Functional recovery and depression mitigation in a case study of chronic stroke receiving intensive, long-duration mobility/fitness training

Abstract

Purpose: Depression is prevalent among stroke survivors and is associated with a number of adverse health outcomes. However, for those with severe depression after chronic stroke, there is little to no information regarding response of depression to exercise addressing persistent physical impairments and dysfunction or response to exercise therapy for those who are severely depressed. Methods: We enrolled a male stroke survivor at 1.75 years post stroke, with severe depression. Measures collected at preand post-treatment were as follows: Beck Depression (mood); Fugl-Meyer (FM joint movement coordination); Berg Balance Scale (BBS); Timed Up and Go (TUG; mobility); Functional Independence Measure (FIM; subscales of Self-Care, Transfer, Locomotion); Craig Handicap Assessment and Reporting Technique (CHART; quality of life assessment of how patients with disabilities function in the community and at home); 36-Item Short Form Survey (SF36; quality of life measure); and the Stroke Impact Scale (SIS; stroke-specific quality of life measure). Exercise was scheduled as follows: 6mo therapy, five times/wk (1–2.5hrs/session); and additional 6mo, 2-3times\wk, and included aerobic exercise and coordination/strength training for balance and gait. The treatment protocol included exercises for balance and coordination of the lower limb, strengthening, gait coordination, and aerobics exercise on a stationary cycle. Results: Depression improved from severe to mild. The initial presence of severe depression did not preclude significant improvement in mobility and life role participation. Clinically significant gains were exhibited, not only in depression, but also in balance, mobility, and activities of daily living. Moreover, his quantified changes included clinically significant progression to categories of ‘low fall risk’ and ‘functionally independent’. He achieved important clinical and functional goals, as reflected by improved scores in measures of life role participation and personal milestones. Conclusion: Though this is a case study, it is reasonable to consider that a long-duration exercise program can be of great benefit in terms of functional and quality of life gains, regardless of the initial presence of severe depression. *Correspondence to: Daly JJ, Ph.D., Professor, Department of Neurology, College of Medicine, University of Florida, Director, Brain Rehabilitation Research Center, North Florida/South Georgia VA Medical Center, Florida, Tel: 1-216-402-8940; E-mail: janis.daly@neurology.ufl.edu