Stroke Rehab: Home Exercise as Good as Rehab Facility
Study Shows Walking Improves for Stroke Patients Who Get Physical Therapy at Home
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Effects of a Stroke continued...
"To see that, in this study, that the body weight support wasn't superior to home exercises was a little bit surprising," says Susan Linder, a research physical therapist with the Cleveland Clinic in Ohio. "Because everything that we have thought really indicates that patients really learn better not just on the treadmill, but with this body weight support."
Linder says the results of the study are clouded by the fact that more than 80% of study participants in all groups also received additional physical therapy, usually in outpatient facilities, on top of the gait training work they were assigned for the study.
"What isn't controlled for is what physical therapy interventions they were receiving outside of the study," Linder tells WebMD.
Treadmill Training vs. Home Exercise
For the study, patients over age 18 with one weakened leg after a recent stroke were recruited from six rehabilitation facilities in California and Florida.
To be included, they had to be able to walk at least 10 feet with minimal help and to tolerate exercise. They also had to be living at home or were expected to return home after therapy.
Four hundred eight patients qualified for the study. The average age of study participants was 62.
Two months after their strokes, they were randomly assigned to one of three groups: early treadmill training, later treadmill training, or home exercise.
All participants received 30 to 36 sessions of physical therapy for 90 minutes, three days per week. The early treadmill training group and home exercise group started their regimens two months after their strokes. The late treadmill training group began six months after their strokes.
In the treadmill training sessions, patients were strapped into a harness that partially supported their body weight. A physical therapist helped them move their weakened leg as they walked for 20 to 30 minutes on a treadmill. They followed that with practicing walking on the ground for another 15 minutes. The rest of the session was used for warm-up and stretching exercises.
In the home exercise sessions, a physical therapist worked with participants to improve balance, strength, and flexibility. Sessions became progressively more challenging. Home exercisers were encouraged to walk daily, but walking was not part of their structured training.
By one year after their strokes, 52% of participants had improved by one functional level, meaning that if they walked more slowly than about 1 mile per hour before the study, they were able to walk at least as fast as a mile per hour after their exercise training. If they walked between about 1 and 2 miles per hour before the study, they were able to walk at least as briskly as 2 miles per hour afterward.
Those are significant improvements, Linder says.