The group assigned to robotic therapy used a Reo Therapy System by Motorika Ltd. in Tel Aviv, Israel. For the therapy, the patient’s forearm, either resting on or strapped to a platform, is moved in multiple directions based on preprogrammed exercise movements. The researchers selected five such preprogrammed movements. For instance, in one of the movements, “forward reach,” the robot helped patients extend their arms forward as if reaching for something in front of them.
Therapists also selected from five levels of robotic assistance according to what was most appropriate for the patient, from movement entirely guided by the robot and passive on the patient’s part, to movement actively performed by the patient.
The successful test of robots adds a new wrinkle to stroke rehabilitation strategies, Dr. Takahashi noted. Although repetitive movement is an essential therapy, physical and occupational therapists are not always available to provide care. Self-training, if not done correctly, can result in pain and disability. “Robots, on the other hand, can carry out the repetitive movement exercise with exactly the right movement pattern to prevent misuse,” Dr. Takahashi said.
Based on initial mobility scores, patients with severe hemiplegia were more likely to benefit from the robotic therapy. The finding is consistent with the notion that higher-functioning patients already can correctly carry out self-training programs, while patients with lower function—only reflex and minor voluntary movement—are more likely to benefit from the support and aid of robots, Dr. Takahashi noted.
“Further research using larger groups of patients is necessary to investigate the efficacy of such robotic exercise in more detail,” Dr. Takahashi said.
Advanced Macular Degeneration Is Associated With an Increased Risk of Brain Hemorrhage in Elderly Persons
Older patients with late-stage, age-related macular degeneration (AMD) appear to have an increased risk of brain hemorrhage, but not stroke, caused by brain infarction, researchers reported.
“Other studies have found there are more strokes in older individuals with late AMD, but ours is the first to look at the specific types of strokes,” said Renske G. Wieberdink, MD, an epidemiologist at Erasmus Medical Center in Rotterdam, the Netherlands. “We found the association is with brain hemorrhage, but not brain infarction.”
AMD is degeneration of the macula, the part of the retina responsible for the sharp, central vision needed to read or drive. Because AMD primarily affects the macula, central vision loss may occur. Age-related macular degeneration usually produces a slow, painless loss of vision. Early signs of vision loss from AMD include shadowy areas in a person’s central vision or unusually fuzzy or distorted vision.
Because the number of brain hemorrhages observed in the study was small, the findings will need to be corroborated in a larger group, Dr. Wieberdink said. “These findings should be considered preliminary,” she said. “Patients and physicians must be very careful not to overinterpret them. We don’t know why there are more brain hemorrhages in these patients or what the relationship with AMD might be. This does not mean that all patients with late-stage AMD will develop brain hemorrhage.”
Beginning in 1990, the Rotterdam Study is a prospective, population-based cohort investigation into factors that determine the occurrence of cardiovascular, neurologic, ophthalmologic, endocrinologic, and psychiatric diseases in older people. The researchers tallied stroke incidence among 6,207 participants 55 and older. All participants were stroke-free at the study’s outset. AMD was assessed during scheduled eye examinations, and participants with the condition were grouped into five different stages of AMD, and whether their condition was wet AMD or dry AMD.
Participants were tracked for an average of 13 years. Of the 726 persons who had a stroke in that time, 397 had brain infarctions, 59 had brain hemorrhages, and the stroke type was not available for 270. Late AMD (stage 4) was associated with a 56% increased risk of any type of stroke. Late AMD, in both the dry and the wet forms, was strongly associated with more than six times the risk of brain hemorrhage, but not with brain infarction. Early AMD (stages 1 to 3) did not increase the risk of any stroke. Associations were adjusted for possible confounders, such as diabetes, blood pressure, antihypertensive medications, smoking status, BMI, alcohol use, and C-reactive protein levels.
“We cannot yet say if there is a common causal pathway or mechanism of action—this association needs to be further investigated,” Dr. Wieberdink said. “But I don’t think it is a causal relationship. It seems more likely that late AMD and brain hemorrhage both result from some as yet unknown common mechanism.”
Ischemic Stroke Hospitalizations Decline in Middle-Aged, Elderly Persons and Increase in Younger People
The number of acute ischemic stroke hospitalizations among middle-aged and older men and women decreased between 1994 and 2007, but sharply increased among those younger than 35—including teens and children, according to researchers.