Walter Biscardi was a nationally known motivational speaker when he had a stroke on April 26, 2000. "I got out of bed that morning and prepared to go to my health club for a workout," says Biscardi, who turned 72 this past April. "I went to kiss my wife goodbye, and as I bent over, I suddenly felt my right leg collapse, and my right arm went dead. My lips skewed dramatically to the right and I couldn't talk."

An ambulance rushed him to the hospital, where for three hours he couldn't speak or move his right arm or leg. While his speech came back on its own shortly thereafter, it took about a year for his memory to fully recover. Today, Biscardi still actively works to regain full range of movement of his body.

Shortly after his stroke, he began rehabilitation with a nurse who helped him exercise his arm and leg. "My leg did not respond as quickly as my arm," he says. "To this day, I can't get a full kick of the right leg while swimming." Before the stroke, he regularly swam 40 laps three days a week at the fitness club near his home in Southbury Conn. "It took four months from the day of my stroke to swim one lap," he recalls. Slowly, he paddled his way back. Three months later, he was up to 16. Nowadays, he swims over 30 laps. He's also back to his aerobic exercise and weight training routine.

Biscardi's credo—be as active as possible—is one of the best strategies for getting better after a stroke, researchers say. New research in stroke rehabilitation therapy is moving towards keeping people more active, says Arthur Gershkoff, M.D., the clinical director of Stroke and Neurologic Diseases at Moss-Rehab, a rehabilitation facility in Philadelphia, Pa. And, he adds, "patients are also required to do more and more work on their own."

New Approaches to Rehabilitation

One new approach to rehabilitation currently under study is constraint-induced movement therapy says Dr. Gershkoff. This therapy limits movement of the arm that hasn't been impacted by stroke—usually by placing a thick oven mitt or padded mitten on the hand—so people are compelled to use their stroke-impaired limb. The method is based on research, which suggests that using the affected arm changes nerve pathways in the brain. Sections of the brain that were previously inactive can become activated when moving the muscles impacted by stroke, he explains. This rearranging of nerve pathways is called brain plasticity, and is proving to be an important concept in stroke rehabilitation.

So far, studies suggest the therapy results in improvements. For example, preliminary results published last year in the journal Neurorehabilitation and Neural Repair from an ongoing five-year study called Extremity Constraint-Induced Therapy Evaluation (EXCITE) showed that the therapy can help restore the person's ability to grip objects.

However, one problem with this form of therapy is that it requires six hours of therapy at a clinic each day, says Stephen J. Page, Ph.D., director of the Neuromotor Recovery and Rehabilitation Laboratory at the University of Cincinnati College of Medicine in Cincinnati, Ohio. Additionally, people have to wear a mitt or restrictive device on their unaffected limbs 90 percent of the time. "It takes a very motivated patient to fully comply," Dr. Page says.

Modified Constraint-Induced Therapy

For this reason, Dr. Page and his colleagues have been evaluating modified constraint-induced therapy. This method requires a half-hour of therapy at the clinic, three days a week, and five hours of activity every weekday at home for ten weeks. People still need to wear a mitt on their unaffected limbs to prevent movement, but as part of therapy, they are able to go about their daily activities and undergo the "constraint" part of the treatment during the evenings.

This therapy may help people up to 10 years after having their stroke, according to research published in the journals Archives of Physical Medicine and Rehabilitation and American Journal of Physical Medicine & Rehabilitation. Research presented at the 2005 International Stroke Conference indicates that modified constraint-induced therapy can also help with brain plasticity. Most importantly the treatment effect is comparable to the more rigorous constraint-induced movement therapy.

The Benefits of Mental Practice

Dr. Page is also evaluating how thinking about movement can help stroke patients recover more quickly. Just mentally focusing on writing or reaching for a cup stimulates the brain to activate the same muscles as if the individual were actually performing the activity.

In one study published this year in the journal Archives of Physical Medicine and Rehabilitation, Dr. Page and his colleagues found that people who mentally practice a movement in addition to receiving physical therapy can move their affected limb more often and better than people who receive physical therapy alone.

Robotics in Rehabilitation

Scientists are also exploring the use of robotics for helping people with stroke who have lost mobility in their legs to walk again. For example, researchers at Georgetown University's National Rehabilitation Hospital are using robotics to help move patients' legs on a treadmill, even if they don't have mobility, while their upper body is supported with a special harness and rails they can hold onto. Leg movements are controlled by computer software and adjust to each individual's needs.

