Saturday, 31 March 2012

Supervised therapy helps stroke patients recover faster

Exercising at home not good enough: Study
By Poon Chian Hui, The Straits Times, 29 Mar 2012

TWO in three stroke patients drop out of therapy after they leave the hospital, but a study has shown that supervised sessions can pave the way to faster recovery.

The study revealed that patients who performed exercises only at home lagged behind those who also did so under the watch of a therapist in the year following discharge from hospital.

Associate Professor Gerald Koh said the study underlines the vital role therapists play in stroke rehabilitation.

'Often, patients think that doing exercises at home is enough, but the key thing is to go back to the therapist for reviews,' said Prof Koh, who is from the Saw Swee Hock School of Public Health at National University of Singapore.

This is because at every review, the therapist can prescribe a new set of exercises that are more challenging.

'If you keep doing the same exercises all the time, you won't be able to improve as much,' added Prof Koh, who is among the researchers from the Saw Swee Hock School of Public Health who did the study.

The lower payoff at home is compounded by the fact that only 33 per cent of stroke patients in the study turned up for therapy sessions regularly in the months after discharge.

One year on, only 28 per cent remained on supervised therapy.

This means that two-thirds of the stroke patients in the study could be failing to regain their fullest ability to perform daily activities.

The study of 200 patients from Ang Mo Kio-Thye Hua Kwan Hospital and St Luke's Hospital was carried out between 2002 and 2005.

The results of the study, which tracked discharged stroke patients for one year, were published last month in an international journal.

Every year, more than 10,000 people are admitted to hospitals for stroke, which is also the top cause of disability.

A stroke occurs when blood flow to the brain is interrupted, causing damage to brain cells due to the lack of oxygen. This, in turn, may impair movement of certain parts of the body that are controlled by the damaged brain cells.

Stroke is the fourth leading cause of death in Singapore, accounting for about 1,400 deaths in 2010.

Figures show that more than 60 per cent of stroke survivors remain significantly disabled three months after they were afflicted.

Disabilities can range from memory loss to speech difficulties as well as incontinence and depression.

Patients in the study were taught rehabilitation exercises which they could perform on their own at home.

On top of that, they were advised to go to the nearest centre for supervised therapy regularly. Examples included day rehabilitation centres.

At every assessment point - one month, six months and one year after hospital discharge - patients were scored on an index that rated how well they performed daily activities.

These included moving from one place to another, climbing stairs, eating, showering and putting on clothes.

The study showed that active participation in supervised therapy paid dividends.

Those who attended more than one-quarter of therapy sessions, on top of exercising at home, recovered faster and to a greater extent.

They took an average of one month to see significant improvement. Those who went for therapy less regularly could take six months to achieve similar results.

Prof Koh admits that it is not always easy for stroke patients to attend therapy sessions regularly.

For one thing, many have difficulty walking, so asking them to travel to a centre regularly can be a tall order.

Others may not have friends or relatives to accompany them for such sessions.

Prof Koh estimates that a person will have to set aside at least three hours to take someone for a one-hour therapy session.

Lastly, cost can be a barrier. A day rehabilitation session may cost about $40, compared to $120 for consulting a specialist. But the cumulative cost of weekly therapy can exceed that of seeing the doctor, whom a patient may visit only a few times a year, said Prof Koh.

He urged stroke patients not to drop out of therapy.

'A stroke is not a life sentence. It does not mean you have to be bed-ridden. Do your rehab and you can regain a better quality of life.'

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