Is rehabilitation at home after stroke more effective than conventional rehabilitation?

This study compared the effect of a conventional rehabilitation (CR) program to a home-based motor training rehabilitation (TR) program for patients with hemiplegia after stroke. 

The study showed that TR positively impacts movement function in the upper and lower extremities as well as skills like balance and sensitivity.

During a stroke, a blood vessel in the brain is clogged and can even burst. This leads to the deprivation of oxygen and nutrients in that brain area. Without oxygen and nutrients, the area can suffer serious damage. The symptoms of this damage vary depending on the affected area. One common result of a stroke is hemiplegia. This is paralysis in one half of the body. The muscles can be weak or stiff or transition between states. 

Additionally, motor function is impacted. Motor function describes the skills to fulfill movements and complete tasks like grabbing a pen. Further, the transmission of signals and communication within the brain can be impacted. The brain of a healthy patient will show more activity and more signals than that of a patient after a severe stroke. This resting-state functional connectivity (rsFC) can be measured by the means of functional MRI (fMRI). To restore a healthy state of brain signal-activity after stroke is especially important for the M1 areas of the brain (primary motor cortex) that are responsible for the initiation of motoric activities. 

After a stroke, rehabilitation is needed for patients to learn again how to move the affected areas. CR is based in a rehabilitation facility while TR is carried out at home with a telemedicine rehabilitation system (TRS). The influence on motor function of TR compared to CR is yet to be investigated.

The study included 52 patients with hemiplegia after stroke. 26 patients were placed in each of the TR-group and CR-group. Both groups completed a 12-week program with 10 hour-long rehabilitation sessions weekly. The sessions included occupational therapy (OT), physical therapy (PT), and electromyography-triggered neuromuscular stimulation (ETNS). The CR-group performed the program in a rehabilitation facility in the physical presence of therapists. The TR-group executed the program at home. They were instructed by a therapist using TRS. 

Motor functioning scores score significantly improved in the TR-group compared to the CR-group. Also, significant improvements in brain functions with the TR program compared to the CR program were seen on fMRI.

No side effects were recorded during the study.

The authors concluded that TR is a good and safe way of treatment for patients with hemiplegia after stroke. 

The study was limited to a single location (Shanghai). The specific therapies can affect each patient differently and vary greatly. Also, the number of participants in the study was small.