In The News

Brain Stimulation May Prove Helpful to Acute Stroke Patients, Pilot Study Suggests

Highly targeted electrical stimulation to the brain showed promise as a new treatment for the most common type of stroke, according to a pilot study led by UCLA Health researchers.

The study is the first in humans to test the feasibility of using a targeted type of electrical current, called high-definition cathodal transcranial direct current stimulation (HD C-tDCS), to treat acute ischemic stroke, which occurs when a clot blocks blood supply to part of the brain and accounts for approximately 85% of all strokes. Stroke is a leading cause of death and disability in the United States.

Many patients are not candidates for the two main treatments currently available for acute ischemic stroke: clot-dissolving drugs and a device that reaches into the bloodstream and yanks out clots. Even among those who are eligible for those treatments, just an estimated 20%–30% are disability-free three months after their stroke.

In their new study, published June 21 in JAMA Network Open, UCLA Health researchers tested HD C-tDCS as a novel therapy for acute ischemic stroke, in which a series of electrodes are strategically placed across the scalp to deliver a weak inhibitory form of electrical current to the part of the brain suffering from low blood flow.

This form of noninvasive stimulation has been used to treat certain neurological and psychiatric conditions, and the researchers had noted the electrical currents appeared to have an effect on the brain's blood flow. The researchers theorized it may be possible to use HD C tDCS to enhance blood flow to parts of the brain impacted by stroke and protect the threatened brain tissue, known as the penumbra, from irreversible injury.

The pilot study involved 10 acute stroke patients who presented to the emergency department or were admitted at neuro-intensive care and stroke units, were ineligible for currently available treatments, and were within 24 hours of stroke onset. Seven patients were randomized to receive active HD C-tDCS treatment, and three received "sham" stimulation. Using hemodynamic brain scans that acute stroke patients receive upon arrival, the researchers located the stroke area with low blood flow to where the HD C-tDCS treatment was delivered.

"This treatment was aimed at being as targeted and as individualized as possible, only to the area of the brain that has low blood flow or is suffering from stroke," said the lead researcher on this innovative project, Mersedeh Bahr-Hosseini, MD, a vascular neurologist at UCLA Health. "With this high-definition form of C-tDCS, we were able to refine this electrical field to focus it just on this area."

The first set of patients, which included 3 patients in the treatment arm and one in the sham group, received 20 minutes of 1 milliamp of stimulation. In the remaining patients, the dose was escalated to 2 milliamps for 20 minutes.

Researchers were able to efficiently provide the treatment in emergency settings, and patients tolerated the treatment.

Bahr-Hosseini said the most exciting finding was that in patients receiving HD C-tDCS, a median of 66% of the penumbra—the threatened brain tissue surrounding the core of the stroke—was rescued in the first 24 hours after stroke, compared to 0% in the sham group.

According to the hemodynamic brain scans performed soon after treatment, patients who received HD C-tDCS showed signs of improved blood flow that was greater in patients receiving 2 milliamps compared to 1 milliamp. In contrast, the blood flow decreased in sham group. "That was also very exciting, because it showed a possibly true biological effect of the treatment," she said.

Researchers are planning a new multi-site study with Johns Hopkins, Duke University, and the University of Pennsylvania, to gather more data on the treatment's safety and efficacy. The next study will also include patients who are eligible for the clot-dissolving drugs, known as intravenous thrombolytics.


Traumatic Brain Injury Should be Recognized as Chronic Condition, Study Argues

"Our results dispute the notion that TBI is a one-time event with a stagnant outcome after a short period of recovery," said study author Benjamin L. Brett, Ph.D., of the Medical College of Wisconsin in Milwaukee. "Rather, people with TBI continue to show improvement and decline across a range of areas including their ability to function and their thinking skills."

The study involved people at 18 level 1 trauma center hospitals with an average age of 41. A total of 917 people had mild TBI and 193 people had moderate to severe TBI. They were matched to 154 people with orthopedic injuries but no head injuries. Participants were followed for up to seven years.

Participants took three tests on thinking, memory, mental health and ability to function with daily activities annually from two to seven years post-injury. They also completed an interview on their abilities and symptoms, including headache, fatigue, and sleep disturbances.

When researchers looked at all test scores combined, 21% of people with mild TBI experienced decline, compared to 26% of people with moderate to severe TBI and 15% of people with orthopedic injuries with no head injury.

Among the three tests, researchers saw the most decline over the years in the ability to function with daily activities. On average, over the course of 2 to 7 years post-injury, a total of 29% of those with mild TBI declined in their abilities and 23% of those with moderate to severe TBI.

Yet some people showed improvement in the same area, with 22% of those with mild TBI improving over time and 36% of those with moderate to severe TBI.

"These findings point out the need to recognize TBI as a chronic condition in order to establish adequate care that supports the evolving needs of people with this condition," Brett said. "This type of care should place a greater emphasis on helping people who have shown improvement continue to improve and implementing greater levels of support for those who have shown decline."

A limitation of the study was that all participants were seen at a level 1 trauma center hospital within 24 hours of their injury, so the findings may not apply to other populations.


Trouble Falling Asleep, Staying Asleep Linked to Increased Risk of Stroke

People who have insomnia symptoms such as trouble falling asleep, staying asleep and waking up too early, may be more likely to have a stroke, according to a study published in Neurology. In addition, researchers found the risk was much higher in people under 50 years old. The study does not prove that insomnia symptoms cause stroke; it only shows an association.

