At NYU Langone’s Rusk Rehabilitation, physiatrist Preeti Raghavan, MD, treats patients recovering from stroke and traumatic brain injuries, as well as those with neurological conditions such as multiple sclerosis and cerebral palsy. She’s also director of the Motor Recovery Research Laboratory, which pioneers techniques to restore arm and hand function in patients with neurological damage. Dr. Raghavan’s research is supported, in part, by Ilse Melamid and Carol Feinberg.
Why specialize in rehabilitation medicine?
As a girl, I was very close to my great-grandfather, an engineer who’d built one of the largest dams in India. In his 90s, he had a stroke, and what bothered him most was losing the use of his right hand. Later, when I was in medical school, researchers were just beginning to understand how the brain can rewire itself in response to experience, a phenomenon known as neuroplasticity. So I decided to specialize in neurorehabilitation, focusing on the connection between the brain and the upper extremities.
You and your team invented the m2 Bimanual Arm Trainer, the first FDA-cleared device that uses a stroke patient’s unaffected arm to retrain their weak or paralyzed counterpart. How did you come up with the idea?
A decade ago, physicians would immobilize a stroke patient’s good arm, on the theory that this would force the affected arm to relearn motor skills. But in my clinical studies, I found that the affected arm learned a task much better when the good arm did it, too. In fact, the unaffected side could actually teach the affected side. This led my team to develop several devices in which the patient’s arms, hands, or fingers are connected by cables. When the good side moves, the weakened side moves in the same way. Because the arm trainer was easy for even severely impaired patients to use, we made it a priority to get it patented and approved. At present, it’s available only at Rusk Rehabilitation.
How does the device work?
The patient places his or her arms on a pair of specially designed movable arm rests and performs a series of exercises. Initially, that was all there was to it. But when we began treating a five-year-old boy with attention deficit hyperactivity disorder, we added a customizable video-game component to increase engagement and motivation. Now, the patient rows on a virtual river, catches virtual objects, or cups virtual water in his hands, earning points for good performance. It’s fun, and patients love being able to train on their own because it gives them a sense of control over their own body. Clinical trials are ongoing, but the device has been shown to improve shoulder rotation, forearm rotation, and wrist extension. Anecdotally, we’ve seen improvements in hand opening as well. After a few sessions, many patients find it easier to put on a coat, turn a doorknob, or hold a steering wheel. The exercise routine can be tailored to the patient’s stage of recovery.
How do you motivate your patients?
I try to empower them to take charge of their own recovery. Patients are often told that if they haven’t recovered hand function within the first six months, they never will. But research shows that recovery can occur long after injury if people work at it. I tell patients that they’re like elite athletes: they have to practice to keep on top of their game.