Stroke Rehab Getting Patients Back On Their Feet: Intensive Home Therapy As Good As
Stroke patients to intensive home physical therapy improved their ability to walk the same way as those who were more "high-tech" program in which they walked on treadmills with their weight supported wiring, in accordance with the results of the largest studies of stroke rehabilitation when ever conducted in the United States.
Funded primarily by the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health (NIH), with the assistance of the National Center for Medical Rehabilitation Research, the study also showed that patients continued to improve until 12 months after stroke, contrary to popular belief, that recovery will occur early and peaks at six months.
In fact, this study showed that even patients who have begun an intensive six months of rehabilitation after stroke improved their walking.
Dr. Pamela W. Duncan, chief researcher experience musculoskeletal applied after stroke (LEAP) trial, and a professor at Duke University School of Medicine in Durham, North Carolina, and colleagues presented their findings on February 11 in the course of American International Association of Conference Proceedings 2011 in Los Angeles, February 12 (APTA) American Physical Therapy Association in 2011 combined meeting sections of New Orleans.
Duncan told the press that:
"We were pleased to see that stroke patients are at home exercise therapy to improve as well as those who did locomotor training."
"The main program of physical therapy is more convenient and pragmatic. The usual care should include more intensive training programs that are readily available for patients to improve walking function and quality of life," she added.
NINDS deputy director Dr. Walter Koroshetz said that more than 4 million stroke survivors in difficulty walking experience in the U.S., so it is important to conduct thorough comparison of available physical therapy, to determine which is better:
"The results of this study show that the more expensive high-tech therapy is not superior to intensive strength training at home and the balance, but they were better than the lower intensity of physical therapy," said Koroshetz.
Locomotor training, which is becoming very popular in the U.S., where patients go to a rehabilitation center and walking on a treadmill in a harness that partially support their body weight. When they finished this part of the program they practice walking.
Previous studies have shown that this "high-tech" training, with the use of commercial tows or robotic race tracks, is very effective in helping patients to walk after a stroke.
But no one tested them on a large scale and looked at them from the standpoint of the best time to have therapy.
So Duncan and his colleagues set out to compare the effectiveness of locomotor training started two months after a stroke and six months after the stroke, and compared against the house of a program under the guidance of a physiotherapist.
To investigate, they invited 408 patients mean age 62 years, who recently suffered a stroke and is now considered a 6 stroke rehabilitation centers in the U.S. in the period from April 2006 to June 2009.
Participants were 45% women, 58% Caucasian, 22% African American and 13% Asian.
They were appointed out of 36 sessions lasting 75 to 90 minutes from 12 to 16 weeks, or as part of the locomotor training (ranging from two to six months after a stroke) or a home study (ranging from two months after the stroke). In all three groups, the program was structured and progressive, and patients for achieving specific goals and objectives.
Home program, which began two months after a stroke, to improve patients' strength and balance, flexibility and range of motion, as a way to improve walking.
The main measure of researchers interested in was how much each walk three groups' improved one year after the stroke. However, they also looked at what it was like 6 months after stroke.
To measure improvement in a patient population where there were different ranges of ability to walk after a stroke, the researchers based their assessments of how well patients were able to walk independently by the end of 12-month study period.
For example, a severely impaired stroke patient, who by the end of the study was to walk inside the house without the aid was considered improved, as was a patient who was already inside the mobile home, but that by the end of the study was progressing to walk independently in the community.
All participants began the study with ordinary care, where they passed a series of physical therapy sessions lasting about an hour each before they are assigned to one of three study groups.
The suggestion of researchers at the beginning of the study was that by the end of 12-month study period, patients on a more "high tech" program of musculoskeletal would show better improvement than those in the home exercise program, especially those who began their training support- movement two months after the stroke.
But what they found: After 12 months, all groups made similar progress in walking speed, movement, or motor recovery, balance, social activity and quality of life. 52% of all participants had made significant improvements in their ability to walk. Preparation period of the locomotor not make a difference: after 12 months, there were no differences between early and late groups locomotor training in terms of the proportion of patients who improved their ability to walk. And stroke severity did not affect their ability to make progress on the 12-month Mark. Duncan said: "walkers with severe and moderate limitation improved with all programs."
"In all groups, the largest improvement of the results were made after the first 12 sessions of therapy, but 13% of the subjects continued to make functional gains in a few minutes' recovery for 24 sessions and another 7% improvement at 30 to 36 sessions," she added.
There are some differences between the locomotive and the home of groups that patients in the musculoskeletal group, most likely, dizziness and fainting during their implementation, and those in the group of early locomotive had more falls. 57% of all participants fell once, 34% fell more than once, and 6% had a fall that resulted in injury.
Waterfalls common among stroke survivors, and Duncan and his colleagues said their study strengthens the case for more research on the prevention of falls among stroke patients.
Another interesting finding was that patients who received only conventional treatment to 6 months, Mark did show some improvement in walking speed, but only about half of the improvement shown in patients who were assigned to receive either the locomotive or in-home program in 2-Month Mark.
Duncan said it was evidence that a locomotive or a home program as intense, are more effective than conventional treatment, the current standard of practice, number of patients on their feet and walk.
In the U.S., two thirds of stroke patients have a limited ability to walk 3 months after stroke.
"The bottom line is that patients recover faster and maintain recovery when given early intervention," said Duncan.
Sources: NIH News, the American Physical Therapy Association (press releases, Feb 11, 2011).
Author: Catherine Paddock, PhD