Stem cells as an emerging paradigm in stroke 3

Article Reviews
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Read Full Text: Stem Cells as an Emerging Paradigm in Stroke 3: Enhancing the Development of Clinical Trials
Journal: Stroke
Year Published: 2014
Ranked 4th on our 2014-2019 list of the 50 most influential articles

Article Overview for OT Practitioners

Wowza!

Looking at the title, I thought this article might be a too futuristic to help the average OT practitioner. But, this relatively short special report is a must-read for anyone who works with stroke survivors or clients with neurological conditions.

I’ll get the sci-fi part over with first. (Cue the eerie music!)

This article is part of a larger effort to explore whether introducing neural or stem cells into the brain after an injury will essentially re-activate the injured part of the brain to re-establish lost connections.

In simpler terms, researchers are looking at brain injections consisting of neural cells or stem cells. And they’re studying whether these injections can literally recreate lost connections and make the injured part of the brain start working again. Cool, right???

This article is not a clinical study, but instead is a compilation of recommendations for clinical testing around this topic. This article adds to already established guidelines by the FDA and NIH.

At the time of this special report, many of the studies have been in animal models, but they are preparing for clinical trials into whether this is safe with humans, and ultimately if this could be an effective treatment—the early research is promising.

Where does OT fit in?

Occupational therapy comes up in this article in two ways:

1. Research seems to suggest that cell-based therapies are most effective when they are coupled with physical rehab. The theory behind this is that the the cell-based therapy re-activates the brain’s neuroplasticity, but you need physical rehab to actually forge new neural pathways and improve function. Of course, the question we have seen in other articles comes up here: which type of therapy, and how much of it, is most effective? That is a question for further research :slight_smile:
2. Stem cells may offer new hope for clients who have plateaued in recovery, even after receiving maximum OT and PT. The article refers to this stagnant state as a “chronic stroke phase.” It also suggests a definition of a chronic stroke as meeting these criteria:

  • The stroke occurred at least six months ago.
  • The patient has spent at least two months without significant changes in deficits.

Assessments for OTs to Utilize

Even in research like this, a familiar conversation is happening: assessments should be balanced between impairment-based assessments and function-based assessments.

Here are the function-based assessments that the article states are already being used in trials.

Here are the impairment-based assessments that have been validated for stroke and used in large-scale clinical trials.

Listen to a summary in podcast form:


Check out the OT Potential Podcast page for all your listening options!

What questions/thoughts does this article raise for you?

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Fascinating. (No surprise coming from this journal club.) Hmm. I was just inspired to look further into assessments and find it fun that they, too, landed on Barthel Index.

Who is going to invent the next updated functional assessment? Just sayin’. Sarah, let’s add that to the list for creation. I’d definitely weigh in as a home health OT there.

The link did not open on the Rankin assessment for me just now. The NIH Stroke scale is fascinating and inspires further use in home health or areas to expand my current assessments.

I would NOT be surprised and in fact hope OT is onboard for future trials in this area. What do we need to do as a profession to stay in and show our value to be part of cutting edge progression?

Thanks for getting me thinking outside the box.

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Hey Monika! Thanks for letting me know about the broken link. I just fixed it. The Rankin is a simple 6 point scale and I see it come up quite a bit!

I agree that I really hope OTs stay involved in this field of study. A great article just came out about PT’s role in cell-based therapy. The article is a great overview of how cell therapies can be used beyond brain injuries! http://www.apta.org/PTinMotion/2019/4/Feature/LeadingEdge/

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It does seem intutitive that USING your brain would be better stimulation for growing and differentiating cells…! But sarcasm aside, I can see an interesting future study looking to compare if outcomes between occupation-based treatment are better than straight up physical rehab (exercise, limb use in repetitive tasks).

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