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New hope for stroke survivors with NHS robot research

Thursday, 03 July, 2014
New hope for stroke survivors with NHS robot research

The RATULS (Robot Assisted Training for the Upper Limb after Stroke) Trial

A major new national research programme using robot assisted training to help NHS stroke patients regain movement in their affected arm, has been officially launched in the North East today.

Led by stroke specialists at Northumbria Healthcare NHS Foundation Trust, with researchers at Newcastle University and other UK institutions, the £3 million research grant from the National Institute for Health Research (NIHR) will see NHS patients take part in the first ever and largest study of its kind in the UK.

The five-year clinical trial will involve up to 16 stroke services across the NHS focussed around four major study centres: North Tyneside General Hospital in North East England, Queen’s Hospital in Romford, Addenbrooke’s Hospital in Cambridge and the Western Infirmary in Glasgow.   Each of the four study centres will work with neighbouring local hospitals, community rehabilitation services, stroke clubs and GP practices to enable over 700 stroke patients to participate in the research project.

North Tyneside General Hospital is one of the first in the country to house the new state-of-the-art stroke ‘rehabilitation robots’ from the Massachusetts Institute of Technology (MIT) in the US after investing over £250,000.  Now, the hospital will lead the research programme in the North East, working with stroke patients from across Tyne and Wear.

Each year 110,000 people in the UK have a stroke and many have long-term problems moving or feeling their affected arm.  Rehabilitation with physiotherapy and occupational therapy starting as soon as possible after a stroke is currently the best way to maximise the amount of movement people eventually regain. 

A clinical trial of robot assisted training in the USA has shown that this approach to rehabilitation may improve upper limb recovery for some stroke patients. Now, the NHS is conducting a much larger study to see if robot assisted training leads to improved clinical outcomes for patients and more efficient use of valuable NHS resources.

How robot assisted therapy works

During robot assisted training, the person who has had a stroke sits at a table facing a computer screen and places their arm onto the device.  The therapist then asks the patient to undertake some arm exercises such as moving between targets on the computer screen.  If the person is unable to move their arm then the robot moves the patient’s arm to complete the task.  If the patient initiates movement, the robot provides adjustable levels of assistance to facilitate the person’s arm movement – all of which helps the brain and arm to learn to work together again.

Researchers from Newcastle University will work in collaboration with teams from the Universities of Glasgow, East London and Cambridge, as well as the Massachusetts Institute of Technology (MIT) and NHS stroke teams.

Helen Rodgers, Professor of Stroke Care at the Institute for Ageing and Health at Newcastle University and Consultant Stroke Physician at Northumbria Healthcare NHS Foundation Trust is leading the research. 

She said:  “Announcing the start of this clinical trial is a really exciting step forward for stroke rehabilitation research in the UK. We have been looking at the research undertaken in the USA and we are working closely with colleagues at the Massachusetts Institute of Technology to see if robot assisted training is an effective treatment. If shown to be effective, robot assisted training has the potential to change how we provide NHS rehabilitation for people with arm weakness due to stroke.”

Dr Hermano Igo Krebs, Principal Research Scientist and Lecturer at MIT in the USA, has pioneered the robot technology.  He said: “The robotic technology we have developed at MIT is already helping many stroke patients and people with other neurological conditions in the US.  The whole concept is revolutionising the practice of rehabilitation medicine by applying robotics that can assist and enhance recovery.

“Our focus is on helping clinicians to facilitate a functional recovery for their patients by using intensive and highly interactive robotic therapy to help people achieve their absolute optimum movement. By using robotics not only do we get a greater understanding of the neuro recovery process, but we can also build a rich stream of data that assists in ongoing patient diagnosis and customisation of the therapy.”

From April 2014, researchers began to recruit patients with first ever stroke to participate in the clinical trial. To be eligible to take part in the study, participants should be between one week and five years since their stroke and have moderate or severe difficulty moving their arm. 

Participants will be randomly allocated into one of three groups – one will receive the robot assisted training over a three-month period, one will receive equivalent intensive therapy carried out by a therapist and the final group will receive usual therapy treatment from the NHS.

