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  • October 07, 2021

    Washington, D.C., – A phase II, randomized clinical trial found that the optimal period for intensive rehabilitation of arm and hand use after a stroke should begin 60 to 90 days after the event. The study, conducted by Georgetown University and MedStar National Rehabilitation Network (NRH) researchers, was published September 20, 2021, in PNAS (Critical Period After Stroke Study (CPASS): A Phase II Clinical Trial Testing an Optimal Time for Motor Recovery After Stroke in Humans).

    The same intensive rehabilitation at less than 30 days after a stroke provided some benefit, but rehabilitation at six months or more after a stroke showed no significant benefit compared to those receiving standard care.

    Approximately 750,000 new strokes occur each year in the United States. Nearly two-thirds of people who have a stroke do not recover complete function in their hands and arms, an impairment that can severely limit everyday activities.

    “Our finding demonstrates the existence of a critical period or optimal time when adults are most responsive to rehabilitation after a stroke,” says lead author Alexander Dromerick, MD, professor of Rehabilitation Medicine and Neurology and chair of Rehabilitation Medicine at Georgetown University Medical Center and vice president for research at MedStar NRH. “Previous clinical trials have found few or very small improvements in motor function post- stroke, so our research could be an important breakthrough in finding ways we can make substantial improvements in arm and hand recovery.”

    For their trial, the clinicians enrolled 72 stroke participants, primarily from the Washington, D.C., area, within three weeks after their stroke. The participants were randomly assigned to receive 20 extra hours of activity-focused motor skills therapy, starting at different times after stroke, in addition to their regularly prescribed therapies. The additional therapy began either at 30 days after their stroke, at 60 to 90 days post-stroke, or at six months or more post-stroke. The results were compared to a control group that received only their prescribed rehabilitation therapies but no extra motor rehabilitation training.

    “Our results suggest that more intensive motor rehabilitation should be provided to stroke patients at 60 to 90 days after stroke onset,” said Elissa Newport, PhD, director of the Center for Brain Plasticity and Recovery at Georgetown University Medical Center and corresponding author of this article. “It is well known that a young developing brain shows great plasticity, compared to other times in life. Our results show that there may be a similar period of heightened plasticity for stroke patients at a specific time after their stroke.”

    The improvement in hand and arm function found in this study was not only statistically significant, it was large enough to be perceived as functionally meaningful by the patients themselves.

    “Our approach shows that patients can tolerate much more intensive motor training than is traditionally provided if they are free to choose the activities used in their training,” said Dorothy F. Edwards, PhD, professor of Kinesiology and Medicine at the University of Wisconsin- Madison and member of the Center for Brain Plasticity and Recovery. “Knowing there might be a critical period for recovery, there are many techniques one might imagine bringing to bear on understanding and enhancing recovery during this time period.”

    The researchers hope that this study will establish a time window in which future research can combine therapy with brain stimulation or medications aimed at helping remaining healthy areas of the brain recover impaired functions or take over functions lost from the damage inflicted by a stroke. The investigators also plan to design a larger clinical trial to confirm the current findings and to determine the optimum dose of therapy, thereby achieving the best effects during this time-sensitive window.

    ###

    Note: Dromerick passed away after providing information for this press release, but prior to the study’s publication. This release is dedicated to him in memoriam.

    In addition to Dromerick, Newport and Edwards, the authors of the manuscript at Georgetown include Shashwati Geed, Matthew A. Edwardson, Ming T. Tan and Yizhao Zhou; Kathaleen P. Brady, Margot M. Giannetti, and Abigail Mitchell are at MedStar NRH; and Jessica Barth is at Washington University, Program in Physical Therapy, St. Louis.

    The authors report no competing interests.

    This work was supported by funds from Center for Brain Plasticity and Recovery at Georgetown University and MedStar National Rehabilitation Hospital; grants from NIH/NINDS StrokeNet SCANR 5U24NS107222-03, NIH/NICHD National Center for Medical Rehabilitation Research K12HD093427 and NIH/NIDCD R01 DC016902, and MedStar NRH clinicians and study participants.

