A Day in the Lab
with Anna Barrett, MD
by Mary Ann Littell
UMDNJ Magazine spent a day shadowing Anna Barrett, observing the tragedy that is stroke. Patients struggle to walk, to communicate, and most of all, to regain their normal lives. Sometimes it happens, sometimes it doesn’t.
nna Barrett provides equal parts of compassion, empathy and expert medical care to stroke survivors at the Kessler Foundation Research Center (KFRC) in West Orange, NJ. “Many people think of stroke as being a paralysis problem, but that’s not the whole story,” says Barrett, who is director of the Stroke Rehabilitation Research Lab at KFRC. “Many people with stroke — probably more than half — have what we call hidden disabilities, which include memory, vision and communication problems. Our research team focuses on finding treatments that will improve their lives.”
Barrett, an associate professor of neurology/neurosciences and physical medicine and rehabilitation at UMDNJ-New Jersey Medical School, is principal investigator for six clinical studies, three of them in communication and visual disabilities. Patients are referred through New Jersey’s Kessler Institute for Rehabilitation, ranked by U.S. News & World Report as among the top two rehabilitation hospitals in the country. It is one of the largest providers of stroke rehabilitation in the U.S., admitting 1,200 to 1,300 patients a year to its three hospital campuses in West Orange, Saddle Brook and Chester. “We screen almost all the stroke patients admitted to Kessler and enroll about 200 a year into our studies,” says Barrett. “We offer them the hands-on medical attention they need and may not get elsewhere.”
IT specialist Gary Barrett (no relation to the physician) smiles when asked about his progress post-stroke. “Considering I was paralyzed and couldn’t speak at all, I’m doing pretty well,” he says. Following months of rehab, he walks with a cane and his speech is impaired. He is participating in a study evaluating stroke patients’ attitudes towards using a device that produces speech. “The problem is that many people don’t want to use it because it’s visible, and others will then know they have a disability,” observes the physician.
High on Barrett’s list of research priorities is a type of vision problem called spatial neglect. These patients can see visual images but their brains have lost the ability to process them. Claudia Larino is one such patient. “People with spatial neglect have
difficulty processing images on the opposite side of their brain lesion,” says the physician. “If the lesion is on the right side of the brain, they neglect objects to their left.” Treatment is behavioral — for instance, training patients with cues and strategies. Barrett's team examines whether deep-seated brain systems may be activated by intensive training with devices such as optical prisms, resulting in better recovery.
Barrett heads to Kessler Institute’s West Orange campus (connected by corridors to KFRC) to meet Karen Rose, who’s recovering from a recent stroke. Barrett explains the importance of clinical research and Rose says she will consider entering a study. Barrett then gives Rose a test of visual attention, using a sheet of paper imprinted with stars of different sizes. Rose is asked to circle all the stars that are the same size. “Tests like this one may seem simplistic, but they are the best
prognosticators for evaluating visual impairment,” explains Barrett.
Using a hand-held dynamometer — a clickable counting device — research assistant Naureen Zaidi gives Rose another test. “People with hidden disabilities who have functional vision can have trouble directing movements to one area,” says Barrett. “We’re examining how this asymmetrical movement might affect not only one side of the body versus the other, but even the same side of the body when moving in left versus right space.”
Rose clicks with the unaffected hand, first on one side of the body, then the other. “Most survivors will click faster in right space than in left space,” says Barrett. “For the same reason, survivors can have trouble walking straight or operating the phone, television, or an elevator if the equipment is on their left.”
Rose finishes the test, visibly fatigued. “When someone has a stroke, it affects
how they feel about themselves,” says Barrett. “The psychological recovery is difficult. We’re here to help.”