The typical stroke patient receives rehabilitation therapy only during the first six months following the event. Conventional thinking holds that no additional benefits would be accrued after that point, although recent studies have begun to suggest otherwise.
To explore this issue further, investigators randomly assigned 49 patients to receive intensive robot-assisted therapy (repetitive guided movement three times a week for three months), 50 to receive intensive comparison therapy (similar high-intensity exercises with a therapist), and 28 to receive usual care (general health care but no specific therapy for the stroke-damaged limb). All participants had moderate to severe upper-limb impairment after having had a stroke at least six months earlier. On average, the strokes had occurred nearly five years previously, and a third of the patients had suffered multiple strokes.
At the 12-week mark, the only notable outcome was the improvement in quality of life for the robot-assisted patients compared with the usual-care group. However, at 36 weeks, robot-assisted therapy improved motor function and motor recovery modestly but significantly, compared with usual care. Similar improvements were seen for the therapist-assisted individuals.
“The study provides evidence of the potential for long-term benefits of intensive rehabilitation in patients with moderate-to-severe impairment even years after a stroke,” the authors observed (N Engl J Med. 2010;362:1772-1783).
Additional encouraging news regarding stroke was reported by Jacob R. Sattelmair, MSc, and colleagues: Their analysis of data from 39,315 females, aged 45 years and older, from the Women’s Health Study showed that leisure-time physical activity in general and walking in particular were associated with lower risks of ischemic, hemorrhagic, and total stroke. Brisk walkers had a 37% lower risk of any type of stroke, a 68% lower risk of hemorrhagic stroke, and a 25% lower risk of ischemic stroke (Stroke. 2010; published online ahead of print).
In other developments on the stroke front:
Stroke may be the first sign of Chagas disease, an emerging but underacknowledged infectious disease in the United States, caused by Trypanosoma cruzi (Lancet Neurol. 2010;9:533-542).
Young adults (aged 18 to 44 years) with hyperthyroidism have a 44% greater risk of ischemic stroke than those with normal thyroid function, according to a large study (Stroke. 2010;41:961-966).