Stroke Victims and Rehabilitation

In Australia today stroke is now a major cause of disability affecting many adults in our society.  For many people the effect of stroke can be debilitating causing muscle weakness and paralysis.

The effects of stroke can limit a person’s ability to use their legs, arms, hands and many muscles contained within their bodies.  For many people this condition often encourages people to leave a sedentary life.  Unfortunately inactivity can worsen their condition and often lead to other more complicated conditions affecting their heart and pancreas resulting in diabetes.

For many years stroke rehabilitation centred on an intense 3-4 month program as it was believed that after this time further progress tended to plateau.  However Richard F. Macko, MD, associate Professor of Neurology and director of Geriatric Research Education and Clinical Centre (GRECC) in the United States are testing two new therapies.  Macko Richard F. comments: “Evidence from our initial studies indicates that even individuals whose strokes occurred many years ago can benefit from structured exercise that promotes the ‘re-learning’ of basic movement skills that are useful in everyday life,” says Macko.  “We are exploring a new model of stroke recovery in which repetitive motion forces people who have had strokes to use their paralyzed limbs.  This prompts areas in the nondamaged portion of the brain to take over some of the functions lost as a result of the stroke.”

In one study, participants with partial paralysis that affects their ability to walk are using specially calibrated treadmills that go as slowly as .1 mile per hour. The exercise retrains their legs and rewires critical pathways in their brains.  Preliminary research shows that stroke patients who have already completed all conventional rehabilitation therapy can benefit from the additional exercise training on the treadmill, gaining improved leg
strength, balance, and walking capability.

“Of course, progress is variable, depending on the patients and their level of disability,” says Macko.  “But the link between exercise and recovery is unmistakable.” The exercise often has another positive outcome.  “Treadmill training increases fitness levels, and aerobic exercise has the potential to improve cardiovascular health, which governs long-term health outcomes,” adds Macko.

Participants in the study are experiencing the benefits of exercise.  After two months of treadmill training three times a week for 30 minutes, Leonard Thomasos says he feels stronger, no longer needs his cane, and is motivated to exercise more.  “Even on my off days, I try to walk and do exercise. I use an ab roller and do some squats,” he says.

Anonn York, another study participant, has seen similar gains.  “The only reason I use my cane now is to get a seat on the bus faster,” he jokes.

A second GRECC study, headed by Jill Whitall, PhD, associate professor of physical therapy, focuses on 72 patients whose arms have been weakened by strokes.  Study participants exercise their arms on a machine designed by Whitall and Sandra McCombe-Waller, MS, PT, NCS, assistant professor of physical therapy.

Seated at a table, holding the handles on the bilateral arm trainer in front of them, participants extend one arm forward, keeping the other arm close to their body.  Following the sound of a rhythmic auditory cue, participants alternate pushing one arm out and pulling the other arm in.

The therapy lasts six weeks, and the results will be compared with that of participants doing six weeks of conventional therapy.  Whitall and other researchers on the project think the training will improve motor control, strength, and range of motion.  If the bilateral arm trainer produces good results, it could one day be used in community and home-based settings.

The results are preliminary but encouraging,” says Whitall.  “Even those with quite limited ability to use their weak arm have found this trainingto improve some aspects of motor function.”

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