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  • October 07, 2021

    Washington, D.C., – A phase II, randomized clinical trial found that the optimal period for intensive rehabilitation of arm and hand use after a stroke should begin 60 to 90 days after the event. The study, conducted by Georgetown University and MedStar National Rehabilitation Network (NRH) researchers, was published September 20, 2021, in PNAS (Critical Period After Stroke Study (CPASS): A Phase II Clinical Trial Testing an Optimal Time for Motor Recovery After Stroke in Humans).

    The same intensive rehabilitation at less than 30 days after a stroke provided some benefit, but rehabilitation at six months or more after a stroke showed no significant benefit compared to those receiving standard care.

    Approximately 750,000 new strokes occur each year in the United States. Nearly two-thirds of people who have a stroke do not recover complete function in their hands and arms, an impairment that can severely limit everyday activities.

    “Our finding demonstrates the existence of a critical period or optimal time when adults are most responsive to rehabilitation after a stroke,” says lead author Alexander Dromerick, MD, professor of Rehabilitation Medicine and Neurology and chair of Rehabilitation Medicine at Georgetown University Medical Center and vice president for research at MedStar NRH. “Previous clinical trials have found few or very small improvements in motor function post- stroke, so our research could be an important breakthrough in finding ways we can make substantial improvements in arm and hand recovery.”

    For their trial, the clinicians enrolled 72 stroke participants, primarily from the Washington, D.C., area, within three weeks after their stroke. The participants were randomly assigned to receive 20 extra hours of activity-focused motor skills therapy, starting at different times after stroke, in addition to their regularly prescribed therapies. The additional therapy began either at 30 days after their stroke, at 60 to 90 days post-stroke, or at six months or more post-stroke. The results were compared to a control group that received only their prescribed rehabilitation therapies but no extra motor rehabilitation training.

    “Our results suggest that more intensive motor rehabilitation should be provided to stroke patients at 60 to 90 days after stroke onset,” said Elissa Newport, PhD, director of the Center for Brain Plasticity and Recovery at Georgetown University Medical Center and corresponding author of this article. “It is well known that a young developing brain shows great plasticity, compared to other times in life. Our results show that there may be a similar period of heightened plasticity for stroke patients at a specific time after their stroke.”

    The improvement in hand and arm function found in this study was not only statistically significant, it was large enough to be perceived as functionally meaningful by the patients themselves.

    “Our approach shows that patients can tolerate much more intensive motor training than is traditionally provided if they are free to choose the activities used in their training,” said Dorothy F. Edwards, PhD, professor of Kinesiology and Medicine at the University of Wisconsin- Madison and member of the Center for Brain Plasticity and Recovery. “Knowing there might be a critical period for recovery, there are many techniques one might imagine bringing to bear on understanding and enhancing recovery during this time period.”

    The researchers hope that this study will establish a time window in which future research can combine therapy with brain stimulation or medications aimed at helping remaining healthy areas of the brain recover impaired functions or take over functions lost from the damage inflicted by a stroke. The investigators also plan to design a larger clinical trial to confirm the current findings and to determine the optimum dose of therapy, thereby achieving the best effects during this time-sensitive window.

    ###

    Note: Dromerick passed away after providing information for this press release, but prior to the study’s publication. This release is dedicated to him in memoriam.

    In addition to Dromerick, Newport and Edwards, the authors of the manuscript at Georgetown include Shashwati Geed, Matthew A. Edwardson, Ming T. Tan and Yizhao Zhou; Kathaleen P. Brady, Margot M. Giannetti, and Abigail Mitchell are at MedStar NRH; and Jessica Barth is at Washington University, Program in Physical Therapy, St. Louis.

    The authors report no competing interests.

    This work was supported by funds from Center for Brain Plasticity and Recovery at Georgetown University and MedStar National Rehabilitation Hospital; grants from NIH/NINDS StrokeNet SCANR 5U24NS107222-03, NIH/NICHD National Center for Medical Rehabilitation Research K12HD093427 and NIH/NIDCD R01 DC016902, and MedStar NRH clinicians and study participants.

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  • October 03, 2019

    The following q & a is with patient Daniel Ford. Daniel came to MedStar NRH this summer for inpatient rehabilitation after he suffered a stroke on a bus. Daniel relives the terrifying incident but also his excellent experience in rehabilitation getting him back to the life he wants to live.

