Arms And Legs: Mobility During A Stroke

A stroke is a brain injury that can affect a person's ability to move their arms and legs. It occurs when the brain is deprived of oxygen, causing brain cells to die. This can happen due to a blocked blood vessel (ischemic stroke) or bleeding in the brain (hemorrhagic stroke). The effects of a stroke can vary, ranging from mild to severe, and may include muscle weakness, paralysis, or changes in sensation and movement. In some cases, a person may experience partial or complete paralysis on one side of the body, affecting their ability to move their arms and legs. However, the impact of a stroke differs for each individual, and some people may not experience any physical effects.

Muscle weakness and paralysis

A stroke can cause muscle weakness or paralysis, which can affect the arms, legs, hands, and feet. This can make it difficult for the person to move their limbs and perform basic tasks. The effects of a stroke can vary, ranging from mild to severe, and some people may experience paralysis on one side of the body.

Causes of Muscle Weakness and Paralysis

A stroke occurs when the brain is deprived of oxygen due to a blocked or burst blood vessel. This results in the death of brain cells and disruption of neural pathways, leading to muscle weakness or paralysis. The shoulder joint is particularly vulnerable to the effects of a stroke, as the weight of the arm can cause a partial dislocation or subluxation.

Treatment and Rehabilitation

Proper arm and shoulder care are crucial after a stroke to prevent further injury and promote recovery. This includes positioning the arm correctly, using support devices such as slings or braces, and preventing partial separation of the shoulder joint. Rehabilitation exercises, such as active and passive arm exercises, can help stimulate the brain and encourage neuroplasticity, improving muscle strength and mobility over time.

Recovery Timeline

The recovery timeline after a stroke varies for each individual. While some people may regain full use of their limbs within weeks, others may continue to experience weakness, pain, or paralysis. Intensive rehabilitation and consistent practice are key factors in improving the chances of recovery.

Shoulder joint issues

The primary cause of shoulder pain after a stroke is shoulder subluxation, or partial dislocation of the shoulder joint. This happens when the muscles that hold the joint in place are weakened due to the stroke, causing the arm to pull down and away from the shoulder blade under the effect of gravity. This condition can be exacerbated by slumped posture caused by weak back muscles and muscle stiffness, which places uneven stress on the joint. Shoulder subluxation can be diagnosed by a physical therapist or physician by measuring the space between the arm bone and the shoulder blade; a separation of more than one finger width is considered a sign of subluxation.

To prevent and manage shoulder subluxation, the following strategies can be employed:

• Constraint-induced movement therapy: This involves forcing the use of the affected arm by restraining the unaffected arm with a sling.
• Mental practice with motor imagery: Rehearsing physical activities by memory without body movement.
• Task-specific training: Relearning specific tasks by training for them.
• Proper positioning: Correctly positioning the arm and shoulder can help reduce strain on the ligaments and capsule, preventing frozen shoulder and subluxation. Foam supports, pillows, and other devices can be used to ensure proper positioning.
• Shoulder taping or orthotic supports: These should be prescribed by a therapist and regularly monitored to ensure they do not impede movement.
• Electrical stimulation: Electrical stimulation devices can be used to stimulate the muscles around the shoulder to prevent or reduce subluxation.
• Painkillers: Paracetamol or other painkillers can be taken to manage pain, but it is important to consult a doctor first, especially if the patient is on blood-thinning medication.
• Intra-articular steroid injections: In some cases, steroids may be injected into the joint to reduce pain.

It is important to manage shoulder pain and subluxation properly to avoid further complications and to improve the patient's quality of life.

Spasticity

A stroke can affect a person's ability to move their arms and legs in several ways. The effects of a stroke can leave one side of the body paralysed or weakened, posing challenges to independence. The muscles in the arms, legs, hands and feet may become limp and heavy, and in the weeks or months after a stroke, they may shorten and become very tight, making them more difficult to move. This is called spasticity.

Foot drop

There are two common ways to manage foot drop: bracing with an ankle-foot orthosis and functional electrical stimulation (FES). An ankle-foot orthosis is a device that keeps the ankle and foot in position to help the foot clear the ground. Functional electrical stimulation (FES) sends small pulses of electrical stimulation to the nerve that controls the muscles lifting the foot. FES is delivered through surface electrodes placed on the skin.

A study on the effects of FES on stroke patients with foot drop found that it improved walking speed, the ability to walk longer distances without fatigue, reduced energy expenditure, and resulted in fewer falls. However, FES is not suitable for patients with cardiac pacemakers or defibrillators.

Another study compared the effects of FES and moving treadmill training on stroke patients with foot drop. The combination of FES and moving treadmill training was found to be more effective in improving gait characteristics and promoting the normalization of hip flexion, knee flexion, and ankle flexion compared to FES alone.

In summary, foot drop is a common issue following a stroke that can significantly impact a person's mobility and quality of life. While bracing and orthotics can help manage the condition, FES and other rehabilitation techniques, such as moving treadmill training, can also improve walking ability and reduce the impact of foot drop on daily life.

Rehabilitation methods

Rehabilitation should begin as soon as possible after a stroke, ideally in the hospital. The patient, their family, and the healthcare team should work together to achieve the best results. The patient's independence and quality of life can be improved through rehabilitation, which can help physically, emotionally, socially, and spiritually.

The rehabilitation team includes doctors, such as neurologists, physiatrists, and internists; occupational therapists; speech and language pathologists; registered dietitians; social workers and chaplains; and psychologists, neuropsychologists, and psychiatrists.

Rehabilitation programs are tailored to the individual and may include:

• Self-care skills, including activities of daily living (ADLs) like feeding, grooming, bathing, dressing, and toileting.
• Mobility skills, such as walking, transfers, and using a wheelchair.
• Communication skills, including speech, writing, and other methods of communication.
• Cognitive skills, such as memory, concentration, judgment, problem-solving, and organizational skills.
• Socialization skills, including interacting with others at home and in the community.
• Pain management, including medicines and alternative methods.
• Psychological testing and support for emotional issues.
• Assistance with adapting to lifestyle changes, financial concerns, and discharge planning.
• Patient and family education about stroke, medical care, and adaptive techniques.

Physical therapy is an important aspect of stroke rehabilitation, helping to rebuild strength, balance, and coordination. Exercises that train the arms and legs together, such as cycling, have been shown to improve walking ability, as well as arm and leg strength, and nerve connections. Even training with only the arms can help improve walking ability, as well as overall strength and nerve connections.

Mobility aids, such as canes, walkers, and wheelchairs, can also be important for improving independence and safety. These devices need to be fitted to the individual and used correctly under the guidance of a physiotherapist or occupational therapist. Orthotics and braces can also help to support and stabilize weakened muscles.

In addition to physical rehabilitation, stroke survivors may also need help with emotional and social issues. Speech and language pathologists can assist with communication problems, while psychologists and psychiatrists can provide support for emotional disturbances and thinking problems. Social workers and chaplains can offer spiritual and social support, helping the patient and their family to adapt to lifestyle changes and connect with the community.

Frequently asked questions