While many people survive strokes and manage to keep their own “selves” very much intact, for others the remnant physical or mental damage of the stroke goes on and on. Careers and relationships suffer when a formerly vibrant, independent person is transformed into one who is in need of assistance for everything from driving to dialing the phone to showering and dressing.
Since 1995, survival rates for stroke patients have been boosted by nearly 30% — but, sadly, many of those patients have remained deeply impaired. They have trouble walking and they are at high risk for falls. Innovative therapies have been developed for physical therapy to aid in recovery. While helpful, much of this technology is expensive to develop, costly to purchase and must be administered by a trained specialist as part of a structured exercise program, putting it out of reach for many patients.
Now a study from Duke University has taken the results of patients doing intensive, center-based rehab with high-tech equipment and compared them with the results of people who work at home with a visiting physical therapist. The researchers also investigated whether rehab started long after a stroke — as much as six months later — still can be helpful.
Exciting, Unexpected Results
The study examined the progress of 408 stroke survivors, all of whom had their strokes either two months or six months earlier. Some of the patients who had suffered strokes six months previously were wait-listed to begin therapy at a center and so had not received any rehab. All of the patients were divided into three groups. Those who had strokes two months previously either underwent therapy in a center for high-tech rehab (group one)… or had home-based rehab with a therapist (group two), emphasizing progressive strength, balance and walking exercises. The third group of patients — those who were wait-listed — also started the high-tech program. Rehab for all groups took place in three weekly sessions over 12 weeks.
I spoke with the study author, Pamela Woods Duncan, PhD, PT, professor of physical therapy at Duke University School of Medicine. She explained that the goal of the study was to determine how well patients functioned one year after a stroke with different therapy protocols — and that the research yielded two excellent findings:
First, while the researchers had anticipated that high-tech rehab would be more effective, much to their surprise that was not the case. “Using technology was not superior to working with patients at home in function, balance and walking exercises,” Dr. Duncan said.
Furthermore, the study put to rest the belief that only early rehab works. The results were the same in all three groups including the late starters — 52% of all patients showed significant improvement, walking well in the home and walking more in their communities.
On Your Own?
Stroke patients absolutely need rehabilitation and regular exercise, Dr. Duncan told me, but added that it would be a grave mistake to misinterpret these findings to mean that stroke patients can do well simply by exercising on their own at home. Stroke patients need careful cardiovascular monitoring and a trained therapist to design and conduct a program that is in keeping with their progress. Safety is an issue, especially early on in rehab when the risk of falling is high — so using professional therapists, at least initially, is critical. That said, in-home therapy uses less expensive equipment (such as elastic bands), requires less training for therapists and needs fewer clinical staff members than in-patient care. And, physical therapy for stroke patients is not just a 12-week endeavor — it must be a lifelong habit in order to keep the muscles strong and supple. Developing an at-home therapy plan that can be administered by family members can be cost-effective and also very helpful at maintaining and even continuing to improve the physical function of the patient.