

Monica and Daniel devised a portable medical device that allows them to go out to patients houses and allows them to do exercises and use the mirrors.

They've had such good results, they're now in talks with Enterprise Ireland to see about developing it as an official medical device.

"We think there's great potential in it and they're very interested in it. It's kind of like an offspring of what's happened. It's very good for your soul," says Ken.

"They do all the training on their good side so that the other side will benefit," says Monika.

"The strength increases and stiffness decreases, it relaxes in nearly every patient we've seen," she says, adding that "significant improvements" have been seen, with patients able to open a jar of coffee or button up a coat.

Industrial Designer David Roberts from the IT's Creative Design Department is tasked with developing the new devices and is currently building a portable treadmill for Patrick's patients.

"It's always exciting to work in a new area, particularly with people who are enthusiastic about what they are doing," he says.

"I'm really excited by this because it could have a huge benefit to people."

Ken and his team are in touch with the five or six people in the world that see potential in this kind of therapy. It's the only research of its kind going on in Ireland at the moment.

They have high hopes for the future of both the therapy and the device.

"When a person sees a little bit of an improvement, that's a great motivator. It encourages people to do more. In the early stages it was difficult to get people involved in trials.

"What's lovely now is for the first time the word is out there and people are starting to contact us now looking to be involved in the trials.

"You don't need much supervision. It's completely safe. Imagine somebody using it every day for a week? Surely there's benefit for acute patients in hospitals," he says.

"My hopes are that we could inject some virtual reality into this. That would be the next stage," says Ken.

"In ten years time that device will be used in hospitals worldwide - that would be the hope."

A stroke destroys two million brain cells every minute. If you suspect that someone is having a stroke call 999 immediately.

When stroke strikes, act F.A.S.T.

F.A.S.T. stands for:

F - Face - has their face fallen on one side? Can they smile?

A - Arms - Can they raise both arms and keep them there?

S - Speech - is their speech slurred?

T -Time to call 999 if you spot any single one of these signs.

Helen Cassells was four years post-stroke when she heard about Dr Monaghan and the work he was doing with his team at IT Sligo.

She'd had a stroke in 2011 and while she wasn't confined to a wheelchair or a stick, she felt much slower than normal in walking.

"I felt I needed a little bit extra so I joined the IT team and found the mirror therapy very good," she said. "I had a weakness on the right side but I was mobile."

Helen completed a four week trial of the mirror therapy in 2015, for half an hour three days a week. The results were surprising: "For the first time I could actually run again without thinking. I wouldn't run a four minute mile but I can go much faster than I could before," she said.

Helen also credits the therapy on Daniel and Monika's device for restoring movement back to her arm. "All of a sudden I was turning on the tap with my right arm and I didn't realise I was doing it. It's the simple things. It's definitely another way of treating people with strokes," she said.

Sligo Champion