In people who still have some movement in their legs, the robotics system can improve their ability to walk, explains Timea Hodics, M.D., assistant professor of neurology at Georgetown and research investigator at National Rehabilitation Hospital. Another benefit of the machine is that it can be tailored to the patient's needs by increasing or decreasing support. It can also measure what movement a patient is doing on his or her own.

Brain Stimulation

Dr. Page is also studying another cutting-edge form of therapy—brain stimulation. In this method, an electrode is placed on the surface of the brain area that acts on the movement of the affected arm or hand. The electrode is connected to a pulse generator—similar to a pacemaker implanted below the collarbone. The pulse generator is activated during physical rehabilitation exercises of the arm or hand. Researchers hope the added brain stimulation will improve movement.

Using Statins and Botox

Researchers are studying a variety of drugs that may help with stroke recovery. The cholesterol-lowering drugs known as statins, for instance, may also help people with stroke, says Dr. Hodics. A study presented at the American Academy of Neurology's 57th annual meeting in April found that people taking statins before and after stroke are more likely to recover better than people who have never taken these drugs.

Botulinum toxin type A, commonly known as Botox, is another form of therapy that can be used to ease spastic paralysis, a condition in which muscles are stiff and afflicted by persistent spasms—involuntary movements. This medication is injected to temporarily disrupt the muscle's function. Each injection lasts for about two to three months. If spasticity reoccurs, the injections can be repeated. Research published last year by the BOTOX Poststroke Spasticity Study Group in the journal Neurology found that the treatment helps improve muscle function in patients' arms.

Keep an Upbeat Outlook

While researchers continue to sort out what type of therapy will benefit people who have experienced a stroke, Biscardi applies his upbeat attitude to his post-stroke life. He teaches communication skills to town employees, works for Visiting Nurse Services of Connecticut (where, last year, he was credited with saving the life of a woman who had fallen unconscious) and he is in demand to speak on stroke survival at Waterbury (Conn.) Hospital, where he was treated. "Listen to your doctor, get therapy, and do not get discouraged if your progress seems slow," he says. "Commit yourself to doing it and don't ever give up."

Ischemic Stroke

The brain requires a steady supply of blood. A stroke occurs when this blood supply is interrupted, causing brain damage. There are two types of stroke. An ischemic stroke occurs when a blood clot blocks an artery, disrupting flow to the brain. A hemorrhagic stroke occurs when a blood vessel in the brain bursts and damages nearby tissue.

Detecting Strokes

Walter Biscardi recalls very vividly the day he suffered his stroke, but he also acknowledges that he experienced symptoms the day before, but didn't do anything about them. "I went out to lunch with friends and felt dizzy to the point where I leaned against the car. I was very surprised by that," he recalls. "My doctor said he wished I had called him, because it was the first sign that something was wrong," he adds.

The sudden dizziness Biscardi experienced is a warning sign of stroke. If he had sought immediate medical attention right away, his stroke might have been avoided.

You should call 911 immediately if you experience one or more of the following symptoms of stroke:

• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

Other danger signs include double vision, drowsiness, and nausea or vomiting.

Source: The National Institute of Neurological Disorders and Stroke

Tips to Prevent a Stroke

The National Institutes of Health suggest the following measures for stroke prevention:

• Get screened for high blood pressure at least every 2 years
• Check your cholesterol
• Treat high cholesterol, blood pressure, diabetes, and heart disease
• Eat low-fat foods
• Exercise regularly
• Quit smoking
• Maintain a healthy weight
• Avoid excessive alcohol use; drink no more than 1 to 2 drinks per day

For more information visit "Brain Basics: Preventing Stroke" at ninds.nih.gov.

For More Information

American Stroke Association
(888) 4 STROKE (478-7653), strokeassociation.org

Brain Aneurysm Foundation
(617) 723-3870, bafound.org

Children's Hemiplegia and Stroke Association (CHASA)
(817) 492-4325, chasa.org

The Hazel K. Goddess Fund for Stroke Research in Women
(212) 734-8067, thegoddessfund.org

National Aphasia Association
(800) 922-4NAA (4622), aphasia.org

National Stroke Association
(800) STROKES (787-6537), stroke.org

For more information go to the American Academy of Neurology's Journal, Neurology, to read "Clot-busting Therapy Helps Stroke Victims—but Only if They Get Treatment in Time."