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Is Surgery Always Needed for Meniscal Tears of the Knee?

WEDNESDAY, July 20, 2016 (HealthDay News) -- A meniscal tear is a common and disabling knee injury affecting many Americans at some point in their lives.

Now, new research suggests that in many cases, exercise may work just as well as surgery to heal the condition in middle-aged people.

Meniscal tears occur when damage is done to the rubbery discs that cushion the knee joint.

According to the European research team, about 2 million people worldwide undergo surgeries known as knee arthroscopy each year -- although there's debate over how valuable these procedures are for meniscal tears.

To help settle the matter, a team led by Nina Jullum Kise, an orthopedic surgeon at Martina Hansens Hospital in Sandvika, Norway, tracked outcomes for 140 patients.

These patients averaged 50 years of age and had degenerative meniscal tears, largely without any signs of arthritis.

Half of the patients performed two to three supervised exercise sessions a week for three months, while the other half underwent arthroscopic (keyhole) surgery, followed by simple daily exercises at home.

After three months, thigh strength improved in the exercise group, but not in the surgery group, Kise's team reported. After two years, pain, sports and recreation function, and knee-related quality of life were similar for both groups, the findings showed.

Thirteen (19 percent) of the patients in the exercise group also underwent knee surgery during the study follow-up period, but it did not provide them with any additional benefits, the researchers said.

According to Kise's group, the findings suggest that exercise therapy should be considered for middle-aged patients with meniscal tears.

Two knee specialists in the United States had differing views on the findings.

Dr. Matthew Hepinstall is an orthopedic surgeon at Lenox Hill Hospital in New York City. He said the new study "complements prior research" finding much the same thing, and he believes that "the majority of patients can experience significant improvement over weeks to months without undergoing surgery."

He did offer one caveat, however: the size and cause of the tear matters. "The study results are most likely to apply to patients with small degenerative tears that occur without a discrete injury," Hepinstall explained.

Still, "the bottom line for middle-aged patients with meniscus tears is to try conservative treatments [such as exercise] before jumping to surgical intervention," Hepinstall said.

But another orthopedic surgeon took issue with the study's design.

"Many important factors were not taken into account," said Dr. Victor Khabie, who co-directs the Orthopedic and Spine Institute at Northern Westchester Hospital in Mount Kisco, N.Y.

"This study did not look at 'injuries,' it only looked at patients who did not have a specific traumatic event. Middle-aged, athletic individuals who sustain sports-related injuries causing meniscal tears comprise a significant proportion of individuals evaluated in an orthopedics office; excluding these patients limits this study," Khabie said.

"My sense is that if this population of patients were examined, a significant benefit to knee arthroscopy would be seen," Khabie said.

He also agreed with Hepinstall that the benefits of an exercise regimen without surgery might be limited to smaller meniscal tears. "The study included 'all' meniscal tears," Khabie noted. "Most orthopedic surgeons will only offer surgery to large tears, which on physical exam correlate with the patient's symptoms."

According to Khabie, "The bottom line is that each meniscal tear has its own unique characteristic. Only a well-trained orthopedic surgeon with experience in knee surgery can determine the best treatment option for any given patient."

The study was published July 20 in the BMJ.

More information

The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases has more about knee problems.

Early Bedtime for Preschoolers, Healthier Weight Later?

THURSDAY, July 14, 2016 (HealthDay News) -- Sending preschoolers off to bed early may bring them an unexpected benefit: less chance of obesity when they are teens.

So suggests research that compared preschoolers who went to bed at 8 p.m. with same-age kids who had later bedtimes. A team at the Ohio State University College of Public Health found that a bedtime just one hour later seemed to double the likelihood that young children will be obese teens.

"For parents, this reinforces the importance of establishing a bedtime routine," said the study's lead author, Sarah Anderson, an associate professor of epidemiology. "It's something concrete that families can do to lower their child's risk."

She added that the earlier bedtime is also likely to benefit youngsters' social and emotional development as well as their brain development.

The study reviewed data on nearly 1,000 children who were part of a study that followed healthy babies born in 1991 at 10 U.S. locations.

When the children were about 4 years old, they were divided into three groups: those who went to bed by 8 p.m.; those whose bedtime was between 8 p.m. and 9 p.m., and those went to bed later.

Half of the youngsters went to bed between 8 p.m. and 9 p.m. The rest were evenly divided between early and late bedtimes, according to the study published July 14 in the Journal of Pediatrics.

