Retraining the Brain: Neuroscience & Stroke Rehabilitation

Rhys Waters 0:00

Welcome to Beyond Research. A podcast brought to you by Research Nova Scotia.

Stephanie Reid 0:08

More than 50,000 Canadians suffer a stroke each year. Of those who survive more than half will require ongoing assistance with daily activities due to cognitive deficits.

Anne-Sophie Champod 0:19

Stroke rates and disability rates are expected to increase dramatically over the next 15 years due to our aging population.

Stephanie Reid 0:27

This is Dr. Anne-Sophie Champod, and associate professor of psychology at Acadia University. Today, you will hear how her research team is working to develop more effective cognitive rehabilitation interventions to ultimately contribute to improvements in patient recovery, independence and quality of life. Thanks for joining us today. And Sophie, thank you for the invitation. You’ve recently received funding for the Acadia University Center for neuroscience and cognitive health, which is very exciting. Congratulations on that. Thank you. I’m curious if you could tell us a little bit about what neuroscience is. And what attracted to you to this line of research because obviously, it’s a very niche field. And I’m curious how you got into neuroscience research.

Anne-Sophie Champod 1:14

So simply put, neuroscience is the study of the brain and all of it. So neuroscientists are interested in the different structures composing the brain, different brain regions, neuroscientists are interested in the role of these brain regions in behavior in cognition and emotions. neuroscientists might, for example, study, what happens in the brain when someone is learning a new language. I’m particularly interested not just in what’s happening in the brain when someone is learning a new skill or learning a new ability, but how can the brain relearn some of those skills and some of those abilities when they’re lost? Following a stroke? So I’ve been particularly interested in the past decade or so in a neurological condition that’s quite common after a stroke, which is called spatial neglect.

Stephanie Reid 2:12

And why did you choose the stroke rehabilitation as a specialty,

Anne-Sophie Champod 2:16

I got interested in stroke rehabilitation, really just at the very end of my PhD in clinical psychology, really, during my internship, and I noticed really clear gaps in clinical practice at that point, particularly in terms of how we assess and how we treat disorders affecting attention and spatial attention more specifically. And that was a bit of a aha moment for me, because I realized that this could be the way for me to integrate my research and my clinical work. So use the knowledge that I had acquired, and I continue to acquire about how the brain works, and try to use this knowledge to develop clinical tools that can be used in clinical practice.

Stephanie Reid 3:01

Can you just simply explain what a stroke is, its impact on Canadians, and some of the cognitive and motor processes that are impacted by stroke.

Anne-Sophie Champod 3:17

When someone has a stroke, what happens is the blood supply is cut off to a specific part of the brain, so that there’s that specific part of the brain that will be lacking oxygen and nutrients. And that will result in cell death. There’s different ways by which this can happen. The most common reason is a blocked artery. So this is what we call ischemic stroke. And they can also be what we call hemorrhagic strokes that are when you have blood vessels in the brain that will rupture or burst. So it will be bleeding inside of the brain that will also result in cell death. So when this happens, there’s a range of cognitive abilities or thinking abilities that can be affected that will depend on where the stroke happen in the brain and the role of that brain region, I would say the most common cognitive functions affected by a stroke, our attention, particularly spatial attention, so how people can pay attention to what’s going on in their environment, memory is often affected as well, language skills. And then executive functions are also often affected. So these are the higher order level cognitive functions like problem solving or planning skills. So all of those abilities are very often affected after a stroke. Now, in terms of the impact on Canadians, you had mentioned some of the statistics about how common strokes are, so we know that in Canada, there’s someone who will have a stroke every 10 minutes or so. So it is very common, and we know as well that one of the main risk factor for stroke is his age. And people tend to forget that when you think about risk factors for strokes, a lot of people think about, you know, smoking, for example, or hypertension, but we forget that the main risk factor is simply getting older. And so we know, for example, that after 55 years old, the risk of having a stroke more than doubles every decade. So with the aging population, it’s obviously really significant public health concern at this point. And when we’re thinking about the impact of stroke on Canadians, we have to think about how common they are. But we also have to think about what happens after a stroke. So in terms of clinical outcomes, right, we know from the research that about 10 to 15% of individuals will die as a result of stroke. So that still stroke is still the third leading cause of death in Canada, then we also know that about 10% of individuals will fully recover from the strokes, that means we’ll go back to their previous level of functioning. So what that means is that there’s like the vast majority of people after a stroke, and we’re talking up to 80%, will be living with the chronic effects of a stroke. So we’re talking about significant issues with activities of daily life. Spatial neglect is just one of the conditions that can occur after a stroke.

