Stretching Arm Exercises After a Stroke continued...
Your therapist will teach you range-of-motion stretches. Some of these involve using your other arm to produce the forces needed to move the disabled arm. Called passive exercises, these can help prevent muscle shortening and joint stiffness.
"Taking the arm and stretching it with the other arm is the bedrock of spasticity self-management," Stein says. You can also use the unaffected hand to stretch the thumb and all the fingers on the affected hand.
Your therapist will instruct you on how to do stretches, but these are some general guidelines:
- Move the arm through its full range of motion at least three times a day.
- Gently stretch tighter muscles to a point of slight discomfort.
- Then hold the stretch for at least 60 seconds.
Although these stretches are helpful in preventing spasticity and other problems, they don't directly address the primary impairment -- control of the arm, Ryerson says.
Functional Arm Exercises After a Stroke
Repeatedly using the arm to complete tasks is effective for recovery after a stroke, says Stein, chairman of the department of rehabilitation medicine at Columbia University's College of Physicians and Surgeons. And, repetitive practice is now considered key to stroke rehab, much like practicing scales when learning a musical instrument.
Ryerson says that researchers now better understand how the brain controls movement. "They've learned that a lot of our movements are set down in the brain in a functional context. So we’ve moved from treating isolated impairments of the arm to treating the arm in a functional context."
One technique for encouraging use of the affected arm is called constraint-induced movement therapy (CIMT). It involves restricting use of the unaffected hand for several hours a day by putting a mitt on it and performing tasks over and over with the affected arm. The EXCITE trial, conducted at seven academic institutions between 2001 and 2003, showed that this technique promoted use of the affected arm in people with mild to moderate stroke impairment. Improvement lasted at least two years.
Other research is showing that this kind of repeated "forced use" of the hand and fingers can actually cause the brain to reorganize to help move the hand -- the first demonstration of the brain's plasticity in response to intensive therapy after a stroke.