May 25, 2011 -- When it comes to helping stroke patients walk again, low-tech, home-based approaches to rehabilitation may work just as well as specialized treadmill training in a rehab facility, a new study shows.
The key to the success, researchers say, appears to be the intensity and frequency of the exercise, not where it's performed or even how long after stroke patients wait to start physical therapy.
The study is said to be the largest study on stroke rehabilitation ever conducted in the U.S. It found that about half of 408 participants, who were partially paralyzed when they started therapy, were able to walk longer distances at faster speeds a year after their strokes, whether they received physical therapy for 90 minutes three times a week for three months at home or on a body-weight-supported treadmill in a rehab facility.
What's more, participants who started their rehabilitation programs later, about six months after their strokes, saw just as much improvement as those who began rehab just eight weeks after the event.
"There's a lot of optimism in this study," says study researcher Pamela W. Duncan, PhD, PT, a professor of nursing and physical therapy at Duke University in Durham, N.C. "Patients can recover after a stroke and they can recover later than we thought they could recover in the past. But it's going to take very structured, intensive interventions to do that."
The study is published in the New England Journal of Medicine.
About two-thirds of people who experience a stroke have limited ability to walk, at least initially.
Those who do manage to get back on their feet often find it can be slow-going and hazardous. Studies show that having a stroke quadruples the risk of falling and elevates the risk of breaking a hip after a fall by 10 times.
There has been no consensus about the best way to help people recover their gait. But one therapy -- body-weight-supported treadmill training -- has become increasingly common in rehab facilities.
In this kind of treadmill training, patients are supported by a harness over a treadmill while therapists help them move their weakened legs. Over time, the harness supports less body weight until the patient is able to stand and walk on his or her own.
"This was, to my knowledge, the first large-scale, rigorously done trial showing that patients could make just as much progress, in terms of walking, with intensive home physical therapy as with the much more expensive inpatient rehab using treadmills and other complex equipment than are available at home," says Richard B. Libman, MD, chief of the division of vascular neurology at Long Island Jewish Medical Center, in New Hyde Park, N.Y.
Other experts, however, said they were surprised and unconvinced by the results.