Researchers then looked at the kids' weight at an average age of 15. They found that only 10 percent of kids with the earliest bedtimes were obese teens. That compared to 16 percent of the children with bedtimes between 8 p.m. and 9 p.m., and 23 percent of those who went to bed after 9 p.m.

Most likely to become obese were kids who went to bed latest and whose mothers' interactions with them were observed to be less supportive and more hostile, the researchers found. They said later bedtimes were more common among non-white children who had less-educated mothers and lived in lower-income households.

However, only an association was seen between bedtimes and obesity risk, rather than a cause-and-effect link.

"It's important to recognize that having an early bedtime may be more challenging for some families than for others," Anderson said in a university news release. "Families have many competing demands and there are tradeoffs that get made. For example, if you work late, that can push bedtimes later in the evening."

The study authors said their findings suggest that household routines for preschoolers are important.

More information

The U.S. National Heart, Lung, and Blood Institute provides more information on the importance of sleep.

Study Hints at HPV Vaccine's Cancer Prevention Promise

MONDAY, July 4, 2016 (HealthDay News) -- The human papillomavirus (HPV) vaccine appears to prevent abnormalities that can lead to cervical cancer, a new study shows.

Canadian researchers found that young women who received the vaccine through a school-based program were less likely to have such abnormalities when screened for cervical cancer than those who did not receive the vaccine. The young women were screened less than 10 years after they received their first HPV vaccine.

The findings are from the province of Alberta. In 2008, Alberta introduced HPV vaccination for grade 5 girls (aged 10-11) and a three-year catch-up program for grade 9 girls (aged 14-15). The program provided three doses of the vaccine that protects against two strains of HPV. Those two strains of HPV account for 70 percent of all cases of cervical cancer, the researchers said.

The study evaluated Pap test results for more than 10,000 women, taken between 2012 and 2015. During a Pap test, cells are collected from the cervix to check for cervical cancer. The women were between 18 and 21 years old.

Among those women, 56 percent had not received HPV vaccination. The remaining 44 percent had received one or more doses of the HPV vaccine through the school program. About 84 percent of those given the vaccine were considered fully vaccinated. That means they had three or more doses of the vaccine, the researchers noted.

More than 16 percent of unvaccinated women had cervical abnormalities on a Pap test. Among women who had been fully vaccinated, the rate of cervical abnormalities was 12 percent, the study showed.

"Eight years after a school-based HPV vaccination program was initiated in Alberta, three-dose HPV vaccination has demonstrated early benefits, particularly against high-grade cervical abnormalities, which are more likely to progress to cervical cancer," study author Dr. Huiming Yang and co-authors wrote. Yang is the medical officer of health, and medical director of screening programs, for Alberta Health Services.

The researchers said they hope these findings and future research leads to improved prevention efforts. They also suggested that HPV vaccination programs could be integrated with cervical cancer screening programs.

The study was published online July 4 in the journal CMAJ.

More information

The U.S. Centers for Disease Control and Prevention has more on HPV vaccination.

How to Prevent Painful Swimmer's Ear

SATURDAY, June 18, 2016 (HealthDay News) -- Swimmer's ear -- a common summertime problem among children -- is easy to prevent, an expert says.

"Swimmer's ear is a bacterial or fungal infection caused by water caught in the ear canal. The tell-tale signs are swelling of the ear canal and some drainage or discharge," said Dr. Nina Shapiro, director of pediatric otolaryngology at Mattel Children's Hospital of the University of California, Los Angeles.

Other types of ear infections cause pain inside the ear, but swimmer's ear causes pain when the outside of the ear is touched, Shapiro said in a university news release.

Swimmer's ear can be prevented by using the corner of a washcloth or towel to dry ears after swimming. If a hair dryer is available, use the low setting and place the dryer about one foot away from the ear to dry it, Shapiro said.

Never use a cotton swab to clean or dry the ear canal because it can damage the ear drum, she warned.

You can get over-the-counter ear drops to prevent swimmer's ear, but these should not be used on children who have ear tubes, ruptured eardrums or have had ear surgery, Shapiro said.

If a child does develop swimmer's ear, doctors may prescribe anesthetic, antibiotic or antifungal ear drops, she said.

More information

The American Academy of Pediatrics has more about swimmer's ear.

