Researchers are testing an experimental brain stimulator that promises to spark more recovery in arms and hands that have been weakened by strokes.

	Robin Rombach, Post-Gazette Joe Marchione, 74, of Hampton, goes through physical therapy exercises to help him recover from a stroke at UMPC South Side Hospital as physical therapist Amy Sopko times him. Click photo for larger image. Graphic: Brain stimulation in stroke study

Dr. Douglas Kondziolka, vice chairman of neurosurgery at the University of Pittsburgh, is leading the local arm of the multicenter trial, known as the Everest study.

After a stroke, the brain tries to build alternate pathways to restore function. "There's science that suggests low-level electrical stimulation facilitates that recovery," Dr. Kondziolka said.

The Everest trial, launched by medical device company Northstar Neuroscience Inc., will focus on stroke survivors who have weakness in one arm or hand.

"Unfortunately many patients who've had a stroke end up with no arm function," Dr. Kondziolka said. "This is not truly for all patients. They should have some residual movement there that hopefully can be improved upon."

Joe Marchione, 74, of Hampton, will be the first participant in the local study.

"I'm very excited about it," he said. "I have always been adventuresome and I want things to improve, and this is one way of making improvements."

Four years ago, Mr. Marchione had just packed his car for a road trip to Maryland when a heart tumor he didn't know he had threw off a clot that lodged in a blood vessel in his brain, causing the stroke.

"I was in the hall and I found my way to the back room and lay down on the couch," he said. His wife, a nurse, "had no idea how I did that."

After the crisis, and the successful removal of the heart growth, Mr. Marchione began the rehabilitation process for his weakened right side.

"I had to learn how to walk all over again," he said. "I learned to walk and climb stairs and open cans and do those occupational things we all have to go through and do."

Mr. Marchione regained much function during the next six months, and now considers himself "very fortunate." But his right hand doesn't always do what he wants. His grip is strong and he can pick up small objects, he said, but his fingers no longer have their former dexterity.

"My writing is abysmal," he said. "It was never good to start with, but it's really bad now. I used to be a rapid typer. Now I sort of hunt and peck."

In the Everest study, participants will be randomly assigned to either get a stimulator implanted in the brain or not. All will get six weeks of intensive hand and arm therapy. The stimulators will be turned on in those who have them during the sessions to deliver brief electrical impulses to the targeted area.

Mr. Marchione will know whether he has a stimulator or not, but he has to keep that a secret from the therapists and the rest of the medical team so their findings are not biased.

"I have to go to and from the hospital with a hood on," he said, laughing.

	Online Graphic

Participants will have a functional MRI to locate the area in the brain that controls hand movement, Dr. Kondziolka explained. In the operation, narrow strip electrodes are placed over that spot, sewn to the brain's protective covering.

The electrode cable is tunneled through the neck to a battery in the chest. Doctors wave a wand over it to give the stimulator commands.

"The patient feels nothing when the stimulator is on," Dr. Kondziolka said. "Later on, the device can be taken out."

Participants will be regularly reassessed so researchers can determine if the stimulator enhanced recovery.

According to Northstar Neuroscience data from previous studies, patients who had stimulation during therapy had a 15 percent to 30 percent improvement in tests of their hand and arm function, while those who didn't have a stimulator improved up to 12 percent.

For more information about the Everest study, call 1-888-546-9779.