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People who have had a stroke seem to regain better hand and arm function if intensive rehabilitation begins two to three months after the brain injury.
A study of 72 stroke patients suggests this is a “critical period” when the brain has the greatest ability to rewire itself, a team reported this week in the journal. PNAS.
This finding calls into question the current practice of starting rehabilitation as soon as possible after a stroke.
“Two to three months after a stroke is when people are at home, not when most people are in rehabilitation,” says Elissa Newport, study co-author and director of the Center. for Brain Plasticity and Recovery at Georgetown University. Medical Center.
Newport spoke in place of the study’s lead author Dr Alexander Dromerick, who died after the study was accepted but before it was published.
If the results are confirmed by other larger studies, “the clinical protocol for the timing of stroke rehabilitation would be changed,” says Li-Ru Zhao, professor of neurosurgery at Northern State Medical University. of Syracuse, who was not involved in the search. .
The study looked at patients treated at Medstar National Rehabilitation Hospital in Washington, most in their 50s and 60s. One of the study participants was Anthony McEachern, who was 45 when he suffered a stroke in 2017.
“My ability to move was diminishing in front of my eyes”
Hours earlier, McEachern was imitating Michael Jackson’s dance moves with his children. But at home that evening, he found himself unable to stand.
“My ability to move was diminishing before my eyes,” says McEachern, who is now a professor of visual and performing arts at North Carolina Agricultural and Technical State University.
After the stroke, McEachern spent a week in the hospital for treatment and over a month in a rehabilitation center. He slowly regained the ability to walk. But after returning home, he still had issues with basic chores involving his right arm and hand.
“Normally I could jump in the shower and 20 minutes [later] I’m showered, dressed and out, ”he says. After the stroke, it took him two hours.
The study drew on previous research on the rehabilitation of stroke animals.
When rehabilitation starts too quickly, “you can often make a stroke worse and worse,” Newport explains. When rehab therapy was briefly delayed, “you have had great success.
In the stroke patient study, participants were randomly assigned to receive an additional 20 hours of intensive training that began during one of three periods: less than 30 days after event, 60 to 90 days after or at least six months after. Training may involve reaching or gripping exercises, with a specific regimen tailored to each patient.
A “critical period” for optimal recovery
“What we found was that the best recovery was for people who received their hard training two to three months after their stroke,” Newport said.
Treatment is not a panacea, she notes. “There is a measurable and noticeable amount” of improvement in tasks like reaching and grabbing, she says, “but they’re not fully recovering.”
McEachern’s intensive training started before the optimal period. Despite this, he believes that the additional therapy and its intensity helped him regain the use of his right hand.
“I can carry a toothbrush. I can carry bottles. I can use one hand to hold the bottle while I use the other to open it,” he says. “None of this stuff was possible immediately after the stroke, and probably not even imaginable.”
Brain scientists say the study’s findings are likely to spark a new debate on when to start intensive rehabilitation for stroke patients.
“This is a good start to help identify the optimal time or sensitive period to begin heavy motor training,” Zhao said. But the study was relatively small and limited to a single treatment center.
The idea that there is a critical period when the brain is most able to recover is “something that we suspect from the start, based on animal models,” says Dr. Jin-Moo Lee, president of neurology at the University of Washington in St.. Louis. “But this is really the first human evidence that there is a period in which rehabilitation therapies are most effective in improving recovery.”
Lee says that right after a stroke, the brain is in survival mode, trying to “clean up the mess” caused by an injury. Eventually, however, the brain enters an intervening period in which an injury gradually becomes a scar.
“And probably in the intervening period, there are also changes that allow the brain to become more plastic,” he says. This period is a bit like early childhood, he says, when the brain is able to learn and reconnect very quickly.