Stroke victims having rehabilitation at home receive same benefits as high tech
Findings from the largest stroke rehabilitation study ever conducted in the United States has revealed stroke patients having comprehensive therapy at home had improved walking ability in comparison to patients having “high tech” therapy programs, such as use of treadmill.
This study was mainly funded by National Institute of Neurological Disorders and Stroke (NINDS) and in part by National Institutes of Health (NIH) along with assistance from the National Center for Medical Rehabilitation Research. This study had also revealed that patients had continual improvement for up to twelve months after enduring a stroke, challenging the vastly held view that recovery occurs early and reaches its highest point at six months.
This study had demonstrated that even patients who had began intensive rehabilitation six months after their stroke had improved walking.
Dr. Pamela W. Duncan, principal researcher of the study and professor at Duke University School of Medicine in Durham, North Carolina and associates presented their findings at the American Stroke Association's International Stroke Conference 2011, held on February 11th.
Dr. Duncan announced to the press they were happy to witness stroke patients who had a home physical therapy exercise program performed just as well as in comparison to patients with locomotor training.
The home physical therapy program is more convenient and practical. Routine care should include more intensive exercise programs for patients that are easily accessible to improve their walking, functioning and quality of life.
Dr. Walter Koroshetz, deputy director of NINDS stated there are more than four million stroke survivors in the United States who experience difficulty walking. Therefore, its is vital to conduct rigorous comparisons of available physical therapy treatments to determine which works best.
The studies findings revealed that the more expensive high-tech therapy was not better in comparison to intensive at home strength and balancing training. Both were much better than low intensity physical therapy.
Locomotor training which is gaining popularity in the United States, is when the patient goes to a rehabilitation center and walks on a treadmill with a harness which is partially supporting their body weight. When this portion of the rehabilitation program is done, the patient practices walking.
Previous studies have advocate that this type of training is very beneficial in aiding patients to walk again. However, none have been tested on a large scale and examine them as to the best time to have the therapy.
Researchers had proceeded to compare the effectiveness of locomotor training at two and six months after stroke and compare both of those against home based program supervised by a physical therapist.
For the study 408 patients of average age 62 years and endured a stroke as well as being treated at six rehabilitation centers in the U.S., between April 2006 and June 2009 had been recruited.
The participants consisted of 45% female, 58% Caucasian, 22% African American and 13% Asian.
Participants were assigned 36 sessions for a length of 75 to 90 minutes for a duration of twelve or sixteen weeks, either composed of locomotor training(beginning two or six months after stroke) or home based training beginning two months after stroke. All groups consisted of a structured program and patients needed to achieve specific goals and tasks.
The goal of the home based program was to improve the patients strength and balance, flexibility and range of motion in order to improve walking.
The primary degree the researchers were interested in was the amount of each of the three groups walking had improved one year after the stroke. They did observe what it looked like after six months.
To gauge the improvement in each patient population where there were various ranges of walking ability post-stroke, researchers based their evaluation on how well patients could walk unassisted by the end of one year study period.
In an example, a severely impaired stroke patient who by end of study could walk around inside the home unassisted was considered improved along with a patient who could already walk around unassisted in home but was also doing so in the community.
All participants in the study had began with the normal care, having several physical therapy sessions lasting about one hour each prior to being assigned to a group.
Results of the study had shown:
All groups after twelve months had alike improvements in walking speed, movement or motor recovery, balance, social interaction and quality of life.
Among the participants 52% had remarked improvements in walking ability.
The start time of locomotor training had made no difference in terms of the portions of patients who had improved walking ability.
There were differences between the locomotor group and home based therapy. Patients in locomotor groups were more likely to feel dizzy and faint during exercise and those in early locomotor group had more falls. Out of all participants 57% fell once, 34% more than one time and six percent had a fall which ended up in injury.
Patients who had received only the routine care up to six months had shown improvement in walking speed but only half improvement was observed in patients at the two month period regardless of group.
Dr. Duncan stated that either locomotor or home based program both intensive were more beneficial than standard care, the current practice at getting patients up and around again.
Dr. Duncan notes the main point is that patients recover quicker when intervention is done early.
Some studies have shown that acupuncture treatments used in combination with physical therapy can aide stroke victims.
In one study the right study of a patient was paralyzed and he could not turn over. After eight treatments he could turn over and after twenty treatments he could walk without a cane.
Usually forty sessions are prescribe for stroke patients and sessions are at three times a week used by most acupuncturists.