”Either you take it vigourosly or softly, the results are the same when it comes to stroke recovery”

Emobileclinic Researcher’s corner

Emobileclinic Reporter: Dr. Tomi Orungbe

When a patient is down with stroke, the urgency to recover by adhering to doctor’s advice 100 percent isn’t a force but a must for him. Most patients become opened to various advises at this time just to get their body back to what it used to be. Logically one might tend to believe that vigorous activities will hasten recovery process.

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A study says this isn’t usually the case. According to the scientists from the University of Southern California in Los Angeles ” task-oriented rehabilitation program for patients with motor stroke and primarily moderate upper extremity impairment did not significantly improve motor function or recovery, compared with either an equivalent or lower dose of usual and customary occupational therapy”
The authors challenged the use of more training programs other than the usual day to day activities or non rigorous training in the recovery process of patients affected by hand and arm stroke. The researchers proved their points by revealing that ”patients who received intensive upper body training — 30 one-hour sessions over a 10-week period — fared no better than individuals who received a more standard type of rehabilitation and those who received significantly fewer hours”, said the co author ,Carolee J. Winstein, PhD, a professor of biokinesiology and physical therapy and director of the motor behavior and neuro-rehabilitation laboratory.

 Over the years, there are various studies on this same subject with mixed conclusion and it is very important to know which one is an effective method of recovery. 309 patients were recruited for the study after 45 days of their stroke attack and their improvement was monitored over 12 months at 6 months interval. The patients were divided to receive 3 different therapies at the different number of hours. One groups were set to receive 30 hours of activities ;one-hour intensive patient-centered rehabilitation which includes a structured, task-oriented extremity training program, or Accelerated Skill Acquisition Program (ASAP) , three times a week for 10-weeks, another received dose-equivalent usual and the last set were those that got customary occupational therapy (DEUCC); or monitored usual and customary occupational therapy (UCC) at more or less than 30 hours a week- average of 11 hours a week.

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 At the end of 12 months, 304 patients completed the study and they were tested using Wolf Motor Function Test (WMFT) which also include the improvement on their normal day to day activities.
The author is of the opinion that the study counters other recent research that has suggested that more time spent on task-oriented upper extremity training is better for stroke patients than conventional physical and occupational therapy.
They were disappointed that almost the same results was gotten with the rigorous therapy and the normal one. According to them we ”were hoping to see a significant difference in the primary outcome — motor performance — in those who received the intensive patient-centered rehabilitation, but they did not. The differences in the WMFT changes between groups at the end of the study were small: for ASAP vs. DEUCC, they concluded . At the end of a year, patients in all the study arms, even those who received an average of 11 hours of usual occupational therapy, improved. This is just to say that it is not necessary to subject the stroke patients to intensive therapy weather they jump or crawl, the results are the same by 12 months.

Trust medical experts to react to a unique research like . One of them was a good critics as he evaluated the  positive and the other side of  the research. He believes the study might lead to further findings. Bruce H. Dobkin MD, FAAN, director in the University of California ,neurological rehabilitation and research program said ”the three interventions may not have had enough contrast between them, so all may have engaged the neural networks for motor control in a similar fashion” He equally added that  the researchers cannot monitor what each patients do whenever they get to their various homes. He believes ”that a high enough dose of progressive task- related practice will lead to increases in adaptability within neural networks for a particular skill and will lead better outcomes”, he said. By this he believes  there are other vigorous activities going on at their different homes.

Steven C. Cramer also feels the same way about the result . According to him this is just a small percentage of their time and we really do not know what the patients do with the remaining time. He said ”11 hours or 30 hours is a fraction of their lives. It may also be quite important to measure what people do outside of their therapy”. I love this part when he said ” nobody should walk away thinking that it doesn’t matter how much or what type of rehabilitative therapy a person get. That will be a narrow interpretation,” he said.



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