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For the first time, a stroke study reveals the optimal timing and intensity for arm and hand rehabilitation.

Micrograph showing cortical pseudolaminar necrosis. Findings on medical images and autopsy strokes. H & E-LFB staining. Credit: Nephron / Wikipedia

Phase II randomized clinical trials found that the optimal duration of intensive rehabilitation of arm and hand use after stroke should begin 60-90 days after the event. The study, conducted by researchers at Georgetown University and the MedStar National Rehabilitation Network (NRH), was published on September 20, 2021. PNAS ..

Same intensive rehabilitation within 30 days stroke Although there was some effect, rehabilitation more than 6 months after the stroke did not show a significant effect compared to those who received standard care.

About 750,000 new strokes occur each year in the United States. Almost two-thirds of people with a stroke have not regained full functioning of their hands and arms. This is an obstacle that can cause serious limitations. Daily activities..

“Our findings indicate the existence of a critical or optimal time for adults to respond most to post-stroke rehabilitation,” said Georgetown University Medical Center Professor of Rehabilitation Medicine and Neurology, Rehabilitation Medicine. The lead author, Alexander Dolomerick, MD, who chairs the program, said. Vice President of Research at MedStar NRH. “Previous Clinical trials With little or no improvement in motor function after stroke, our study could be an important breakthrough in finding ways to significantly improve arm and hand recovery. .. “

For their trial, clinicians enrolled 72 stroke participants, primarily from the Washington, DC region, within three weeks of stroke. Participants were randomly assigned to receive an additional 20 hours of activity-focused motor skills therapy, starting at various times after the stroke, in addition to the regularly prescribed treatment. Additional treatment was initiated either 30 days after stroke, 60-90 days after stroke, or 6 months or more after stroke. Results were compared to controls who received only prescribed rehabilitation therapy and no additional exercise rehabilitation training.

“Our result is a more focused motor Rehabilitation “It should be provided to stroke patients 60-90 days after the onset of stroke,” said Dr. Elissa Newport, director of the Georgetown University-Medical Center’s Center for Restoration of Brain Plasticity and the corresponding author of this article. Stated. The young developing brain is known to exhibit greater plasticity compared to other parts of life. Our results show that at certain times after a stroke, there may be periods of similar plasticity in stroke patients. “

The improvement in hand and arm function found in this study was not only statistically significant, but large enough to be perceived as functionally meaningful by the patient himself.

“Our approach shows that patients can tolerate much more intensive exercise training than ever before if they are free to choose the activities they use in their training,” said a professor of kinematics and medicine at the university. Dr. Dorothy F. Edwards said. He is a member of the University of Wisconsin-Madison and a member of the Center for Brain Plasticity and Recovery. “We know that recovery may have a critical period, so there are many techniques we can imagine to bring to understand and enhance recovery during this period.”

Researchers, this research time frame Future studies will combine treatment with brain stimulation or medication aimed at helping the remaining healthy areas of the brain recover from dysfunction or take over the function lost from stroke damage. I can. Researchers are also planning to design larger clinical trials to confirm current findings and determine optimal doses of treatment, thereby during this time-sensitive window. Achieve the best effect.

The title of this study is “Post-stroke Critical Period Study (CPASS): Phase II clinical trial to test optimal time for post-stroke motor recovery in humans.”


Insights into how stroke affects reading can be useful in rehabilitation


For more information:
Post-stroke Critical Period Study (CPASS): Phase II clinical trial to test optimal time for post-stroke motor recovery in humans, PNAS (2021). doi.org/10.1073/pnas.2026676118

Quote: Arm and hand rehabilitation obtained from https://medicalxpress.com/news/2021-09-reveals-optimal-intensity-arm on September 20, 2021 by Stroke Study (September 20, 2021) For the first time, the optimal timing and strength of the was revealed. .html

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For the first time, a stroke study reveals the optimal timing and intensity for arm and hand rehabilitation.

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