Clinical studies on the effects of stroke, and the subsequent rehabilitation of patients, abound in health literature. I compiled the following studies to showcase the groundbreaking advancements in stroke therapy and technology.

Gender Differences

More women than men appear to be having a stroke in middle age, according to a study published in the online edition of Neurology®, the medical journal of the American Academy of Neurology. Researchers say heart disease and increased waist size may be contributing to this apparent midlife stroke surge among women.

For the study, researchers analyzed data from 17,000 people over the age of 18 who participated in the National Health and Nutrition Examination Survey. Of the participants, 606 people experienced a stroke.

The study found women in the 45 to 54 age range were more than twice as likely as men in the same age group to have had a stroke. There were no sex differences in stroke rates found in the 35 to 44 and the 55 to 64 age groups.

"While our analysis shows increased waist size and coronary artery disease are predictors of stroke among women aged 45 to 54, it is not immediately clear why there is a sex disparity in stroke rates among this age group," says study author Amytis Towfighi, MD, with the Stroke Center and Department of Neurology at the University of California at Los Angeles, and member of the American Academy of Neurology. "While further study is needed, this midlife stroke surge among women suggests prompt and close attention may need to be paid to the cardiovascular health of women in their mid-30s to mid-50s with a goal of mitigating this burden."

In addition, Towfighi says several vascular risk factors, including systolic blood pressure and total cholesterol levels, increased at higher rates among women compared with men in each older age group.

"For instance, with each decade, men's blood pressure increased by an average of four to five points, whereas women's blood pressure increased by eight to 10 points. Similarly, men had significantly higher total cholesterol levels than women at age 35 to 44, but men's total cholesterol remained stable while women's total cholesterol increased by 10 to 12 points with each decade, so that by age 55 to 64, women had significantly higher total cholesterol than men," Towfighi says.

Effect on the Elderly

Elderly patients who were diagnosed with stroke in the emergency department (ED), including many who had had stroke previously, still did not identify their symptoms as stroke-related and delayed seeking care for as long as 8 days, according to a study released during the 2007 annual meeting of the American College of Emergency Physicians, Dallas.

Researchers studied 344 stroke patients in the emergency department (ED), all over the age of 65. Forty-one percent of the subjects were older than 80. On average, patients waited nearly 3 hours from the onset of symptoms before going to the hospital. Some waited more than a week. Nearly three quarters of the patients (71.8%) had experienced acute ischemic stroke, while the remaining 28% had a transient ischemic attack (TIA). Roughly half (51.4%) thought they were having a stroke or a TIA.

Some 700,000 people suffer a stroke annually, and 150,000 in that group die each year.

The most frequent symptoms of the studied patients were weakness (65%); inability to speak, or slurred speech (59%); numbness or tingling in the arm, face, or leg (37%); and facial droop (31%). Some patients who knew their symptoms suggested stroke still did not come to the ED right away.

Stroke symptoms include weakness in one part of the body, particularly an arm or leg, difficulty speaking, facial droop, severe headache, mental confusion, and dizziness.

People often ignore the symptoms of a TIA because they disappear after a while. However, the risk of acute ischemic stroke is highest in the 48 hours following a TIA, which is often categorized as a warning sign of a more serious stroke to come.

Exercise and Technology Trends

Repetitive training that simulates everyday leg function can help people walk more easily after stroke, according to a new review of studies.

The analysis appears in the October 2007 issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research.

The review gathers evidence from 14 trials with more than 650 study participants. In the studies, patients repeatedly practiced everyday tasks or the movements associated with the tasks, like buttoning clothes, walking up steps, reaching for items on shelves, or standing up from sitting.

The analysis found that repetitive task training is effective—and does result in health gains for stroke patients—but did not determine whether the approach is better than other rehabilitation interventions.

According to the lead review author, repetitive task training is not a method of therapy; rather, many therapies can incorporate the technique as "an underpinning for everything a therapist does with a patient."

The therapy typically lasted for 1-hour sessions, 3 to 5 times per week, for 6 to 8 weeks. Researchers tested both arm and leg mobility in the studies, but the review found only significant improvements for lower-limb function. Moreover, it was not clear if the gains in leg mobility were permanent.

Another review in the October 2007 issue of The Cochrane Library also explores gait training—assisting people with walking ability—after stroke.

That review found that physical therapy after stroke that incorporated electromechanical devices for gait training was better than usual care.

The programmed robotic devices support and steady a patient's body weight while footplates guide the legs through repeated walking movements. People who rely on a wheelchair and are unable to stand or walk alone are the most common users of the devices.

All of the electromechanical devices analyzed in the review performed about equally.

"Gait training with electromechanical devices is better than without such devices if ambulation is the main goal of people who have had a stroke," says lead review author Jan Mehrholz, a researcher in the Department of Public Health, Technical University of Dresden, and a PT in the Department of Early Rehabilitation at The Klinik Bavaria in Kreischa, Germany.

Mehrholz said the devices increased the chance that patients regained the ability to walk without help.

"Walking dependency is a major problem after stroke for patients and their relatives," Mehrholz says. "To be able to walk without any assistance is therefore a major goal for many people."

"If electromechanical devices are used in gait rehab, one of four people with stroke would now be able to walk alone again," he says. Three of four people with stroke remain dependent in walking or need assistance even if they use the devices in rehabilitation.

Recovery through Robotics

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A new robotic therapy device, which senses muscle activity and provides power assistance to facilitate movement, has shown positive results for severe stroke patients, according to a study that appeared in the April 2007 issue of the American Journal of Physical Medicine & Rehabilitation.

The robotic therapy device—developed at the Massachusetts Institute of Technology, Boston—was tested on stroke patients at MIT's Clinical Research Center and at Spaulding Rehabilitation Hospital in Boston.

The study showed that the severely impaired patient's arm function improved, on average, 23% after using the brace, and the arm muscle tightness typical of stroke victims was significantly reduced.

When used under the supervision of an OT or PT, the device can be used to help patients progress from basic motor training, such as lifting boxes or reaching for a light switch, to more complex tasks, such as carrying a laundry basket or flipping a light on and off while holding an object with the unaffected limb.

Helen Arkin, PT, is a staff therapist at Peak Physical Therapy in Atlanta. She has specialized in the treatment of stroke patients for more than 10 years. She can be reached at .