'Robo legs' for stroke patients

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23 September 2011 Last updated at 04:29 GMT By Neil Bowdler Health reporter, BBC News The LOPES therapeutic robot can do all or some of the walking for you Scientists in the Netherlands are using robotic legs to try to improve the movement of stroke patients.

The prototype device is called the Lower-extremity Powered ExoSkeleton, or LOPES, and works by training the body and mind of a patient to recover a more natural step.

The machine is also being tested on spinal injury patients who have recovered some restricted movement in their legs.

It is hoped a commercial version could be made available to rehabilitation centres around the world as early as next year.

Feedback mechanism

LOPES has been developed by engineers at the University of Twente in Enschede in the Netherlands over several years. Designed for the rehabilitation clinic, it is not a mobile device but supports the patient as they walk on a treadmill.

It can do all the walking for the patient, or it can offer targeted support in either one leg or with one element of the walking process. The machine can also detect what the patient is doing wrong.

"For instance, some people cannot lift their foot up appropriately," explains Dr Edwin van Asseldonk, who is working on the project. "What this device does is it senses that the foot is not lifting properly.

"It then compares it with a reference pattern and then exerts a force or torque to assist that subject in doing it."

Dr Edwin van Asseldonk explains what LOPES can do

Petra Hes is one of those testing the device. She suffered a stroke aged just 17. Years of physiotherapy have helped, but she still has what is known as a "drop foot", which means she cannot lift and flex her left foot in the way she once did, or even remember how to do so.

The machine provides the forces to enable her to physically move her left leg and foot the way it should move, but it also operates as a memory aid, the researchers believe.

"I got a eureka moment because I felt an old feeling of how to walk normally," she recalls of the first time she used the machine.

"That push-up I felt and my knee lifting it is what I've forgotten. I couldn't reproduce it myself so I had to feel it again."

Dr van Assledonk believes that by physically showing patients how to walk properly, the machine can help them develop the brain signals required to drive improved movement.

"With stroke survivors, it's very important that they get signals to the brain but also that they send signals downwards from the brain," he says.

"It's only when you get information from your legs to your brain and vice-versa that can you hope for some plasticity in your brain."

Dr Sharlin Ahmed from The Stroke Association in the UK hopes the innovation will help.

"Mobility issues have negative effects upon stroke survivors' quality of life, so we welcome any research or technology that will help improve mobility for stroke survivors and enable them to have a better quality of life," she told the BBC.

Military exoskeletons The HULC exoskeleton is designed to take the load off US infantry

Work on a commercial version of the LOPES machine is already under way, with two private companies co-operating on the project. Two rehabilitation centres in the Netherlands will then test the device before it is rolled out to other clinics at home and abroad.

The LOPES project is by no means the only example of scientists turning to "exoskeletons" to aid human performance.

Berkeley Bionics of California has designed an exoskeleton called the Human Universal Load Carrier (HULC). The device enables infantry soldiers to lift and carry weights of up to 90kg in the field, and consists of a hydraulic-powered frame which straps around the soldier's body.

The same company has also developed an exoskeleton called "eLegs". Billed as an alternative to the wheelchair for those with restricted mobility, the frame can help users to walk upright with the aid of sticks.

A rival machine called ReWalk by Israeli company Argo Medical Technologies is also intended to help those with lower-limb disabilities to walk upright using sticks.

Dr van Asseldonk believes the possibilities are manifold.

"I foresee that older people in the future might just wear an exoskeleton when they're going around so they can keep pace with the grandchildren.

"You can imagine devices like this could keep people mobile for longer."

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'Robo legs' for stroke patients

AppId is over the quota
AppId is over the quota
23 September 2011 Last updated at 04:29 GMT By Neil Bowdler Health reporter, BBC News The LOPES therapeutic robot can do all or some of the walking for you Scientists in the Netherlands are using robotic legs to try to improve the movement of stroke patients.

The prototype device is called the Lower-extremity Powered ExoSkeleton, or LOPES, and works by training the body and mind of a patient to recover a more natural step.

