A Study Finds That Stroke Recovery May Depend On When Rehab Starts : Shots - Health News Intensive rehabilitative therapy that starts two to three months after a stroke may be key to helping the injured brain rewire, a new study suggests. That's later than covered by many insurance plans.

The Best Time For Rehabilitation After A Stroke Might Actually Be 2 To 3 Months Later

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People who've had a stroke appear to recover more fully if intensive rehabilitation starts two to three months after the event. That's the conclusion of a study suggesting there is a critical period in which an injured brain is best able to rewire. The finding challenges the current practice of starting rehabilitation within a few days. NPR's Jon Hamilton has more.

JON HAMILTON, BYLINE: The day before Tony McEachern's stroke in 2017, he was doing Michael Jackson dance moves with his kids. A few hours later, he couldn't stand up.

TONY MCEACHERN: My ability to move was diminishing in front of my eyes.

HAMILTON: McEachern, who was then 45 and a professor at Howard University, lost control of the right side of his body. He would spend a week in the hospital and more than a month in a rehabilitation center, but he still had trouble with basic tasks.

MCEACHERN: Whereas normally I could jump in the shower - 20 minutes, I'm showered, dressed and out. Coming from the stroke, it took me two hours - took me a long time.

HAMILTON: McEachern kept improving, though, perhaps because he was part of a study on when intensive rehabilitation is best able to restore a person's use of their arm and hand. Elissa Newport of Georgetown University Medical Center says the study was inspired by what scientists had learned about rehabilitation in animals.

ELISSA NEWPORT: Very, very early, you can often make a stroke bigger and worse. Moderately early, you got very good success. And then as you got farther out of the stroke, you didn't get any success anymore.

HAMILTON: So Newport and a team of researchers studied 72 stroke patients at the MedStar National Rehabilitation Hospital in Washington, D.C. She says participants were randomly assigned to receive an extra 20 hours of intensive training during one of three time periods.

NEWPORT: And what we found is that the best recovery was the people who received their intensive training at two to three months after their stroke.

HAMILTON: The results, published in the journal PNAS, found that earlier training wasn't as good, while training that started more than six months after a stroke showed no benefit. And Newport says even rehabilitation at the ideal time produced only a modest improvement in patients' ability to do things like reach and grasp.

NEWPORT: This is a measurable, noticeable amount, but they don't recover fully.

HAMILTON: Newport says it will take a larger study to confirm the finding, but she says it appears that intensive rehabilitation should go on longer than most insurance coverage allows.

NEWPORT: Two to three months after stroke is when people are at home. That's not when most people are having their rehabilitation.

HAMILTON: Tony McEachern's intensive training started before the optimal period. Even so, he thinks the extra therapy helped him regain some use of his right hand.

MCEACHERN: I can carry a toothbrush. I can carry bottles. I can use one hand to hold the bottle while I use the other hand to open it. None of this stuff was possible immediately after I had the stroke and probably not even imaginable.

HAMILTON: Stroke experts say the study's finding is likely to stoke debate about when to start intensive rehabilitation for stroke patients. Dr. Jin-Moo Lee is the chair of neurology at Washington University in St. Louis.

JIN-MOO LEE: It's something that we've suspected all along based on the animal models, but this is really the first human evidence that there is a critical period in which rehab therapies are most effective in improving recovery.

HAMILTON: Lee says right after a stroke, the brain is in survival mode. Cells are dying. There's inflammation. Eventually, though, he says it enters an interim period in which injuries become a scar.

LEE: And probably in that interim period, there's also changes that allow the brain to become more plastic.

HAMILTON: Lee says the brain seems to enter a mode similar to childhood, when rewiring and relearning can happen very rapidly.

Jon Hamilton, NPR News.


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