For stroke victims, intense therapy provides longterm gains, study shows

Irene Maher, Tampa Bay Times June 16, 2011

Hannah Bugg was only 27 when she suffered a stroke - it left her paralyzed on her left side. She could not walk, talk or care for her two young children. Doctors were not encouraging about her prospects for recovery. "I had very little hope after the stroke," said Hannah. "I thought that I would never be able to walk again." Even so, Hannah worked hard for four months with therapists. At home she worked with help from her husband, mother and sister. She went from a wheelchair, to using a walker, then a cane. Six months after her 2009 stroke she walked into her first job as a lawyer. Today, Hannah still does many of the exercises that were part of her rehab - she continues to notice improvement. "Just last night I was able to wiggle my toes . . . I couldn't do that a year ago," she said. A new study from the University of Florida supports what Hannah learned: There may be a lot of pessimism about stroke but patients can benefit from therapy long after their stroke.

The study also found that intensive therapy, particularly to regain the ability to walk, works it works even if it is delayed for six months and even if it is delivered at home. The study, led by researchers at the University of Florida, looked at 408 participants, ages 25 to 98, who couldn't walk due to stroke. They received intense physical therapy either in a clinic using a special treadmill, or in their homes. They did intense exercises focused on strength, balance, flexibility and range of motion. Treatment in both places was given by physical therapists/physiotherapists. "When we were with them, we were working. There wasn't a lot of chitchat. We were doing serious exercise." Each participant received 90 minutes of therapy, three times a week, for 12 to 16 weeks. "The keys were intensity and progression. The program got more and more challenging as time went on," said a researcher. The patients in the home-based group started two months after their strokes. The clinic-based group started at two or six months post-stroke. Researchers followed up patients at six and 12 months poststroke. Just more than half had made huge improvement in walking when tested one year after their stroke.

"During that time they didn't get any extra therapy from us. We had no control over what they were doing - but they maintained their initial gains. "It's very exciting and shows that therapy has a lasting impact. It can be applied later, six months after a stroke, and patients can continue to improve." Dr. David Decker, a stroke specialist, said he sees many patients who do well if they continue their rehab. He hopes the study changes attitudes about stroke recovery. "There's a lot of pessimism with stroke. People think if you don't have it back soon after the stroke, you're done. That's simply not true,'' said Decker, who treated Hannah. Research shows what we already know and should encourage patients. They will continue to get better if they work at it." Hannah's stroke was due to a heart condition that caused her to form a clot. Overcoming it took hard work and dogged determination. Hannah wanted to start her career, care for her children and get back to running every day goals she made clear to her therapist from the outset. "I set my mind to it and decided I am going to do this," she remembers, "I was so determined. I wanted it so bad. The key is you just can't give up."

Hannah Bugg, 29, works out early Tuesday morning. An avid runner, she was paralyzed on her left side.

Dr Decker echoes that advice when talking to patients. "Progress may become slower and become less noticeable -but people who really work at it continue to improve," he said. "You can improve to some degree the rest of your life." Decker hopes the research encourages patients, their families and clinicians - he also hope that it leads to improved insurance coverage for rehab. "This type of research supports the idea that we should continue therapy and not stop it early," he said.