The machine is also being tested on spinal injury patients who have recovered some restricted movement in their legs.

It is hoped a commercial version could be made available to rehabilitation centres around the world as early as next year.

Feedback mechanism

LOPES has been developed by engineers at the University of Twente in Enschede in the Netherlands over several years. Designed for the rehabilitation clinic, it is not a mobile device but supports the patient as they walk on a treadmill.

It can do all the walking for the patient, or it can offer targeted support in either one leg or with one element of the walking process. The machine can also detect what the patient is doing wrong.

"For instance, some people cannot lift their foot up appropriately," explains Dr Edwin van Asseldonk, who is working on the project. "What this device does is it senses that the foot is not lifting properly.

"It then compares it with a reference pattern and then exerts a force or torque to assist that subject in doing it."

Dr Edwin van Asseldonk explains what LOPES can do

Petra Hes is one of those testing the device. She suffered a stroke aged just 17. Years of physiotherapy have helped, but she still has what is known as a "drop foot", which means she cannot lift and flex her left foot in the way she once did, or even remember how to do so.

The machine provides the forces to enable her to physically move her left leg and foot the way it should move, but it also operates as a memory aid, the researchers believe.

"I got a eureka moment because I felt an old feeling of how to walk normally," she recalls of the first time she used the machine.

"That push-up I felt and my knee lifting it is what I've forgotten. I couldn't reproduce it myself so I had to feel it again."

Dr van Assledonk believes that by physically showing patients how to walk properly, the machine can help them develop the brain signals required to drive improved movement.

"With stroke survivors, it's very important that they get signals to the brain but also that they send signals downwards from the brain," he says.

"It's only when you get information from your legs to your brain and vice-versa that can you hope for some plasticity in your brain."

Dr Sharlin Ahmed from The Stroke Association in the UK hopes the innovation will help.

"Mobility issues have negative effects upon stroke survivors' quality of life, so we welcome any research or technology that will help improve mobility for stroke survivors and enable them to have a better quality of life," she told the BBC.

Military exoskeletons The HULC exoskeleton is designed to take the load off US infantry

Work on a commercial version of the LOPES machine is already under way, with two private companies co-operating on the project. Two rehabilitation centres in the Netherlands will then test the device before it is rolled out to other clinics at home and abroad.

The LOPES project is by no means the only example of scientists turning to "exoskeletons" to aid human performance.

Berkeley Bionics of California has designed an exoskeleton called the Human Universal Load Carrier (HULC). The device enables infantry soldiers to lift and carry weights of up to 90kg in the field, and consists of a hydraulic-powered frame which straps around the soldier's body.

The same company has also developed an exoskeleton called "eLegs". Billed as an alternative to the wheelchair for those with restricted mobility, the frame can help users to walk upright with the aid of sticks.

A rival machine called ReWalk by Israeli company Argo Medical Technologies is also intended to help those with lower-limb disabilities to walk upright using sticks.

Dr van Asseldonk believes the possibilities are manifold.

"I foresee that older people in the future might just wear an exoskeleton when they're going around so they can keep pace with the grandchildren.

"You can imagine devices like this could keep people mobile for longer."

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Food for thought: can fish lower your stroke risk?

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Fresh sardines, caught just after sunrise, are on display at a fish market on Croatia's largest Adriatic city of Split Aug 20, 2004.

Credit: Reuters/ Matko Biljak

By Genevra Pittman

NEW YORK | Fri Sep 23, 2011 3:35pm EDT

NEW YORK (Reuters Health) - People who eat fish a few times each week are slightly less likely to suffer a stroke than those who only eat a little or none at all.

That's the conclusion of an analysis of 15 studies, each of which asked people how frequently they ate fish, then followed them for between four and 30 years to see who suffered a stroke.

"I think overall, fish does provide a beneficial package of nutrients, in particular the omega-3s, that could explain this lower risk," said Dr. Dariush Mozaffarian, a Harvard School of Public Health epidemiologist whose research was included in the analysis.

