IMPROVING RECOVERY AFTER STROKE

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Description: A major focus of this OAIC is to conduct IDSs designed to improve the function and independence of older Americans recovering from stroke. The primary goal of this project is to determine if a physiologically based 12-week program of therapeutic exercise which targets upper and lower extremity strength, balance, endurance, and upper extremity use can improve key impairments and functional performance (motor function, balance, endurance, gait and upper extremity function) in individuals following a stroke. The secondary goals are to determine the clinical significance of the intervention and examine the mechanism underlying the treatment effect. Three elements of clinical significance will be addressed: 1) the effects on disability outcomes (physical function domain of M0S-36, proportion achieving community ambulation, reduction of recurrent falls, instrumental activities of daily living, physical and social role domains of M0S-36 and self-reported improvement); 2) the influence of potential modifiers of treatment effects (depression, social support, self-efficacy, and co-morbidity) on disability outcomes; and 3) the comparative costs of the intervention and usual care. The three mechanistic factors that will be explored include the effects the interventions have on impairment in disability outcomes, on postural control, and on the biomechanical characteristics of gait. The long-term goal is to design effective exercise interventions to enhance stroke recovery. The study is a randomized clinical trial of a therapist-supervised program of therapeutic exercise delivered at the subject's home. The study will recruit 180 adults, aged 50 years and older, who are 30 to 90 days post-stroke, who are discharged to the community from acute rehabilitative services, and who meet the criteria for mild to moderate stroke. After screening and baseline assessment, participants will be randomly assigned to a usual-care control group or to the group receiving therapeutic exercises three times a week. The primary outcome measures will be those taken immediately post-intervention, with long-term treatment effects assessed at six months after the intervention.