Understanding stroke rehabilitation: Exercise tips for stroke recovery

By: Mohan Garikiparithi | Heart Attack and Stroke | Sunday, June 18, 2017 - 05:30 AM

stroke rehabilitationStroke rehabilitation often involves exercises to improve post-stroke recovery. This is because many motor skills can become affected after a stroke, depending on what area of the brain is affected. For example, patients may need to redevelop their ability to walk or even use their hands.

Rehab is often conducted alongside a physiotherapist who will work closely with you to improve mobility. They may also provide you with exercises to complete at home in order to boost your abilities and ensure you become stronger more quickly.

Rehabilitation exercises are often repetitive in nature. This is because in order for the brain to rewire itself, these activities must be repeated over and over to teach the brain what to do. This process is known as neuroplasticity.

The type of rehabilitation you perform is based on a few different things, including stroke severity, the part of the brain that was affected, the impact of the stroke on your mind and body, your general health, and how long you are able to work on your recovery.

In stroke rehabilitation patients, walking on an underwater treadmill produces better exercise performance

Research has found that in stroke rehabilitation patients, walking on an underwater treadmill produces better exercise performance. Researcher Bo Ryun Kim explained, “Aquatic treadmill exercise may be a useful option for early intensive aerobic exercise after subacute stroke, as it may both improve their aerobic capacity and maximize functional recovery.”

The study included 21 patients recovering from stroke with some walking ability and impaired leg movement on one side.

The patients underwent a conventional treadmill test and an aquatic treadmill test, where the patient is submerged in water up to their chest. Gradual increases to speed and incline were completed until the patient could no longer continue. Exercise capacity was compared between the two tests.

Higher measurements were seen during the aquatic treadmill test in both maximal oxygen consumption (VO2max), reflecting heart and lung function during exercise, and metabolic equivalents (METs), reflecting the use of energy. Heart rates were not that different between the two tests.

Even though the results showed harder performance during the aquatic treadmill test, patients did not feel as if they were working harder, which shows the aquatic treadmill exercise is a viable way to improve stroke recovery faster without the added strain.

The authors explained, “The fact that the aquatic treadmill efficiently provides aerobic exercise without requiring full weight bearing means that it may be highly suitable for rehabilitation after stroke.”

Although additional research is needed, the aquatic treadmill test looks promising for promoting more effective stroke rehabilitation.

Core exercises for stroke recovery

Suffering from a stroke can leave you struggling with poor control and strength on one side of your body. By strengthening your core muscles, you are helping boost recovery speed of your extremities and the rest of the body. The following are some of the best core exercises for stroke patients.

Pelvic floor contractions: These are also known as Kegels, which help to strengthen the muscular base of the abdomen attached to the pelvis.

To perform this exercise, first, find the muscles that you use to hold urine or stop from passing gas. Squeeze those muscles by lifting and drawing in, then hold to the count of three. Now relax and repeat. Gradually increase the length of time you squeeze to gain the most from this exercise.

Knee rolling: Lay down on your back and rest your hands on your sides. Bend your knees with your feet flat on the ground. Now, roll your hips so that your knees push to the left, then to the right, then back to the center. Repeat this exercise 10 to 20 times.

Single leg drop-outs: Lay on the floor with your hips and feet flat but with your knees bent. By keeping your pelvis still, inhale and drop the knee to the left as far as possible without lifting your pelvis off the ground. Now exhale and draw the knee back in. Repeat this exercise five times per side.

Balance exercises for stroke recovery

One of the main struggles when recovering from a stroke is keeping your balance. Thankfully, with enough exercise, you can help strengthen the muscles involved in keeping you balanced. Since strokes affect the brain, it may weaken the messages sent from your ears, eyes, and muscles to help coordinate balance, so it is important to remember that residual balance problems may still occur. However, with perseverance, you can make the best out of a bad situation. The following are a few exercises to help improve balance:

Heel raises: First, find a study chair or countertop you can hold on to. When you are stable, raise yourself up onto your tiptoes, keeping your knees straight and holding your upper body tall. Now lower yourself back down slowly. Repeat as many times as you can.

Sidestepping: Use a sturdy counter or ledge to hold on to. Step sideways, keeping one foot planted on the ground with the other stepping over it. Do this for both sides.

Once you feel like you have gained a good sense of the exercises mentioned, the next step is to do them without the support of a ledge or counter. This may be difficult but will help improve your balance further.

Arm and hand exercises for stroke rehab patients

Many people don’t feel that stretching is an exercise, but it most definitely is, and it can help improve arms and hands during stroke rehabilitation. Stretching helps relieve muscle spasticity that can occur post-stroke.

With stretching as a foundation, range-of-motion exercises are also useful for the arms and hands.

Some basic movements you can complete are moving the arm to its full range of motion several times a day. This should feel like a slight pull or strain sensation, but comfortable enough that you aren’t causing injury.

When holding a stretch, you should feel slight discomfort, but no numbness, tingling, or serious pain. Stretches should be held for a minimum of 20 seconds, and you can gradually extend this time period as you progress in your rehabilitation.

Another type of exercise for arm and hand rehabilitation is known as functional exercise. This involves repeating the same task with your hand and arm over and over. Some specialists will recommend constraint-induced movement therapy (CIMT) to accompany this exercise.

CIMT involves restricting the use of your unaffected arm and only using your affected arm to perform tasks. This helps your brain relearn how to use that arm along with building strength in it again.

Some examples of CIMT include opening and closing a door several times, holding a grocery bag in the affected hand and carrying it around the house, pulling laundry out with the affected arm, moving light objects from one area to another, squeezing toothpaste, or turning a light switch on and off.

