Arm-Strengthening Exercises After a Stroke
In the past, there has been some controversy about strength training for the arm and hand after a stroke. It was thought that strengthening spastic muscles might do more harm than good. Now research indicates that strengthening spastic muscles can even reduce spasticity.
A recent review of 13 studies including 517 stroke patients with mild to moderate impairment of their arms found that strengthening hands and arms with small weights, resistance bands, and pulley weights could be done without increasing spasticity and pain.
Other Techniques to Help With Arm Recovery
In addition to stretching, functional, and strengthening exercises, other techniques may also help you recover use of your arm after a stroke. The effectiveness of some of these techniques and devices is still being explored.
Active-passive bilateral therapy. A stroke upsets the balance between the two sides of the brain. Active-passive bilateral therapy involves performing a task by using the non-affected and the affected hand together. It may help the two sides of the brain work better together, restoring balance and possibly improving hand function when combined with other therapy.
A form of bilateral therapy called BATRAC (bilateral arm training with rhythmic auditory cueing) may also help the brain reorganize after a stroke. It uses sound cues to signal participants to start pushing or pulling on two T-bar handles. You may do this by either using both arms at the same time or by using one arm, and then the other.
Ryerson takes these principles and adapts them so that patients can use everyday objects to act as an assist. "Can they take their cane or a broom handle or a towel rolled up into a cylinder and reach it forward, rotate up and down, slide it left and right, and reach it to the floor?"
Robotic devices. As consultants for robotics companies, Stein and Ryerson have worked with a variety of devices and have seen some potential for stroke patients. Robotic devices assist movement, achieving more consistent, measurable repetition than can be achieved with conventional therapy, Stein says. And, though not widely available, they have the potential to be a labor-saving device, he says. "If we can create devices that supplement our standard therapy, then I think we have a better shot at improving outcomes."
Functional electrical stimulation. This technique involves generation of an electrical current that stimulates nerve activity in limbs affected by stroke, strengthening weak or spastic muscles. Ryerson says this technique may be helpful for opening a contracted hand. Some devices are commercially available and becoming more widely used, even in the home, Stein says. However, they are not currently covered by insurance.
Brain stimulation. Magnetic or direct current stimulation of the healthy hemisphere of the brain is a technique that can reduce the activity of overactive neurons. This may help restore balance in the brain after a stroke.
Biofeedback. Although biofeedback is not well researched, this technique provides a sound or light signal that shows if muscles are active. This might help by creating greater awareness of muscle contractions, which is impaired after a stroke. With greater awareness, it may become easier to relax muscles and coordinate hand movements.