New findings challenge stroke reco?very theories

STROKE survivors left weakened or partially paralyzed may be able to regain more arm and hand movement than their doctors realize, say experts at The Ohio State University Wexner Medical Center who have just published two new studies evaluating stroke outcomes.

One study analyzed the correlation between long-term arm impairment after stroke and the size of brain lesions caused by patients’ strokes – a visual measure often used by doctors to determine rehabilitation therapy type and duration. The other study compared the efficacy of a portable robotics-assisted therapy program with a traditional program to improve arm function in patients who had experienced a stroke as long as six years ago.

“These studies were looking at two entirely different aspects of a stroke, yet they both suggest that stroke patients can indeed regain function years and years after the initial event,” said Stephen Page, PhD, OTR/L, author of both studies and associate professor of Health and Rehabilitation Sciences in Ohio State’s College of Medicine. “Unfortunately, we know that this is not a message that many patients and especially their clinicians may be getting, so the patients may not be reaching their true potential for recovery.”

Size doesn’t matter 
Clinicians frequently tell patients that the bigger the size of the area of their brains affected by their strokes, the worse that their outcomes will be. However, in a lead article in the Archives of Physical Medicine and Rehabilitation, Page’s research team found that there was no relationship between the size of stroke lesions and recovery of arm function in 139 stroke survivors. On average, study participants had experienced a stroke five years earlier.

“Historically, lesion size been thought to influence recovery, but we didn’t find that to be the case when looking at regaining arm and hand movement,” said Page, who also runs Ohio State’s B.R.A.I.N Lab, a research group dedicated to developing approaches to restore function after disabling injuries and diseases. “This has important implications because we know clinicians look closely at lesion volume and may make decisions about the type and duration of therapy, and that some may communicate likelihood for recovery to patients based on this size. Many people think the window for therapy is roughly six months, but we think it’s much longer.”

Page agrees that the first six months after a stroke may represent important healing time for the brain, but that “retraining” it with occupational therapy can potentially be helpful at any time after the stroke. He says that his findings support other theories that the health of remaining brain tissue influences recovery much more than lesion size.

Although there are many studies that have identified a relationship between stroke lesion size and overall neurological function, Page’s study is the first to specifically look at lesion size and upper extremity outcomes.

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