Stroke patients' intense rehab brings big gains, study finds

PLANT CITY, Fla. — Hannah Bugg was only 27 when she suffered a stroke that left her paralyzed on her left side, unable to walk, talk or care for her two young children.

Despite her youth, doctors were not encouraging about the Florida woman's prospects for recovery.

“I had very little hope after the stroke,” Bugg said. She believed she'd “never be able to walk again.”

Even so, Bugg worked hard for four months with therapists and at home with her husband, mother and sister. She went from using a wheelchair to a walker, then a cane. Six months after her 2009 stroke, she walked, unassisted, into her first job as a lawyer.

Bugg still does many of the rehabilitation exercises and continues to improve: “Just last night I was able to wiggle my toes. ... I couldn't do that a year ago.”

The nation's largest stroke rehabilitation study, conducted by the University of Florida, supports what Bugg learned: Patients can benefit from physical therapy long after a stroke.

The study, published in the New England Journal of Medicine in May, also found that intensive therapy, particularly to regain the ability to walk, works even if it is delayed for six months and even if it is delivered at home.

The study, led by physical therapy researchers at UF's College of Public Health and Health Professions, looked at 408 participants, ages 25 to 98, who couldn't walk unassisted because of stroke.

They received intense physical therapy: either in a clinic using a special treadmill, or in their homes, where their intense exercises focused on strength, balance, flexibility and range of motion. Licensed physical therapists delivered treatment in both settings.

“There wasn't a lot of chitchat,” said Dorian Rose, the study's clinical research coordinator and an assistant professor of physical therapy. 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 Rose.

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 with patients at six and 12 months after their strokes. Slightly more than half — 52 percent — of participants had significantly improved in walking ability one year after their strokes.

“It's very exciting and shows that therapy has a lasting impact,” Rose said. “And it can be applied later, six months after a stroke, and patients can continue to improve.”

Dr. David Decker, a stroke specialist with the University of South Florida and Tampa General Hospital, 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 Bugg.

Research such as the UF study “convinces others of what we already know and should encourage patients. They will continue to get better if they work at it.”

Bugg's stroke stemmed from a congenital heart condition that caused her to form a clot, her doctor said. Overcoming it took hard work.

Bugg wanted to start her career, care for her children and get back to running every day. “I set my mind to it,” she remembers. “... The key is you just can't give up.”

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. You can potentially improve to some degree the rest of your life.”

Decker hopes the research encourages patients, families and clinicians — and improves insurance coverage for rehab.

“This type of research supports the idea that we should continue therapy and not stop it early,” he said.

<b>Learn about strokes</b>

Chronic migraine headaches, undetected high blood pressure, high cholesterol, use of birth control pills and smoking — in combination or even individually — all are major risk factors for strokes in young people. They also are at risk for “silent strokes'' — which show up on magnetic resonance imaging, but usually cause only slight memory, balance or information processing problems, all easily attributed to stress or fatigue.

<b>Stroke facts:</b>

Ÿ A stroke occurs about every 40 seconds in the United States.

Ÿ The number of stroke deaths has declined in recent years because of better treatment, but it's still the third leading cause of death.

Ÿ Women are more likely to die of stroke than men.

Ÿ One-quarter of strokes occur in people younger than 65.

<b>Symptoms:</b>

Ÿ Common stroke symptoms seen in both men and women strike suddenly and include: numbness or weakness, especially on one side of the body; confusion and trouble speaking or understanding; trouble seeing or walking; dizziness, loss of balance or coordination; severe headache.

Ÿ Women also may report symptoms such as sudden face and limb pain, hiccups or nausea; general weakness; chest pain, shortness of breath and palpitations.

<b>Risk factors: </b>

Ÿ For men and women: high blood pressure, diabetes, high cholesterol, obesity, family history, personal stroke history.

Ÿ Unique to women: taking birth control pills or hormone replacement therapy; pregnancy; migraine headaches.

Sources: American Stroke Association, National Stroke Association, U.S. Centers for Disease Control and Prevention