By JOE KERNAN

It would seem that one of the worst pieces of advice a doctor can give a stroke survivor is to tell him to go and play a video game. Persons who are recovering from a stroke need to use their arms and legs to exercise if they will have any hope of recovering function.

But now that the Nintendo people have come out with their Wii game console, doctors and physical therapists are encouraging stroke survivors to get up and play the game. Wii is the video game console that allows players to use the remote controller as if it was sporting equipment, letting users swing and mock-throw to play baseball, tennis, golf, bowling and boxing.

When Wii came on the scene, physical therapists almost immediately saw the potential as a tool for rehabilitation.

We have already learned that just playing Wii alone increases the amount of function that a stroke survivor regains, said Susan E. DAndrea, PhD., who is the director of clinical research for Afferent, a Providence company that specializes in devices to enhance the recovery of neurological function in stroke survivors. What we are trying to learn with this study is whether the recovery function is much better and how much higher function with our device.

Afferent Corporation, an early-stage medical device company focused on treating chronic neurologic dysfunction, has initiated a clinical study to explore the use of a new neurostimulation technology to improve rehabilitation following a stroke. The study will test the noninvasive device to see its effect as far as regaining arm function is concerned.

The study is being conducted at Omega Medical Research in Warwick. The device being tested delivers low-level, non-painful electrical and mechanical sensory stimulation to the affected arm. By comparing arm function before and after a two-week rehabilitation program, it will be possible to judge how effective the stimulation is in improving outcomes.

Neuroscientists and clinicians are aware that the brain can recover, or re-map functions that were lost due to a stroke. Therapists have learned that the brain will create new connections for those parts of the brain that control arm movement and other functions if the physical stimulation is there. In other words, a patient can regain the use of an arm by using it. The devices being tested at Omega have demonstrated that they boost sensory feedback from the extremities of stroke patients. That sensory information is integrated and synchronized with movement and muscle contraction to push the brain into re-mapping so that another part of the brain takes over the function that used to be done with the part of the brain that was damaged by the effects of a stroke. The success of the recovery depends on the severity of the damage, but studies have shown that stimulating the brain with sensory information can enhance the effect of exercise not just on the arm, but in the brain itself.

The study at Omega will equip some of the stroke survivors with the device and others will not have them. The idea is to find out if what Afferent calls Stochastic Resonance Stimulation improves the speed and scope of recovery. But everyone in the study will get some benefit from the test. The Nintendo approach to physical therapy has been in use for some time and it does work. Again, how much function they regain depends on the amount of damage and the amount of effort the test subjects put into the therapy.

Some do get a lot of function back and some dont get as much, said DAndrea. But they will all increase the amount of function they have. We are hoping that our device enhances that recovery.

DAndrea said the devices are completely painless and said there is a little extra stimulation when the device is applied to make sure they are applied properly and are functioning.

This neurostimulation technology originated at Boston University and has been evaluated in a range of human clinical studies for applications in stroke rehabilitation, elderly balance and diabetic neuropathy. Results from these studies have been published in peer-reviewed journals.

Volunteer subjects will undergo an exercise regimen three times a week for two consecutive weeks. The exercise will be done at the Omega Medical facility, not at home.

All subjects will participate in the exercise. All subjects will have the stimulation device prototype mounted onto the affected limb and some subjects will be selected at random for the control group, with the device turned off during exercise or they will be in the group that has the device turned on. There will be 10 subjects in each group.

The stimulation device is placed on the outside of the skin and the risk of injury or side effects is extremely low.

Confidentiality will be strictly maintained by Omega Medical and by Afferent.

According to the American Stroke Association, stroke is the number one cause of adult disability and the third leading cause of death in the United States. Although stroke affects people of all ages, genders and races, people over 55, males and African-Americans are at higher risk for stroke.

Risk factors include obesity, smoking, diabetes, high blood pressure, high cholesterol and heart disease. By seeing a doctor regularly and following their instructions, you can control these risk factors.

Knowing the signs and symptoms of a stroke can make all the difference in the world. If a patient can get to the hospital in a timely way, a clot-busting drug can be administered to diminish the effects of a stroke, but there is only a three-hour window of opportunity to administer the drug. If you suspect someone is having a stroke, call 911 immediately. The quicker the treatment, the more brain function you keep.

But many stroke victims are not aware of symptoms or are inclined to dismiss the symptoms as insignificant. Any numbness or loss of motion or balance is plenty of reason to get to the emergency ward.

But strokes do hurt people and there is more hope now than ever that they can survive and recover functions. There is a burgeoning body of scientific and medical research that supports the idea that it is possible, even years after a stroke, to regain control and strength in partially paralyzed extremities.

It is becoming widely recognized that technology such as that being tested at Omega can play a crucial role in improving outcomes of post-stroke rehabilitation.

One of the truths we already know about function in virtual reality is that it can sometimes lead to function in the real world for stroke survivors. If you have lost function in one of your arms, you may be eligible for this trail.

To participate in the study, you must be 18 or older; had a stroke at least six months ago; able to understand instructions; and feel vibration in your arm.

You cannot participate if you are pregnant; have an implanted device like a pacemaker; or are medically unfit for exercise.

For more information on the trial, call Omega Medical Research at 739-3573 or e-mail ompatty@aol.com.