When Studying Disease, Healthy Controls Are Also Needed

fMRI images of brains

Above, fMRI activation of the blogger’s brain while making decisions about words and tones. At left a whole brain rendering, at right a coronal slice.

“Have we scanned your brain?”

Jerzy Szaflarski, MD, PhD, gave me his best smile. It was the smile of a leading medical researcher – 10 papers published last year alone – in need of “healthy controls” for a long and growing list of clinical trials at the University of Cincinnati (UC) College of Medicine and the UC Gardner Neuroscience Institute, a multidisciplinary center within UC Health.

In particular, Dr. Szaflarski is looking for 200 healthy controls for a major federally funded study about language difficulties (aphasia) in people who have suffered a stroke. Dr. Szaflarski and his colleagues want to learn how language impairments after stroke improve over time and how that improvement relates to the size and location of the stroke. In Greater Cincinnati alone, some 5,000 people are struggling with aphasia, which Dr. Szaflarski describes as “one of the most feared symptoms of stroke.”

A healthy control is a person who does not have the disorder or disease being studied and who can be used as a comparison. I qualified for the aphasia study because I have never experienced a stroke nor been diagnosed with a neurological condition such as multiple sclerosis or Parkinson’s disease. In my mid-50s, I am also in a desirable age range, if not for bathing suits, then for studies that are relevant to my peer group, which is beginning to fray a bit around the edges.

“We have a trial of therapy for aphasia, and we need healthy controls to see how the language patterns in stroke patients differ from the language patterns in healthy controls,” Dr. Szaflarski explained. “Because people with strokes are mainly in their 50s, 60s and 70s, we look for healthy controls who are in their 50s, 60s and 70s. But, because strokes can happen at any age, we also need people in their 40s and 80s and 30s. So we look for all the age groups, and we need healthy right- and left-handers to help establish language patterns so we can relate those to survivors of stroke.”

The act of participating as healthy control is something on the order of donating blood. The results aren’t as immediate, but at some point, knowledge gained from the study could prove invaluable to others. Thus, your faithful blogger agreed to participate in one of Dr. Szaflarski’s aphasia research studies.

My participation began on a recent weekday at 9:30 a.m. at Cincinnati Children’s Hospital Medical Center, which has a 3-tesla MRI machine that is used for research, and I was finished by noon. I was given $75 in cash, a stipend that every participant in the study receives. Christi Banks, CCRP, Senior Research Assistant in UC’s Department of Neurology, explained everything I would be asked to do. She advised me that the MRI machine would be loud, and it was. She also said that I would be informed if the researchers observed anything unfavorable on my brain scans.

The experience was interesting and also challenging. If you like word games, crossword puzzles, KenKen or Jumble, you are a natural for aphasia studies in need of healthy controls. (Some studies also involve arithmetic.) Even if you aren’t a fan of puzzlers, this is an intriguing way to spend a morning or afternoon.

Ms. Banks, sitting across from me at a table, began by taking some family history and then gave me five neuropsychological language tests. She asked me to name numerous illustrated objects, such as a truck, potholder and andiron. She asked me to come up with as many words as I could think of in one minute that began with a certain letter. (Of course, elegant, eloquent examples easily eluded me.) She asked me to move little blocks according to size and color. She checked my semantic fluency. And she gave me the Peabody Picture Vocabulary Test, during which I selected one picture out of four that best represented the meaning of a stimulus word. The words started out easily, got a little harder and then, near the end, veered into SAT vocabulary territory. A scholarly gentleman who had studied Latin is to date the only person to correctly identify all the correct images, Ms. Banks said.

At some point during the testing she told me I had just passed the test for memory problems. I was grateful for that but felt a chill thinking what life would be like if I could not name everyday objects or follow simple commands.

These tasks completed, I was off to the MRI machine, which would take a series of pictures of my brain while I was engrossed in several different tasks. I lay on my back with my knees propped up, wore headphones to hear instructions, and watched word tests on a small screen. While the machine was being prepared, I watched part of a movie.

The banging of the MRI is very real, bringing to mind a construction site, but I grew accustomed to it. Early on, I also felt a little nervous, and my heart sped up when I saw the words GET READY for the first exercise. Ms. Banks spoke to me frequently, asking me how I was doing.

During the next hour or so, the machine recorded how I think without talking, how I combine thinking with talking, and how I respond physically — by tapping my fingers – to specific sounds. The time went fast, and soon I was sitting up and feeling a little like an astronaut leaving her space capsule.

If you are in good health, have an interest in humanity’s well-being and can spare a few hours, I highly encourage you to consider being a healthy control in a scientific study. For more information, please contact Christi Banks at (513) 558-3975.

— Cindy Starr

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