Improved Outcome for Stroke Patients

I have two new pieces of information that came in this week that could be critical in improving the health and outcome for stroke patients. First, a Swedish discovery by brain researchers at Lund University could lead to a new effective therapy with a substance that opens up the possibility of treatment up to two days after a stroke. The opportunities to treat a stroke have long been limited to the hours after an attack and the loss of brain function caused by the stroke has previously been regarded as permanent.

The only acute treatment for a stroke currently available is thrombolysis which uses drugs that dissolve the blood clot responsible for the stroke. However, this only reaches around 10 per cent of stroke patients in time to prevent lasting damage. For other patients, there are no other effective drugs that reduce the loss of brain function following a stroke.

Swedish and American researchers have discovered a substance that reinforces the brain’s self-healing functions after a stroke. It has long been known that people affected by a stroke can regain some lost function during the first six months. Professor Tadeusz Wieloch and his colleagues have found a way to activate a protein in the brain, the sigma-1 receptor, which plays an important role in the brain’s recovery during the critical period after the injury.

The idea is to recreate and reinforce the brain’s natural response to an enriched environment. By injecting the activating substance, brain repair is stimulated. This result of Swedish basic research, which started over 15 years ago, has led to a clinical trial on stroke patients by a Japanese pharmaceutical company. It is not available yet, but it shows great promise for helping many thousands more stroke victims than at present can be treated with the usually prescribed drugs.

Physical Therapy Improves Recovery by over 50%:
Secondly, just a year after having a stroke, 52% of people who participated in physical therapy as part of their recovery programme experienced improved functional walking ability according to the results of a trial being presented this month at the American Stroke Association’s International Stroke Conference 2011 in Los Angeles.

The 408 participants (average age 62 with recent stroke) were recruited from 6 US stroke rehabilitation centers between April 2006 and June 2009. All were assigned to 36 sessions of 75 to 90 minutes for 12 to 16 weeks in either a structured and progressive task-specific walking program that included body weight supported treadmill training provided early (2 months post-stroke) or late (6 months post-stroke), or a structured and progressive home-based exercise program of strength and balance provided 2 months post-stroke.

The researchers had thought that the body-weight supported treadmill and walking program would be superior to a home exercise program but they were wrong. After one year, the early walking group, late walking group, and exercise program targeting strength and balance achieved similar important gains in walking speed, motor recovery, balance, functional status, and quality of life.

All participants made the greatest improvements in outcomes after the first 12 sessions, but 13% of the subjects continued to make functional gains in walking recovery by 24 sessions and another 7% improved by 30 to 36 sessions.

What this suggests is that undertaking physical therapy will considerably improve quality of life and that patients recover faster and sustain recovery when the intervention is given early. If your doctor has not suggested physical therapy then take it up with them and also talk to your local group for support. You will find help via The Stroke Association at www.stroke.org.uk

How vitamins can help stroke patients

Taking vitamin supplements is an area fraught with controversy. In the red corner are the true believers who think it can cure everything and in the blue corner the sceptics who won’t accept they do any good at all. As ever, I like the balanced view and personally have found supplements very helpful for some things and not much use for others though in general I am more in favour than not.

The following report though gives me hope that the sceptics might see a chink of light as it was carried out in a bona fide hospital by properly qualifed doctors. In fact it was tested at the Burke Rehabilitation Hospital for stroke victims at Cornell University in the USA. One of the features of hospital stroke patients is that they are often undernourished and have lost weight and the researchers took 100 people who ‘qualified’ and gave half the standard hospital regime for stroke patients but included a multivitamin and mineral supplement and a drink that which would give them calories, protein and 36 mg of vitamin C which they were given every eight hours. The other half of the group got the same, but with double the quantities, and an increased amount of vitamin C – 90mg.

When the patients were studied, the group that had the higher levels of vitamins and minerals were found to have a much better rate of improvement, so that more of them were able to go home after their hospital stay, rather than being moved to a nursing home for more care. The use of supplements for stroke patients is not new, in fact previous researchers have focused on the role of the B vitamins for reducing the risk of strokes by up to 20 percent in those with a genetic predisposition, or who are deemed to be vulnerable.

If this is you, or someone you know then I would first consult a qualified nutritionist who will be able to advise on the dosages required, though the levels of vitamin C in the trial seem woefully to me. Dr Linus Pauling, the Nobel prize winner who pioneered the use of vitamin C for many conditions advocated a minimum of 500 mg a day for healthy people and much higher doses when dealing with chronic illness. Vitamin C is not stored in the body, and is immediately excreted if not used. Increasing the levels needs to be done slowly and with full body awareness as we all have a different tolerance level. Signs that your body has had enough, or that you need to go more slowly are either a tingling sensation on the tongue, or a loosening of the bowels. In either case, cut back your dose and only gradually increase again when things have settled down.