Saturday, September 30th, 2017
Stroke rehabilitation is often a slow, gradual journey, and it is not uncommon to feel that a physically, mentally, and financially challenging road lies ahead. But with ever-expanding modern therapies, there are many ways to approach the rehabilitation process without extravagant costs or discomfort.
Recuperation from the effects of stroke should be taken one day and one issue at a time, each increment of progress building into the next. Small repetitive actions are easier to take on in the months just after a stroke, when balance and strength have yet to be restored and the rate at which neuroplasticity takes place is at its highest.
Basic hand exercises are encouraged as soon as the recuperative process begins, giving hope and direction at the start of the road to recovery. Whether a portion of dexterity has already returned to the hands or the journey is just beginning, hand rehabilitation exercises aim to reinforce strength and motor skills often weakened during a stroke.
The following are common reactions survivors have after a stroke:
When a stroke occurs, the hands may experience increased tone or stiffness due to disrupted connections between the brain and the hand muscles, this is called spasticity. Without this strong neural connection, it may become more difficult to fully straighten the fingers or grasp an item.
As hands recover, strong signs of improvement include complete extension of the fingers without assistance. Simple, repetitive rehabilitation exercises strengthen the missed connections between the mind and muscles, adjusting the pathways and preventing the spasms. A series of treatments are often prescribed to relax, stretch, and strengthen the hand muscles.
The grip, strength, and overall function of the hands is often additionally impaired, making it difficult to completely lift, grasp, or release items. This complicates everyday tasks and possibly the ability to be independent with functional activities. Additional issues include loss of sensation—sometimes causing a pins-and-needles feeling—or periods of swelling. Intensity of pain and loss of sensations caused by the stroke are often dependent on whether the neurological damage occurred on the dominant or non-dominant side of the brain.
Stroke recovery succeeds when a supportive and knowledgeable team aids in both the specific and overarching goals of rehabilitation. A team of therapists, caretakers, and family members are key in regaining or surpassing the pre-stroke level of health. As mentioned above, decreasing hand spasticity and increasing strength and motor function are often two of the main focus points in initial stroke rehab when it comes to regaining upper extremity function.
The most important aspect of a treatment regimen is consistent participation. Overall, repetition and regularity are the best ways forward with any treatment program. This promotes neuroplasticity—the capability for the mind to form or repair connections—which grow out of consistency. Much like learning an instrument or practicing a new language, you must activate the same part of the brain with repeated information to fortify the connections.
Exercises are one approach to reconnect the lost or damaged neurological pathways in need of repair that the stroke has caused. Simple and repetitive actions such as picking up small objects, stringing beads, or assembling puzzles may be combined in a treatment program to address the recuperation of fine motor skills. Each exercise is modified depending on the limitations of the person’s hands. Gross motor exercises for those with little to no hand function are also encouraged, such as steadying a rolling ball on a table’s surface or various stretching exercises to decrease spasticity.
Though stretching can feel less active, it is incredibly beneficial post-stroke. The greater the range of motion achieved, the more improvements have been found in tendon recovery, overall sensation, and mobility in the hands and fingers.
While implementing the stretching workouts that your therapist has recommended, slight discomfort may occur, but this should never extend to extreme pain or numbness. Just like with any exercise, stretching should move slowly and gradually, only increasing as flexibility and comfort improve. Lengthen the duration of a stretch as you progress, only increasing the practice further when it is safe and comfortable to do so.
A simple yet effective way to enhance the neuroplasticity in the brain, mirror therapy involves opening one side of a medium-sized box and securing a mirror to the outside wall that faces the affected side. The affected hand lies inside the box out of sight as the healthy one sits outside, catching the reflection. Ordinary, “mirror symmetric” actions are explored by the healthy hand, and the reflection aids the mind in visualizing the hands on both sides of the body responding accordingly.
Sensory Stimulation Therapy provides low-level stimulation (i.e., without producing a muscle contraction) to the hand and arm, increasing signals delivered to the brain. This form of treatment primes the cortex so that more activation appears during therapy or when performing a functional task. This new increase in activation can lead to improved sensory/motor recovery, function and cortical reorganization. The SaeboStim Micro provides sensory electrical stimulation (SES) to the arm and hand using a specialized Electro-Mesh Garment. This is worn like a glove and is intended to be worn for everyday tasks and rehabilitation exercises. The glove is lightweight and comfortable to wear and use. The SaeboStim Micro consists of an elbow sleeve for arm stimulation. and a glove for hand stimulation.
TENS Therapy, or Transcutaneous Electrical Nerve Stimulation sends small, pain-free electrical pulses into the sensory nerves of the affected region and is said to ease pain and numbness for stroke patients and other sufferers of chronic pain. TENS devices work by sending stimulating pulses across the surface of the skin and along the nerve strands in a glove word. The stimulating pulses help prevent pain signals from reaching the brain. It also helps stimulate the body to release endorphins.
