Chronic rehab After a Stroke

From a study in the UK. The last two paragraphs are here and very disappointing.

Chronic rehab After a Stroke

What should we deduce from this?
The results of this study are, quite frankly, disappointing. Of course, the therapy was being tested in patients one year, at least, after their stroke. However, the participants were typical of those sent for physical therapy, and the type of therapy given was ‘routine’. The investigators make a revealing statement in their publication. They report that, in interviews with the patients in the ‘treatment’ group, they found that patients were thankful for the therapy, but felt that it was not designed to help them with their practical difficulties with day-to-day activities.

New thinking about the possible ways stroke patients might restore damaged or destroyed nervous tissue connections suggest the need for very intensive, long-lasting stimulation. Such a degree of stimulation is hardly likely to occur in routine therapy sessions. New approaches are required – balance, strength and endurance training, simple task repetition, group therapy, and family involvement – as well as ‘therapy’ for several (many?) hours a day. A new concept, forced-use therapy (also called constraint-induced movement therapy — see link below) is just such a technique that deserves wider trials. It doesn’t make sense for HMOs (or other health providers) to continue to pay for therapy that is not clearly very effective, when there may be other more useful, but less traditional, approaches.

What should we learn from this?
That we have to reduce the amount of damage by stopping the neuronal cascade of death. Existing treatments are failing and until we acknowledge that we aren't going to support survivors in the best way.