What Difference Exercise can make to Stroke Patients

Recovering after a stroke may feel like a daunting task. Among other things, your brain must relearn skills it lost when it was damaged by thestroke.Recent research, though, shows that the brain is amazingly resilient and capable of adapting after a stroke. This means that recovery is more possible than previously thought.Recovering use of your arm does bring special challenges, though — different than those experienced with the leg, says Susan Ryerson PT, ScD, owner of Making Progress, a physical therapy business. Ryerson has specialized in post-stroke recovery for more than 40 years with a special interest in rehab for arms.

“But you don’t have to do anything with the arm because you have the other one to use,” Ryerson says. “In the beginning, it’s easier to do things with your ‘good’ arm. So you develop a behavioral pattern of nonuse.” But because early muscle activation is critical to good recovery, you should be devoting as much time as possible to getting your arm to work, she says.

What to Expect During Stroke Rehab for Your Arm

Your stroke rehabilitation program involves working with a team to guide you. This usually includes physical and occupational therapists. The rehab team will likely recommend combining a variety of exercises and other techniques to help your arm recover. Two big goals of stroke rehab are to enhance muscle control and reduce spasticity. This is a constant contraction of muscles that can lead to pain and other problems.

Stroke rehabilitation for your hand and arm includes passive movements or exercises that are movements done with the help of a therapist and more active exercises you do with little or no assistance.

Stroke rehabilitation can be tiring. It may also help to be active during times of the day when you have more energy. Set realistic goals.

Stretching Arm Exercises After a Stroke

Stretching is especially important for reducing spasticity. “Stretchingshould be used not as an alternative to medications, but as a foundation,” says Joel Stein, MD, director of the rehabilitation medicine service and physiatrist-in-chief at NewYork-Presbyterian Hospital. “Patients that are very meticulous about it can often manage with substantial spasticity.”

Stretching Arm Exercises After a Stroke continued…
Your therapist will teach you range-of-motion stretches. Some of these involve using your other arm to produce the forces needed to move the disabled arm. Called passive exercises, these can help prevent muscle shortening and joint stiffness.

“Taking the arm and stretching it with the other arm is the bedrock of spasticity self-management,” Stein says. You can also use the unaffected hand to stretch the thumb and all the fingers on the affected hand.

Your therapist will instruct you on how to do stretches, but these are some general guidelines:

Move the arm through its full range of motion at least three times a day.
Gently stretch tighter muscles to a point of slight discomfort.
Then hold the stretch for at least 60 seconds.
Although these stretches are helpful in preventing spasticity and other problems, they don’t directly address the primary impairment — control of the arm, Ryerson says.

Functional Arm Exercises After a Stroke

Repeatedly using the arm to complete tasks is effective for recovery after a stroke, says Stein, chairman of the department of rehabilitation medicine at Columbia University’s College of Physicians and Surgeons. And, repetitive practice is now considered key to stroke rehab, much like practicing scales when learning a musical instrument.

Ryerson says that researchers now better understand how the braincontrols movement. “They’ve learned that a lot of our movements are set down in the brain in a functional context. So we’ve moved from treating isolated impairments of the arm to treating the arm in a functional context.”

One technique for encouraging use of the affected arm is called constraint-induced movement therapy (CIMT). It involves restricting use of the unaffected hand for several hours a day by putting a mitt on it and performing tasks over and over with the affected arm. The EXCITE trial, conducted at seven academic institutions between 2001 and 2003, showed that this technique promoted use of the affected arm in people with mild to moderate stroke impairment. Improvement lasted at least two years.

Other research is showing that this kind of repeated “forced use” of the hand and fingers can actually cause the brain to reorganize to help move the hand — the first demonstration of the brain’s plasticity in response to intensive therapy after a stroke.

Other Techniques to Help With Arm Recovery continued…

Brain stimulation. Magnetic or direct current stimulation of the healthy hemisphere of the brain is a technique that can reduce the activity of overactive neurons. This may help restore balance in the brain after a stroke.

Biofeedback. Although biofeedback is not well researched, this technique provides a sound or light signal that shows if muscles are active. This might help by creating greater awareness of musclecontractions, which is impaired after a stroke. With greater awareness, it may become easier to relax muscles and coordinate hand movements.

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