3 Popular Diet Plans May Help Ease Type 2 Diabetes, Too

FRIDAY, June 10, 2016 (HealthDay News) -- People with type 2 diabetes may get some help with blood sugar control from a few commercial weight-loss programs, but conclusive evidence on most plans is lacking, a new review finds.

Researchers reviewed 18 published studies. The studies looked at 10 popular, commercial weight-loss programs that involved a total of 764 people with type 2 diabetes.

Three programs -- Jenny Craig, Nutrisystem and Optifast -- seemed to reduce blood sugar levels more than when people received weight-loss counseling alone, the review found.

"A few of these programs may be a viable option for improving blood sugar control in patients with type 2 diabetes and those at risk for the disease, but we need more gold-standard studies to make that claim," said review leader Dr. Zoobia Chaudhry.

Chaudhry is an assistant professor of medicine at Johns Hopkins University School of Medicine.

The researchers said it's possible that other commercial weight-loss programs may help lower blood sugar levels, but there's currently not enough evidence to say so.

Chaudhry noted that there is a link between being overweight or obese and developing type 2 diabetes. She said that previous research has shown that losing even a small amount of body weight -- 5 to 10 percent -- can help lead to long-term blood sugar reductions in people with type 2 diabetes.

However, that research was mostly based on intensive lifestyle change programs that include carefully controlled diets and guided exercise. Such programs aren't readily available to most of the estimated 29 million people in the United States with type 2 diabetes, Chaudhry said in a university news release.

The review also looked at information from more than 2,400 people who didn't have type 2 diabetes. None of the commercial weight-loss programs in the review led to lower blood sugar in people without diabetes, the study authors said.

The findings were published in the June issue of Obesity Reviews Journal.

More information

The American Diabetes Association has more on type 2 diabetes.

Many Take Opioids Months After Hip, Knee Replacements

FRIDAY, June 3, 2016 (HealthDay News) -- A significant number of patients continue to take powerful prescription opioid painkillers many months after joint replacement surgery, a new study shows.

The findings are important because joint replacement surgery is increasingly common and there are sharply rising rates of opioid overdoses in the United States. Common prescription opioid painkillers include drugs such as OxyContin, Vicodin and Percocet.

In fact, an autopsy report released Thursday showed that music legend Prince died in April after taking fentanyl, a powerful synthetic opioid painkiller. The artist was said to have suffered from severe hip pain after years of performing intense acrobatics during his shows.

For the new study, researchers looked at 574 patients undergoing knee or hip replacement surgery. About 30 percent of the patients were taking potentially addictive opioid painkillers before their surgery. Among this group, 53 percent of knee patients and 35 percent of hip patients were still taking the narcotics six months after their surgery.

The investigators also found that among patients who did not take opioids prior to having surgery, 8 percent of knee patients and 4 percent of hip patients were still taking the painkillers six months after receiving their joint replacement.

The strongest predictor of long-term opioid use among the study participants was taking high doses of the drugs before joint replacement surgery, the study authors said.

The results suggest that some patients continue to use opioids despite improvements in their hip or knee pain.

Also, some patients who did not use opioids before joint replacement will become chronic users after the surgery. And continued narcotic painkiller use after joint replacement surgery is more common than previously believed, said researcher Jenna Goesling, from the University of Michigan in Ann Arbor.

Goesling and colleagues published their report in the June issue of the journal Pain.

One long-term goal in pain management for joint replacement patients is to find ways to help patients stop using opioids after their surgery, the researchers said in a journal news release.

More information

The U.S. Department of Health and Human Services has more about opioids.

Stool Transplant Soothes Tough-to-Treat Colitis in Study

By Maureen Salamon
HealthDay Reporter

MONDAY, May 23, 2016 (HealthDay News) -- Stool transplants helped ease debilitating symptoms and heal the colons of tough-to-treat ulcerative colitis patients, new research shows.

Australian scientists said the findings could pave the way for such transplants to be used on a more widespread basis. Transferring fecal matter from healthy donors into these patients alters the composition of their gut bacteria, circumventing one of the drivers of ulcerative colitis, experts said.

"We were not completely surprised by the study findings, as . . . smaller studies along with unpublished experience suggested repeated fecal microbiota transplantation may be an effective treatment for ulcerative colitis," said study author Dr. Sudarshan Paramsothy, a gastroenterologist at University of New South Wales. "This study shows that [stool transplant] is a very promising therapeutic option for ulcerative colitis patients."

