Dorothy Farrar Edwards is a co-author of a study published in the prestigious Proceedings of the National Academy of Sciences (PNAS) in September 2021 that found an optimal time for intensive rehabilitation of arm and hand use after a stroke.
This work is significant because it’s estimated that 750,000 new strokes occur each year in the United States — with almost two-thirds of the people who have a stroke not recovering complete use of their hands and arms. Such an impairment can significantly restrict a range of everyday activities — such as getting dressed, cooking, and using a smartphone — that impact quality of life measures.
“Understanding that there could be an important window for best rehabilitating after a stroke is exciting because it gives us an optimal period for designing stroke rehabilitation programs using a range of techniques and therapies,” says Farrar Edwards, the UW–Madison School of Education’s associate dean for research and a member of the Center for Brain Plasticity and Recovery at the Georgetown University Medical Center.
The study reports on a phase II, randomized clinical trial of 72 stroke participants. The results indicated the optimal period for intensive rehabilitation of arm and hand use after a stroke should begin 60 to 90 days after the event.
In addition to regular therapies, the participants in the clinical trial were randomly assigned to get 20 additional hours of activity-focused motor skills therapy, starting at different times after their stroke. This additional therapy began either at 30 days after their stroke, at 60 to 90 days post-stroke, or at six months or more. The outcomes were compared to a control group that received prescribed rehabilitation therapies — but no extra motor rehabilitation training.
Farrar Edwards’ key contribution was in designing the study so that participants were able to choose activities they enjoyed or wanted to work on for their intensive rehabilitation.
“Our approach shows that if patients can choose the activities used in their rehabilitation, they can tolerate much more intensive motor training than is traditionally provided,” says Farrar Edwards, who is a professor of occupational therapy with the School of Education’s Department of Kinesiology. “Stroke rehabilitation work is really difficult. To keep people engaged in this training, you have to find things that they really want to do. That’s where the hand experts and hand therapists on the study team were able to take what I wanted to do theoretically — and turn it into intensive treatment that kept the participants motivated and moving forward.”
Farrar Edwards, who also holds appointments with UW’s departments of Medicine and Neurology in the School of Medicine and Public Health, is hopeful that future stroke studies can combine therapy from occupational therapists with brain stimulation, medications, and other treatments to further examine improved outcomes.
The paper published in PNAS is titled, “Critical Period After Stroke Study (CPASS): A Phase II Clinical Trial Testing an Optimal Time for Motor Recovery After Stroke in Humans,” and it was conducted by Georgetown University and MedStar National Rehabilitation Network (NRH) researchers, including Farrar Edwards. Another co-author on
the report is UW–Madison alumna Shashwati Geed, who earned her PhD from the Department of Kinesiology in 2014. Geed is an assistant professor with Georgetown University’s Department of Rehabilitation Medicine and a research scientist with the MedStar National Rehabilitation Hospital in Washington, D.C.