"There are many therapies that can help people improve the quality of their sleep, so determining which sleep problems lead to an increased risk of stroke may allow for earlier treatments or behavioral therapies for people who are having trouble sleeping and possibly reducing their risk of stroke later in life," said study author Wendemi Sawadogo, MD, MPH, Ph.D., of Virginia Commonwealth University in Richmond and member of the American Academy of Neurology.

The study involved 31,126 people with an average age of 61. Participants had no history of stroke at the beginning of the study.

Participants were asked four questions about how often they had trouble falling asleep, trouble with waking up during the night, trouble with waking up too early and not being able to return to sleep, and how often they felt rested in the morning. Response options included "most of the time", "sometimes" or "rarely or never." Scores ranged from zero to eight, with a higher number meaning more severe symptoms.

The people were then followed for an average of nine years. During that time, there were 2,101 cases of stroke.

After adjusting for other factors that could affect the risk of stroke including alcohol use, smoking and level of physical activity, researchers found that people with one to four symptoms had a 16% increased risk of stroke compared to people with no symptoms. Of the 19,149 people with one to four symptoms, 1,300 had a stroke. Of the 6,282 people with no symptoms, 365 had a stroke. People with five to eight symptoms of insomnia had a 51% increased risk. Of the 5,695 people with five to eight symptoms, 436 had a stroke.

The link between insomnia symptoms and stroke was stronger in participants under age 50 with those who experienced five to eight symptoms having nearly four times the risk of stroke compared to people with no symptoms. Of the 458 people under age 50 with five to eight symptoms, 27 had a stroke. People age 50 or older with the same number of symptoms had a 38% increased risk of stroke compared to people with 33 had a stroke.

"This difference in risk between these two age groups may be explained by the higher occurrence of stroke at an older age, " Sawadogo added. "The list of stroke risk factors such as high blood pressure and diabetes can grow as people age, making insomnia symptoms one of many possible factors. This striking difference suggests that managing insomnia symptoms at a younger age may be an effective strategy for stroke prevention. Future research should explore the reduction of stroke risk through management of sleeping problems."

This association increased further for people with diabetes, hypertension, heart disease and depression.

A limitation of the study was that people reported their own symptoms of insomnia, so the information may not have been accurate.

More information: Neurology (2023).

Journal information: Neurology 


President’s Legislative Update

The State Legislative Session ended in mid-May. It was an extraordinarily busy session. The Association Lobbyist followed multiple bills important to Physical Therapists in Colorado. Chris Edmundson, Governance Affairs Chair, testified on behalf of APTACO on House Bill 1116-Contracts Between Carriers and Providers. This Bill requires that any contract between a health insurance carrier and a health care provider include at least one method of payment to the provider that does not have a fee and prohibits that contractor from only accepting virtual credit card payments. In addition, the bill allows providers to charge a reasonable fee related to transaction management, data management or other value-added services back to the carrier-essentially allowing you to recoup fees on virtual payments. Enforcement of this section is under the Commissioner of Insurance. The Bill had bipartisan support with a 57-2 vote in the House and 35-0 vote in the Senate and was signed into law by Governor Polis. This law will go into effect on August 7, 2023. At this time, APTA is not able to provide guidance on what would be considered a reasonable fee or how best to charge the carrier. Through coordination with the bill sponsors and other provider groups, we intend to send out guidance to our members prior to August 7th.

Our Lobby team, with speed and foresight, headed off Medicaid’s attempt to require Electronic Visit Verification (EVV) compliance for outpatient therapies that are delivered by telehealth. This was a departure from the Association’s understanding that EVV requirements would only be limited to Home Health. We shared our concerns and our plan to run a bill to prevent the EVV requirement resulting in Medicaid decision not to move forward with the changes.

Our Bill to allow physical therapists and physical therapists assistants to obtain Level 1 Accreditation in the Colorado Worker’s Compensation System was not introduced. With many new members in the State Legislature and their desire to advance their causes, our Bill was not considered. House Leadership was incredibly strict on what bills would be introduced and ours was not one of them. We did secure bipartisan sponsorship and will re-introduce the Bill next year.

Sunset Update
In 2024 the Colorado Physical Therapy Practice Act is up for Sunset Review. This means that our Practice Act may be modified by the State Legislature. APTA Colorado has been gathering input from members on potential revisions to the Practice Act and we have begun discussions with interested parties. The Association met with the Department of Regulatory Agencies’ (DORA) Analyst three times. We have discussed our answers to the required Statutory Questions and the changes we will be pursuing in Colorado’s Physical Therapy Practice Act. The Analyst accepted our offers to observe classes at Regis University and Sarah Gallagher’s Private Practice South Valley PT. Our interest in providing those opportunities was to deepen the Analyst ‘s understanding of Physical Therapist education and practice. Dora’s report will be completed in October of 2023. In the meantime, we are meeting with other interested parties, identifying physical therapists we may need to testify on our behalf and continue to raise money to support the Sunset 10/30 Campaign. I want to THANK you if you have donated your $30 to the campaign. If not, you can donate by texting “APTA” to 243725.  We have raised $5,880.00 of our goal of $60,000 on our text to give site.

Jill Flaherty, PT, MS
American Physical Therapy Association Colorado Chapter 


Share Your Research, Knowledge and Expertise!

Call for Poster Abstracts and Platforms for the 2023 Fall Conference!

We encourage all PTs, PTAs, and students to submit poster abstracts and platforms on case reports, special interest reports, or research projects. Posters and platforms submitted will be selected for presentation that demonstrates quality research and clinical relevance.

Please submit your abstract no later than Sunday, July 30, 2023 by e-mail to Melissa Tran, PT, DPT, MPH, Co-Chair of the Research Committee: [email protected]. When submitting your abstract, please indicate if you are submitting for a poster, platform or both.

For more information, click here

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