"A lot of the evidence comes together suggesting that about two to three servings per week is enough to get the benefit."

Close to 800,000 people in the U.S. have a stroke each year, and 136,000 die from it. Smoking, drinking, being overweight and having high blood pressure and cholesterol are all linked to a higher risk of stroke.

Dr. Susanna Larsson and Dr. Nicola Orsini of the Karolinska Institutet in Stockholm, Sweden wrote in the journal Stroke that omega-3 fatty acids in fish might lower stroke risk through their positive effects on blood pressure and cholesterol.

Vitamin D, selenium and certain types of proteins in fish may also have stroke-related benefits, Mozaffarian added.

Data for the analysis came from close to 400,000 people age 30 to 103. The studies were done in the U.S., Europe, Japan and China.

Over anywhere from a few years to a few decades, about 9,400 people had a stroke. Eating three extra servings of fish each week was linked to a six-percent drop in stroke risk, which translates to one fewer stroke among a hundred people eating extra fish over a lifetime.

And the people in each study who ate the most fish were 12 percent less likely to have a stroke that those that ate the least.

Mozaffarian's own report separated the effects of different kinds of fish and found that people who ate more fried fish and fish sandwiches didn't get any stroke benefit, not surprisingly.

But the research can't prove that adding more non-fried fish to your diet will keep you from having a stroke. People who eat a lot of fish, Mozaffarian told Reuters Health, "could have healthier diets in other ways, people could exercise more, people could have better education that could lead them to see their doctors more." All of those things might decrease their risk of stroke.

Still, he added, most studies have tried to take those other health and nutrition factors into account to isolate the effects of fish as much as possible -- and they suggest a cause-and-effect relationship.

It's likely, Mozaffarian said, that people who start out eating no fish or very little probably have the most to gain by putting it on their plate more often. "You get a lot of bang for your buck when you go from low intake to moderate, a few servings per week," he said. After that, the benefit from each extra serving probably goes down.

Fatty fish such as salmon and herring are especially high in omega-3s. The American Heart Association recommends at least two servings of fatty fish in particular each week.

SOURCE: bit.ly/oe88xL Stroke, online September 8, 2011.

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Depression increases risk of stroke, study says

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Four percent of the estimated 795,000 strokes that occur in the United States each year can be attributed to depression.Depression increased the risk of ischemic strokeDepression increases the risk of heart attacks (and especially fatal ones)People who are depressed are more likely to smoke or drink heavily

(Health.com) -- People with depression are more likely to have a stroke than their mentally healthy peers, and their strokes are more likely to be fatal, according to a new analysis published this week in the Journal of the American Medical Association.

Depression is a relatively minor risk factor for stroke compared to high blood pressure (hypertension) and other health conditions and behaviors that damage blood vessels, the researchers say. Still, their analysis suggests that as many as 4% of the estimated 795,000 strokes that occur in the United States each year can be attributed to depression.

"If you have depression but no other health issues, you probably don't have to pay too much attention to stroke risk," says An Pan, Ph.D., the lead author of the analysis and a research fellow at the Harvard School of Public Health, in Boston. "But if you are depressed and are also obese, or have hypertension or...unhealthy lifestyle factors, your risk is going to increase dramatically."

Health.com: The 10 most depressing states in the U.S.

Pan and his colleagues combined data from 28 studies dating back to the mid-1990s that included about 318,000 people overall. Roughly 2.7% of the participants had a stroke during the studies, which ranged in length from two to 29 years.

Compared to those who showed no signs of depression, people who received a depression diagnosis from a doctor or who reported feeling depressed were 45% more likely to have a stroke and 55% more likely to die from a stroke, the researchers found.

Depression increased the risk of ischemic stroke, in which a blood vessel becomes blocked and cannot send blood to the brain. But it did not measurably raise the risk of the other major type, hemorrhagic stroke, in which a blood vessel leaks or bursts open.

