Motor recovery is possible even after 12 months
The accepted “critical window of motor recovery” from a stroke refers to the first 3-6 months. A group of researchers has followed 219 individuals with mild-moderate severity of upper limb hemiparesis from the stroke; they have found the critical window can extend beyond 12 months after the event. This is great news. The exercising interventions need to carry out without stopping at the end of six months or so. The study is published in the Journal of Neurophysiology in 2019. Free access through this link: https://journals.physiology.org/doi/full/10.1152/jn.00762.2018.
The nature of the study individuals: They experienced a stroke first time, aged between 45-85 years, with mild-to-moderate upper limb hemiparesis, and did not have any cognitive impairment. They have undergone a series of training sessions of occupational therapy and rehab gaming system (RGS).
Promoting a technology-assisted home exercise program
The adherence to a home exercise program is vital for the best results in recovery. It depends on a lot of factors; The supportive home environment will determine the successful adherence provided a feasible home exercise program exists. This study’s authors present a conceptual framework to promote perseverance with technology-assisted home-based upper limb practice after stroke based on their findings from a systematic mixed studies review.
What is the adequate dose for a meaningful recovery?
Much similar to medication regimen, stroke recovery depends on the adequate dose for an adequate duration. How much and for how long?
Computer-assisted arm exercises (Robotic-assisted therapy); are higher doses bring higher improvement?
This study looked at whether a higher “exercise dose” brings more motor improvement in arms among those who had a recent (within the first three months) moderate-severe degree of stroke. The two doses were 30 minutes twice a week and additional 45 minutes five times a week. The “doses” lasted three weeks. The researchers used special equipment to deliver the doses: Armeo®Spring exoskeleton (Hocoma AG, Zurich, Switzerland) which provides weight support for the upper extremity and is connected to a PC with which various virtual-reality based games can be played.
The researchers found a significant improvement in the intervention group at the neurophysiological level, not at the clinical level. They have measured the neural level changes using transcranial magnetic stimulation motor evoked potentials (MEPs); The clinical level changes were measured using the Fugl-Meyer Assessment for the Upper Extremity (FMA-UE) questionnaire.
However, they have employed a prospective case-control study design. They have also suggested future studies with a longer duration higher than three weeks because the treatment duration might have been shorter to translate neural level changes into clinical improvement. This study was published in the Journal of Neuroengineering and Rehabilitation in 2021.
Sehle, A., Stuerner, J., Hassa, T., Spiteri, S., Schoenfeld, M. A., & Liepert, J. (2021). Behavioral and neurophysiological effects of an intensified robot-assisted therapy in subacute stroke: a case-control study. Journal of neuroengineering and rehabilitation, 18(1), 6. https://doi.org/10.1186/s12984-020-00792-1