For stroke victims, intense therapy provides long-term gains, study shows

Hannah Bugg, 29, works out early Tuesday morning. Bugg, an attorney and mother of two, had a stroke in October 2009 and collapsed at home. An avid runner, she was paralyzed on her left side.

SKIP O’ROURKE | Times

Hannah Bugg, 29, works out early Tuesday morning. Bugg, an attorney and mother of two, had a stroke in October 2009 and collapsed at home. An avid runner, she was paralyzed on her left side.

PLANT CITY — Hannah Bugg was only 27 when she suffered a stroke that left her paralyzed on her left side, unable to walk, talk or care for her two young children.

Despite her youth, doctors were not encouraging about her prospects for recovery.

"I had very little hope after the stroke," said Bugg. "I was under the impression that I would never be able to walk again."

Even so, Bugg worked hard for four months with therapists and at home with help from her husband, mother and sister. She went from a wheelchair, to using a walker, then a cane. Six months after her 2009 stroke she walked, unassisted, into her first job as a lawyer.

Today, Bugg still does many of the exercises that were part of her rehabilitation and continues to notice improvement.

"Just last night I was able to wiggle my toes . . . I couldn't do that a year ago," she said.

A new study from the University of Florida, the largest stroke rehabilitation study ever conducted in the nation, supports what Bugg learned: Despite the popular pessimism about stroke and its aftermath, patients can benefit from physical therapy long after their stroke.

The study, published last month in the New England Journal of Medicine, also found that intensive therapy, particularly to regain the ability to walk, works even if it is delayed for six months and even if it is delivered at home.

The study, led by researchers from the department of physical therapy at UF's College of Public Health and Health Professions, looked at 408 participants, ages 25 to 98, who couldn't walk unassisted due to stroke.

They received intense physical therapy either in a clinic using a specially designed treadmill, or in their homes where they performed intense exercises focused on strength, balance, flexibility and range of motion. Treatment in both settings was delivered by licensed physical therapists.

"When we were with them, we were working," said Dorian Rose, research assistant professor of physical therapy and clinical research coordinator for the study. "There wasn't a lot of chitchat. We were doing serious exercise."

Each participant received 90 minutes of therapy, three times a week, for 12 to 16 weeks. "The keys were intensity and progression. The program got more and more challenging as time went on," said Rose.

The patients in the home-based group started two months after their strokes. The clinic-based group started at two or six months post-stroke.

Researchers followed up with patients at six and 12 months post-stroke. Slightly more than half — 52 percent — of participants had made significant improvement in walking ability when evaluated one year after their stroke.

"During that time they didn't get any coaching or extra therapy from us. We had no control over what they were doing and they maintained their initial gains," said Rose.

"It's very exciting and shows that therapy has a lasting impact. And it can be applied later, six months after a stroke, and patients can continue to improve."

• • •

Dr. David Decker, a stroke specialist with the University of South Florida and Tampa General Hospital, said he sees many patients who do well if they continue their rehab. He hopes the study changes attitudes about stroke recovery.

"There's a lot of pessimism with stroke. People think if you don't have it back soon after the stroke, you're done. That's simply not true,'' said Decker, who treated Bugg.

Research such as the UF study "convinces others of what we already know and should encourage patients. They will continue to get better if they work at it."

Bugg's stroke was due to a congenital heart condition that caused her to form a clot, her doctor said. Overcoming it took hard work and dogged determination.

Bugg wanted to start her career, care for her children and get back to running every day — goals she made clear to her therapist from the outset.

"I set my mind to it and decided I am going to do this," she remembers, "I was so determined. I wanted it so bad. The key is you just can't give up."

Decker echoes that advice when talking to patients. "Progress may become slower and become less noticeable, but people who really work at it continue to improve," he said. "You can potentially improve to some degree the rest of your life."

Decker hopes the research both encourages patients, their families and clinicians, and also leads to improved insurance coverage for rehab.

"This type of research supports the idea that we should continue therapy and not stop it early," he said.

Irene Maher can be reached at imaher@sptimes.com.

For stroke victims, intense therapy provides long-term gains, study shows 06/15/11 [Last modified: Wednesday, June 15, 2011 9:49pm]

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