- Associated Press - Sunday, February 13, 2011

LOS ANGELES | The largest study ever on stroke rehabilitation found that doing physical therapy at home improved walking just as well as a high-tech treadmill program.

Patients who started rehabilitation late — six months after their strokes — still improved. It’s long been thought that there was little to gain from rehab after half a year.

“We now have evidence, for the first time, that a prolonged course of therapy will have benefits,” said Dr. Jeffrey Saver, director of the stroke center at the University of California at Los Angeles. “For virtually everyone, we should be doing more intensive therapy than we are.”

He had no role in the federally funded study, which was led by Duke University researchers and discussed Friday at an American Stroke Association conference in Los Angeles.

Each year, nearly 800,000 Americans suffer strokes, and up to two-thirds of survivors have problems walking. Sophisticated machines such as robots and weight-supporting treadmills increasingly are being used, but researchers have only limited data on how well they work compared with more traditional therapy.

Such equipment is popular in high-end rehab hospitals such as the one in Houston where Rep. Gabrielle Giffords of Arizona is being treated after her gunshot wound to the head.

The study included 408 stroke survivors who had trouble walking. On average, they took 1,700 steps a day; normal is 10,000 steps a day. They either traveled to a facility to get high-tech rehab or received physical therapy at home. Some began therapy two months after a stroke; others started six months after the stroke to see whether there was a difference.

In high-tech rehab, patients exercised on a treadmill while their weight was supported by an overhead harness. As they gained speed and endurance, they could practice walking on their own.

In the home program, a physical therapist helped patients do exercises to walk every day and improve strength and balance.

After a year, both groups made similar improvements in how far and how fast they could walk. However, the treadmill exercisers were more likely to feel dizzy or faint during training and had a higher risk of falling.

Furthermore, only 3 percent of patients dropped out of the home therapy, compared with 13 percent in high-tech rehab.

“There’s a tendency in our country to go to high-tech machines,” but this study shows they’re not always better, said Dr. Walter Koroshetz, deputy director of the National Institute of Neurological Disorders and Stroke, the study’s main sponsor.

The bigger message, said study leader Pamela Duncan of Duke, is that more treatment over a longer period is best. She said many insurance companies allow 20 visits, while this study gave 36.

The care that stroke victims usually get now — less-intense therapy for three to six months — “does not get them to the point where they could be,” Dr. Koroshetz said.

Doctors are working on a cost comparison but think the home program is much cheaper. High-tech rehab requires expensive equipment and two to three therapists per patient; the home program needs only one.



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