Stroke Study Reveals Optimal Timing, Intensity for Arm and Hand Rehabilitation

September 21, 2021
The optimal period for intensive rehabilitation of arm and hand use after a stroke should begin 60 to 90 days after the event, according to a phase 2 randomised study published in PNAS. The same intensive rehabilitation at less than 30 days after a stroke provided some benefit, but rehabilitation at ≥6 months after a stroke showed no significant benefit compared with those receiving standard care. “Our finding demonstrates the existence of a critical period or optimal time when adults are most responsive to rehabilitation after a stroke,” said lead author Alexander Dromerick, MD, Georgetown University Medical Center, Washington, DC. “Previous clinical trials have found few or very small improvements in motor function post-stroke, so our research could be an important breakthrough in finding ways we can make substantial improvements in arm and hand recovery.” For their trial, the clinicians enrolled 72 patients, primarily from the Washington, DC area, within 3 weeks after their stroke. The participants were randomised to receive 20 extra hours of activity-focused motor skills therapy, starting at different times after stroke, in addition to their regularly prescribed therapies. The additional therapy began either at 30 days after their stroke, at 60 to 90 days post-stroke, or at 6 months or more post-stroke. The results were compared with a control group that received only their prescribed rehabilitation therapies but no extra motor rehabilitation training. “Our results suggest that more intensive motor rehabilitation should be provided to stroke patients at 60 to 90 days after stroke onset,” said Elissa Newport, PhD, Georgetown University Medical Center. “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 heightened plasticity for stroke patients at a specific time after their stroke.” The improvement in hand and arm function found in this study was not only statistically significant, it was large enough to be perceived as functionally meaningful by the patients themselves. “Our approach shows that patients can tolerate much more intensive motor training than is traditionally provided if they are free to choose the activities used in their training,” said Dorothy F. Edwards, PhD, University of Wisconsin-Madison, Madison, Wisconsin. “Knowing there might be a critical period for recovery, there are many techniques one might imagine bringing to bear on understanding and enhancing recovery during this time period.” The researchers hope that this study will establish a time window in which future research can combine therapy with brain stimulation or medications aimed at helping remaining healthy areas of the brain recover impaired functions or take over functions lost from the damage inflicted by a stroke. The investigators also plan to design a larger clinical trial to confirm the current findings and to determine the optimum dose of therapy, thereby achieving the best effects during this time-sensitive window. Reference: https://www.pnas.org/content/118/39/e2026676118 SOURCE: Georgetown University Medical Center