Last updated in July 2025
Regaining arm and hand function after a stroke is possible – but it requires repetition, task-specific exercises, and caregiver support. This guide outlines evidence-based strategies to improve the weaker arm after a stroke, based on the 2019 Canadian Stroke Best Practices Guidelines and Cochrane reviews.
Why focus on the weaker arm after a stroke?
Use it or lose it – this principle is vital for stroke rehabilitation. If the affected arm is not used regularly, the brain may interpret it as non-functional, reducing the chances of recovery.
✅ Promote the use of the weaker arm and hand more than the stronger one.
— 2019 Canadian Stroke Best Practice Guidelines; 2014 Cochrane Review
Encouraging the use of the affected arm triggers surviving brain cells to send electrical signals, which stimulate the release of Brain-Derived Neurotrophic Factor (BDNF)—a protein essential for neural regeneration and brain plasticity.
Q: Why should caregivers 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 a lack of stimulation.
What kind of exercises help arm recovery after a stroke?
The best post-stroke arm exercises are:
- Meaningful
- Engaging
- Task-specific
Daily activity-based exercises:
- Lifting a cup
- Grasping
- Gripping
- Sit-to-stand
- Folding clothes
- Pouring
- Buttoning
- Lifting
- Combing hair
The above exercises should become progressively challenging over time to stimulate improvement.
Make those activities challenging and progressively difficult. That means the difficulty of doing these activities should increase 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 goal.
Choose common activities of daily living for training sessions.
2019 Canadian Stroke Best Practice Guidelines1
How much and how long?
Hundreds of repetitions required.
Researchers are searching for a definite answer to this question. However, based on animal research, about 250-300 successful repetitions seem necessary per session4.
How to promote continuity
Virtual reality and video gaming
The success of the re-training sessions depends on continuity. This is a result of fatigue and frustration stemming from the lack 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 stroke caregivers can achieve better results when they assist in rehabilitation exercises.
However,
A physical therapist’s assistance is ideal for creating personalised stroke arm rehabilitation exercises. The good news is that the outcome of home-based programs is similar to a typical outpatient hospital programme6.
Add the following supportive activities too;
Training sessions should include the following supportive activities.
- 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
There is no adequate evidence to support the following methods!
According to a Cochrane review published in 2015, no evidence exists to support the following methods aimed at improving the arm function after stroke.
- Music therapy
- Repetitive transcranial magnetic stimulation
- Medications
- Electrical stimulation
Below is the best practices summary applicable to all lost functions;
1. Start early,
These best practices apply to regain all lost functions after a stroke; you can read about it later in this blog post: https://www.strokecarer.com/best-practices-for-caregivers-to-regain-movements-after-stroke/. This is based on standard expert recommendations.
2. Adhere to an intense program,
3. Do activities that are meaningful, engaging, and task-specific,
4. Be consistent & make it incremental,
5. Include aerobics & muscle-strengthening exercises,
6. Set goals.
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.
References
- 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.
Read more…
- The brain’s recovery attempts after a stroke
- Six rules to recover movements after a stroke
- Games like card play help improve arm/hand stroke recovery.
- Free tools to recover movements after a stroke
