Optimal Timing and Intensity for Poststroke Arm and Hand Rehabilitation Is 60 to 90 Days

A phase 2 randomized clinical trial identified the optimal period for intensive rehabilitation of arm and hand use after a stroke as 60 to 90 days after stroke. The same intensive rehabilitation done 30 days after a stroke provided some benefit. In contrast, no benefits were seen when rehabilitation occurred 6 or more months post stroke. Nearly two-thirds of individuals who have a stroke do not recover complete function in their hands and arms, an impairment that can severely limit everyday activities. The improvement in hand and arm function found was not only statistically significant, but also large enough to be perceived as functionally meaningful.  

“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.”

In this trial, 72 participants were enrolled within 3 weeks of having a stroke. The participants were randomly assigned to receive 20 extra hours of activity-focused motor skills therapy in addition to regularly prescribed therapies. The additional therapy began either at 30 days after stroke, 60 to 90 days post-stroke, or 6 months or more post stroke. The results were compared with a group of participants who 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.”
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