     

    Q: How did you end up in the hospital?

    I had a stroke August 2nd in the late afternoon. It happened on the circulator bus on the way to the hospital when my left side went out.

    Q: What changes did the stroke cause?

    It caused the whole left side of my body to go out, to be in a vegetable type of state for some time. I couldn’t swallow, could barely breath, could barely see. Thinking was very hard to do, talking was hard. My face was drooping and hanging down. The arm on the left side would pop out. Life changing changes

    Q: What is one of the most beneficial things about therapy?

    Oh, the staff! The getting out of the bed actually standing up and moving about and seeing other people work out in the atrium. Being mobile period, to get up and take a shower, to get up and use the bathroom, to get up and get dressed, to get up and go outside and feel the fresh air and sun on your face. Just moving around, walking and standing. That’s one of the things I loved the most, getting out of bed all day long. It gave me a sense of urgency to recover. I saw others walking about and they did amazing, when I saw that I said, that’s going to be me. Excellent staff, excellent PT, OT, SLP. Seeing them gives you that “you’re going to be ok, we’re going to take care of you”. They push you to stay motivated and to practice the ability, never giving up or never saying you can’t do this. They are always positive, even when they are pushing you.

    Q: What is something challenging about therapy?

    Working on the left side, finger motion and picking up objects. That was the most challenging. I’m still working on it now.

    Q: What would you tell a stroke survivor just starting out in rehab.

    To rest, eat well and prepare yourself to get up and walk. Walk with a conviction, it’s such as awesome team. As soon as you get out of bed you are already feeling motivated like I can’ do this. When you go out to the atrium and see all the equipment and the sun light it motivates you to get it down. You can push yourself by seeing others move. Ask your therapists if there is anything you want to do, and they can work on it with you. All my sessions were amazing. 

    Q: What do you like about group therapy?

    Seeing other people going through the same struggles and overcoming those struggles. Being able to communicate and hear their testimonies as they continue their therapy and recovery. I have seen 2 people I’ve been with from the beginning go home and they are doing so well! Listening to them speak helped me be able to speak more clearly. Group was very therapeutic, I had a lot of fun in group.

    Q: Would you recommend NRH to someone looking for stroke rehab?

    Most definitely!!  Someone told me it was the best and it’s true! I would recommend everything.


    To learn more about the Inpatient Stroke Recovery Program at MedStar National Rehabilitation Hospital, please call 
    202-877-1152

    Outpatient Stroke Rehabilitation Services are conveniently located throughout the region. Click here to learn more about the locations of Outpatient Stroke Recovery services

    # # #

    About MedStar National Rehabilitation Network

    The MedStar National Rehabilitation Network is a regional system of rehabilitation care that offers inpatient, day treatment and outpatient services in Washington, D.C., Maryland and Northern Virginia.

    The Network’s interdisciplinary team of rehabilitation experts provides comprehensive services to help people recover as fully as possible following illness and injury.  Rehabilitation medicine specialists, psychologists, physical and occupational therapists, and speech-language pathologists work hand-in-hand with other rehab professionals to design treatment plans tailored to each patient’s unique needs.  Rehabilitation plans feature a team approach and include the use of state-of-the-art technology and advanced medical treatment based on the latest rehabilitation research.  

    The Network provides comprehensive programs specifically designed to aid in the rehabilitation of adults and children recovering from neurologic and orthopaedic conditions such as amputation, arthritis, back and neck pain, brain injury, cancer, cardiac conditions, concussion, fibromyalgia, foot and ankle disorders, hand and upper extremity problems, post-polio syndrome, stroke, spinal cord injury and disease, and sports and work-related injuries.

    Inpatient and day treatment programs are provided at MedStar National Rehabilitation Hospital located in Northwest Washington, DC and at more than 50 outpatient sites conveniently located throughout the region.  MedStar National Rehabilitation Network is fully accredited by The Joint Commission, the Commission on Accreditation of Rehabilitation Facilities (CARF), with CARF accredited specialty programs for Amputations, Brain Injury, Spinal Cord Injury and Stroke.

    For more on MedStar National Rehabilitation Network and to find a location near you, log on to MedStarNRH.org.

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