Positive Effects of Stroke Therapy Linger

Stimulating paralyzed arm effective 5 years later

FRIDAY, March 5, 2004 (HealthDayNews) -- Stroke patients who get stimulation therapy on their paralyzed arm shortly after their brain attack see the positive effects of increased movement last for at least five years, Belgian researchers report.

A stroke, like a heart attack, often happens when blood clots block arteries. And when the blocked part of the brain doesn't get blood and oxygen, brain cells die.

This type of stroke is called an ischemic stroke. A stroke can also happen when blood vessels rupture causing bleeding in the brain. This type of stroke is called a hemorrhagic stroke.

Strokes usually affect one side of the body. Generally, the effects of the stroke are seen as paralysis of the arm, leg and face on the affected side. Speech and movement can also be affected.

After a stroke, a long regimen of physical therapy is needed to restore something close to normal use of the affected arm or leg.

Studies have shown the sooner rehabilitation begins, the better the results. But how long the effects of rehabilitation last has not been known.

"We found the therapy after stroke is still effective after five years," says lead researcher Dr. Hilde Feys, a professor in the department of rehabilitation sciences at the University of Leuven in Belgium.

Feys' team had 100 stroke patients randomly assigned to 30 minutes of sensorimotor stimulation of the affected arm each day for six weeks. The other patients received a phony treatment. After the six weeks, all the patients continued with standard rehabilitation.

Patients receiving sensorimotor stimulation sat in a rocking chair with their affected arm held in place on the arm of the rocker by a splint. This forced the patients to use their arm to rock the chair, which caused muscle contractions in the shoulder.

The patients received 15 hours of this therapy. And the researchers were able to follow 62 patients for five years, according to the report in the March 5 issue of Stroke.

There is a positive effect immediately after most therapy and sometimes for a short time after, but usually the effect diminishes, Feys says. However, with this therapy the beneficial effect was maintained over five years.

Moreover, the patients who were most severely affected by their stroke showed the greatest benefit over time, Feys says.

The researchers used two tests to measure improved function, the Brunnstrom-Fugi-Meyer test (BFM) and the Action Research Arm test (ARA).

After five years, they found patients who had received arm stimulation showed an average of 29 points on the BFM compared to 12 points among the patients who did not get this treatment. Feys' group found the same improvement on ARA (30 points vs. 12 points).

When the researchers classified patients as deteriorated, improved and stable, they found that almost all who received sensorimotor stimulation improved compared to a little over half the patients who didn't receive the therapy.

This therapy works for the most severely affected patients because it causes muscle contractions that make them use their arm, Feys says.

However, the researchers found no difference between the groups on the Barthel Index, which measures daily activities such a washing, walking and dressing.

But Feys adds her team found most patients who had the therapy reported using their affected arm more in daily life compared with those who didn't get sensorimotor stimulation therapy.

"For patients with a severely paralyzed arm, there should be treatments that stimulate muscle activity in the arm," Feys says. "We need to find ways to force patients to use the paralyzed arm."

Dr. Larry B. Goldstein, a professor of medicine and director of the Stroke Center at Duke University, says this study is consistent with other findings.

"Intensive training of the affected arm soon after stroke seems to improve function of the arm over the long term," he says.

However, Goldstein is concerned these gains are not translated into how patients live their daily lives.

"It remains to be seen if this therapy will change they way people go about their lives and improve their quality of life," he says.

More information

The American Stroke Association and the National Institute of Neurological Disorders and Stroke have more on stroke and rehabilitation.

SOURCES: Hilde Feys, Ph.D., professor, rehabilitation sciences, University of Leuven, Belgium; Larry B. Goldstein, M.D., professor, medicine, and director, Stroke Center, Duke University, Durham, N.C.; March 5, 2004, Stroke
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