How to regain arm movement after stroke

Last updated on July 12, 2021

Regaining arm movement after stroke is possible but requires science-based approaches; find what those are.

Before reading this post, read the previous one: Basic rules of post-stroke movement recovery. The following infographic summarises its contents;

Apply above basics to recover arm & hand movements after stroke

And, also skim through this post – brain’s recovery attempts after a stroke: Journeys to the brain -10 before going further.

This post reviews the best available evidence that provides answers to the following questions;

  1. Which side? the affected side or the both sides?
  2. What activities?
  3. How much and how long?
  4. How to promote continuity?
  5. Other supportive activities?

1. Which side? the affected side or both sides?

Exercises for the affected arm are more effective than doing it for both arms; that is what the 2014 Cochrane systematic review found2. In other words training programs should encourage the use of the affected side – this is what the 2019 Canadian Stroke Best Practice Guidelines recommended strongly1.

Encourage the use of affected arm and hand

2019 Canadian Stroke Best Practice Guidelines1

2. What activities?

What activities are meaningful, engaging, task-specific? Following are those;

  • Lifting a cup
  • Grasping
  • Gripping
  • Sit-to-stand
  • Folding
  • Pouring
  • Buttoning
  • Lifting

After choosing these activities, it should be done progressively and challengingly. 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 many repetitions per session and for 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 one gains better results when stroke caregivers assist in rehab exercises. 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 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; this is 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 – this is as 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 trans cranial magnetic stimulation
  • Medications
  • Electrical stimulation

Useful resources to regain arm movement after stroke

  • Viatherapy app: This is an international free app that healthcare workers can use. The app assists to choose activities that 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 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;
  • The Ontario Stroke Network provides a useful guideline for community-based exercise providers; here is the link.

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. Stroke Rehabilitation ClinicalHandbook, 2020: Page13 http://www.ebrsr.com/sites/default/files/EBRSR%20Handbook%20Chapter%204_Upper%20Extremity%20Post%20Stroke_ML.pdf
  5. 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. DOI: 10.1002/14651858.CD008349.pub3. Accessed 23 May 2021
  6. 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: Prasantha De Silva

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