At-Home Stroke Rehab Program as Effective as Outpatient Training

We have seen smaller studies of stroke patients showing that intensive use of weak upper extremities vastly improves arm function, and now we see for the first time that the same thing can occur in the lower extremities. However, many of the services that patients receive for gait improvement are now fiscally restrained by Medicare and insurance companies. Therapy is stopped at a fairly early stage, and thus, so is recovery. We now know for the very first time that a more prolonged and intensive course of therapy will yield important gains. We need to have the payers reexamine how long they will fund these therapies, because the at-home option appears to be a very cost effective way to pursue this.

The main message is that a lot of therapy is better than a little, regardless of whether it's delivered by a therapist in the home or by a locomotor-training apparatus in the outpatient setting.

I suspect we will find that most patients will benefit from home therapy. There might be subgroups with particular gait disorders for whom the locomotor programs might be more beneficial. But this trial will have a major impact because it shows us that, initially, more - and more intensive - therapy is better for everyone.

Ralph Sacco, M.D., is the president of the American Heart Association and the chair of neurology at the University of Miami. He had no financial disclosures.