When Cindy Dalton of Cartersville, Ga., suffered a massive stroke in Oct. 2005, her life was changed in seconds - leaving her unable to do many things most people take for granted, like speaking, feeding herself and writing her own name on a piece of paper. It also robbed her of one of the great joys in her life -- playing hand bells in her church choir.
This holiday season, she will again play the hand bells -- thanks to sheer determination to overcome the debilitating stroke, and with the help of a new clinical trial at Emory University that combines electrical brain stimulation with intensive physical therapy.
Dalton, who was diabetic and suffered high blood pressure for years, admits to sidestepping her health by not watching her diet or taking her required blood pressure medication. One night, while visiting family in Chicago, she experienced a stroke while dining in a restaurant.
"Prior to dinner, I felt tired and weak, and had a terrible headache," recalls Dalton. "I had trouble dressing myself and my vision was blurry. I passed it off as being tired and hungry. At dinner, my husband noticed that my speech was slurring and that there was a noticeable difference in my facial expressions.
"He asked me to grip his hands," continues Dalton, "and when I couldn't, he knew right away that I had suffered a stroke and rushed me to the emergency room."
She was eventually flown back to her home in Savannah, where she would begin weeks of intensive therapy to try and regain use of her left arm and leg, as well as to redevelop her speech. Earlier this year, she learned of a new clinical trial at Emory called the Everest Study.
The Everest study is a randomized, multi-center study comparing the effects of cortical stimulation plus rehabilitation - versus the effects of rehabilitation alone. Cortical stimulation therapy involves the precise delivery of low levels of electricity to the surface of the brain via an implanted stimulator.
According to Robert Gross, MD, assistant professor of neurosurgery, Emory University School of Medicine, the new study is designed to evaluate and treat patients experiencing weakness or loss of function in the arm as a result of ischemic stroke. An ischemic stroke is caused by the blockage of an artery leading to the brain, depriving the brain of oxygen and other nutrients. In response to the stroke, the brain reorganizes in an attempt to compensate for the damaged area, but often a stroke survivor is left with a lasting disability.
"The study evaluates the effectiveness of a device that is similar to a heart pacemaker, in which the electrode is surgically implanted at an active site outside the region of the stroke, which controls hand and arm function" explains Dr. Gross. "The implant electrically stimulates the new active area affected by the stroke, in effect 'waking up' the new nerve pathways, while we also begin vigorous rehabilitation of the hand and arm.
"After three to six weeks of rehabilitation therapy, the implant is removed and the patient is monitored for up to a year afterward," says Dr. Gross. "This is a great example of how neurology and rehabilitation medicine work in concert with one another."
Dalton has spent months undergoing rehabilitation therapy at Emory's Center for Rehabilitation Medicine, and she says she has pushed herself to do more than required in order to better herself and to spur others who find themselves facing the same challenges one day.
"The therapy spanned six weeks, three hours a day, five days a weeks," says Dalton. "If they asked me to do three sets of repetitions of something, I would do four. I used this opportunity to make myself a better individual than I was before the stroke - both in personal discipline and in health.
"Now, I am again able to drive my car, bag my own groceries, write and type in a computer … and ring my hand bells," she explains. "At one point shortly after my stroke, I wasn't sure what was really wrong with me or even if I would survive. Now, I hope, if anything, I can help to inspire others."
"Cindy has done a remarkable job in overcoming her injury, and she embodies the spirit of determination and will to succeed," says Sarah Blanton, therapy program coordinator in the Center for Rehabilitation Medicine. "Suffering from a stroke is a traumatic episode in the life of not only that individual, but his or her family, as well. It takes a tremendous amount of assistance, patience and pure desire to improve. Cindy is a true role model."
Dalton also warns others to recognize the warning signs before a stroke.
"In looking back now, I know that I suffered numerous 'mini-strokes' that happened prior to the big one," she says. "And had I recognized those signs (which include severe headaches, sudden blurred vision or weakness in the arms and legs) I could have possibly done something proactive to avoid having gone through all of this.
"The worst thing anyone can do is ignore warning signals your body is sending you, especially if you aren't already taking the best of care of yourself," says Dalton. "I was lucky."