Stroke Rehabilitation Treatment Video Transcribe
McMullen: I’m Robert McMullen. I’m a psychiatrist. I went to Georgetown Medical School, which was a wonderful experience, and then I did my residency at Columbia Presbyterian. I’ve been in practice in New York City and Mount Kisco for 36 years.
I’ve mainly concentrated on using medications for psychiatric disorders but I want to talk about treating pain with TMS. TMS has turned out to work for a few psychiatric disorders including OCD and depression and bipolar depression especially. It’s also been found to work for various neurological disorders, including Tourette’s Syndrome, seizure disorders, chronic pain, and stroke rehabilitation.
I want to talk about stroke rehabilitation.
Let me explain a little bit about what happens when you have a stroke and why it’s hard to get better.
When you have a stroke, say your right arm is somewhat paralyzed, it’s because a lesion on the other side of the brain, on the left side, in the area that controls the arm. In a stroke a lot of brain cells have died there and as you do rehab and work your arm until you can get a little better control of it that’s all using the plasticity of the brain to improve function. The neurons can change. You can take neurons that are nearby that are normal neurons they can start functioning to take care of the arm movements. Now a problem with the stroke is that when this area has a lesion then the exact opposite area of the brain becomes hyperactive.
That hyperactive area sends signals through the corpus callosum to the area of the lesion that they send inhibitory pulses so they inhibit the area of the lesion from improving. So your own brain is holding you back from the rehab.
There’s two ways of doing TMS that helps strokes. They’ve been doing this at Brooke Rehab and other places. One is to do a stimulating treatment in the area of the lesion and that increases the plasticity there and that increases the growth hormone of the brain, BDNF, it’s called, brain-derived neurotropic factor but another way that works as well or better is to do an inhibitory treatment over the good area. So you use an inhibitory one pulse per second TMS treatment that calms down that area underneath the coil and then you’re preventing that area from inhibiting the area of the stroke. Then that area is no longer being conically inhibited and can begin to repair itself.