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Up to 85 percent of stroke patients suffer impairment of an upper limb, and while existing rehabilitation techniques can be effective, they tend to be costly and complicated, explained Fu-Zen Shaw, an associate professor of biological science and technology at National Chiao Tung University. He is lead author of the report, which appears in the Nov. 3 issue of Stroke.
"We looked at whether a simple, easily used and inexpensive technique could improve motor and sensory recovery in stroke patients within a short time," he said.
Thermal stimulation is used in orthopedic rehabilitation, and it is also used to treat dysphagia, difficulty in swallowing that can be caused by a stroke or other conditions, Fu-Zen Shaw added. But this is the first reported trial of the method in stroke rehabilitation, he said.
The trial included 46 stroke patients. Half got standard rehabilitation therapy, the other half standard treatment plus thermal stimulation.
Those patients had five sessions a day for six weeks. Each session lasted 20 to 30 minutes, with alternate applications to a hand and wrist of a cold pack, whose temperature was just above freezing, and a hot pack, whose temperature was 167 degrees Fahrenheit.
"Thermal stimulation can simultaneously activate a large brain area," Shaw explined. "This great activation of brain areas may be beneficial for functional reorganization and neural plasticity of the brain, which may be helpful for readjusting the motor control circuitry."
The treatment also has a psychological effect, he said. "The generation of reflexive behavior or enhancement of voluntary movement of the paretic [paralyzed] hand may stimulate or create a hope for stroke patients," Shaw said. "This psychological driving force for actively using the paretic hand cannot be ignored."
The thermal stimulation patients had significantly better recovery on four of six measures of function, including changes in sensation, grasping strength and ability to bend the wrist, the researchers said.
Because of the small number of patients, "the same experiment should be performed in a large population to demonstrate the effect of thermal stimulation," Shaw said.
"In fact, we are going to collect data from a larger population," he added. "We hope that we can distinguish the effect of thermal stimulation on different groups of stroke patients."
But even now, Shaw and his colleagues are using the technique to treat stroke patients. "We see great improvement in our patients now," he said.
More information
Information on stroke is available from the American Stroke Association.
"What the studies are showing is that exercise, at least when performed in a group setting, seems to be at least as effective as standard antidepressant medications in reducing symptoms in patients with major depression," said researcher James Blumenthal, a professor of medical psychology at Duke University in Durham, N.C.
According to Blumenthal, other studies are beginning to suggest that solitary exercise, such as workouts at the gym or a daily jog, can be just as effective as group activities in beating the blues, and that "duration of exercise didn't seem to matter -- what seemed to matter most was whether people were exercising or not."
Blumenthal was lead author on a much-publicized study released five years ago that found that just 10 months of regular, moderate exercise outperformed a leading antidepressant (Zoloft) in easing symptoms in young adults diagnosed with moderate to severe depression.
And another study released earlier this year, by researchers at the University of Texas Southwestern Medical Center at Dallas, found that 30-minute aerobic workouts done three to five times a week cut depressive symptoms by 50 percent in young adults.
Theories abound as to how revving up the body helps uncloud the mind.
Robert E. Thayer is a professor of psychology at California State University, Long Beach, and the author of Calm Energy: How People Regulate Mood with Food and Exercise. He said that while workouts probably affect key brain chemicals like serotonin and dopamine, physical activity may also trigger positive changes in other areas, too.
"Depression is a condition characterized by low energy and moderate tension, something I call 'tense tiredness,'" he said. But exercise has a clear "mood effect" that seems to ease that anxious but lethargic state, he said.
According to Thayer, moderate exercise -- a brisk 10-minute walk, for example -- results in a boosting of energy, although it may not be quite enough to relieve stress.
"More intense exercise -- the amount you'd engage in with a 45-minute aerobic workout -- does give a primary mood effect of reducing tension. It might also leave you with a little less energy because you'd be tired, of course," he said. "However, there's also some indication from the research that there's a 'rebound' effect an hour or so later, in terms of [increased] energy."
Blumenthal pointed to the more lasting psychological boost regular workouts can bring. "People who exercise might also have better self-esteem; it may help them feel better about themselves, having that great sense of accomplishment," he said.
Still, the experts acknowledged that truly depressed individuals often find it tough to jump into an exercise routine.
"Why do people not do the thing that's perhaps the most important thing for them to do?" said Thayer. "It's because a drop in energy is such a central component of depression -- you just don't have the energy to do the exercise."
He said the key to breaking that cycle is to start small.
"Thinking about going to the gym and doing all the stuff that's involved with that can be overwhelming for a depressed person," Thayer pointed out. "But if you think 'Hey, maybe I'll just walk down the street 30 yards or so, at a leisurely pace,' that's a start. And it turns out that your body becomes activated then -- you have more of an incentive to walk farther, to do more."
Loved ones can play a key role, too, urging a depressed friend or family member to join in with them as they work out. "Social support, peer pressure, family support -- all of that can be helpful, certainly in getting people to maintain exercise," Blumenthal said.
No one is saying that exercise is always a substitute for drug therapy, especially for the severely depressed. "But we also know that these drugs aren't effective for everyone -- about a third of people aren't going to get better with medication," Blumenthal said.
For those patients, exercise may prove a viable, worry-free alternative -- with one great fringe benefit.
"In addition to its mental health benefits, there are some clear cardiovascular benefits to exercise which we don't see with antidepressant drugs, of course," Blumenthal noted. So, he said, what keeps the mind fit strengthens the body, too. "You're killing two birds with one stone."
More information
For more on recognizing and beating depression, head to the National Institute of Mental Health.
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