Stroke therapy sets its sights higher, farther

Many patients with weakness or paralysis receive some therapy in a rehabilitation hospital or nursing home; others get it on an outpatient basis. But such treatment continues only while they show marked improvement -- usually six months at most. Most private and government insurance programs then provide for a wheelchair or cane, if necessary, and leave patients to manage as best they can. The progress often stops.

It might not have to be that way. New and ongoing research suggests that stroke patients can continue to improve for far longer, making greater gains and returning to productive lives. But such achievement requires a different type of rehabilitation -- one that's more time-consuming, more demanding and much more expensive than the conventional approach.

"I don't think there is any hard limit on how long after a stroke people can continue to recover," says Michael Weinrich, director of the National Center for Medical Rehabilitation Research in Bethesda, Md. Part of the National Institutes of Health, the center funds researchers who are pushing the envelope of expectations for stroke patients.

The new approach, called neuro-rehabilitation, relies on the brain's ability to rebuild itself, to learn new tasks. Adding to evidence of the brain's plasticity, neuroscientists and physical therapists are finding that repetitive, challenging and individualized therapy can rewire the brain and improve stroke patients' ability to move, put words together and articulate them clearly -- not just months after their attack, but even years later.

Most current treatment, on the other hand, primarily teaches patients to compensate for their lost abilities by using their "good side" for daily activities like dressing, eating and cooking. It's often not enough for people accustomed to independence.

Jim Krakowski of Los Angeles knows well the limitations of traditional treatment. The former legislative analyst for the city was left partially paralyzed by a stroke four years ago at age 49. Conventional physical and occupational therapy helped him walk again, relying on a cane and a brace, but at a pace of 1 mph, he could hardly get across intersections before lights changed. Although convinced he could do better, Krakowski had exhausted the therapy his health plan would provide.