More Physical Therapy Aids Stroke Rehab
Extended Therapy Helps Stroke Survivors Regain Mobility
Aug. 14, 2003 -- A progressive, extended physical therapy
program for stroke survivors may allow them to make greater strides in
regaining lost mobility, balance, and endurance.
New research shows that a more aggressive approach to stroke
rehabilitation can speed recovery and reduce the risk of further disability
among stroke survivors better than short-term programs.
Stroke is the leading cause of disability among older Americans
and the most frequent cause for using rehabilitation services. Falls after a
stroke due to loss of balance are also a common cause of additional disability
among stroke survivors.
Contrary to Traditional Belief
Traditionally, experts believed that stroke patients reached
their most dramatic recovery within the first 30 days after a stroke. But
researchers say these findings show that a structured, 12-week physical therapy
program that targets rebuilding strength, balance, mobility, and upper body
function can produce greater benefits.
"We demonstrated that by providing a home-based exercise
program that's much more aggressive than what is typically prescribed, stroke
survivors can improve their walking ability, balance and cardiovascular
endurance," says researcher Pamela W. Duncan, PhD, a physical therapy
professor at the University of Florida in Gainesville, in a news release.
The study appears in Stroke: Journal of the American Heart
Extending Stroke Rehab Beyond Discharge
Researchers say that hospital stays after stroke have decreased
in recent years and recovery is often not complete at the time of
"After hospital discharge, stroke survivors continue to
improve," says Duncan. "But available therapy is highly variable.
Additional therapy often lasts only a few weeks and lacks progression in
intensity and task complexity. We investigated the effect of structured,
progressive intervention on recovery."
Researchers studied 92 stroke survivors who were an average of
70 years old, had suffered a mild to moderate stroke, and had completed
in-hospital stroke rehabilitation. The men and women were randomly divided into
two groups. One received a structured, progressive exercise program, and the
other received "usual care," which ranged from no additional therapy at
all to limited physical or occupational therapy, for 12 weeks.
The extended physical therapy group completed exercises that
focused on rebuilding strength, balance, endurance, and encouraging use of the
affected arm and/or leg during 36 sessions supervised by a physical or
The usual care group received an average about nine physical
therapy visits and an average of 10 occupational therapy visits that primarily
consisted of balance and mobility exercises.
More Therapy, More Recovery
The researchers found that both groups showed improvement after
three months of stroke rehabilitation on either program, but the structured
group experienced significantly more improvement in several key areas, such
- Higher scores on balance tests
- Patients were able to bicycle an average of 1.4 minutes longer during an
exercise stress test than at the start of the study vs. an average improvement
of 0.16 among the usual care group.
- They walked an average of 200 feet farther in 6 minutes after treatment
compared with an average of an extra 110 feet achieved by the other group.
Gains in strength and arm/leg function were not significantly
different between the two groups, but among those who were mildly paralyzed,
upper extremity gains were greater among the structured group.
But researchers say implementing such an extended stroke
rehabilitation program for would be challenging due to the additional
Duncan says additional studies should look at whether these
physical therapy exercises could be performed at home without a therapist's
supervision and whether the benefits are sustained beyond 12 weeks.