Health.com: 12 signs of depression in men

The new study is the latest in a long line of research linking depression to chronic disease and serious physical health problems.

"We knew that depression raises a person's risk of developing diabetes, obesity, hypertension, and cardiovascular disease," Pan says. "We also knew that depression can occur after patients suffer a stroke. We just didn't have strong enough evidence to know if the reverse was true, or what really comes first."

Researchers have already established that depression increases the risk of heart attacks (and especially fatal ones), so it makes sense that depression would have a similar association with stroke, says Norman Rosenthal, M.D., a clinical professor of psychiatry at the Georgetown University School of Medicine, in Washington, D.C.

"Strokes and heart attacks both represent blood vessels becoming blocked and blood being withheld from a vital organ, whether it's the heart or the brain," says Rosenthal, who was not involved in the new study. "They're essentially the same disease."

Health.com: Careers with high rates of depression

Depression could contribute to strokes in many ways, Pan says. For starters, people who are depressed are more likely to smoke or drink heavily, to follow an unhealthy diet, and to neglect their personal health. Most of the studies included in the analysis controlled for these and other risk factors, but the data suggests that at least some of the stroke risk in depressed people can be explained by an unhealthy lifestyle.

There are other possibilities, as well, that aren't as easily measured. Depression can increase the production of stress hormones in the body, for instance, and can trigger dangerous inflammation in the blood vessels. "Little things, like keeping up good dental hygiene or socializing with friends, all affect inflammation levels -- and these are things that a depressed person is less likely to do," says Rosenthal.

Depression may also cause people to slack on taking medications needed to control other stroke-related conditions, such as diabetes or high blood pressure. On the other hand, some medications prescribed for depression -- most notably the class of drugs known as atypical antipsychotics -- have been shown to cause weight gain and obesity, a known risk factor for stroke.

More research is needed to determine whether depression drugs contribute to stroke risk. Doctors should monitor weight gain and blood pressure levels in patients taking these drugs, but there's no reason for patients to stop taking them, Pan says. "For now, physicians should prescribe medication if they think it is necessary, or if non-drug treatments haven't worked."

Although depression isn't the most important risk factor for stroke, the researchers say it likely has a noticeable impact on the stroke rate. They estimate that depression is responsible for an additional 106 strokes per 100,000 people in the United States each year.

Copyright Health Magazine 2010

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Study: An Apple a Day May Keep Stroke at Bay

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Eating white-fleshed fruits like apples and pears was associated with a significant dip in stroke risk, finds a large new study by Dutch researchers.

Although recent studies have touted vibrantly colored fruits and vegetables as being the most healthful — orange sweet potatoes, green kale and bright blueberries, for instance — it was humbly pale-fleshed apples and pears that came out as big winners in the new study.

The researchers analyzed data on more than 20,000 men and women aged 20 to 65, who were healthy and free of cardiovascular disease at the start of the 10-year study. Based on questionnaires filled out by the participants, researchers tracked their intake of fruits and vegetables by color: green (broccoli, kale, spinach and other leafy greens), orange/yellow (citrus fruits, carrots, peaches), red/purple (tomatoes, beets, cherries) and white (apples, including applesauce, pears, bananas, cauliflower, cucumber, chicory).

LIST: 5 Healthier Alternatives to the Potato Chip

Overall, the white category was mostly widely consumed of the color groups, accounting for 36% of all produce eaten. The most common foods in that group were apples, pears and applesauce.

The investigators followed the participants for a decade, logging the number of strokes people suffered. There were 233. When the rate of stroke was compared to the participants' diet, researchers found no association with the amount of brightly colored fruits and veggies they ate, a bit of a surprise considering that the phytochemicals that lend these foods their hue have been linked with good heart health and a lower risk of cancer.

Participants who consumed 171 grams of white-fleshed produce daily, however — the equivalent of one medium to large apple — were 52% less likely to have suffered a stroke than people who ate less than 78 grams of white produce. Overall, for every 25 grams of white fruit consumed each day, participants saw a 9% reduction in stroke risk.

