rehabilitation

Farah Aleisa, MD

Zhao J, Chau JPC, Chan AWK, Meng Q, Choi KC, Xiang X, Zhao Y, He R, Li Q. Tailored Sitting Tai Chi Program for Subacute Stroke Survivors: A Randomized Controlled Trial. Stroke. 2022.

Ancient Chinese medicine suggests that Chi is aligned with our body fluids and stability of the nervous system, and it delivers functional and healing resources to all parts of the body, including the brain. It believes in the resting alert status of the body to activate circulation and facilitate oxygenation to the organs and cells. Its main outcome is harmonizing the nervous system. There are many energy channels connecting organs, glands, and cells, which are equivalent to the chemical and nervous signals. One of the modern definitions of Chi is the functionality of the chemical interactions in different body systems through enzymes, hormones, and even neurotransmitters; the methodology of Chi depends on the mind focus, breathing exercise, and specific body movements that all collaborate to enhance the efficiency of the inner chemical activities.

Dr. Zhao and his team studied the efficacy of a tailored Tai Chi rehabilitation program among stroke survivors who suffered from residual disabilities post-stroke events. The best time for rehabilitation for stroke patients is the first few days, post-stroke event, and the highest rate of recovery is up to 6 months. Beyond the 6 months period, recovery is still possible but in a much slower rate. This is the first study designed as an assessor-blind randomized controlled trial looking for the benefits of tailored Tai Chi exercises in the subacute stroke population. It enrolled patients from April 2020 to August 2020. Four separate inpatient neurology units of two tertiary A-level traditional Chinese medicine (TCM) hospitals in Kunming, China, included stroke survivors aged over 18 years, with a clinical diagnosis of ischemic stroke, with history of first-ever stroke, in the subacute stage of stroke, who can sit independently with or without cushions, use and raise at least one arm while sitting, and who are able to communicate. Few exclusion criteria were applied, like severe stroke with NIH stroke scale >16, cognitive impairment, hearing or visual disabilities, and pregnant women. Participants were randomized on a 1:1 ratio to the intervention or control groups with a block size of 8 stratified by NIHSS score (< 6 or ≥ 6) by an independent statistician according to a computer-generated randomization sequence.

Kate Hayward, PhD, PT
@kate_hayward_

Klassen TD, Dukelow SP, Bayley MT, Benavente O, Hill MD, Krassioukov A, Liu-Ambrose T, Pooyania S, Poulin MJ, Schneeberg A, et al. Higher Doses Improve Walking Recovery During Stroke Inpatient Rehabilitation. Stroke. 2020;51:2639-2648.

Stroke recovery and rehabilitation trials have received much criticism for underdosing the tested intervention,¹ which remains an important consideration when interpreting past trials in the field.²

In this trial of aerobic exercise during inpatient rehabilitation by Klassen et al.,³ the intensity (heart rate reserve during training and walking steps) and amount (minutes of training) of aerobic exercise were increased from usual care. The control group (usual care) typically received 1 hour, 5 days/week, while the Determining Optimal Post-Stroke Exercise 1 (DOSE1) group received 1 hour, 5 days/week (with a target of double the intensity of the control group), and the DOSE2 group received 2 hours, 5 days/week (with a target of quadruple the intensity of the control group), each for a 4-week duration (20 sessions).

Tamaya Van Criekinge, PT
@TamayaVC

Hornby TG, Henderson CE, Plawecki A, Lucas E, Lotter J, Holthus M, et al. Contributions of Stepping Intensity and Variability to Mobility in Individuals Poststroke: A Randomized Clinical Trial. Stroke. 2019;50:2492–2499.

Recovery of gait after stroke is considered one of the most important therapy goals for both patients and therapists, to assure independency and the ability to ambulate in the community. However, over 20% of stroke survivors do not reach independent walking, which necessitates the implementation of more intensive gait rehabilitation strategies. As Hornby et al. correctly state, rehabilitation staff are often too reserved, as they are scared of potential adverse effects, such as cardiovascular events and abnormal kinematic movements strategies.

In this study, Hornby and colleagues questioned if the benefits after high-intensity training in motor recovery outweigh the possible adverse events. In total, 97 chronic stroke patients were randomized in three groups: 1) High-intensity in high variable contexts (speed-dependent and skill-dependent multiple direction treadmill training, overground training and stair climbing at 70-80% of the heart rate reserve); 2) High-intensity with minimal variability (forward stepping treadmill and overground training at 70-80% of heart rate reserve); and 3) Low-intensity in high variable contexts (similar variable contexts as group one, yet performing exercises at 30-40% of heart rate reserve). Primary walking outcomes assessed were self-selected and fasted speed, single-limb stance and step-length asymmetry at self-selected and fasted speed, and six-minute walking test at fasted speed.