Stephanie Reid 6:26

And given those statistics, because that’s quite surprising. You had mentioned one of the things that attracted you to this particular area is you had identified it as a gap in the research community, why do you think it was a gap? And do you still believe that that gap exists today,

Anne-Sophie Champod 6:45

this gap definitely still exist today in the sense that we definitely need more research in stroke rehabilitation, it’s difficult to identify the reasons, I think part of the reason as to why there is a gap is that the focus in terms of research for stroke rehabilitation has been on motor functions for quite some time. So and that’s probably just because, you know, this is something that you can easily see if someone has a stroke, and they struggle with, you know, walking or moving. This is something that you can see right away, right. So there was a lot of effort initially, in all of those rehabilitation treatments focusing on motor functions. And it took us a little bit longer to realize that, you know, it’s not because you cannot see memory, we cannot see attention, that it’s not having a significant impact in people’s life. And in fact, what we know from the research is that people are better at adapting to motor problems than they are at compensating and adapting for cognitive problems. So I think what explains this gap is partly this, this delay, in just starting to be interested in cognitive functions after a stroke and realizing that those deficits are real, it’s not because they cannot be seen as easily as an issue with walking that they’re not important. And so I think it explains the gap. It’s just that we started more recently to look at this. So we have to catch up now.

Stephanie Reid 8:17

That’s really interesting. And I know one of your projects is focused on home treatments for spatial neglect for stroke patients, can you take a moment to explain what spatial neglect is.

Anne-Sophie Champod 8:32

So spatial neglect is a neurological condition that is primarily an attention disorder, which is quite common after strokes, particularly stroke affecting the right side of the brain, so the right hemisphere, and individuals suffering from spatial neglect will struggle paying attention to the left side of their world. And that can include the left side of their body. And so as a result of this, people will constantly for example, bump into things on the left side, you can think about, you know how dangerous something as simple as crossing a street could be if you’re not paying attention to what’s going on on the left side of the world. And so these individuals we know are not doing as well as other individuals after stroke who are not suffering from this condition. They have longer hospitalizations, they are at an increased risk for falls, they are struggling more in their daily activities as well.

Stephanie Reid 9:28

Really interesting. Can you explain a little bit about that research project called Project Peg the Mole, which I love, and what that looks like for a patient recovering from stroke. So

Anne-Sophie Champod 9:41

the idea of Peg the Mole is that we wanted to create a game live version of a prism adaptation treatment. So maybe I’ll start with explaining this technique before explaining Peg the Mole.

Stephanie Reid 9:52

Okay

Anne-Sophie Champod 9:53

Considering that’s an adapted version. So prism adaptation is a technique that consists of the use of prism goggles. So these are special goggles that people put on that will displace the visual field to the right. So what is right in front of you will seem to be a little bit more to the right. So it’s displays by about 10 to 15 degrees. What we do during prism adaptation treatment is we ask patients to wear to use these prism goggles, and they have to interact in some way with the environment. Most prism adaptation programs out there involve the presentation of targets on a computer screen, and you simply have to point to those targets using the prism goggles. Now, because the goggles are shifting vision to the right, and what it means is that people will make right word errors. So they will point to the right of the targets that are presented on the screen, because of the fact that the vision of those targets is displaced to the right now over time, if they continue to point over and over again to the same targets, they will learn to compensate for the rightward shift and vision by pointing more to the left. So their brain will slowly learn to compensate for this shift by pointing more to the left, that will result in a shift in attention to the left that we can observe after people take the goggles off. Now you can imagine for someone with spatial neglect, who has an issue with attention being biased to the right, so this shift and attention to the left can be very therapeutic, because their attention becomes more centered, basically. So this is an experimental treatment. It’s typically used for a few minutes on a daily basis for a couple of weeks. And there are a really interesting results in that promising results in the literature in terms of improvement in symptoms of neglect after using this kind of protocol.

Stephanie Reid 11:49

And is Peg the Mole the next step from the prism goggles?

Anne-Sophie Champod 11:52

That’s right. So the idea of Peg the Mole is that we wanted to create a game like version of a prism adaptation treatment, there’s a number of reasons for this one of it being that this is a treatment that has to be used on a daily basis, right. So if we want to work on treatment adherence, we want to make sure that people are actually going to use it, it has to be something that’s not tedious. And that’s not boring, that’s not painful. But we also wanted to create a version of prism adaptation treatment that wouldn’t require all of the equipment that’s been used in research. So far, the hope for Peg the Mole is that it could be used in rehabilitation centers. And that’s what we’re currently testing at the Nova Scotia rehabilitation center. So we are testing the use of this new game. In this case, it is used on big desktop touchscreen computers,

Stephanie Reid 12:41

I have to ask, is it similar to whack a mole?