Up to 700,000 Americans suffer from ulcerative colitis, a chronic disease believed to stem from an abnormal immune system response, according to the Crohn's and Colitis Foundation of America. The condition causes the lining of the colon to become inflamed and develop tiny, open ulcers. Symptoms include bloody stools, abdominal pain and persistent diarrhea.

Currently, stool transplants -- which experts acknowledge come with a "yuck" factor -- are standard treatment only for virulent Clostridium difficile gastrointestinal infections. These infections can be life-threatening.

Across three Australian study sites, Paramsothy and his team analyzed 81 ulcerative colitis patients whose disease had proved resistant to standard treatments such as steroids or anti-inflammatory medications.

Participants were randomized into two groups, with 41 receiving repeated fecal transplants over eight weeks and the rest receiving a placebo.

The fecal matter used for transplantation had been derived from at least three donors per participant, to minimize the chances that a single donor's gut bacteria could skew results.

Donor stool was homogenized and filtered, then frozen for storage prior to infusion as a liquid "slurry" enema directly into the rectum, Paramsothy said. Multiple donations were needed to supply the 40 infusions required for each participant receiving stool transplants, who administered their own infusions after the first treatment.

"There is a risk of infection transmission whenever a biological product is [used]," he said, "but this can be minimized by comprehensive screening of history [and] stool and blood testing for known pathogens."

After eight weeks, 27 percent of stool transplant recipients achieved the study's primary goal, which was patients reporting no ulcerative colitis symptoms and doctors determining through endoscopic examination that the lining of the colon had healed or significantly improved. Only three of the 40 patients, or 8 percent, in the placebo group had achieved this goal.

When researchers counted only those patients who reported being symptom-free, without colon observation, they found that 44 percent of stool transplant patients reached this milestone, compared to 20 percent in the placebo group.

The study is to be presented Monday at Digestive Disease Week, in San Diego. Research presented at scientific conferences typically hasn't been published or peer-reviewed, and results are considered preliminary.

Still, a U.S. expert said he found the results remarkable.

"I was most impressed . . . and I think we need to pay attention to this study," said Dr. R. Balfour Sartor, director of the Broad Research Medical Program for the Crohn's and Colitis Foundation of America. "There's a 'yuck' factor with stool transplants, although it's quite trendy these days. The clinicians, the patients and the government agencies have to be convinced it's safe and effective, and this study is probably the best example it can be for ulcerative colitis."

But more research is still needed to determine the treatment's long-term effects in ulcerative colitis patients, Paramsothy and Sartor agreed.

"What's not shown here is the staying power -- how long do these patients remain in remission after the eight weeks of therapy is over?" Sartor asked. "One of the defects of the current study is we don't know what happened after the fecal transplants stopped."

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases offers more about ulcerative colitis.

COPD Discovery Might Improve Treatment

SUNDAY, May 15 2016 (HealthDay News) -- Researchers say they've found a new way to predict how chronic obstructive pulmonary disease will progress, a discovery they believe could improve COPD treatment.

Their research might help doctors determine which patients are less likely to respond to standard treatment and are at higher risk for disease advancement, the study authors explained.

COPD -- chronic obstructive pulmonary disease -- is a chronic lung disease that makes it tough to breathe. It includes chronic bronchitis and emphysema, according to the American Lung Association.

The new discovery concerns something called neutrophilic airway inflammation, which is associated with COPD. Neutrophils are white blood cells that are important for fighting infection.

Scientists said that a type of neutrophil behavior called neutrophil extracellular trap (NET) formation in the lungs of COPD patients appears to reduce their ability to destroy bacteria.

"We have known for many years that neutrophils should be able to fight infection, but we haven't fully understood why they don't work in COPD," said study author Dr. James Chalmers, from the University of Dundee in Scotland.

"Some recent studies described the presence of NETs in the COPD lung, so we wanted to know whether there was any relationship between NETs and outcomes in COPD patients," he said in a news release from the American Thoracic Society.

For the study, the researchers collected blood and sputum samples from 141 patients at the end of acute COPD flare-ups.

The researchers found the amount of NET formations in participants' lungs was directly related to the severity of their lung disease and their risk for COPD flare-ups that didn't respond to treatment with corticosteroids.

NETs result in more infections as well as worse lung function and quality of life, the study authors concluded.

