Tuesday, March 20th, 2018
Damage from a stroke often leaves arm muscles and nerves incapable of receiving messages integral to movement and manipulating objects. Stroke survivors may experience symptoms such as weakness in the arms, a lack of coordination, a change in muscle tone, and a range of issues including, but not limited to: swelling, pain, and spasticity. While this reality can present a variety of challenges to stroke survivors and emotionally tax family members and caregivers hoping to help, it’s important to remember there are options for improvement.
With diligent therapy and mindful practice, these lost neural connections between the mind and arms can be repaired. It’s important to remember that a strong rehabilitation team and support system can help stroke survivors repair connections lost during a stroke.
Since spasticity, pain or weakness occurs in the arm itself, it may seem as if the muscles and nerves in the arm are damaged. However, in reality, the damage occurs where the signal originates—particularly the signal that dictates when, which, and whether muscles should contract and relax. The arm does, however, play a large role in rebuilding these lost synapses. Through a combination of repetition, a rehabilitation protocol, arm exercises, and the magic of neuroplasticity, these connections can be redeveloped.
If the arm goes unused immediately after a stroke, it’s common for the muscles to become weaker and less coordinated. Staying mindful of these muscles during the early rehabilitation process significantly supports the healing process. If movement and exercise aren’t immediately possible, support systems help to support the arm during this transition, making exercise possible again. For example, the SaeboMAS, a zero-gravity arm support system, takes weight off the shoulder and allows the arm to achieve the range of motion necessary for standard tasks and exercises. This, in turn, strengthens the muscles around the arm that would have otherwise gone unused. The SaeboMAS and other dynamic arm support devices can assist with performing the prescribed repetitive motions that fight against joint pain, muscle spasticity, and a depletion of muscle mass. With support, the person in recovery is able to perform the exercises, making tasks easier to complete throughout the day, even if a caretaker or therapist is not available.
Stroke survivors often experience what is known as apraxia, a neurological disorder characterized by a loss of ability to execute skilled movements and gestures. When a neural disconnect occurs in the parietal hemisphere of the brain, information or signals from the brain cannot reach the affected areas of the body. Despite having the desire and physical ability to perform a task, the arm cannot carry it out because it is not receiving the signal to do so.
Strokes may also affect the muscle tone of the arm and cause the involuntary tension of its muscles. On one end of the spectrum, muscles may reach a point of hypertonicity. This muscle “tightness” can interfere with the body’s ability to properly grasp and release objects or move the arm away from the body. Conversely, one may experience weakness or a lack of muscle tone, a side effect known as hypotonicity. Most importantly, stroke survivors can begin retraining the brain and body immediately, even if they are experiencing spasticity or hypotonia from the stroke. Exercises and supportive technology help to repair the affected areas of the brain during all periods of stroke recovery.
Sensory deficits occur in most stroke survivors. Studies, like this one, show that sensory deficits can directly affect motor recovery. When a stroke disrupts sensory processing and motor function, a variety of devices may help with the recovery process. Technology like sensory electrical stimulation can stimulate areas with disrupted motor function by sending very low-level impulses to the affected nerves in the arm or hand. The SaeboStim Micro is an electromesh garment that is both comfortable and highly effective in delivering this stimulation at work or at rest. This is essential for survivors in early stages of recovery who may find self-run exercise too difficult.
Pain and stiffness after a stroke are common, especially in the event of inflammation or edema, which is the collection of fluids in the affected extremities. Modalities such as the SaeboStim Micro and a combination of approaches like compression, continuous passive motion, cryotherapy, electrical stimulation with elevation, massage and motor function exercises may be prescribed to counteract the effects of swelling and fluid build-up.
Since changes in the body are so closely linked, many of the symptoms mentioned above can cause pain and discomfort. Subluxation may be the main culprit, but swelling can cause issues of its own. Contracture, a painful muscle contraction from loss of elasticity and increased stiffness post-stroke, is a side effect of limited functionality and learned non-use. Tools and strategies can help mitigate the difficulties stemming from such pain and discomfort. Support equipment and therapeutic exercises allow the affected area to perform more movement or exercise repetitions, within a pain-free range. Exercises work to strengthen and streamline each system’s relationship with the damaged region.
