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Timing is everything. But for stroke survivors, poor timing and rebellious muscles can make even simple movements difficult. Brian Schmit, Ph.D., associate professor of biomedical engineering, and Sheila Schindler-Ivens, Ph.D., assistant professor of physical therapy, are searching for new tools to help stroke survivors conquer those challenges.
Daniel Brian Schmit , Ph.D.,
associate professor of biomedical engineering, and Sheila Schindler-Ivens, Ph.D., assistant professor of physical therapy. Their research could help accelerate the recovery of stroke survivors.
Although Schindler-Ivens and Schmit are supported by the American Heart Association and the National Institutes of Health for their own stroke studies, their collaboration is key in advancing what is known about the interaction between a damaged brain and impaired movement.
“What we know about people with stroke is that they don’t produce enough muscle activity, and when they do produce enough, it’s abnormally timed,” Schindler-Ivens says. “In other words, muscles turn on and off at the wrong point in the cycle. So we’re trying to figure out two things: One, why is their muscle timing poor, and two, what can we do to fix it.”
Schindler-Ivens’ earlier research yielded a surprising discovery: Stroke survivors performed better when pedaling backward on a stationary bicycle than when pedaling forward. Now she’s trying to understand why. While the subjects pedal, she magnetically stimulates their brains and records responses in their legs. She also uses electrical stimulation to activate nerves in the legs to see how the sensory information is controlled.
Stroke reduces excitability in the brain. But Schindler-Ivens believes that a novel task, such as pedaling backward, could counteract that effect.
“We think when the brain excitability goes up, the sensory feedback is improved and that also improves the muscle activation pattern,” she says. “If it’s the case that a more difficult or novel task actually increases brain excitability and improves walking, it could change the way we think about rehab.”
With Schmit’s help, Schindler-Ivens is adding a motor to the bike so she can control the speed and distinguish between changes in the post-stroke nervous system that are caused by simply being moved as opposed to locomotion, or the act of physically pedaling.
But to truly understand what’s happening in the brain, the researchers need to be able to peer inside the brain while stroke survivors are pedaling — something they can do with an MRI. That’s the next stage in their collaboration.
“Nobody has ever looked at locomotion in people with stroke while they’re scanning the brain,” Schindler-Ivens says. “And one of the reasons it hasn’t been done is technically it’s very challenging.”
“The problem is if you take a bicycle into an MRI room, it becomes a ballistic missile because the metal from the bike is rapidly drawn into the magnet,” Schmit explains. To prevent that, he and a biomedical engineering graduate student are building a bike out of plastic.
“This whole idea of building devices that can be used in an MRI environment is really interesting,” Schmit says. “It could have a lot of applications.”
“Nobody has ever looked at locomotion in people with stroke while they’re scanning the brain. Schmit is also examining the role of sensory feedback. For stroke survivors, simply reaching out and grasping something is difficult. Schmit is experimenting with different devices and techniques, such as applying vibration to a muscle, that modify sensory feedback and make the brain think the arm is in a different place than it really is.
“What we’re trying to do is trick the brain,” Schmit says. “It seems kind of backward, but at least the subconscious part of the brain is going to be fooled, and that will make it easier for them to reach out and grasp.”
Schmit’s four-year study is exploratory, but he hopes to end with a design for a clinical trial. By unlocking the key to improving sensory feedback, he and others could accelerate stroke survivors’ recovery.
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