Health Topics – Johns Hopkins Medicine Podcasts

Intensive and personalized physical rehabilitation one to two months after a stroke helps people recover better, a recent study showed, but getting such services paid for remains a challenge. Steven Zeiler, a stroke expert at Johns Hopkins, says technology can help.

Zeiler: That’s why there is a lot of interest for example in some of the immersive environments, robotic assisted play areas, and creating virtual environments that would allow patients to do this with less occupational therapist input. Not to say completely independent, but perhaps less. We were excited to see this data; we’re not surprised. It fits right smack dab into the animal, and human model that we’ve built. It’s nice to see the confirmation and we intend to capitalize on it.  :29

Zeiler states that there’s no doubt of the benefit to society of more fully rehabilitated people who’ve had a stroke in addition to the individual’s quality of life. At Johns Hopkins, I’m Elizabeth Tracey.

Intensive physical therapy delivered to people one to two months after having a stroke and having already received usual rehabilitative services further improved their functioning, a recent study showed. Steven Zeiler, a stroke expert at Johns Hopkins, says this is an area that needs definition.

Zeiler: If we take a step back, what’s the dose of physical and occupational therapy? Nobody knows. We tend, after a stroke, in the right patients, to give a combined total of about three hours a day, and that’s physical, occupational and speech therapy combined. That’s based on what insurance companies will pay. And what emerging studies are showing us is that doing two things seem to be very beneficial. One providing more therapy, but two, providing an intense, tailored therapy. One that is supportive of a particular deficit of which the patient suffers.   :30

Zeiler says this study looked at muscle interactions, known as motor therapy, to help people with movement, and says other intensive strategies might also prove beneficial after a stroke. At Johns Hopkins, I’m Elizabeth Tracey.

People who’d had a stroke, got standard rehabilitation followed by more intensive physical therapy saw better recovery, if they got the additional therapy in the first two months after their stroke, a much awaited study finds. Steven Zeiler, a stroke expert at Johns Hopkins, explains.

Zeiler: Every patient that qualified for this study was then randomized into one of three arms: they were either exposed to twenty hours of intense motor therapy beginning less than 30 days after stroke, beginning at two months after stroke, or beginning at greater than six months after stroke. The end result was that the patients that received the extra 20 hours in that either early or middle time period did significantly better than patients who were exposed to the extra 20 hours at greater than six months.   :34

Zeiler says this study makes the case that rehabilitation that’s specific to someone’s deficits is beneficial for a longer period of time. At Johns Hopkins, I’m Elizabeth Tracey.

Specialized EMS units that only treat stroke improved stroke outcomes for people who were treated by them, a recent study found. Michele Johansen, a stroke expert at Johns Hopkins, says a few things about the study should be noted.

Johansen: If you’re going to really raise up these mobile stroke units it’s interesting that the mobile stroke units and the EMS trucks went together. Because most stroke units are going to be really really good at taking care of stroke and they probably have like critical care nurses who can manage other things, but you know EMS is good at kind of managing everything. And maybe they’re not expert at strokes, but they’re good enough at managing the emergency situation to get a stroke to the experts in the hospital. If you have a mobile stroke unit that’s used to just taking care of stroke, and they get there and it’s not a stroke, how are we going to manage that?  :30

Johansen says specialized stroke units also need CT and techs to do the studies to confirm or rule out a stroke, taking resources away from more centralized places like hospitals where more patients could be evaluated. At Johns Hopkin, I’m Elizabeth Tracey.

Children under twelve remain at risk for Covid infection, and even older children who can’t receive the vaccine or are immunocompromised are also at risk. Anna Durbin, an infectious disease expert at Johns Hopkins, says there are steps parents can take to protect their children.

Durbin: The family is the wall surrounding the children. So you want to make sure of course that you’re vaccinated, people they come in contact with are vaccinated. It’s really really difficult if you’re going to public spaces and you don’t know who’s vaccinated and who’s not vaccinated. I am cautiously optimistic, as kids under 12 get vaccinated, and we have vaccine mandates roll out that we are going to see decreases. And I think delta is slowing, I think that we’re starting to see that it’s peaked. It’s waning, but we still have I think probably six to eight weeks before we might feel safer.  :33

Durbin counsels patience as vaccines for younger children are evaluated. At Johns Hopkins, I’m Elizabeth Tracey.

