How to improve upper limb weakness

About 85 percent of those who experience a stroke will have some sort of weakness in one or both of their upper limbs. This post discusses recommended methods of improving upper limb weakness.

A stroke occurs as a result of an interruption to the blood supply to a part of the brain that controls body movements and sensory inputs from body parts. There are two types of strokes: ischemic and hemorrhagic. Although some of the damage is permanent, still some can be recovered with specific exercises.

Evidence shows that “high-intensity, repetitive, task-specific practice” clearly improves motor recovery after a stroke event. However, the practices to regain lost functions of arms are different from legs’. Let us look at how best practice guidelines translate this evidence into recommendations for practice.

The Canadian stroke best practice guidelines published in 2019 recommends the following principles and methods to improve the function of the upper limbs.

General principles

The Guideline recommends two principles for those who experienced a stroke event less and more than six months.

  • Create activities that are meaningful, engaging, repetitive, progressively adaptable, task, specific, goal-oriented.
  • Create activities of daily living, that encourage the use of the affected limb.

Specific treatment methods

We need to be knowledgeable and creative to use these methods because the selection of method/s depends on the function affected.

Strong evidence from a Cochrane review exists that exercise for the affected arm is more effective than both arms. The Canadian stroke best practice guidelines also do not recommend both arm training when one arm is affected.

Recommended exercise/treatment methods
  • Range of motion (ROM) exercises (passive and active-assisted)
  • Mental imagery
  • Functional electrical stimulation for the wrist and forearm muscles to reduce motor impairment and improve function
  • Constraint-induced movement therapy for those who at least 20 degrees of active wrist extension and 10 degrees of active finger extension, with minimal sensory deficits and normal cognition
  • Mirror therapy as an adjunct for those with very severe paresis

How do we know that these methods are effective?

A large number of research has demonstrated the effectiveness of the exercises. I will mention here one important study.

J. Leipert and colleagues mapped the cortical areas of the brain’s both sides of 13 individuals who were living with a stroke for more than six months. They found that the area of the affected side was significantly smaller than the area of the non-affected side. After subjecting them for 12-days of constraint-induced movement therapy, they re-mapped the same areas. Then, they found that those areas of the affected side were significantly enlarged. They published these findings in the Stroke journal in 2001.

Interventions with no evidence

It is also important for us to know the treatment methods with no sufficient evidence to date. According to a Cochrane review published in 2015, these are as follows;

  • Music therapy
  • Repetitive trans cranial magnetic stimulation
  • Medications
  • Electrical stimulation

A guideline resource for exercise providers

The Ontario Stroke Network provides a useful guideline for community-based exercise providers; here is the link.

Carers’ role in exercises

Research has shown one gain better results when carers assist in rehab exercises.

An excellent resource

This video clip presented by an Occupational Therapist, Mitchel Edwards describes useful exercises to improve upper limb weakness. However, keep in mind that this is for informational purposes only and you need to obtain your health care professional’s guidance.

The latest book on stroke prevention and treatment published in December 2020 re-emphasizes the need of implementing the following interventions to improve upper limb weakness;

  • Constrained-induced movement therapy
  • Upper limb robotics

Author: Prasantha De Silva

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