NIH Record - National Institutes of Health

Critical Time Window for Rehab After Stroke

An older woman uses a theraband while a health care worker supervises
Study suggests a critical window after a stroke in which intensive rehab yields optimal results.


Researchers found that intensive therapy, added to standard rehabilitation, produces the greatest improvement when administered 2-3 months after a stroke. The results could lead to improved rehabilitation programs for stroke patients. NINDS, NICHD and NIDCD supported the study. Results appeared in the Proceedings of the National Academy of Sciences.

About 750,000 new strokes occur in the U.S. each year. Recovery from stroke-induced brain damage requires networks of nerves to adapt and reorganize. This “neuroplasticity” naturally occurs during early development. But studies in rodents suggest there is a brief period of similarly high neuroplasticity after a stroke, during which intensive motor training can lead to nearly full recovery. But no evidence for a similar recovery window in humans has been found before.

A research team conducted a randomized phase II clinical trial to find out if such a window exists in people. They recruited 72 patients from a rehabilitation hospital in Washington, D.C., who were randomly assigned to 1 of 4 groups. All participants received standard stroke rehabilitation therapy. 

Participants in 3 of the 4 groups received an extra 20 hours of intensive motor skills therapy. The extra therapy began in the first group within 30 days of stroke onset, in the second group 2-3 months after onset and in the third group, 6-7 months after onset. The fourth (control group) received no extra therapy.

People in the 2- to 3-month therapy group showed the greatest improvement in arm and hand function 1 year after their strokes. Participants in the 30-day group showed smaller but still significant improvement. By contrast, participants in the 6- to 7-month group showed no significant improvement over controls.

Larger clinical trials are needed to better pin down the timing, duration and optimal dose of therapy during this critical window.—adapted from NIH Research Matters

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