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VA Telerehab Program Improves Post-Stroke Functioning
Combining Natural Agent With Rehab Helps Stroke Victims
A neurovascular protective agent found naturally in the body combined with physical activity improved recovery from stroke in a rat model, according to research from the Medical University of South Carolina and the Ralph H. Johnson VAMC, both in Charleston.
The animal study, published recently in the journal Restorative Neurology and Neuroscience, found that a therapy combining exercise with the neurovascular protective agent S-nitrosoglutathione (GSNO), which has no known side effects or toxicity.1
“In our study, GSNO or motor exercise provided neuroprotection, reduced neuronal cell death, maintained tissue structure and aided functional recovery by stimulating the expression of neuronal repair mediators,” said lead investigator Avtar K. Singh MD. “GSNO in combination with exercise accelerated the rate and enhanced the degree of recovery.”
While stroke’s acute phase is associated with cell death and secondary injury, the chronic phase is characterized by insufficient neurorepair mechanisms, according to the study. It pointed out that monotherapies fail because of ineffectiveness of drugs in the chronic phase and that rehabilitation, used to improve neurofunction in the chronic phase, is effective but slow and limited.
The goal of the research was to find a therapy to ameliorate the injury in both phases, including a combination of rehabilitation and an agent that provides both neuroprotection and repair.
Singh and her colleagues induced stroke in rats, which were then assigned to one of five treatment groups:
- The first group received no treatment;
- the second group was treated with exercise, i.e., running at a constant speed for 20 minutes a day;
- the third group was treated with GSNO;
- the fourth group received both exercise and GSNO treatment; and
- the fifth group received a sham treatment.
Animals in each group were evaluated for neurological function, motor behavior and locomotor function before and after the procedure. In addition, the size of the infarct was measured and, at 7 and 14 days after stroke was induced, brain-tissue samples were removed and tested.
Researchers found that administration of GSNO not only reduced brain injury but also improved neurological scores. While exercise alone began too late to reduce infarct volume, it improved neurobehavioral functions. Adding GSNO created a synergistic effect, providing greater functional improvement than either GSNO or exercise alone, the authors said.
“GSNO is an attractive candidate to be investigated in humans for neurorepair and rehabilitation following stroke,” Singh said.
- Sakakima H, Khan M, Dhammu TS, Shunmugavel A, Yoshida Y, Singh I, Singh AK. Stimulation of functional recovery via the mechanisms of neurorepair by S-nitrosoglutathione and motor exercise in a rat model of transient cerebral ischemia and reperfusion. Restor Neurol Neurosci. 2012 Jun 20. [Epub ahead of print] PubMed PMID: 22717646.
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