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.
Unfortunately, few centers offer CIMT for two main reasons, Stein says. Insurance doesn't pay for it and high-intensity, short-duration therapy is difficult for many patients. "You also have to have a certain degree of movement to participate in CIMT," Stein says. However, variations of this therapy -- spread out over a longer period of time -- are being tried and have been shown to be useful in limited studies, he says.
Ryerson adapts techniques used in the EXCITE trial to encourage use of the hand and arm. She provides patients specific, simple arm movements that don't require hand manipulation. These are activities that most should be able to do, even with severe stroke damage.
These are examples of activities Ryerson suggests trying daily:
- Put your fingers around a refrigerator door handle. Or put your fingers around a drawer handle. Open and close the door or drawer.
- Hold a plastic shopping bag in your affected hand and carry it across the room. Practice putting something light in the bag.
- Pull laundry out of the dryer and carry it in a small bag.
- Carry light objects, supporting them against your body with your upper and lower arm.
- Put a soap dispenser on your hand. Then put it on the table and turn it over more than once.
- Put a tube of toothpaste in your affected hand. Try to squeeze it while you manipulate the tooth brush with your unaffected hand.
- Flip a light switch on and off with your affected hand.
"It's important to keep the sensory messages going into the brain to prevent the nonuse cycle," she says. The sensory information you get from touching may lead to greater recovery. And, doing activities like these also help you gain independence while you're recovering. For example, using a bag to carry objects to and from the refrigerator can free your other arm for use with a cane, if needed, Ryerson says.