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August 28, 2003

Aggressive home-based therapy yields results for stroke survivors

Stroke survivors who received therapist-supervised, progressive therapy after completing in-hospital rehabilitation significantly improved their endurance, balance and walking ability, according to a study reported in the September issue of Stroke: Journal of the American Heart Association.

Stephanie Studenski, a professor in the School of Medicine’s geriatrics division, is co-investigator on the study.

This study goes beyond the commonly held therapy paradigm that stroke patients achieve their most dramatic recovery within the first 30 days after stroke, according to study authors. They demonstrated that by providing a home-based exercise program that is significantly more aggressive than what is typically prescribed, stroke survivors can improve their walking ability, balance and cardiovascular endurance.

The study is the first to incorporate multiple components — strength, balance, endurance and upper extremity function — into a comprehensive stroke-recovery program, according to the authors. Stroke is the leading cause of disability in older Americans, and falls are a major problem for stroke survivors.

The researchers studied 92 stroke survivors (average age 70) from the Kansas City Stroke Registry one to four months after their stroke. Each had mild to moderate stroke deficits and had completed in-hospital rehabilitation. All survivors underwent tests for motor function, strength, balance and endurance at the start of the study. Participants were randomly assigned to one of two groups. One received the structured, progressive exercise program and was designated as the “intervention” group. The “usual-care” group had varied levels of therapies ranging from no additional therapy to limited physical or occupational therapy.

Those in the intervention group performed progressively intensive exercises focusing on their strength, balance, cardiovascular endurance and use of their arms and hands in 36 supervised sessions during the 12-week study. Forty-six percent of survivors in the usual care group did not receive any therapy. The remainder received an average of 8.7 physical therapy visits and an average of 10.4 occupational therapy visits. The usual-care therapy mostly consisted of balance and mobility exercises, upper extremity function and range of motion function. Endurance training was rarely incorporated and the therapy was not progressive, the authors note.

Both groups showed improvement when tested again after three months. However, those in the intervention group improved significantly more in several key areas — balance, endurance and mobility.

The intervention group bicycled during stress tests an average 1.39 minutes longer than they could at enrollment, while the usual-care group bicycled an average 0.16 minutes longer than their enrollment times. Patients in the intervention group walked an average 61.61 meters (about 200 feet) farther in six minutes compared to their baseline; and usual-care participants walked an average of 33.59 meters (110 feet) farther.

Differences in gains in strength and extremity function were not significant between the two groups. Upper extremity gains were better for the intervention group as compared with usual care among patients who were only mildly paralyzed.

Filed under: Feature,Volume 36 Issue 1

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