Rethinking stroke therapy: Use it or lose it

Until recently scientists thought that when a region of the brain was damaged, its function was lost forever. Stroke patients who couldn't use an injured arm were taught to dress and bathe with their good arm.

But sophisticated imaging tests of the brain at work have since revealed that it can reorganize itself after injury so that when nerve cells die, their functions are taken over by other cells.

The incredible, plastic brain

That concept—known as neuroplasticity—has altered stroke therapy considerably. "Now we know that if you want to get motor recovery on the affected side, you have to use the affected side—repetitively and intensively," says Richard Zorowitz, M.D., chief of physical medicine and rehabilitation at the Johns Hopkins Bayview Medical Center in Baltimore, Md. "That stimulates the brain to make those new connections."

Neuroplasticity is the principle behind mirror therapy (see photo), as well as several other new technologies. Those include electrical stimulation of the damaged limb and robots that help patients repeatedly move those limbs.

Restrain yourself

Some rehab therapists are also using constraint-induced movement therapy (CIMT), an increasingly popular approach that forces the use of a patient's impaired limb—usually an arm—by restraining the unaffected one.

In a 2006 trial funded by the National Institutes of Health (NIH), 222 stroke patients were randomly assigned the usual care or CIMT, in which they wore a restraining mitt on their good hand most of the day for two weeks, and did repetitive tasks with their affected hand for up to six hours a day. People in the CIMT group made significantly greater gains in arm movement that persisted a year later, the researchers found.

While CIMT is most effective when it's started soon after a stroke, it can even help patients who had strokes years earlier. A study of people who had the stroke therapy more than four years after their attack, for example, found that it not only improved the use of their weak arm but also doubled the amount of activity in the region of the brain that controls its movement.

Other rehab programs

Here are several other approaches now available at some stroke therapy centers:

Attention training

Many stroke survivors experience shortened attention spans that reduce their ability to relearn skills. A 2009 study from New Zealand found that patients enrolled in a four-week program designed to improve their ability to maintain their focus showed significant improvements in attention compared with those who received standard care.

Depression treatment

Depression is a commonly underdiagnosed complication after a stroke, and untreated patients have a poorer response to rehabilitation. A 2009 study, funded by the NIH, found that depressed stroke patients who received counseling for eight weeks along with antidepressant medications were significantly less depressed than those who received only medication. Many in-patient rehabilitation facilities have psychologists on staff who are trained to identify, treat, and monitor depression in stroke patients.

Fall prevention

Stroke patients are prone to falls and bone loss, and a 2009 Dutch study found that they had twice the risk of breaking a hip or thigh bone. Exercises to improve balance, however, may reduce that risk. For example, stroke survivors who took a 12-week tai chi class did better on tests of balance than those who performed breathing and stretching exercises, according to a 2009 study from Hong Kong. If you take a tai chi class, inform the instructor of your physical limitations.

Music therapy

Music stimulates the brain, research shows. Stroke patients who listened to their favorite tunes daily during the first two months of recovery showed improved verbal memory, attention, and mood compared with patients who received audio books or no listening materials, a 2008 Finnish study found.

For a list of accredited stroke rehab centers, send an e-mail request to the Commission on Accreditation of Rehabilitation Facilities (medical@CARF.org). Include your city and state, and whether you need an inpatient, outpatient, in-home, or adult-day program. Some programs and therapies may not be covered by your insurance, so check your plan.

This article first appeared in the December 2009 issue of Consumer Reports on Health.