Stroke Connection - January/February 2009 - (Page 7)
• The stroke survivors who used the treadmill for six months benefited significantly more than those who used stretching for a comparable period. • The treadmill group increased its peak treadmill walking velocity by 51 percent compared to the stretching group’s 11 percent, and it increased its average over-ground walking velocity during six minutes by 19 percent compared to the stretching group’s 8 percent. • Cardiorespiratory fitness in the treadmill group increased 18 percent but decreased 3 percent in the stretching group. Researchers compared functional magnetic resonance images (fMRI) of participants’ brains while participants did knee-flexing exercises that mimic walking. The fMRIs showed increased blood oxygenation and flow in the brainstem and cerebellum of the survivors who had used the treadmill but not in those who did stretching. Researchers said the increases in blood oxygenation and flow indicated that the cerebellum and brainstem had been “recruited” to replace some of the walking functions of the cortical brain that had been damaged by stroke. The subcortical networks could be where the brain rewires its circuitry and may explain why treadmill exercise improves walking in partially paralyzed survivors even a decade after the stroke. Walking and Neuroplasticity Treadmill therapy rewires brain, helps survivors walk better readmill exercise may help stroke survivors regain their ability to walk by rewiring parts of the brain responsible for controlling balance and motor skills to compensate for stroke damage, researchers report in Stroke: Journal of the American Heart Association. In this study, patients with long-term disability after stroke who did six months of treadmill exercise training increased activity in certain parts of their brains by 72 percent on imaging tests. Brain activity changes did not occur in patients who did stretching exercises. This study provides the first evidence of increased activation in cortical and subcortical circuitry produced by treadmill exercise training in stroke survivors. Researchers compared 37 patients who performed “progressive task repetitive treadmill therapy” to 34 patients who did stretching to determine which could improve walking among stroke survivors with chronic partial paralysis on one side of the body. They found: preventable strokes,” said David J. Gladstone, M.D., Ph.D., lead researcher of the study and a stroke neurologist at the University of Toronto. AF is a risk factor for stroke, because when the heart beats irregularly, or fibrillates, blood clots can form in the upper chambers of the heart (atria); the clots can travel to the brain and block an artery. The blood thinner warfarin has been available for many years and is the most effective stroke prevention medication for AF patients, reducing the risk of stroke by about 67 percent. Strokes caused by AF tend to be severe, and other studies have shown that warfarin use is also associated with reduced severity. The researchers said their findings are “particularly troublesome” because patients in the study were all considered to be at high risk for stroke, were living independently and considered “ideal” candidates for warfarin. Drawbacks of warfarin include the inconvenience of needing regular blood tests to monitor the medication, drug and food interactions and potential bleeding risks. “Unfortunately, the fear of bleeding side effects with warfarin results in many patients not taking effective therapy that could prevent strokes,” Gladstone said. “We must always weigh the pros and cons of any medication for individual patients, but for most high-risk AF patients the benefits of taking warfarin greatly outweigh the potential side effects.” January | February 2009 S T R O K E C O N N E C T I O N
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