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 Association.
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 discharge.
"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 occupational therapist.
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 as:
- 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 costs.
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.