Should physical therapy be continued for a patient with a history of cerebrovascular accident (CVA) and residual left side weakness?

Physical Therapy Should Be Continued for Post-CVA Patient with Left Side Weakness

Physical therapy should be continued for this 67-year-old male patient with history of CVA from 2008 and residual left side weakness, despite his desire to discontinue therapy. 1

Benefits of Continued Physical Therapy for Chronic Stroke Patients

• Physical therapy has been shown to provide ongoing benefits even years after a stroke, as sufficient evidence demonstrates that chronic stroke patients benefit from additional rehabilitation therapy beyond the initial recovery period 1
• Aggressive rehabilitation beyond the traditional recovery period increases aerobic capacity and sensorimotor function in stroke survivors 1
• Regular physical activity in stroke survivors has demonstrated improvements in cardiovascular risk factors including hypertension, arterial function, and insulin response, which are critical for preventing recurrent strokes 1
• Physical therapy helps prevent complications of prolonged inactivity, decrease risk of recurrent stroke, and increase aerobic fitness - all three being major rehabilitation goals for stroke patients 1

Functional Improvements from Physical Therapy

• Continued physical rehabilitation can improve functional status, walking distance, and subjective feeling of well-being in patients with chronic stroke 1
• Stroke patients who received regular physical therapy (30 minutes daily, 5 days/week) showed higher rates of discharge to home (32%) compared to those receiving only occasional therapy (11%) 1
• Rehabilitation programs incorporating aerobic exercise training improve strength, timing of muscle activations, and cardiorespiratory fitness in chronic stroke patients 1
• Physical therapy helps reduce the energy cost of walking, which is typically elevated in hemiplegic patients compared to able-bodied individuals 1

Preventing Secondary Complications

• Without continued physical therapy, stroke survivors risk developing a vicious cycle of decreased activity and greater exercise intolerance, leading to secondary complications 1
• These complications include reduced cardiorespiratory fitness, muscle atrophy, osteoporosis, and impaired circulation to the lower extremities 1
• Regular physical activity can help prevent recurrent strokes by improving glucose tolerance, blood pressure, cholesterol levels, and reducing arterial inflammation 1
• Exercise integrated into a comprehensive care plan could lower the risk of a second stroke by up to 80% 1

Recommended Approach

1. Explain the benefits: Educate the patient on the continued benefits of physical therapy even years after his initial stroke 1
2. Address barriers: Identify and address the patient's specific concerns about continuing therapy 1
3. Involve family: Recommend involving family members/caregivers in decision-making and treatment planning to improve adherence 1
4. Individualize program: Ensure the physical therapy program is tailored to his specific needs and functional limitations 1
5. Set clear goals: Establish specific, achievable goals focused on improving his left side weakness and functional independence 1

Exercise Recommendations

• Frequency: At least 3 days per week, preferably 6-7 days per week 1
• Intensity: Moderate to moderate-high intensity based on individual capacity 1
• Duration: 150-300 minutes per week of moderate-intensity activity, or 75-150 minutes of vigorous-intensity activity 1
• Type: Combination of aerobic training (walking, cycling) and resistance exercises targeting major muscle groups 1

Importance of Long-term Follow-up

• All stroke survivors should receive standardized screening evaluations to determine ongoing rehabilitation needs 1
• Long-term primary care and specialist follow-up should be arranged to identify patients with residual impairments who would benefit from continued rehabilitation 1
• Stroke systems should ensure patients discharged to their homes have appropriate follow-up care arranged 1

Despite the patient's desire to discontinue physical therapy, the evidence strongly supports continuing rehabilitation to improve functional outcomes, prevent complications, and reduce the risk of recurrent stroke.