"This marker may help us identify patients at higher risk of disease progression," said Chalmers. "And it identifies a subset of patients who may need treatments other than corticosteroids. Our data show that inhaled steroids may even exacerbate NETs, so we need to identify new COPD treatments and discover whether inhibiting NET formation will result in improved clinical outcomes for patients with COPD."

The researchers plan to continue their investigation, examining why NET formation occurs and whether it can be prevented or treated.

"While our new research is at an early stage, we hope that detecting NETs may be a biomarker that can identify patients at risk of deterioration, and that we can work toward testing whether inhibiting NET formation would be a beneficial treatment in COPD," Chalmers said.

The findings were to be presented Sunday at the American Thoracic Society's annual meeting, in San Francisco. Research presented at meetings usually is regarded as preliminary until published in a peer-reviewed medical journal.

More information

The American Lung Association provides more information on COPD.

Could 'Breast Cancer Genes' Play Role in Prostate Cancer, Too?

By Dennis Thompson
HealthDay Reporter

MONDAY, May 9, 2016 (HealthDay News) -- A man's risk of aggressive and lethal prostate cancer may be heavily influenced by gene mutations previously linked to breast and ovarian cancer in women, a trio of new studies suggests.

And, at least one expert says these findings may indicate that men with a history of breast cancer in their family probably should receive more intense screening for prostate cancer in the future, particularly if those cancers are linked to mutations in the so-called breast cancer genes -- BRCA1 or BRCA2.

One of the studies found that men newly diagnosed with prostate cancer seemed four times more likely to already have advanced cancer if they carry a BRCA2 gene mutation, compared with the general population.

"They are very much at high risk of cancer and we should be tailoring their screening, to be more aggressive in screening versus less aggressive," said Dr. Srinivas Vourganti, a co-researcher on that study and an assistant professor of urology at SUNY Upstate Medical University.

Findings from the studies were scheduled to be presented Monday at the annual meeting of the American Urological Association, in San Diego. Results from meetings are generally considered preliminary until published in a peer-reviewed journal.

"I think BRCA is a tool we can start using to distinguish who is going to benefit from earlier treatment and more aggressive type treatments" for prostate cancer, added Dr. Brian Helfand, a urologic oncologist with NorthShore University HealthSystem in Chicago. Helfand was scheduled to moderate a panel presentation of the three studies.

Breast cancer has been definitively linked with BRCA1 and BRCA2 mutations. Up to two-thirds of women with a BRCA1 mutation and as many as 45 percent of women with BRCA2 will develop breast cancer by age 70, according to estimates from the U.S. National Cancer Institute.

BRCA mutations have been assumed to influence other forms of cancer as well, because these genes normally produce proteins that repair damaged DNA that could otherwise cause cancer, Vourganti said.

But previous research has estimated that BRCA mutations would be involved in as few as 5 percent of prostate cancers, Helfand said.

"We all just took it for what it was worth," Helfand said. "Yeah, they're there, but it's not applicable to 95 percent of men."

Now, these three new studies indicate that the prostate cancer risk from BRCA mutations may have been severely underestimated, Helfand and Vourganti said.

In the first study, Vourganti and his colleagues conducted an evidence review. The review combined the results of 12 prostate cancer studies. Those studies included 261 men who tested positive for a BRCA2 mutation.

The researchers found that the cancer already had spread to other parts of the body in 17 percent of newly diagnosed prostate cancer patients who had a BRCA2 mutation, compared with 4 percent of new diagnoses across the general population.

Men with BRCA2 mutations also were much more likely to be diagnosed with late-stage prostate cancer -- about 40 percent compared with 11 percent of the general population, the findings showed.

"This is very telling," Vourganti said. "When [these] men are diagnosed, they have very aggressive cancers."

The second study reviewed blood DNA samples from 857 prostate cancer patients treated at the Walter Reed National Military Medical Center in Bethesda, Md.

Researchers found that black prostate cancer patients were more than three times as likely to have a BRCA1 or BRCA2 mutation as white patients -- 7 percent versus 2 percent.

In addition, black prostate cancer patients were more likely to have their cancer spread to another part of their body than whites (9 percent versus 2 percent). And it tended to take less time for their cancer to spread, the findings showed.

BRCA mutations could help explain why black men are two or more times more likely to die from prostate cancer than white men, Helfand said.

