Camp offers real results for infant victims of stroke

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Karlee Steele's goal was to tie her hair in a ponytail without any help. Mike Sametz wanted to be able to change a tire on his bike.

Both teenagers suffered strokes in the womb or shortly after birth and, as a result, have difficulty moving one side of the body. Last year, they attended a two-week training camp at the Alberta Children's Hospital run by neuroscientist Adam Kirton, a world leader in the quest to understand how the developing brain reorganizes after a stroke and the best way to promote recovery.

Dr. Kirton is halfway through a three-year study that will involve 64 children who had a stroke around the time they were born. All attend a two-week camp, but some get other forms of treatment - including a non-invasive technique called transcranial magnetic stimulation that Dr. Kirton suspects enhances brain plasticity, making it easier for the children to learn to control their muscles.

It is too early to draw any conclusions about whether magnetic brain stimulation can help youngsters like Karlee and Mike, but Dr. Kirton says the two-week camps - with or without other treatments - seem to be effective.

"We are learning it is much better to invest everything in a one-time intensive rehab intervention rather than trickling it along over years," said Dr. Kirton, who reported the positive news from the ongoing study at a recent conference in Toronto.

Until a decade ago, stroke was considered an adult disease. But an estimated one in 2,500 infants have a stroke around the time of birth, known as a perinatal stroke. About 80 per cent have difficulty in moving one side of the body, a condition called hemiplegic cerebral palsy. These children often get intensive rehabilitative therapy before they start school. Older children usually work on exercises at home, and have their programs updated every year or so.

The intense training with peers at the hospital's two-week camp seemed to make a difference. Nearly all of the young volunteers, age six to 18, made progress toward the goals they set for themselves at the start of the camp. One boy learned how to dribble a basketball, another to button up a shirt.

In addition to her hair, Karlee, 15, can now also do her nails. Her stroke was on the left side of her brain, affecting both her right arm and leg. "These may sound like simple things, but they are things people who are able-bodied take for granted, " she said.

Mike, also 15, can now handle a flat. His stroke was also on the left side of his brain and affects the right side of his body, especially his hand. Over the years, he has put a lot of effort into learning to swim, snowboard and ride a bike, and now trains at the National Cycling Centre in Calgary. He says he has made small but significant gains in the fine motor control of his right hand, improvements that make it easier to maintain his road bike.

"They all seemed to gain function," said Dr. Kirton, who wants to know whether transcranial magnetic stimulation, or TMS, leads to greater gains.

The technique involves sending a painless magnetic signal through the skull that influences the activity of brain cells - either by firing them up or calming them down.

"The idea is that stimulation can prime the motor parts of the brain to help them learn faster or better," said Dr. Kirton, who works at the University of Calgary. The hope is that the technique can make physical and occupational therapy more effective.

He is also assessing whether putting a cast on a child's "good" hand or foot helps them learn to use the weaker one.

He and his colleagues are mapping the brains of their volunteers, using TMS to assess how active or "excitable" specific regions are, and how well connected with other areas. This will help them understand why some children recover better than others from strokes that caused similar initial damage.

"We try to learn what did their brains do differently," Dr. Kirton said.

The study is funded by the Alberta Children's Hospital Foundation and the Heart and Stroke Foundation of Alberta. Dr. Kirton says many of the teenagers who volunteered had given up on the idea that they might still improve, but after the camp had the confidence to try new things. They attended camps in groups with six or eight other youngsters their own age. They made friends and motivated each other.

"We got encouragement from one another," Mike said.