Physical Therapy Is Key for Stroke Recovery

Feb. 21 -- Stroke may cause serious physical and mental impairments, such asnear paralysis of one side of the body, difficulty understanding or finding words, slow thinking, and fatigue.

About 20 percent of initial survivors are unable to manage themselves in the first week or two and require inpatient rehabilitation.

The goal during this two- to five-week stay is to have them become independent enough in walking and self care to return home and then continue therapy as an outpatient for two to six months.

Remarkably, one-half of victims of a stroke have no weakness six months after the onset. However, many patients are still disabled.

About 20 percent cannot walk alone, 30 percent cannot carry out their daily self care without physical help, and two out of three can no longer socialize much.

Many studies of recovery convey a misconception about gains. They say that recovery only happens in the first three, or at most six, months after a stroke. This is true only if patients stop working at trying to improve the skills that are important to them.

Studies from our laboratory and others show the value of intensive practice at relearning a skill, even in the face of brain or spinal cord damage.

Regaining Upper Body Movement

Constraint-induced movement therapy requires that the patient try to use the affected hand and arm as much as possible to practice reaching and grasping items for two to eight hours a day for at least several weeks. There is no magic about this approach.

Patients must be able to voluntarily cock up the weak wrist at least 20 degrees and extend the fingers at least 10 degrees, meaning that they already have fair control of the hand.

If the hand cannot move or only clenches a bit, then this approach will not work. In general, the person who cannot extend the wrist and some fingers this much by a month after a stroke is not likely to get back much functional use of the hand.

However, many patients can practice and learn to extend the elbow and pinch the thumb against the second finger (key pinch) to use a very weak arm to assist themselves. This gain only comes from spending blocks of time daily in practice.