It's not known why white fruits may be associated with such a dramatic effect on stroke, and the authors cautioned that the findings need to be replicated before making any recommendations specifically about white fruits. But it's well known that diets rich in fiber — found in apples and pears — contribute to overall cardiovascular health. And as the Well Blog's Tara Parker-Pope notes: "Both fruits also contain a number of nutrients and phytochemicals, including the flavonol quercetin, which may have anti-inflammatory properties."

MORE: $5 Friday: How to Eat Healthy for Five Bucks a Pop

Like other research that relies on self-reported questionnaires, the current study is limited by people's potentially faulty recollections about what they ate. Still, the study was large and population based, and tends to support some widely accepted nutritional advice: eating fruits and vegetables is good for your health.

The study was published Thursday in Stroke: Journal of the American Heart Association and was funded by combined grants from Dutch and European public health agencies as well as the Dutch Product Board for Horticulture.

Meredith Melnick is a reporter at TIME. Find her on Twitter at @MeredithCM. You can also continue the discussion on TIME's Facebook page and on Twitter at @TIME.

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Study: An Apple a Day May Keep Stroke at Bay

AppId is over the quota
AppId is over the quota

Eating white-fleshed fruits like apples and pears was associated with a significant dip in stroke risk, finds a large new study by Dutch researchers.

Although recent studies have touted vibrantly colored fruits and vegetables as being the most healthful — orange sweet potatoes, green kale and bright blueberries, for instance — it was humbly pale-fleshed apples and pears that came out as big winners in the new study.

The researchers analyzed data on more than 20,000 men and women aged 20 to 65, who were healthy and free of cardiovascular disease at the start of the 10-year study. Based on questionnaires filled out by the participants, researchers tracked their intake of fruits and vegetables by color: green (broccoli, kale, spinach and other leafy greens), orange/yellow (citrus fruits, carrots, peaches), red/purple (tomatoes, beets, cherries) and white (apples, including applesauce, pears, bananas, cauliflower, cucumber, chicory).

LIST: 5 Healthier Alternatives to the Potato Chip

Overall, the white category was mostly widely consumed of the color groups, accounting for 36% of all produce eaten. The most common foods in that group were apples, pears and applesauce.

The investigators followed the participants for a decade, logging the number of strokes people suffered. There were 233. When the rate of stroke was compared to the participants' diet, researchers found no association with the amount of brightly colored fruits and veggies they ate, a bit of a surprise considering that the phytochemicals that lend these foods their hue have been linked with good heart health and a lower risk of cancer.

Participants who consumed 171 grams of white-fleshed produce daily, however — the equivalent of one medium to large apple — were 52% less likely to have suffered a stroke than people who ate less than 78 grams of white produce. Overall, for every 25 grams of white fruit consumed each day, participants saw a 9% reduction in stroke risk.

It's not known why white fruits may be associated with such a dramatic effect on stroke, and the authors cautioned that the findings need to be replicated before making any recommendations specifically about white fruits. But it's well known that diets rich in fiber — found in apples and pears — contribute to overall cardiovascular health. And as the Well Blog's Tara Parker-Pope notes: "Both fruits also contain a number of nutrients and phytochemicals, including the flavonol quercetin, which may have anti-inflammatory properties."

MORE: $5 Friday: How to Eat Healthy for Five Bucks a Pop

Like other research that relies on self-reported questionnaires, the current study is limited by people's potentially faulty recollections about what they ate. Still, the study was large and population based, and tends to support some widely accepted nutritional advice: eating fruits and vegetables is good for your health.

The study was published Thursday in Stroke: Journal of the American Heart Association and was funded by combined grants from Dutch and European public health agencies as well as the Dutch Product Board for Horticulture.

Meredith Melnick is a reporter at TIME. Find her on Twitter at @MeredithCM. You can also continue the discussion on TIME's Facebook page and on Twitter at @TIME.

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