Activity after Stroke. Muscle weakness and paralysis caused by stroke can rob people permanently of the capacity to perform common daily activities. Rehabilitation for these individuals currently focuses on training limbs less affected or unaffected by the stroke, to help compensate for a weakened or paralyzed limb and to maximize their overall capacity to function. This approach, however, means that the limbs most affected by stroke may deteriorate even more, from lack of use. Scientists recently completed the first controlled clinical trial of a promising new approach to rehabilitation, which focuses on strengthening and retraining the limb most affected by the stroke. Patients receiving this therapy performed routine daily tasks repeatedly with the most affected limb, while having the less affected limb restrained with a simple device. After two weeks of the therapy, stroke patients with weakened or partly paralyzed arms were better able to control motion in their affected limbs. The new approach offers hope for reducing functional impairments and increasing the independence and quality of life for patients with mild to moderate chronic strokes and, possibly, for people with other neurological disorders such as traumatic brain injury.

Pain and Tissue Damage and Artificial Limbs. Each year, injuries, vascular diseases, cancer, diabetes, and other disorders may require patients to have part or all of a leg amputated. These amputees may encounter painful and costly problems as they try to use a prosthesis (artificial limb replacement). Because the residual part of the leg fluctuates naturally in size during the day, the prosthesis socket connection may rub against it, causing blisters and pain. Amputees with poorly fitting sockets commonly try multiple, costly replacements. If unable to solve socket fit problems, individuals with leg amputations tend to reduce activity, adopting a sedentary lifestyle and increasing their risks of weight gain, diabetes, heart disease and other disorders. Recently, a NICHD-supported researcher (who himself has a leg amputation) perfected and completed testing a new type of prosthetic socket that adjusts automatically to changes in size of the residual limb. Amputees using the new socket report more comfort and stability in fit. The invention, which is now being considered for a patent, promises better mobility and quality of life for leg amputees, while saving on costly replacements and care of secondary health conditions.

Pain and Tissue Damage and Artificial Limb. Repeated urinary tract infection (UTI) is a potentially serious medical risk for people with internal bladder catheters. These catheters are used when normal voiding of urine is impossible because of spinal cord injury (SCI), stroke, loss of consciousness or critical illness, spina bifida, or other conditions. If not adequately treated, UTIs can lead to kidney damage. Antimicrobial agents are the standard treatment forUTI; however, they can fail and repeated use of these drugs risks creating drug-resistant bacteria. In a recent pilot study, scientists successfully tested a relatively simple, low-cost intervention to prevent UTIs in individuals using bladder catheters. The scientists were able to significantly reduce rates of UTI in SCI patients by inoculating them with a strain of harmless bacteria. A larger clinical trial is expected to confirm that the treatment is effective and safe for patients at high risk of UTI infection. This new approach to preventing UTI could protect the health of millions of individuals whose acute, chronic or disabling conditions require them to use internal bladder catheters, while reducing the costs of treating frequently recurring infections and their complications.