Combo Therapy Offers Hope to Long-Term Stroke Patients

But improvements may not make functional difference

THURSDAY, June 6, 2002 (HealthDayNews) -- More than four million Americans currently live with a physical impairment from a stroke, making it the leading cause of disability in the United States.

If more than a year has passed since the time of the stroke, rehabilitation options are severely limited and doctors don't usually expect to see much improvement in a patient's physical capabilities.

However, a new combination therapy may be the first step in changing that assumption, according to new research published in the June issue of Stroke: Journal of the American Heart Association.

Researchers from the University of Florida found that by combining electrical muscle stimulation with exercises that used both arms -- one with impaired function and the other functioning normally -- patients performed better on a simple motor skills test than those who only exercised one arm or received no therapy.

The good news for stroke victims is that "the window of recovery is not completely shut one year post-stroke," says the study's lead author, James Cauraugh, the co-director of the Center for Exercise Science at the University of Florida College of Health and Human Performance. "Improvements in motor recovery can occur even after more than one year."

Cauraugh and his team recruited 25 stroke patients who were an average of 39 months post-stroke. The average age of the study volunteers was 63.7.

Ten patients were given combination therapy that included electrical muscle stimulation of the impaired arm and what is known as "bi-lateral" exercises, which means they attempted to simultaneously perform the same exercises with both arms. Another 10 volunteers were given electrical muscle stimulation, but were only asked to exercise the impaired limb. The third group, five people who served as a control group, received no therapy, but tried to complete the arm exercises with their impaired arm.

The volunteers completed four sessions, lasting six hours each, over a two-week period, according to Cauraugh.

The researchers tested the volunteers' motion capabilities using a "box and block" test. In this test, participants must reach inside a box, grab a block, move it to the other side of the box and release it. Cauraugh says this test mimics many tasks needed in day-to-day living, such as grasping, transporting and releasing.

After treatment, volunteers in the group who received the combination therapy were able to move seven more blocks than they had been able to at the start of therapy. The second group improved by four blocks and the control group only by one block.

Cauraugh says the electrical stimulation of the muscles gives a boost to their ability to move and helps them contract. And researchers have long known that bilateral movement, such as raising both arms together, is more efficient and coordinated than raising just one, according to Cauraugh.

Dr. Hal Unwin, vice chairman of the department of neurology at the University of Texas Southwestern Medical Center in Dallas, says the results of this study are somewhat encouraging. But, he says, the work now "has to move from the lab to real life."

"Does moving a block around on a table have anything to do with recovery? What does that translate into for real life?" he asks. "Does it mean you can hold a fork and feed yourself?"

The answer right now is probably not, he adds. But, Unwin says, this work could lead to the development of new therapies that might lead to functional improvements for stroke victims.

What To Do

To learn more about rehabilitation and recovery after a stroke, visit the National Stroke Association, or the National Institute of Neurological Disorders and Stroke.

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