Basic rules to recover movements after stroke

This post highlights expert evidence-based recommendations that stroke caregivers need to adhere to recover movements after stroke. Another two posts deal with activities specific to arm/hand movement recovery and walking ability.

Six basic rules to recover movements after stroke

  1. Move early
  2. Follow up with an intense activity and exercise program
  3. Choose activities that are meaningful, engaging, task-specific, and goal-oriented
  4. Repeat the chosen activities on an incremental basis consistently over a period of time
  5. Add aerobic and muscle-strengthening exercises
  6. Set goals

1. How early to move out of the bed?

NICE (National Institute of Health and Care Excellence) Guidelines (2019)1 recommend,

  • Sit out of bed, stand, or walk after 24 hours of the incident (Australian Clinical Guidelines strongly recommend not to start intense out-of-bed activities within 24 hours but to start within 24-48 hours of the event2.)
  • It should be a part of an active program in a specialized stroke unit.
  • The attending physician should determine the absence of contraindications doing so.

2. Follow up with an intense activity and exercise program

Make every effort to create an intense program to carry out at regular intervals for at least three months.

However, before embarking on an exercise program, a qualified health professional should screen and prescribe a suitable exercising program. Finding a qualified health professional, a physiotherapist, would be a challenge.

Exercise and physical activities become effective if those are done consistently.

Stroke Journal, 20143

3. Choose meaningful and engaging tasks; do repetitively

An example of such tasks is sit-to-stand.

Research reveals that its benefit may last six months after the completion of the training4. This is critically important. The Stroke Rehabilitation Clinician Handbook says such activities help reorganize new neurons and make changes last long5.

4. Do repetitively; how many times?

How frequently one should engage in rehab exercises to gain a desirable effect? Janice Eng, a UBC physiotherapist6 has responded to this question. More specifically, the question was this:

How many arm and hand movements repetitions per day can positively change the brain after stroke?

Quoting findings from earlier researchers (Nudo et al. 1996; Murata et al. 2007), she said it would be between 600- 1000 successful reach and grasp repetitions per day. The successful means that the number of reach and grasps without any droppings. These findings were based on research work using monkey brains after a stroke lesion to the motor cortex. The research has shown that hand representation in the undamaged primary motor cortex has regained. This is pretty impressive. The improvements have even progressed to precision finger grips.

Does this happen even in the best rehab centers? It is not. Not even close to it. In 2009 Lang C. et al.7 found that it was about 32 per session (day). Later research8 that analyzed metadata showed the more the better.

And, the 2021 Australian Guidelines9 recommend encouraging the affected to practice outside the scheduled treatment sessions.

5. Add aerobic and muscle-strengthening exercises

The Heart and Stroke Foundation10 emphasizes four types of exercises to recover movements after stroke. Those are;

  • Endurance (aerobic)
  • Strength
  • Balance
  • Stretching

The American Heart and Stroke Association statement3 recommends that people with stroke perform aerobic exercises 3-7 days a week and other types – strengthening, flexibility, and neuromuscular 2-3 days a week for life. Having a sufficient dose or intensity is essential to recover movements after stroke.

6. Set goals

The 2021 Australian Guidelines strongly recommend setting goals for each activity in consultation with the affected and stroke caregivers2.

Next, read also

References

  1. National Institute for Health and Care Excellence (NICE) Guidelines 2019): Stroke and Transient Ischemic Attack in over 16s: Diagnosis and Initial Management, published on May 1, 2019. accessed on May 27, 2021.
  2. Australian Clinical Guidelines for Stroke Management: Chapter 5 of 8. Rehabilitation. accessed June 5, 2021.
  3. American Heart Association/American Stroke Association (2014): Physical activity and exercise recommendations for stroke survivors. Stroke Journal, 2014. Accessed on June 6, 2021.
  4. French B, Thomas LH, Coupe J, McMahon NE, Connell L, Harrison J, Sutton CJ, Tishkovskaya S, Watkins CL.Repetitive task training for improving functional ability after stroke.Cochrane Database of Systematic Reviews2016, Issue 11. Art. No.: CD006073.DOI: 10.1002/14651858.CD006073.pub3.www.cochranelibrary.com repetitive task training for improving functional ability after stroke (Review)Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
  5. Teasle R. et al. (2020): Stroke Rehabilitation Clinicians Handbook (2020): Lower extremity Motor and Mobility Rehabilitation. accessed May 27, 2021.
  6. Janice Eng (2013): Strategies to increase upper and lower extremity physical activity after stroke. CPSR lecture. 2013. Youtube presentation. Accessed on June 6, 2021.
  7. Lang C. et al. (2009): Observation of amount of movement practice during stroke rehabilitation. Arch Phy Med Rehab. Accessed on June 6, 2021.
  8. Lohse K.R. et l. (2014): Is more better? Stroke. Accessed on June 6, 2021.
  9. Australian Clinical Guidelines for Stroke Management (2021): Amount of rehabilitation. Accessed on June 6, 2021.
  10. Heart and Stroke Foundation: Exercise after stroke. accessed May 25, 2021.

Read more…

Additional resources

Exercises after stroke: An excellent but simple resource guide from the Stroke Foundation, New Zealand

It is rare to find online materials without copyright issues. However, I found an excellent open-access resource published by Margot Andrew, Margaret Hoessly, and Kate Hedges. It is under the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

Physical activities and exercise, and wellness videos for people with mobility challenges

A team of physiotherapists and occupational therapists from the University Health Network have published a list of exercises and wellness videos for people with mobility challenges. It includes an excellent collection of YouTube video clips. Here are some relevant ones. One should keep in mind that these resources do not replace the exercise regimen prescribed by your healthcare professional.

Three-part series of the “it’s Your Choice” project:

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Author: Prasantha De Silva

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