"The frequency of BRCA mutations in African American men has been largely unknown," he said. "This study shows it's much higher than we thought, and may be a good reason why African American men are more likely to die or have aggressive disease."

The third study focused exclusively on men who'd been treated for breast cancer.

Breast cancer is extremely rare in men, Helfand said. A man's lifetime risk of breast cancer is about one in 1,000, compared with a one in seven lifetime risk for prostate cancer, according to the American Cancer Society.

A review of nearly 5,800 men diagnosed with breast cancer revealed that they had a more than 30 percent increased risk of developing prostate cancer later on.

Doctors should consider screening men with a personal or family history of breast cancer for BRCA mutations that could influence their risk of prostate cancer, Helfand concluded from these three studies.

"We need to recognize this as a risk factor and start screening those men more aggressively," he said.

In addition, prostate cancer patients who test positive for a BRCA mutation might respond better to cancer treatments that are more effective in treating BRCA-positive breast cancer, Vourganti said.

"In this era of personalized medicine, there's promise for men who present with BRCA2," he said. "We're learning that prostate cancer is not one disease. Rather, it is many different diseases that need to be treated on a personalized and individual basis. Men need to talk with their doctors and know that their genes do matter."

More information

For more on BRCA mutations, visit the U.S. National Cancer Institute.

New Guidelines Recommend Inpatient Rehab After Stroke

WEDNESDAY, May 4, 2016 (HealthDay News) -- If possible, people who've had a stroke should be sent directly to inpatient rehabilitation after their hospital discharge. This would be instead of a skilled nursing facility or nursing home, according to new guidelines by the American Heart Association/American Stroke Association (AHA/ASA).

Inpatient rehabilitation may be part of the hospital. Or, it may be a freestanding facility.

Ideally, stroke patients should begin their rehabilitation before they even leave the hospital. For example, they should start to learn how to prevent falls while still in the hospital, the groups recommend. This includes tips on how to make their home safer such as by removing throw rugs and improving lighting.

Patients should also learn about the side effects of their medication and how to use devices such as wheelchairs, walkers and canes before they leave the hospital, the AHA/ASA advises.

"This recommendation will probably change medical practice. Even the top stroke centers may not have a formal falls-prevention program, but it is very important because a high percentage of patients end up falling after a stroke," the lead author of the new guidelines, Carolee Winstein, said in an AHA/ASA news release.

Once discharged from the hospital, stroke patients should be sent to an inpatient rehab facility where they can continue their recover and receive more intensive therapy, the guidelines say.

"Previous guidelines have focused on the medical issues involved in the initial management of stroke, but many people survive a stroke with some level of disability. There is increasing evidence that rehabilitation can have a big impact on the survivors' quality of life, so the time is right to review the evidence in this complex field and highlight effective and important aspects of rehabilitation," said Winstein.

Winstein is a professor of biokinesiology and physical therapy at the University of Southern California in Los Angeles.

Unlike a nursing home, an inpatient rehabilitation facility provides patients with at least three hours of rehab on daily basis. Patients work with a range of health care providers. They may include physical therapists, occupational therapists and speech therapists, the AHA/ASA explained.

"If the hospital suggests sending your loved one to a skilled nursing facility after a stroke, advocate for the patient to go to an inpatient rehabilitation facility instead -- unless there is a good reason not to, such as being medically unable to participate in rehab," said Winstein.

"There is considerable evidence that patients benefit from the team approach in a facility that understands the importance of rehabilitation during the early period after a stroke," she said.

Other recommendations issued by the AHA/ASA include:

  • Stroke patients who have trouble walking should undergo intense mobility-task training to help relearn how to perform daily activities, such as climbing stairs.

  • The use of a computer, books, music and virtual reality games could help enhance rehabilitation for stroke patients, making it more engaging and mentally stimulating.

  • Stroke patients who have trouble speaking should undergo speech therapy.

  • Patients who have vision problems and have trouble focusing should perform eye exercises.

  • Balance training should be offered to stroke survivors at risk for falls.

  • Exercise regimens tailored to individual stroke patients can help them continue to improve their fitness level once their rehabilitation is complete.

"For a person to fulfill their full potential after stroke, there needs to be a coordinated effort and ongoing communication between a team of professionals as well as the patient, family and caregivers," said Winstein.

The new guidelines were published May 4 in the journal Stroke.

More information

The U.S. National Institutes of Health provides more information on rehabilitation after stroke.