Tuesday, April 19, 2011

Stroke Recovery

Do patients recovering from stroke (ischemic) receive enough rehabilitation?

There exists a "critical period" post-stroke where specific neuronal growth factors are upregulated, such as brain-derived neurotrophic factor (BDNF). In fact, the critical period (5-14 days post-stroke) also involves a downregulation of proposed neural growth-inhibiting factors. This combination provides an excellent opportunity for cortical-neuronal regeneration following a stroke.

The problem is that patients recovering from a stroke are alone 60% of the time, and are inactive (sitting or lying in bed) 75% of the time (1). There is also a lack of stimulation and exercise, as most programs only engage patients for one to two hours of their waking day. Clearly, rehabilitation programs are not capitalizing on the timeliness of one's innate enhanced ability to recover from a stroke.

Further to this, in rehabilitation programs centred on upper-limb impairment rehab, patients engaged in a reaching exercise may only reach about 1/10 the amount, as compared to mice with similar impairments. The mice seem to make a significantly better recovery with increased reaching. It seems that the intensity of the stroke recovery program may play a major role in cortical-neuronal regeneration.

Should there be consideration for increased timeliness, duration, and intensity of stroke rehabilitation programs?

(1) Bernhardt et al. Inactive and Alone: Physical Activity Within the First 14 Days of Acute Stroke Unit Care. Stroke, 2004; 35:1005


  1. I completely agree with this. But on the other hand (from experience in OT) we give patients exercises to do during the time that we are not there. They are expected to do this exercises in order for a faster recovery. We are just there to assist, not do the work for them. We tell them what they can do to improve, and then it is up to the patient to do these exercises in order for a faster recovery. In SAH there were only about 5 OT's for the whole hospital, with 3 OTAs to do the actual treatment. We don't have enough people to be around patients for hours during the day... But that's why they should hire more people (like me!), in order to have longer rehab sessions. This would help.

  2. Do the patients actually do the exercises at home? Is there someone with them throughout the day to stimulate their rehab and help them with the exercises?

    Perhaps longer sessions would be better, especially in the post-stroke critical period.

    Sass, do you think that there should be more emphasis on early rehabilitation? One could allocate the funds from more long-term patients who have the experience doing the exercises and may be better able to do them at home.

  3. It sounds like the support of family and friends is really important. It's hard to think, Mike, that not everyone is as fortunate as we are to be surrounding by people that would encourage us to continue with rehab programs as necessary.

  4. Even more reason to support home-care as a viable and efficient alternative to hospitalizations and some long-term care facilities. People are often best off at home where they are comfortable- if they do not have access to support, we should support them.