This is the optimal time to start intensive hand and arm rehabilitation after a stroke



Stroke is the leading cause of acquired disability in adults. In Spain, about 110,000 people have this cerebrovascular accident each year, of which at least 15% will die and, among the survivors, around 30% will remain in a situation of functional dependence, according to data from the Spanish Society of Neurology (SEN). The rehabilitation seeks to minimize these disabilities experienced by the patient who has suffered a stroke, as well as to facilitate their social reintegration. But in the case of the upper extremities, almost two-thirds of people do not fully regain function in their hands and arms, a circumstance that can limit daily activities.

Now, a randomized phase II clinical trial, the results of which is published this Monday in the journal PNAS, has found that the optimal period for intensive rehabilitation of the use of arms and hands after a stroke should begin between 60 and 90 days later of the event. The study was conducted by researchers from Georgetown University and the MedStar National Rehabilitation Network (NRH).

The same type of rehabilitation less than 30 days after a stroke provided some benefit, but doing it six months or more after a stroke did not show a significant benefit compared to those receiving standard care.

“Our finding demonstrates the existence of a critical period or optimal time when adults respond better to rehabilitation after a stroke,” says lead author Alexander Dromerick, Professor of Rehabilitation Medicine and Neurology, Chairman of Rehabilitation Medicine. at Georgetown University Medical Center and vice president of research for MedStar NRH. “Previous clinical trials have found little or very small improvements in motor function after stroke, so our research could be an important advance in finding ways to achieve substantial improvements in hand and arm recovery,” he adds.

For this trial, physicians enrolled 72 participants who had suffered a stroke, primarily from the Washington, DC area, within three weeks of the event. They were randomly assigned to receive 20 additional hours of therapy activity-focused motor skills training, starting at different times after stroke, in addition to your regularly prescribed therapies. Additional rehabilitation began 30 days after the stroke, 60 to 90 days after the stroke, or six months or more later. The results were compared with a control group that received only their prescribed rehabilitation therapies, but without extra motor rehabilitation training.

‘Our results suggest that a more intensive motor rehabilitation to patients 60 to 90 days later from the onset of stroke, ”says Elissa Newport, director of the Center for Brain Plasticity and Recovery at Georgetown University Medical Center and author of this article. “It is well known that a young developing brain shows great plasticity, compared to other times in life. Our results show that there may be a similar period of increased plasticity for patients at a specific time after their stroke, ”he says.

The authors note that the improvement in hand and arm function found in this study was not only statistically significant, but large enough to be perceived as functionally significant by the patients themselves.

“Our approach shows that patients can tolerate much more intensive motor training than traditionally provided if they are free to choose the activities that are used in their training. Knowing that there may be a critical period for recovery, there are many techniques one could imagine that can be applied to understand and improve recovery during this period of time, ”says Dorothy F. Edwards, Professor of Kinesiology and Medicine at the University of California. Wisconsin-Madison and a member of the Center for Brain Plasticity and Recovery.

The researchers hope that this study will establish a time window for future research to combine therapy with brain stimulation or medications intended to help healthy areas of the brain regain impaired functions or take over those that have been lost due to stroke damage. . The authors also plan to design a larger clinical trial to confirm the current findings and determine the optimal dose of therapy, thus achieving the best effects during this time-sensitive window.

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