Long-Term Improvements After Multimodal Rehabilitation in Late Phase After Stroke

This study addresses 3 important clinical questions concerning the rehabilitation of stroke survivors. Is further recovery possible once patients are returned to the community having completed an acute/subacute-stage rehabilitation program? Can interventions that address a range of functional deficits and behavioral limitations be effective and lead to improvement? Can such interventions lead to sustained recovery in late phase after stroke? Treatment strategies using multimodal approaches and stimulating environments may hold some answers to these questions. Multimodal interventions are designed to engage patients in concurrent physical, sensory, cognitive, and social activities. They are attractive for complex conditions like stroke because they target a range of functions. There is also emerging support for the contention that a combination of different modalities, rather than the individual components, may produce additive or synergistic effects on brain plasticity underpinning stroke recovery. Recently, multimodal interventions, such as music therapy, rhythmand music-based therapies (R-MT), dance, and horseriding therapy (H-RT), have demonstrated promising results when applied to people with various neurologic conditions. These interventions share important core components but differ from each other with respect to their combinations of Background and Purpose—Treatments that improve function in late phase after stroke are urgently needed. We assessed whether multimodal interventions based on rhythm-and-music therapy or horse-riding therapy could lead to increased perceived recovery and functional improvement in a mixed population of individuals in late phase after stroke. Methods—Participants were assigned to rhythm-and-music therapy, horse-riding therapy, or control using concealed randomization, stratified with respect to sex and stroke laterality. Therapy was given twice a week for 12 weeks. The primary outcome was change in participants’ perception of stroke recovery as assessed by the Stroke Impact Scale with an intention-to-treat analysis. Secondary objective outcome measures were changes in balance, gait, grip strength, and cognition. Blinded assessments were performed at baseline, postintervention, and at 3and 6-month follow-up. Results—One hundred twenty-three participants were assigned to rhythm-and-music therapy (n=41), horse-riding therapy (n=41), or control (n=41). Post-intervention, the perception of stroke recovery (mean change from baseline on a scale ranging from 1 to 100) was higher among rhythm-and-music therapy (5.2 [95% confidence interval, 0.79–9.61]) and horse-riding therapy participants (9.8 [95% confidence interval, 6.00–13.66]), compared with controls (−0.5 [−3.20 to 2.28]); P=0.001 (1-way ANOVA). The improvements were sustained in both intervention groups 6 months later, and corresponding gains were observed for the secondary outcomes. Conclusions—Multimodal interventions can improve long-term perception of recovery, as well as balance, gait, grip strength, and working memory in a mixed population of individuals in late phase after stroke. Clinical Trial Registration—URL: http//www.ClinicalTrials.gov. Unique identifier: NCT01372059. (Stroke. 2017;48:1916-1924. DOI: 10.1161/STROKEAHA.116.016433.)