Last updated on January 2023
This post delves into evidence-based post-stroke arm recovery recommendations.
You can adopt and adapt to those in your recovery journey.
At the end of this post, you can find several free resources that will help you in your journey.
Follow the basics:
There are basic rules to follow in the stroke arm paralysis recovery journey. These rules apply to stroke leg paralysis recovery as well.
- Start early, (This is discussed in detail on the basic rules to follow in regaining movements after stroke post)
- Adhere to an intense program (Ideally, we need professional assistance from a physical therapist)
- Choose activities that are meaningful, engaging, and tasks-specific (This is discussed below)
- Do it incrementally and consistently
- include muscle-strengthening exercises also
- Set goals.
Ideally, read the post below first;
Basic rules to follow in regaining movement after a stroke. You can find out what those basic rules are and how you can apply those rules. The following infographic illustrates those rules;
And, also read this post as well to find out how the brain fights back in its recovery journey in the event of a stroke attack.
2. Specific rules that we should know when we are planning to regain arm movements after a stroke
When applying the basic rules in regaining movements after a stroke, you may need to answer the following questions.
- Which side? the affected side or both sides?
- What hand and arm exercises?
- How much and how long?
- How can we ensure continuity?
- Other supportive activities?
1. Which arm? the affected arm or both arms?
The guideline recommends paying more attention to the affected arm.
Give priority to the weaker arm and hand if only one side is affected – Promote the use of the weaker arm and hand more and more, than both arms; this is what the latest research reveals.
The evidence comes from the 2019 Canadian Stroke Best Practice Guidelines1 and the 2014 Cochrane review2.
Why should we promote the use of the affected arm?
The affected neurons stop sending electric signals to the affected arm. This arm does not recover its function due to lack of stimulation.
promoting the use of the affected arm and hand is crucial after a stroke. These attempts stimulate the surviving neurons and send electric signals to the affected side of the brain.
As a result, the surviving neurons release a unique protein. Researchers call it the “Brain-Derived Neurotrophic Factor” (BDNF). This protein promotes the growth of new dendrites and synapses3.
Warning! If we do not promote using the affected body parts, the brain recognizes it as non-functioning. So,
“Either use it or lose it”
Jeffrey A. Kleim and Theresa A. Jones, Journal of Speech, Langauge, and Hearing Research, Vol. 51 • S225–S239
2. What are those meaningful activities?
The activities should be meaningful, engaging, and task-specific. What are those? Those are;
- Lifting a cup
- Combing hair
We need to make the chosen activities challenging and progressive. That means the difficulty of doing these activities should be increased with time.
Experts caution against a common pitfall while carrying out those exercises – the trunk should not be used to compensate during the training sessions.
In addition to these, muscle-strengthening exercises are also necessary. however, these exercises should not be the main goal3.
3. How much and how long?
Researchers still are searching for a definite answer to this question. However, as of present, based on animal research about 250-300 successful repetitions seem necessary per session4.
4. How to promote continuity
Virtual reality and video gaming
The success of the re-training sessions depends on continuity. This is very difficult because of fatigue and frustration due to the absence of quick results.
One way to address the challenge is to incorporate gaming practices such as video gaming. Virtual reality is another. Evidence shows these strategies promote engagement3.
The 2015 Cochrane review found beneficial effects of virtual reality and video gaming in improving arm function. The benefit was greatest for those with a low-moderate impairment and within less than six months post-stroke5.
Carers’ role in exercises
Research has shown that one gains better results when stroke caregivers assist in rehab exercises. However, a physical therapist’s assistance is ideal to create personalized stroke arm rehabilitation exercises. They know what post-stroke arm recovery techniques are. The good news is that the outcome of home-based programs is similar to the usual outpatient hospital program6.
5. Add these supportive activities too to regain arm movement after a stroke
Training sessions should include the following supportive activities also.
- Range of motion (ROM) exercises (passive and active-assisted)
- Mental practice or mental imagery
- Functional electrical stimulation for the wrist and forearm muscles
- Constraint-induced movement therapy; is for those who have at least 20 degrees of active wrist extension and 10 degrees of active finger extension, with minimal sensory deficits and normal cognition
- Mirror therapy – this is an adjunct for those with very severe paresis
No adequate evidence to support the following methods
According to a Cochrane review published in 2015, no sufficient evidence exists to support the following methods to improve arm function after stroke.
- Music therapy
- Repetitive transcranial magnetic stimulation
- Electrical stimulation
Useful free resources to regain arm movement after a stroke
- Viatherapy app: This is an international free app that healthcare workers can use. The app assists to choose activities that are best suited for the stroke survivor’s arm/hand requirements.
This app from Canadian and US experts translates standard guidelines into a decision-making algorithm. It guides occupational therapists and physiotherapists for personalized care.
- 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 healthcare 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;
- The Ontario Stroke Network provides a valuable guideline for community-based exercise providers; here is the link.
- An evidence-based toolkit to recover arm and hand movements in stroke rehab Canadian guidelines; here is the link. (This resource gives many practical, simple examples of how to assess and what to do).
- GRASP: GRASP is a free, very useful resource to regain arm and hand movements after a stroke. It is a product of the University of British Columbia’s researcher-practitioner, Dr Janice Eng, PhD, PT/OT. She and her team developed this resource after a comprehensive neuro-rehab research program; it has two versions: A hospital version and a home version. Both versions consist of books, manuals, and video clips.
You can access this resource through this link: https://neurorehab.med.ubc.ca/grasp/grasp-manuals-and-resources/grasp-home-patient-book-2/
- FAME: FAME is a group exercise program developed for people with stroke who have some standing and walking ability. Research has shown that this program improved mobility, cardiovascular fitness, and arm and hand function. A physical therapist or occupational therapist instructed the patient in the program, but the patient did the program independently.
- Canadian Stroke Best Practice Guidelines (2019): 5.1. Management of Upper Extremity Following Stroke
- Alex Pollock, Sybil E Farmer, Marian C Brady, Peter Langhorne, Gillian E Mead, Jan Mehrholz, Frederike van Wijck, Cochrane Stroke GroupCochrane Database Syst Rev. 2014 Nov; 2014(11): CD010820. Published online 2014 Nov 12. doi: 10.1002/14651858.CD010820.pub2PMCID: PMC6469541
- AHA/ASA guidelines for Adult stroke Rehabilitation & Recovery June 2016 – Upper Extremity Activity Recommendations
- Cameron S. Mang, Kristin L. Campbell, Colin J.D. Ross, Lara A. Boyd, Promoting Neuroplasticity for Motor Rehabilitation After Stroke: Considering the Effects of Aerobic Exercise and Genetic Variation on Brain-Derived Neurotrophic Factor, Physical Therapy, Volume 93, Issue 12, 1 December 2013, Pages 1707–1716, https://doi.org/10.2522/ptj.20130053
- Stroke Rehabilitation ClinicalHandbook, 2020: Page13 http://www.ebrsr.com/sites/default/files/EBRSR%20Handbook%20Chapter%204_Upper%20Extremity%20Post%20Stroke_ML.pdf
- Laver KE, George S, Thomas S, Deutsch JE, Crotty M. Virtual reality for stroke rehabilitation. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD008349. accessed on August 16, 2021.
- Coupar F, Pollock A, Legg LA, Sackley C, van Vliet P. Home-based therapy programs for upper limb functional recovery following stroke. Cochrane Database Syst Rev. 2012;5:CD006755. doi: 10.1002/14651858.CD006755.pub2.