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Intensive physical therapy boosts stroke recovery

After a stroke, the brain and body can start recovering immediately, and can show improvement up to six months afterwards. However, a new VA study has found that for those with persistent disability even after completing standard rehabilitation therapy, intensive physical therapy can provide additional recovery even the therapy begins a year or more after the stroke.

The study, covered by the Daily Caller and other media outlets, was led by Dr. Janis Daly, director of the Brain Rehabilitation Research Center of Excellence at the Gainesville (Fla.) VA Medical Center and a researcher at the University of Florida.

The average change in function for patients who had been severely affected by their stroke was clinically significant for arm movements and for performing complex tasks. For example, a man who had been unable to lift a spoon to his mouth is now able to feed himself.

To help the 39 participants regain movements of their shoulders, arms, and hands, the study team delivered an intensive physical therapy program that included five hours of rehabilitation per day, five days per week, for 12 weeks. They tested three different modes of rehabilitation, including motor-learning rehabilitation, which involves the repetitive practicing of tasks as deliberately as possible; electrical stimulation rehabilitation, in which electrodes stimulated forearm muscles to cause the hand to lift; and robotics-assisted rehabilitation, in which robots provided support to help the patients make reaching movements on their own, gradually lessening the support as the patients regained function.

The motor-learning group received five full hours of this therapy daily. Those using the other two modes received motor learning most of the time, but either electrical stimulation or robotics therapy for the remaining time. Each of the groups improved significantly, on average doubling or nearly doubling their scores on a scale that assesses coordination. Recovery for all three groups was equal, with no statistically significant difference between the groups.

"The magnitude of recovery we observed in our study is higher than any other studies that have been published so far, which supports the promise of longer treatment and more intensive treatment after stroke, even for those who are more severely impaired," said Daly in a University of Florida news release.

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