Constraint-Induced Movement Therapy (CIMT) centers around the concept that by restraining the functional limb during waking hours, stroke survivors are forced to depend more on the damaged side, strengthening it in the process. Stroke survivors in the early stages of stroke recovery and learned non-use are the best candidates for this method of therapy. This therapy discourages learned non use which is the reliance on the healthy limb for everything.
Similar to the concept of mirror therapy, active-passive bilateral arm therapy uses repetitive motions between two sides of the mind to rebuild the half that was affected by the stroke. Switching between the right and left hand, simple movements are mimicked repetitively back and forth, the damaged side imitating the stronger one. This activates similar neural patterns in alternating sides of the brain, assisting the neuroplasticity on the damaged side.
FES (Functional Electrical Stimulation) is a technique that uses low energy electrical pulses to generate movement similar to TENS therapy but focuses more specifically on the motor neurons to increase muscle growth and re-stimulation. Small electrodes are placed on the affected muscles, sending out a light pulse to direct the muscles to contract. The goal when using this method of therapy is to restore voluntary function in the short-term. The Saebo MyoTrac Infiniti is a comprehensive, portable biofeedback electrical stimulation system designed for orthopedic and neurological patients. The device delivers stimulation to the targeted muscles based on the client’s very own EMG signal.
Recognized for benefitting a wide range of ailments—including migraines, anxiety, and physical therapy—biofeedback provides physical reinforcement cues when patients complete particular exercises. Electrodes are placed on affected areas of those healing from a stroke, and visual feedback is generated when a simple movement is completed correctly. This trains the mind to seek out these actions, rewiring its original pathways to favor the desired outcome.
One of the primary goals of robot-based hand motor therapy is consistent improved steadiness and hand function, traits often challenging to attain when the muscles have yet to heal. This is especially difficult to maintain as you become more tired toward the end of the therapy session. Robotic devices gently support and guide movements of the hand to increase exercise consistency.
Rehabilitation aids available at Saebo can both advance recovery and provide essential support throughout the course of recuperation. There are several options depending on the needs of the patient. At Saebo, we have three core product lines for hand rehabilitation: The SaeboFlex, SaeboGlove, and SaeboStretch. These three products have aided in the re-establishment of limited motor function after suffering a stroke or other neurological or orthopedic condition.
Saebo’s functional dynamic orthoses are specifically designed for people suffering from a neurological injury such as a stroke, head injury, and incomplete spinal cord injury. The SaeboFlex gives people the ability to perform grasp-and-release activities, which allows them to participate in task-oriented hand training. Evidence-based research supports this training as critical to recovery. The SaeboFlex is appropriate for individuals with minimal to severe tone/spasticity.
The SaeboFlex is a high-profile orthosis with an outrigger system that covers the back of the hand, fingertips, and forearm. This orthosis positions the wrist and fingers into extension to prepare them for grasp and release exercises. With the assistance of the SaeboFlex, the user is able to grasp objects by voluntarily flexing his or her fingers. Once the fingers relax (stop gripping), the extension spring system assists in re-opening the hand to release the object.
The SaeboGlove is a low-profile, lightweight glove that helps clients suffering from neurological and orthopedic injuries incorporate their hand functionally in therapy and at home which may lead to improved motor recovery and functional independence. The proprietary tension system has elastic bands that offer various tensions for individual finger joints. The tension system extends the client’s fingers and thumb following grasping and assists with hand opening.
The SaeboGlove is appropriate for individuals with minimal to little spasticity or contractures People with moderate to severe soft-tissue shortening would need an orthosis like the SaeboFlex. The SaeboGlove can be worn to assist with day-to-day functional tasks and during grasp-and-release exercises/activities. Saebo Glove’s technology stems from the research surrounding neuroplasticity, and the brain’s ability to recalibrate and reconnect otherwise lost neural connections necessary for strength and extension.
The SaeboStretch is a soft and adjustable dynamic resting hand splint recognizable for its unique strapping and energy-storing technology and energy-storing technology. This splint is worn to stretch and prevent soft-tissue shortening and helps neurologically impaired clients maintain or improve motion. Saebo’s energy-storing technology allows the fingers to gradually return to the optimal stretched position if tone has occurred, resulting in increased comfort. and compliance.
SaeboStretch is appropriate for people suffering from minimal to moderate spasticity. The orthosis includes the choice of three tension plates that offer various levels of resistance depending on the amount of tone and spasticity the individual has. The flexible hand plates also prevent or minimize joint pain and deformities. The SaeboStretch can be worn during the day or when sleeping.
Hand-focused therapies and have more extensive benefits than simply progressing the recovery of stroke. According to the American Heart Association, medical professionals also notice improvements in psychological well being, overall endurance, and a lowered risk of future stroke. As with all exercise, a consistent regimen for rehabilitation aids all parts of the mind and body, sustaining healthy circulation, coordination and strength. And as more of these factors are improved, the lower the risk for cardiovascular-related problems or accidents is, such as trips or falls.
Stroke rehabilitation can feel slow or frustrating at times, but reconnecting lost neural connections is a steady and gradual process, and is supported by strong research.
All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Saebo website is solely at your own risk.