People who have experienced a stroke may benefit from being treated with physiotherapy for much longer than is typically the case, to take best advantage of a critical window for rehabilitation exercises.
Strokes involve damage to brain tissue caused by a blood clot or a burst blood vessel, which can leave people unable to use an arm or leg, for instance. People generally do recover some function as time passes, especially with physiotherapy. This is thought to be听because the brain forms new neural pathways to replace the ones lost, an example of a rewiring process called neuroplasticity.
To investigate the benefits of physio, at Georgetown University Medical Center in Washington DC and her colleagues studied the effects of giving an extra 20 hours of treatment, on top of usual rehab, to 72 people who had a stroke that affected an arm. Each participant was randomly assigned to receive up to 3 hours of physiotherapy a day, either in the first month after the stroke, between months two and three, after six months or not at all.
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After one year, people who got the extra therapy between months two and three improved the most, by nearly seven points on a commonly used 57-point scale听for rating physical ability, compared with usual care. That could mean the difference between being able to dress independently and not, says Newport. People who got the extra therapy in the first month improved by about five points, and people who got it after six months showed no significant benefit.
The difference between treatment in the first month and from months two to three wasn鈥檛 statistically significant. But the fact that benefits were seen during the third month听contradicts the prevailing belief that for post-stroke rehab, 鈥渢he earlier the better鈥�, says Newport. In the US, most stroke survivors get rehab only for the first four weeks, while in the UK it tends to last up to six weeks.
suggests there is a delay after brain injury before neuroplasticity mechanisms are at their peak, says Georgina Hill at the UK . 鈥淒uring the [first] hours and weeks, the brain is coping with a lot of inflammation and damage which might mean the brain plasticity mechanism isn鈥檛 optimised.鈥�
Proceedings of the National Academy of Sciences
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