A more aggressive approach to stroke therapy at Allina Health hospitals has helped patients get back up to speed with daily life.
Therapists have encouraged stroke victims to pick up the pace, or gait, of their walking as part of their inpatient rehabilitation, often within 24 hours of being hospitalized.
The end result, according to new research, is that patients doubled the gains made through conventional inpatient rehab, provided at Allina hospitals by the Courage Kenny rehab program.
Walking speed can be a major challenge after a stroke, which is a lack of blood to the brain caused by blocked or ruptured blood vessels.
Patients who slow down after strokes struggle with daily activities as well as getting the amount of exercise needed to prevent second strokes, said Nancy Flinn, a senior scientific adviser at Courage Kenny. She presented the research results last month to the American Congress of Rehabilitation Medicine.
“The gains patients made in gait speed meant that, on average, patients were now walking at community walking speeds,” she said. “If they went to the mall or the grocery store, they would be able to move at the speed of others, so they are safer, because they are less likely to get bumped by others who are passing them.”
Rehab within 24 hours of hospitalization is somewhat controversial, given concerns that stroke patients will be too weak. But a recent national study validated the safety of this approach, and Flinn said there was no increase in complications or deaths among Allina stroke patients who received the stepped-up therapy in 2015 compared to patients in 2014 who received the less-intensive approach.
“People have more capacity than maybe we think of,” Flinn said. “The nature of stroke has changed in the last 10 years because we have many more early interventions” that expedite rehab and recovery.
Comparing results of a 10-meter walking test, stroke patients at four Allina hospitals increased their gait by .11 meters per second with the old approach. Using the new approach, their gait increased on average by .22 meters per second. The difference was enough to get most patients back up to the average “community’’ walking pace, 0.8 meters per second.
The new rehab approach emphasizes “task-oriented” exercises, so stroke patients see their progress in everyday activities rather than in the straight-ahead pace on a treadmill.
“You need to be turning corners, you need to be walking in different environments,” Flinn said. “It needs to be challenging for patients.”