In the 1980s, University of Cincinnati medical research doctors pioneered the use of the clot-busting drug tPA, or tissue plasminogen activator, now globally recognized as the gold standard in stroke care.
Decades later, their legacy reverberates in millions of lives changed for the better—and in a thriving lab where cross-trained researchers reimagine life after stroke for survivors at all ages and stages of recovery.
The university’s storied history of innovations in stroke care attracted Oluwole Awosika, MD, to join the Gardner Neuroscience Institute in 2016. Awosika’s pedigree includes a double bachelor’s from UCLA, a neurology residency at Massachusetts General/Brigham and Women’s Hospitals/Harvard Medical School and a post-doctoral research fellowship at the National Institutes of Health.
“I knew this was the right place to be,” says Awosika, a College of Medicine assistant professor. He works alongside other neurologists—as well as physical and occupational therapists, speech language pathologists and psychiatrists—as part of an ambitious trans-disciplinary research team that develops and oversees clinical trials for patients more than six months after their strokes. The timing is important because Awosika and his colleagues target patients beyond the reach of traditional post-stroke therapy, patients who have been told they have no more progress to make.
Awosika and the rest of the stroke rehab team, though, believe otherwise.
The successes of Cincinnati’s stroke treatment program, along with other medical advances that allow people to live longer after strokes and other shocks to their systems, have contributed to demand for more rehabilitation options. Longer lives can also lead to new sets of stressors for people with limited mobility and brain function as well as those who care for them.
Providing treatment—and hope
In one recent clinical trial, Awosika watched a man who, 12 years after his stroke, dramatically improved his ability to walk independently after just six weeks of therapy. The patient increased his six-minute walk distance by 120 meters—or more than the length of an NFL football field. “Normally, 20 meters (63 feet) is good,” Awosika says.
“Normally, 20 meters is great,” adds Brett Kissela, MD, chair of the Department of Neurology and Rehabilitation. Kissela was the 18th hire for the College of Medicine’s neurology department in 2000, when tPA innovator Joe Broderick, MD, led the group.
Today, Broderick directs UC’s Gardner Neuroscience Institute, which includes more than 125 physicians and researchers. A new, $60.5 million home for the institute is set to open in 2019, thanks in part to a $14 million gift from a grateful patient.
“When you have a stroke and you are left impaired, it feels hopeless,” says Kissela, who carries a laminated list of the lab’s current clinical trials, his “cheat sheet,” to connect his rehab patients with opportunities to extend their recoveries. “The way our current healthcare system works, you are abandoned after the first six months, more or less. Knowing that there is a group of really smart people who are really trying to find solutions, it just brings hope.”
A recent list of ongoing clinical trials at the stroke rehab lab included:
- Directly stimulating targeted areas of the brain through the skin using MRIs to map responsive areas
- Closely monitored high intensity interval training as post-stroke physical therapy
- Yoga for patients and caregivers
- iPads programmed to speak common messages to ease pressures on stroke patients with speech language disorders.
Accelerating advances through teamwork
Researchers from the College of Medicine routinely partner with peers from the College of Allied Health Sciences (departments of social work, speech language pathology, physical and occupational therapy), the College of Nursing and the College of Arts and Sciences.
Kissela notes that those collaborations, known as transdisciplinary because each researcher brings distinctive disciplinary strengths and perspectives to projects, provide both short and long-term benefits.
“Things we learn in one field aren’t just for that field but will have applicability somewhere else,” says Kissela, who sees collaboration as “part of what accelerates the science.”
“Here in Cincinnati, we are part of the solution. We are not just going to be care providers, we’re going to change the game for tomorrow.”
Awosika, for example, specializes in mobility and has a history of researching traumatic brain and spinal cord injuries. What he learns through stroke rehab trials helps him continue to unravel the mysteries of how the brain controls walking, which can help patients with a wide range of neurological disorders.
“There are a lot of commonalities that lead to some new and creative thoughts and that could be the next big idea,” Kissela says. "Here in Cincinnati, we are part of the solution. We are not just going to be care providers, we’re going to change the game for tomorrow."
Challenging the status quo, getting results
Early career researcher Pierce Boyne, PT, DPT, is Cincinnati native and a physical therapist who has spent his entire academic life at UC. He assisted with clinical research while he was an undergraduate at UC under the mentorship of Kari Dunning, PT, PhD, a long-time member of the stroke rehab team.
Boyne spearheaded a series of pilot studies in the lab testing the use of high intensity interval training—the kind of conditioning associated with elite athletes—with stroke patients, some of them decades after their strokes.
“It used to be thought that if you challenged someone who had had a stroke, they were going to compensate more, and their walking quality would get worse,” Boyne says. “In fact, it usually gets better if you just ask people to try walking faster. One reason is that we use momentum more efficiently when walking closer to normal speed.”
He credits his surprising pilot findings—along with pointers from research veterans Dunning, Kissela and Broderick—for his early grant success. Against formidable odds, his first-ever R01 grant application to the NIH to expand the study in Cincinnati and other sites across the country scored in the fundable range and is planned to start in 2018.
When it comes to describing the reactions of patients and their family members, Boyne echoes his colleagues who have seen dramatic, and sustainable, increases in mobility and brain function. “People certainly get tired, but there is also an uplifting effect,” he says. “You would hope it makes people more motivated to continue.”
Motivation is another common thread in the rehab lab, not just for the patients, but also for the researchers they inspire.
By Elissa Yancey