The National Institute for Health Research Health Technology Assessment Programme (NIHR HTA) has awarded the research team £3 million to undertake this important work. 

Further information about the study can be found at http://research.ncl.ac.uk/ratuls/ or by contacting  the study coordinating centre at Newcastle University on 0191 208 6322 or email ratuls@ncl.ac.uk.

Stroke patient Tom Means – “Stroke robot is ideal for me”

Tom Means, from Walkerville, Newcastle, is one of the patients already taking part in the stroke robot clinical trial.

He had a stroke on 11 March this year and spent around two months in hospital. Now back at home, he continues to receive physiotherapy twice a week.

Tom attends North Tyneside General Hospital three times a week for the 45-minute sessions on the stroke robot as part of the trial. After only a few sessions into the 12-week programme, he is already seeing improvements in his arm and shoulder. 

In the immediate aftermath of the stroke, Tom, who used to work as a self-employed electrician, was unable to use his right arm or walk however gradually has regained movement.

Tom, 61, said: “When you’ve had a stroke, every bit of exercise and movement you can do is a big help. Using the robot alongside my other exercises is ideal for me and what’s great about the robot is that it also helps my hand-eye co-ordination.

“I’ve only had a few sessions so far however I’ve really felt the difference in my arm as I’ve got a lot more movement and much more strength. I’m under no illusions that it’s going to be a lot of hard work but it’s all worthwhile because I know it’s going to make me better.

“I’m pleased to be taking part in the trial and helping people who suffer a stroke in the future.”

Stroke patient Steven Hogg – “This research brings new hope for all stroke survivors”

56-year-old Steven Hogg, from Sunderland, was only 47 when he had a major stroke in April 2005.  It was a complete shock to his entire family and has changed their lives completely in the past nine years. Since having his stroke Steven has been volunteering for the Stroke Association and has been appointed as a lay member on the investigative panel and is the official patient representative for the new stroke robot research. 

Steven explains his story: “I had been working quite normally up until I had my stroke and remember coming back from a client meeting in London and attending a Sunderland match the night before it happened.  I remember feeling tired and having a pain in my right arm when I went to bed but just put it down to tiredness.

“At 4am that morning my wife Judith called 999 for an ambulance after recognising what are now the classic signs of stroke, slurred speech and a complete loss of movement down the right hand side of my body.”

On arrival at Sunderland Royal Hospital, Steven was quickly thrombolised and given lifesaving clot busting drugs to help return the blood supply to his brain.  His stroke was so severe he spent three days unconscious with doctors not sure if he would walk or talk again.  He spent a further three weeks in Sunderland Royal Hospital before being transferred to Monkwearmouth Hospital where he spent three months undergoing intensive rehabilitation. 

Steven said: “When I first had the stroke, the whole of the right hand side of my body was paralysed – I couldn’t speak and I had no feeling in my right arm or my right leg. The NHS care has been fantastic.  I underwent a major operation on my right leg to help try and regain some balance and ability to walk.  I have been really determined to build my strength up as part of my recovery from the operation and have pushed myself further and further to walk using an aid.

“My daughter Sarah has also been an absolute angel.  She was the only one who could understand what I was trying to communicate and has persevered to help me practise and regain my speech.  I am really proud to say that I can now hold a full blown conversation which is phenomenal.”

Steven lives in Roker, Sunderland, with his wife Judith.  He has three grown-up children Christopher, 22 who lives in Cornwall, Ros 32, who lives in Manchester and Sarah, 25 who still lives in Sunderland. 

Talking about the new stroke robot research, Steven said:

“This national research is very exciting and gives real hope to everyone who has suffered a stroke.  The care I got from the NHS as part of my rehabilitation nine years ago was absolutely fantastic but as my stroke was so severe, sadly I am still unable to move my right arm very much at all.  In the time since I had my stroke, advances in technology have come on leaps and bounds and the research that has gone on in the US has had really promising results.”


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