Florida: Time may heal all wounds, but in the case of stroke survivors, the
key to better recovery is to spend more time in an intensive physical
therapy program, according to a University of Florida Health study. After a stroke, the brain and body can start recovering immediately
and can show improvement up to six months afterward, said UF Health
researcher Janis Daly, Ph.D. But this study focused on people who had
persistent disability even a year or more after completing standard
care. The study found that extensive physical therapy helped them
recover motor function, even though they began the study treatment a
year or more after stroke.
“The recovery was meaningful to patients in terms of physical
function. Each person’s recovery was somewhat unique,” said Daly, the
paper’s lead author and a professor in the UF College of Medicine’s
department of neurology. “Some had dramatic recovery, some had less.
Some were able to perform functional tasks that they weren’t able to do
before; some recovered the ability to move their arm so they could
actually place the arm for functional tasks, for example into the sleeve
of a sweater.”
Daly said the average change in function for patients who had been
severely affected by their stroke was clinically significant for arm
movements and for performing complex tasks. For instance, a man who had
been unable to lift a spoon to his mouth can now feed himself.
Inability to combine regular motions -- for example, flexing the
shoulder and simultaneously extending the elbow while reaching for an
object -- can be one result of a stroke. The patient may concentrate on
the reaching movement of the arm, but the normal neural pathways are
interrupted, and the patient’s arm may flex inward toward the body
instead of extending to reach for a glass of water or a fork, said Daly,
also the director of the National Veterans Affairs Brain Rehabilitation
Research Center of Excellence in Gainesville.
To help patients regain movements of the shoulders, arms and hands,
which are crucial in many daily activities, researchers administered an
intensive physical therapy program that included five hours of
rehabilitation per day, five days per week, for 12 weeks to 39 study
participants.
The researchers tested three different modes of rehabilitation. The
first was motor learning rehabilitation. Daly compared motor learning
rehabilitation after stroke to learning a new sport move, such as a
beginner learning a tennis serve. In this type of rehabilitation,
patients must concentrate on performing a movement as deliberately as
possible, with as much normal movement as possible, and must practice
the task repetitively.
“Think about a child learning to walk or to ride a bicycle,” Daly
said. “They must practice over and over until they come close to
perfection.”
The second and third modes of rehabilitation were electrical
stimulation rehabilitation and robotics-assisted rehabilitation. In
electrical stimulation rehabilitation, electrodes comfortably stimulated
the muscles on a person’s forearm and caused the hand to lift.
Participants in the robotics-assisted rehabilitation group practiced the
reach movement using robot software. The software guided them to
attempt to reach targets displayed on a computer monitor. Their forearm
and hand were cradled in a support so participants could concentrate on
moving the shoulder and elbow.
One group received five hours per day of motor learning alone, while
the other two groups received motor learning for 3 1/2 hours and
electrical stimulation or robotics-assisted rehabilitation for the
remaining 1 1/2 hours per day. All three groups received some motor
learning rehabilitation. Each of the groups improved significantly, on
average doubling or nearly doubling their scores on a scale that
assesses coordination.
Daly says the recovery for all three groups was equal, with no
statistically significant difference between the groups. The researchers
named a small sample size as a potential limitation of the study,
pointing out that there might have been statistical differences in the
results between groups if the group sizes had been larger. Because of
the intensity of the program, one physical therapist worked with three
patients; this ratio of therapist to patients was successful. Factoring
in the salaries of the therapists and the cost of equipment used in
rehabilitation, the researchers calculated that treatment for each
patient cost between $4,500 and $5,600.
“Often after stroke, people can recover normal function without
intensive treatment, in response to normal protective physiological
processes. Some people recover quite well and can function normally. For
this study, however, we enrolled people who had a stroke a year or more
prior to their study participation, and who were still severely
impaired,” Daly said. “The magnitude of recovery we observed in our
study is higher than any other studies that have been published so far,
which supports the promise of longer treatment and more intensive
treatment after stroke, even for those who are more severely impaired.”