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Enriched, Task-Specific Therapy in the Chronic Phase After Stroke: An Exploratory Study
Sara Vive1, Jean-Luc Af Geijerstam, H Georg Kuhn
1Section for Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden (S.V. and L.B-K.); Neurocampus, Sophiahemmet Hospital, Stockholm, Sweden (S.V.); Karolinska Institute Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden (J-L.G.); Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (H.G.K.); Center for Stroke Research and Neurocure Cluster of Excellence, Charité-Universitätsmedizin, Berlin, Germany (H.G.K.); and Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, Mölndal, Sweden (L.B-K.).
Background And Purpose:
There is a need to translate promising basic research about environmental enrichment to clinical stroke settings. The aim of this study was to assess the effectiveness of enriched, task-specific therapy in individuals with chronic stroke.
Methods:
This is an exploratory study with a within-subject, repeated-measures design. The intervention was preceded by a baseline period to determine the stability of the outcome measures. Forty-one participants were enrolled at a mean of 36 months poststroke. The 3-week intervention combined physical therapy with social and cognitive stimulation inherent to environmental enrichment. The primary outcome was motor recovery measured by Modified Motor Assessment Scale (M-MAS). Secondary outcomes included balance, walking, distance walked in 6 minutes, grip strength, dexterity, and multiple dimensions of health. Assessments were made at baseline, immediately before and after the intervention, and at 3 and 6 months.
Results:
The baseline measures were stable. The 39 participants (95%) who completed the intervention had increases of 2.3 points in the M-MAS UAS and 5 points on the Berg Balance Scale (both P < 0.001; SRM >0.90), an improvement of comfortable and fast gait speed of 0.13 and 0.23 m/s, respectively. (P < 0.001; SRM = 0.88), an increased distance walked over 6 minutes (24.2 m; P < 0.001; SRM = 0.64), and significant improvements in multiple dimensions of health. The improvements were sustained at 6 months.
Discussion And Conclusions:
Enriched, task-specific therapy may provide durable benefits across a wide spectrum of motor deficits and impairments after stroke. Although the results must be interpreted cautiously, the findings have implications for enriching strategies in stroke rehabilitation.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A304).
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