Efficacy and tolerance of a neurological restoration program in stroke patients

The present paper shows the result of an open prospective study performed to evaluate the tolerance and efficacy of a program for neurological restoration (PRN) in stroke patients. The PRN is organized 4 weeks cycles - 39 hours per week - and applied by a team of physical, occupational, and speech therapists, physiatrists, psychologists, clinicians and nurses; directed by a neurologist. The first phase of treatment aims to increase the physical capacity and tolerance to exercise. The second phase trains specific abilities (balance, posture, gait and handling). Drugs were only used to modulate physical or mood disorders, spasticity, or pain. The study was performed in 80 stroke patients attended in our institution (2005-2007). Only patients with a confirmed diagnosis of stroke in the carotid territories, over 15 years old, and not least than 6 months post-ictal evolution were included. Tolerance to treatment was very good, with only 4 adverse events not related to treatment. The neurological condition was evaluated using the Scandinavian Stroke Scale (SSS), and the functional condition using the Barthel Index (BI). The results show significant improvements both in the neurological (113.45 ± 1.59%) and functional (130.11 ± 5.17%) condition after one treatment cycle, which improved further when therapy continued for a second cycle (233.71 ± 7.76% and 207.62 ± 27.16% respectively). Severity of the impairment was not a negative predictor of the outcome. Age correlated negatively with the initial condition, but does not prevent improvement. Sex, time of evolution, affected hemisphere or interactions among them did not influence the outcome. These results demonstrate that the PRN is well tolerated and effective promoting recovery even in chronic stroke patients.