Anne-Sophie Champod 12:43

So yeah, so that’s the reason for the name. So basically, this is based on. So as you would know, and I guess, other people, older people like myself would know, because these are, you know, these old arcade games.

Stephanie Reid 12:56

Fabulous games.

Anne-Sophie Champod 12:58

That’s right, where you hit the moles with like a hammer, basically, or a toy version of a hammer,

Stephanie Reid 13:03

A little aggressive.

Anne-Sophie Champod 13:04

That’s right, so we basically develop a safer version that is not involving a hammer so that no one get hurt. But it’s exactly the same idea, which is that you have cartoon moles that are presented on the screen. So you have the again, the desktop version for a rehabilitation center, we’ve developed another version that can be used on an iPad or a tablet computer, that’s the home use part that we’re hoping to develop as well. So you have little cartoon moles that are appearing on the screen, and people have to point so pack them all as quickly as possible before they disappear. So pack them all is different from other prisoner adaptation treatments because of the game like nature. But also because of the algorithm that we’re using in the game. That basically means that all that is needed is a tablet. So it could be an iPad and the prism goggles, that’s all. So we’re basically decreasing the need in terms of additional equipment so that ultimately people can have access to that treatment after being discharged from the hospital, because that’s a major issue with spatial neglect, tends to be a chronic condition. And there’s a lack of resources once people are discharged from the hospital. So that’s what kind of what we wanted to work on. Very interesting.

Stephanie Reid 14:18

So much like you’re evaluating the effectiveness of the prism treatment, you’re also looking at the Peg the Mole treatment

Anne-Sophie Champod 14:25

That’s right, we’ve compared and we started with healthy individuals. That’s the great thing about prism adaptation, it’s easy to study because this leftward shift and attention is seen actually in healthy individuals as well. So if you were to use pack them all with the prism goggles, you could see that right after your attention would be shifted to the left. So we were able to compare the effectiveness of Pagnell with a more standard prism adaptation treatment in healthy individuals and we could see that it was just as effective meaning that it’s it’s shifting attention to the left to the same extent as the experimental treatments that are not as fun and require more equipment.

Stephanie Reid 15:05

Do these treatments have any potential implications or could they be implemented in our long term care facilities across the province?

Anne-Sophie Champod 15:13

Absolutely. And that was one of the goals with Peg the Mole, when we were working on porting this game so that it can be used on different systems, including iPads and tablets, the goal was that it could facilitate the use of that program in different facilities, including long term care facilities. So this is definitely something that we had in mind, when we worked on developing the game.

Stephanie Reid 15:42

It’s very cool. And in theory, like, given the results you’ve had so far, could you just hand that over at any point to the province or the healthcare system to implement on a wide scale? Or is it way too early for that?

Anne-Sophie Champod 15:56

We’re not too far from that. Because we know from the research that prism adaptation, the the the more typical prism adaptation protocol, we know that it works for a large number of individuals after stroke, living with spatial neglect, the worth the work needs to be done is to figure out all of the optimal parameters so that it’s as effective as possible. So we are not that far from using this clinically. And in fact, the research that we are conducting right now at the Nova Scotia rehabilitation center, the goal would be for occupational therapists to actually continue to use that treatment. If obviously, assuming that we get the positive results that we think that we’re going to get, the clinicians will have been trained to use the technique with patients. So the idea would be that it would continue to be used there. And then that we could basically expand to other rehabilitation settings from there, if we want to improve the health of Nova Scotians. One thing that we particularly need to do is to increase the collaboration between researchers and clinicians, because often what happens is that you have researchers working on all sorts of cool equipment and tools and techniques and games as right, that do not end up being used clinically, because they’re basically just staying they’re being studied for for research purposes. And that’s part of what we want with this center. We want to engage clinicians and our research projects so that the tools that we’re developing and what we’re learning about how the brain works in health and in disease can ultimately be used clinically.

Stephanie Reid 17:41

Well, it sounds like that collaboration could result in some really amazing outcomes around quality of life for these individuals poststroke across Nova Scotia, which is really exciting. Yeah, that’s the ultimate goal. That’s fantastic. Well, thank you so much for taking the time to chat with us today. We really appreciate it.

Anne-Sophie Champod 18:01

Thank you very much.

Stephanie Reid 18:04

You have been listening to Dr. Anne-Sophie Champod, an associate professor of psychology at Acadia University.

Rhys Waters 18:11

To find out more about this podcast and the research featured in this episode, visit researchnovascotia.ca. My name is Rhys Waters and we will see you next time