Health: Doctor, let me shake your hand: A stroke patient can once again stir coffee and drive a car, thanks to a new gadget. Julie Newing reports

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Indy Lifestyle Online
TERRY INGLIS greets friends and acquaintances with an unusually vigorous handshake. 'I can't help showing off,' he says proudly. Until recently his right hand was almost useless: a stroke seven years ago had left him partly paralysed, with a rigid, claw-like grip. He recalls being reduced to tears of frustration at his inability to perform the simplest tasks.

Yet after three months' treatment with a gadget the size of a television remote control, Mr Inglis can use his hand again. He can stir a cup of coffee once more, and drive his car. The device, a neuromuscular stimulator, works by artificially powering muscles that have grown weak after years of disuse. It can be used regularly at home by the patient.

Watching 68-year-old Mr Inglis use the stimulator is more reminiscent of a Frankenstein film than of modern medical practice. First he sticks two electrodes, attached to the stimulator by wires, on to the skin of his right forearm; then, using his left hand, he switches on the gadget. As he does so, his right hand moves up and down in response. It felt strange to start with, he says. 'But I soon got used to it. I used to practise while I was watching television.'

The technique, called functional electrical stimulation (FES), has also been successful in treating multiple sclerosis sufferers, and stroke patients with drop-foot syndrome. Dr Ian Swain, who heads the research team at Odstock hospital, Salisbury, where Mr Inglis is a patient, explains: 'One of the last things stroke patients can get back is the ability to lift the foot up. As a result, it drags along the ground when they try to walk.'

Using microchip technology, Dr Swain has developed a tiny gadget that fits inside the heel of the patient's shoe. When switched on, it activates an electrical impulse which triggers the muscle, so that when

patients lift a heel off the ground, their foot automatically rises, too.

Stroke patients are delighted with the results. Mr Inglis is particularly pleased that he can drive again, using a special glove that helps him to grip the steering wheel. His own doctor, he says, was amazed at the transformation.

Mr Inglis also adds that the optimism of Dr Swain and his staff is a far cry from the attitudes of some hospital staff just after his stroke. He recalls one incident when he was at his lowest point: 'I was asked to look at myself in the mirror, and I was told: 'As you are now, that's how you'll be for the rest of your life.' '

Paul Taylor, a hospital engineer who works with Dr Swain, says: 'Some of these patients have been able to get out on their own and taste freedom for the first time in years. One man says it has meant he can go to the local museum, something he hasn't been able to do for ages. For others it means they can have just a trip round the shops.'

As a treatment for certain kinds of paralysis, electrical stimulation is not new. A decade ago it was seen by some doctors as a 'miracle' treatment for spinal injury, offering hope to thousands of people facing life in wheelchairs. The most famous was police constable Philip Olds, who went to the the United States for FES in 1983 after being paralysed by a gunman's bullet. But FES received negative publicity when Mr Olds, frustrated at his inability to get up and walk unaided, killed himself with a drug overdose.

For spinal injury patients such as Mr Olds the technique has so far proved unsatisfactory. The problem is that when the spinal cord is severed, there is no connection between the brain and the muscles. The spinal cord will never recover and the muscles will always need to be stimulated artificially.

By putting spinal injury patients in a special frame and wiring them up to a stimulator, doctors can enable them to walk for a few minutes. But the equipment is bulky and takes a long time to set up; it fails to offer these patients independence.

With stroke and multiple sclerosis patients, the connection between brain and muscle may not be completely severed, and the neuromuscular stimulator can help to strengthen muscles so that the patient can eventually use them again without resorting to FES.

Not all stroke patients can benefit from FES. Those who have already made a moderately good recovery will probably derive most benefit; for a stroke patient who is completely immobilised on one side, FES may not be effective. Similarly, FES

can help multiple sclerosis patients only in the early stages of the disease.

According to Dr Swain, treatment with FES is also limited by a severe lack of funding. With his team of two engineers and a physiotherapist, he has treated two patients with hand stimulation and 32 drop-foot patients. Clinical trials of FES also started last month at Strathclyde University, where it is hoped that up to 24 stroke patients will be treated by the end of this year.

This is a tiny number out of the 100,000 people who suffer from strokes every year. And the money these research teams receive for their work is small compared to their counterparts in the US. Dr Swain expects to receive pounds 147,000 to continue his FES programme over the next three years. 'Compare that with one group in Cleveland, Ohio, which is running on about dollars 6m a year,' he says.

Dr Swain would like to see FES offered to stroke patients by physiotherapists at hospitals throughout Britain. He argues that the costs would be minimal - each stimulator, he says 'need only cost around pounds 200 and that would get cheaper the more units were manufactured'.

Meanwhile, he is working on developing FES for spinal injury patients - but using an electronic stimulator that could be implanted in the same way as a pacemaker. Electrodes would be connected to the nerves attached to the spinal cord. By operating an external switch, the wheelchair-bound patient would be able to stand up.

A three-year project to develop this idea is due to start in October. Researchers from Odstock hospital will work with engineers at the University College Hospital, London, and the Royal National Orthopaedic Hospital, Stanmore, London. Dr Swain says that the device could take three or four years to develop: 'We are at the same stage with this type of work that doctors were with pacemakers in the late Sixties. It works quite well in the lab but it's not so easy to get it working with the patients.'

He is quick to stress, however, that paraplegics will not be able to throw away their wheelchairs. 'But it would enable them to get from the car to the house. It would help them get around in those difficult situations. Wheelchairs would remain their principal means of getting around.'

For Terry Inglis, FES has meant regained freedom and independence. 'My friends all think it's a miracle,' he says. 'After seven years struggling to use my hand, I'm starting to agree with them.'

(Photograph omitted)

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