How to regain arm movements after stroke

Last updated on January 2023

This post delves into evidence-based post-stroke arm recovery recommendations.

You can adopt and adapt those recommendations to yours 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:

We can recognise several basic rules to follow. Those apply in regaining leg movements as well.

Those include;

  • Start early, (You can find a detailed account in this post: Basic rules to follow in regaining movements after stroke post)
  • Adhere to an intense program (Ideally, you need professional assistance from a physical therapist; but it may be expensive – about 100-150 CAD in Ontario, Canada.)
  • Choose activities that are meaningful, engaging, and tasks-specific (This is discussed below)
  • Increase your activities consistently.
  • Include muscle-strengthening exercises as well.
  • Include aerobic exercises as well.
  • 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;

Apply the above basics to recover arm & hand movements after a stroke

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, think of the following questions.

  1. Which side? the affected side or both sides?
  2. What hand and arm exercises?
  3. How much and how long?
  4. How can we ensure continuity?
  5. Other supportive activities?

1. Which arm?: The affected arm or both arms?

The guideline recommends paying more attention to the affected arm.

“Promote use of the weaker arm and hand more and more”

2019 Canadian Stroke Best Practice Guidelines; 2014 Cochrane Review

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.

Q: Why should we promote the use of the affected arm?

A: The affected neurons stop sending electric signals to the affected arm. This arm does not recover its function due to lack of stimulation.

Therefore,

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 brain’s affected side.

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 identifies that part 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
  • Grasping
  • Gripping
  • Sit-to-stand
  • Folding
  • Pouring
  • Buttoning
  • Lifting
  • 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.


Choose common activities of daily living for training sessions.

2019 Canadian Stroke Best Practice Guidelines1

3. How much and how long?

Researchers are searching for a definite answer to this question. However, 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 for creating 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.

Research has shown that one gains better results when stroke caregivers assist in rehab exercises. However, a physical therapist’s assistance is ideal for creating 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.

Home-based programs bring similar results as the outpatient hospital program

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.

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 adequate evidence exists to support the following methods to improve arm function after stroke.

  • Music therapy
  • Repetitive transcranial magnetic stimulation
  • Medications
  • Electrical stimulation

Useful free resources to regain arm movement after a stroke

  • Viatherapy app: This is an international free app healthcare workers can use. The app assists in choosing 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.

  • 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.

References

  1. Canadian Stroke Best Practice Guidelines (2019): 5.1. Management of Upper Extremity Following Stroke
  2. 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
  3. AHA/ASA guidelines for Adult stroke Rehabilitation & Recovery June 2016 – Upper Extremity Activity Recommendations
  4. 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
  5. Stroke Rehabilitation ClinicalHandbook, 2020: Page13 http://www.ebrsr.com/sites/default/files/EBRSR%20Handbook%20Chapter%204_Upper%20Extremity%20Post%20Stroke_ML.pdf
  6. 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.
  7. 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.

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Author: Ed Jerard

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