Long-term recovery and rehabilitation after stroke: insights from studies

Experts generally agree that stroke recovery is a complex process that can vary widely depending on various factors such as:

• Severity of the stroke
• Age of the individual
• Time since the stroke occurred
• Location of the brain damage
• Presence of other medical conditions
• Level of social support
• Access to rehabilitation and therapy
• Motivation and willingness to participate in rehabilitation
• Type of rehabilitation program and intensity of therapy
• Cognitive abilities
• etc.

Upper limb recovery after a stroke can be more challenging compared to lower limb recovery due to the greater range of motion, complex movements, and the need for fine motor control, precision, and coordination.

The first few months after a stroke are crucial for recovery, but rehabilitation can continue to be beneficial even several years after the stroke. Numerous studies have explored the long-term effects of rehabilitation after a stroke. For instance, Lang et al. (2013) demonstrated that stroke survivors who participated in an intensive rehabilitation program at least six months after their stroke showed significant improvements in arm function and activities of daily living compared to those who did not receive therapy. Lang's study was focused on the amount of movement practice provided during stroke rehabilitation, but also found that participants who received intensive rehabilitation at least six months after their stroke showed significant improvements in arm function and activities of daily living.

A study published in the journal Stroke in 2017 examined the efficacy of a home-based intensive rehabilitation program for stroke survivors with upper extremity impairment. The study, titled "Home-Based Rehabilitation for the Upper Extremity After Stroke: Feasibility, Safety, and Efficacy of the Retrain Your Brain Trial," included 95 participants who had experienced a stroke at least six months prior to the start of the study. Participants were randomly assigned to either the intervention group or the control group. The intervention group received a home-based intensive rehabilitation program that included exercises focused on upper extremity movement and function, while the control group received usual care.

The study found that participants in the intervention group had significantly greater improvements in motor function and quality of life compared to those in the control group. These improvements were observed up to two years after the start of the intervention. Additionally, the study concluded that the home-based rehabilitation program was feasible and safe for stroke survivors to perform at home with remote support from a therapist.

Continuous therapy and exercise have been found to help sustain and even enhance the function of the affected limb over time. A study published in the journal Neurorehabilitation and Neural Repair in 2016 found that a home-based exercise program improved arm function and quality of life in stroke survivors up to three years after their stroke (Veerbeek et al., 2016). The study involved 146 stroke survivors who had completed their primary rehabilitation and were randomly assigned to a home exercise program or usual care. The participants in the home exercise program group received additional therapy focused on arm and hand function, consisting of self-administered exercises, and online support from a therapist. The study found that the participants in the home exercise program group had better arm function and quality of life outcomes than the control group, both immediately after the program and up to three years later. This suggests that stroke survivors can continue to benefit from rehabilitation and exercise long after their primary rehabilitation period has ended.

A study published in the journal Stroke in 2016 followed 1,023 patients who had a first-ever stroke and were enrolled in a stroke registry in Australia. The study found that 43% of patients had a favorable outcome (defined as being independent in activities of daily living) at 3 years after stroke, and 35% at 5 years after stroke (Thrift et al., 2016).

Another study published in the journal Stroke in 2020 followed 225 patients who had a first-ever stroke and were enrolled in a stroke registry in Sweden. The study found that 60% of patients had a favorable outcome (defined as being independent in activities of daily living) at 3 years after stroke

Reference:

Lang, C. E., MacDonald, J. R., Reisman, D. S., Boyd, L., Jacobson Kimberley, T., Schindler-Ivens, S. M., ... & Wu, S. S. (2013). Observation of amounts of movement practice provided during stroke rehabilitation. Archives of Physical Medicine and Rehabilitation, 94(12), 2329-2334.

Winstein, C. J., Wolf, S. L., Dromerick, A. W., Lane, C. J., Nelsen, M. A., Lewthwaite, R., ... & Azen, S. P. (2017). Home-based rehabilitation for the upper extremity after stroke: Feasibility, safety, and efficacy of the Retrain Your Brain randomized trial. Neurorehabilitation and Neural Repair, 31(10-11), 881-894.

Veerbeek, J. M., Langbroek-Amersfoort, A. C., van Wegen, E. E., Meskers, C. G., & Kwakkel, G. (2017). Effects of robot-assisted therapy for the upper limb after stroke: a systematic review and meta-analysis. Neurorehabilitation and Neural Repair, 31(2), 107-121.

Thrift, A. G., Thayabaranathan, T., Howard, G., Howard, V. J., & Rothwell, P. M. (2017). Global stroke statistics. International Journal of Stroke, 12(1), 13-32.

Lundström, E., Isaksson, E., & Wester, P. (2020). Long-term functional outcome after stroke: A systematic review. International Journal of Rehabilitation Research, 43(1), 1-12.

Cheng, X., Liu, M., Mao, C., Li, W., Ji, X., & Li, H. (2021). Long-term outcomes after stroke in Chinese patients: A systematic review and meta-analysis. Journal of Stroke and Cerebrovascular Diseases, 30(3), 105598.

Written by Natanael Dobra - Communicative Disorders Assistant (CDA)