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 After 12 weeks of twice-weekly lessons, 56 percent in the riding
group and 38 percent in the music group said they had experienced
meaningful recovery compared to 17 percent who were not given any
extra activity. The self-reported benefit persisted six months after
the lessons stopped.
Coauthor Dr. Michael Nilsson told Reuters Health by phone that the
results counter the attitude that stroke patients can't improve if a
year has passed since their brain damage occurred.
"For a big, big, big group of stroke survivors, it's highly
unethical to say nothing can be done after 12 months," said Nilsson,
who directs the Hunter Medical Research Institute in New South
Wales, Australia. That attitude can "kill the motivation for further
rehabilitation."
The findings are "interesting from a variety of standpoints," said
Dr. Daniel Lackland, a professor of epidemiology and neurology at
the Medical University of South Carolina in Charleston, who was not
involved in the study.
"Most stroke recovery research seems to take place in the acute
phase," he told Reuters Health in a phone interview. "This is doing
it at a later phase, which is very much needed."
On average, the 123 Swedish volunteers started the study nearly
three years after suffering their stroke.
The Nilsson team, writing in the journal Stroke, speculated that the
physical and social aspects of riding or moving to the music were
responsible for the improvements. However, it did not compare them
to patients who were given other types of extra attention, such as
twice-weekly group outings.
In addition, the study measured how the patients thought their
rehabilitation was progressing, not how well they scored on more
objective tests designed to measure their improvement.
Such tests of gait, balance, hand strength and memory sometimes did
not show enough consistent benefit to rule out the possibility it
was due to chance.
Nilsson said self-reported improvement was the point of the test.
"We wanted their opinion" because positive self-perception "is the
key for long term improvement. It's getting the patients engaged and
motivated to participate, and to do that in an intense way.
"Why? We must understand that you need to be prepared to invest in
training and rehabilitation over a long period of time to relearn
and learn in new ways to master your disability," Nilsson said.
The interventions were done on patients who were moderately
debilitated. All could walk, use transportation services for the
disabled and use the toilet without assistance.
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Horseback riding sessions - which lasted four hours and included
special exercises, grooming, equipping the therapy horse and 30
minutes of sitting on the horse as it was being led - produced an
immediate jump in perceived improvement.
It wasn't until three months after the end of music therapy - where
people were asked to move their hands and feet in time with the
music in sessions lasting 90 minutes - that patients showed a
comparable improvement in how they thought their recovery was going.
But when it came to more objective measures, the benefits were less
clear.
Horseback riding produced immediate and significant improvements in
gait and balance in all three tests used by the researchers, but by
the sixth month of follow-up, only one of the three tests was still
showing better performance. In the rhythm-and-music group, only one
of the three tests showed a benefit, either immediately or at the
six-month follow-up point.
Although limited, the data might help doctors tease out the best
types of activities for retraining the brain, Lackland said.
Nilsson, who is also a professor at the University of Newcastle in
Australia and University of Gothenburg in Sweden said a larger
follow-up study is being planned to confirm the findings. The
results are also being analyzed to see if the time elapsed since the
stroke influenced how well individual patients did.
SOURCE: http://bit.ly/1j5r0UV Stroke, online June 15, 2017.
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