Studies have explored the rehabilitative powers of mindfulness after stroke; specifically, the practice of remaining present and mindful during exercise or exertion. Those progressing through stroke rehabilitation are more likely to continue with the often-difficult task of repetitive and persistent rehab over a long period of time if they apply mindfulness practices to their program. An awareness of progress keeps the stroke survivor motivated while keeping the specifics of the exercise on track as well. By setting the intention to heal, our mind is more in tune with progress and process. Mindfulness also helps when dealing with pain. When the mind is open to the body’s frequent changes, the pain’s messages become easier to read and express to medical professionals.
It is important to remain aware that there is a possibility for plateauing in stroke recovery. During this crucial process of rehabilitation, therapists should incorporate evidence-based strategies for strengthening, coordination, and motor function-boosting activities and technology. Studies have found that therapists may not always encourage the proper amount of functional movements or exercise repetitions necessary for a fully-recovered connection; as many as 400-600 repetitions a day may be ideal. Possible exercise tasks can also include movements such as moving an object across a table, pressing piano keys, or rolling and lifting a ball just to name a few.
Above all, it’s important to increase the difficulty of exercises that become too easy. Neuroplasticity is more likely to occur when rehabilitation exercise focuses on skills that require concentration and problem solving, as opposed to simple motor activities.
So where to begin? With the help of Saebo’s various supportive rehabilitation tools, these arm exercises can strengthen and help regenerate lost neurological connections to the arms. With consistency and concentration, basic to advanced-level exercises move the brain closer to full recovery.
It is important to begin with simple and straightforward movements that don’t cause pain. After the shock of a stroke, starting small is a gentle way to remind both your mind and body that progress is possible, especially in the early stages of stroke rehabilitation.
Inner Arm Stretch: Find a comfortable seat at a table and place your hands palms-down in front of you on the table surface. Slowly rotate your wrist and point your fingers toward your body. Without bending the elbows, shift your body backward, away from your hands, staying aware of the stretch in the arms. The table is there for support as you gain strength.
Wrist and Hand Stretch: Now, begin with your forearms touching the table and drape your hands and palms over the edge. Use one hand at a time to gently stretch the active hand—first back toward the body, then down and sideways, exploring each area of the wrist in a full stretch.
Elbow Stretch: In the style of dumbbell curls, hold the arm in a supported outright position and bend at the elbow toward the body. Depending on comfort, either sitting or standing for the exercise is fine. This elbow stretch helps to restore or maintain your elbow’s range of motion.
Crawling Stretch: On a comfortable spot, support your body on all fours in a crawling position. While keeping the elbows straight, shift the body back toward your heels and stretch the inside of your arms. Repeat and hold as necessary.
Wrist Motion: This is an easy exercise to perform throughout the day while either sitting or standing. Extend the elbow in front of you and rotate the wrist in all directions.
Weakened muscles experience continued atrophy due to a lack of activity. While basic and intermediate exercises focus on the return of motor function and expansion of range of motion, advanced options begin the work of strengthening the surrounding muscles.
Elbow Weight Training: Similar to the elbow stretch above, add a small weighted object or dumbbell to the affected hand and bend at the elbow. While either sitting or standing, repeat this motion until you’ve reached a comfortable yet challenging stopping point for the day.
Finger Walk: In front of a wall or sturdy door, stand and place your fingers on the surface in front of you. Slowly walk the fingers up the wall, crawling them along like a spider. Crawl the fingers back down and then repeat.
Seated Push Up: In the seated floor position—as if you were about to lay back into a sit-up—place your palms flat on the floor at your sides. With your knees bent, gently press your hands into the floor, lifting your bottom into the air. Intensify the lift and add repetitions as wrists strengthen.
Regaining original arm strength and motor function after a stroke is not an easy journey. With one limb often affected more than the other, it is natural to fall into habits that favor the healthy side, exacerbating the negative effects of the lost neurological pathways. With the right tools, focus, and understanding of the symptoms, use of the arms can be improved in most cases. Click here if you want to learn more about the steps toward stroke recovery.
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.