Mu is just the latest Covid-19 variant that’s drawing the attention of many, with potentially worrisome mutations that may predict how infectious it might be.  Anna Durbin, an infectious disease expert at Johns Hopkins, says current vaccines should still provide pretty good protection against mu.

Durbin: We know that with mu the antibody responses are similar to beta. Meaning that the antibodies don’t work as well against mu just like they did not work as well against beta. That being said however, we know that people who were vaccinated, part of clinical trials in South Africa where the beta variant was spreading, efficacy against infection was lower, so about 65%, but the efficacy against severe disease and hospitalization was about 95%.   :29

Durbin says that while the best case is being able to avoid infection entirely, avoiding severe disease and staying out of the hospital are very good outcomes. At Johns Hopkins, I’m Elizabeth Tracey.

When enough people in certain geographic areas choose not to be vaccinated against viral diseases, outbreaks happen. We’ve been seeing this nationally with measles for years, and Covid-19 is no exception. Anna Durbin, an infectious disease expert at Johns Hopkins, explains.

Durbin: It’s all about who’s susceptible to infection. You can have in your state for instance 70% of adults vaccinated but you could have 90% of those adults in one place. When it burns through, when it gets transmitted through and it now longer has susceptible people to infect we see reduction in infections. Unfortunately then, delta came in which was more highly transmissible, so it was able to infect when alpha wasn’t. It was able to infect more people at a time than alpha.  :31

Durbin notes that because it isn’t possible to determine who’s vaccinated and who’s not, remaining vigilant is your best strategy. At Johns Hopkins, I’m Elizabeth Tracey.

The mu variant of Covid-19 is spreading, with new variants cropping up all the time. Anna Durbin, an infectious disease expert at Johns Hopkins, says although variants are concerning, the beauty of mRNA vaccines is the ease with which new ones can be created.

Durbin: They’ve already made variant specific mRNA vaccines. It’s really easy to do. As soon as you know the sequence you can redesign your RNA insert. The other thing that they’ll do in terms of how you license it, it’ll be looking at antibody response, so it’ll be immune bridging trials to show that the variant antibody titers are within statistically specific designed range of the other mRNA vaccines and then they’ll be good to go.  :31

Durbin says other strategies such as masking are also a good idea since as long as the virus keeps infecting people new variants will continue to emerge. At Johns Hopkins, I’m Elizabeth Tracey.

The best strategy to mitigate Covid-19 infection is still prevention with vaccines, but if you develop the disease, new oral medicines are poised to take their place in treatment. Mark Sulkowski, an infectious disease expert at Johns Hopkins, explains.

Sulkowski: There’s still I think a strong push for oral antivirals, both a protease inhibitor in development from Pfizer and a drug that acts on the polymerase, molnupiravir, that Merck is helping to develop. I think both of those hold promise for early treatment and prevention. And there is a an EUA for the Regeneron monoclonal for prevention. I think the challenge is just the rollout of that. You’re now talking about people who do not have Covid-19, and figuring out how we’ll administer that.  :30 

Sulkowski says Merck issued a press release describing its new medicine, but notes that no studies have been published on the drug yet, but he welcomes new options to manage Covid-19. At Johns Hopkins, I’m Elizabeth Tracey.

Many countries have or are in the midst of rolling out third doses or boosters against Covid-19, even as the World Health Organization decries the practice. Anna Durbin, an infectious disease expert at Johns Hopkins, says while such a strategy might keep some well, it’s not the way to stop the pandemic.

Durbin: If you want to stop the spread of delta, if you want to stop the emergence of new variants giving booster shots is not the way to do it. We have to get unvaccinated people vaccinated. I think unfortunately the discussion around booster shots has been a bit of a distraction and has moved the discussion away from what do we need to do to get unvaccinated people vaccinated. Will a booster help your immune system? Yes. Will it raise your antibody titers? Yes. Do you absolutely need it? Most people probably not.  :33

Durbin says those with special needs such as transplant recipients may need a third dose to produce any antibodies. At Johns Hopkins, I’m Elizabeth Tracey.