Strength training is also an option. One study of 517 stroke patients found that using small weights and resistance bands to strengthen arm and hand muscles did not increase spasticity or pain, making it safe for stroke rehab patients to perform for rebuilding muscle and strength.

If you haven’t exercised in a while, it’s important that you embark on physical activity carefully and make sure you have approval from your doctor. To begin, you will want to work with a physical therapist who can guide you with proper form and techniques in order to improve mobility and function and decrease pain and other uncomfortable sensations.

The key is to not become frustrated. Stroke rehabilitation can take some time, and as long as you work at it, you can gain back many functions that were temporarily lost after the stroke occurred. Staying positive and putting in the necessary work can have you feeling like yourself in no time.

Shoulder rolls: Simply roll your shoulders in large circular motions forward and backward, 20 times each direction

Torso twists: While in a stable seated position, twist your torso to the right while exhaling simultaneously. Grabbing on to the armrest of a chair will grant you more leverage to get a better twist, but do not go so far as to inflict pain on yourself. Repeat on the opposite side aswell, repeating this stretch three times for each side

Isometric hold: By holding out both arms, make two fists and place one on top of the other. Angle your fists 45 degrees towards your face with your arms bent at 90 degrees, and then use the top fist to push down on the lower one without moving your arms, providing a stretch felt in the biceps and triceps.

Trap shrugs: A muscle found on the back near your neck and shoulder area can be targeted from a seated position. First grab the edges of your chair and pull up making a shrugging motion, enough to feel a stretch in your back.

Seated triceps dips: While sitting, grab the chairs armrests and keep your elbows back. Now push yourself up extending both arms, then carefully let yourself back down.

Shoulder exercises for stroke recovery

A stroke may leave your feeling weakness in your shoulder muscles. This may present as having difficulty with grasping and releasing objects you interact with every day. Doing shoulder exercises can help mitigate this problem as best as possible. The following are some exercises you can do:

Towel slide: This requires a towel and a flat table. Fold or spread the towel on the table. Now place the weak arm or hand on the towel and place your strong hand on top. Apply enough pressure to keep your hands together. Use your hands to slide the towel away from you, towards the middle of the table and bring it back towards you. This motion helps to stretch the shoulder helping to strengthen it.

Towel slides: To expand on the previously mentioned exercise, you can incorporate a bigger range of motion by sliding the towel in a different direction. While staying in a similar position, in one and over the other, move your hands from side to side, in a circular motion, and up and down.

Leg exercises for stroke recovery

Walking is one of the most commonly lost ability after a stroke. While regaining this ability can be challenging it is still worth your effort to try. Walking requires more than just your leg muscles, as it includes balance as well. So it is advised to strengthen other aspects of stroke recovery first. The following are various leg exercises to help strengthen the leg muscles:

Bridging exercise: This is also known as the Inner Range Quade Movement, helping to strengthen the thigh muscles. This can be performed by laying down and placing a pillow or rolled towel under the knee joint. Next, press the knee down, raising your heel off the floor

Ski squats: This may be a little difficult for most people buy is a great exercise to strengthen leg muscles. To perform this lean against a flat wall with your back. Now slowly bend your knees and lower yourself to the ground using the wall to support your weight and you back. When in this bent position, hold it for 10 seconds if you can. Now slide back up using the wall as support.

Stroke rehabilitation: Exercise tips

Experiencing a stroke can be a difficult ordeal to overcome, with every case of stroke being different from patient to patient. Depending on the level of impairment, it is important to try your best depending on the extent of your circumstances. There are individuals out there who are able to give you assistance and a boost in morale, and can tailor an exercise program most appropriate for you.

You are unique

No one in this world is exactly the same. Each of us have our own lives and experiences that shapes how we see the world. Your values and your lifestyle are your own and may be different from others and that is okay. It is important to stay true to yourself and set realistic goals for yourself based on what is important and meaningful for you.

Meaningful activity

Finding an activity that is interesting and taken from real life. If regaining the ability to walk is a priority, take the steps to improve leg strength and maybe use a cane to start with.

Inclusion not seclusion

Try to use the affected body part more often during the day. If your arm is weak, use it more when doing tasks, and over time it will get stronger. Doing things a little at a time will help speed up recovery.

Practice makes perfect

Frequency of repetition trains the mind and improves your skills. You can make a game out of it, tallying how many time you can do a task with your affected part, and then try to beat it.

Do what you like

Do things that you enjoy, as it will ensure that you keep doing them. There is no point in doing something if you are not having fun doing it.

Home sweet home

It’s best to do your exercises at home, as everything you need is at your fingertips in relative comfort. The typical home contains an assortment of potential stretching opportunities like walking up stairs and organizing small items.

Sound sleep

Getting enough sleep plays a big role in solidifying memories and consolidating learning. It also gives you more energy throughout the day.

Movement and exercise

Staying active is key, and moment is closely related to exercise. No one is expecting you to be a star athlete. All you need to do is make an effort to stay moving and results will come. Participate in group exercise programs, games, or even sports. Staying active can improve memory, language, thinking, and judgment.

Reward yourself

Giving yourself a reward after putting in great effort goes a long way to motivate you to keep going and achieve your goals.

Related: How to recover from a stroke quickly and naturally


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Sources:

http://strokerecoverybc.ca/newsletter/top-10-tips-hand-arm-exercise-stroke/
https://www.saebo.com/reclaim-your-stability-with-core-exercises-for-stroke-recovery/
https://www.flintrehab.com/2017/best-exercises-for-stroke-recovery/

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