Building Muscle Post-Stroke: Is It Possible?

A stroke can have a significant impact on your muscles, affecting your ability to perform everyday tasks and causing muscle weakness, stiffness, and tightness. However, the good news is that it is possible to build muscle and improve your strength after a stroke. The key to achieving this lies in dedicated rehabilitation and consistent therapeutic exercise.

The effects of a stroke on the muscular system can vary, but commonly include muscle weakness, paralysis, and coordination issues. These issues can make simple tasks like getting out of bed, standing up, or drinking from a glass more challenging. To counter these effects, functional strength training and progressive task-oriented training are recommended.

Passive range-of-motion exercises, where a therapist or the patient's unaffected limbs move the affected limbs, are beneficial for activating neuroplasticity and improving muscle function. As the patient's condition improves, they can transition to active exercises that involve voluntary muscle contractions.

Additionally, addressing underlying causes such as malnutrition and prolonged hospitalization is crucial for preventing and reversing muscle atrophy.

Passive exercises can be performed by a therapist moving the affected limbs for you

Passive exercises can be performed by a therapist who moves the affected limbs for you. This is particularly important if you are experiencing hemiplegia (paralysis on one side of the body). The longer you go without moving your affected side, the more muscle mass you will lose. This immobility can also lead to further complications like muscle and joint contractures.

Even if you can't move independently right now, there are ways to lessen and even reverse the effects of stroke paralysis. Passive exercises can stimulate your brain and activate neuroplasticity, which is the brain's ability to heal and rewire neural pathways. This allows undamaged portions of the brain to take over functions from areas of damaged tissue.

The more you passively move your arms or legs, the more you will stimulate your brain and form new neural pathways between your brain and muscles. Eventually, you can increase active muscle participation and you may even regain movement.

Active exercises are performed with voluntary muscle contractions

• Work with your therapy team: It is important to work closely with your therapy team, which may include a physical therapist, occupational therapist, and speech therapist. They will help you create a customised rehabilitation plan that addresses your unique symptoms, abilities, and goals.
• Start with basic movements: Before beginning active exercises, you may need to focus on passive exercises, where a therapist or your unaffected limb moves your affected limb for you. This stimulates your brain and activates neuroplasticity, the brain's ability to heal and rewire neural pathways. Once you have regained enough movement in your affected muscles, you can progress to active exercises.
• Practice and progression: The more you practice active exercises, the more you will reinforce the neural pathways that help you move. Start with simple movements like moving your affected arm or leg without resistance. As your abilities improve, gradually progress to more challenging activities, such as weight-bearing exercises or exercises with added resistance.
• High number of repetitions: Regaining muscle strength and control will require a high number of repetitions. Animal studies have shown that it takes about 400 to 600 repetitions per day of challenging functional tasks to trigger neuroplasticity and recover movement. Consistency and repetition are key to your recovery.
• Incorporate variety: In addition to active exercises, your rehabilitation plan should also include other types of exercises such as aerobic exercise, strength training, stretching, and balance training. This variety will help improve your overall recovery and reduce the risk of another stroke.
• Prevent muscle atrophy: Muscle atrophy, or the decrease in muscle mass, is a common complication after a stroke, especially following long hospital stays or severe secondary effects. To prevent and reverse muscle atrophy, it is essential to address the underlying causes, such as immobility, malnutrition, and learned nonuse.
• Seek medical guidance: Before starting any exercise program, be sure to discuss it with your neurologist or doctor. They can guide you toward the most appropriate exercises for your specific needs and condition. Additionally, a physical therapist can create a strength-training program tailored to your individual requirements.
• Scooting in bed (bridges): Lie on your back with your knees bent and heels close to your hips. Lift your buttocks off the bed, shift your hips laterally, and then lower your buttocks. Move your legs to align with your hips, and use your abdominal muscles to bring your shoulders into alignment. This targets your glutes, abs, and hip flexors.
• Standing up from bed (squats): Sit at the edge of the bed with your feet on the floor. Lean forward, press your feet into the floor, and stand up without using your hands for support. This targets your glutes, hamstrings, and quads while also improving your balance.
• Pushing up from a chair (tricep dips): Sit at the edge of a chair with armrests and press your hands into the armrests to push yourself up to a standing position. Then, slowly lower yourself back down. This targets your triceps, deltoids, pecs, and back muscles.

Remember to always consult with your healthcare team before starting any new exercises, and gradually increase the intensity and difficulty of your active exercises as your strength and endurance improve.

Malnutrition can speed up muscle atrophy, so it's important to treat conditions like dysphagia

Malnutrition can speed up muscle atrophy, so it is important to treat conditions like dysphagia. Dysphagia is a global health problem, affecting an estimated 8% of the world's population. It diminishes an individual's quality of life and can lead to malnutrition if the person does not have access to appropriate treatment and interventions. Dysphagic patients who are malnourished have longer hospital stays, a higher risk of complications, and a higher mortality rate than those who are properly nourished.

Dysphagia and malnutrition are closely associated. It is reported that 39.2% of dysphagic patients are at risk of malnutrition, and 13.6% of individuals at risk of malnutrition have dysphagia. The prevalence of concurrent malnutrition and dysphagia has been estimated to be between 3% and 29%. Patients with oropharyngeal dysphagia are prone to receiving inadequate food intake and presenting malnutrition because of fear of choking, anorexia, and decreased food preference related to food texture. In addition, texture-modified diets are lower in nutrients than a regular diet and are more likely to induce malnutrition and sarcopenia.

Malnutrition leads to systemic muscle mass loss and atrophy of the muscles used for swallowing, ultimately leading to dysphagia. Therefore, it is recommended that the nutritional status of all dysphagic patients should be assessed. Nutritional assessment is the process of determining if there is a problem with an individual's nutritional status, identifying it, and performing a detailed examination to determine the severity of malnutrition. It includes the evaluation of subjective and objective parameters, such as medical history, dietary intake, physical examination, anthropometric measurements, physical function, mental function, quality of life, medications, and laboratory data.

Body mass index (BMI) is generally used as a common indicator of malnutrition. Although many global regions use BMI as a criterion for determining malnutrition, overweightedness and obesity are more of a problem in North America than a low BMI. Therefore, BMI is not necessarily used as a marker of clinical malnutrition. In addition, the percentages of lean fat mass and fat mass in the body are not determined by BMI. Sarcopenia is found in obese and non-obese individuals and is an important health problem for older adults, leading to poor prognosis in terms of physical dysfunction, poor quality of life, and increased mortality. Therefore, in older adults, not only BMI but also muscle mass and muscle function should be assessed.

The Global Leadership Initiative on Malnutrition (GLIM) criteria may be suitable for assessing nutrition in adults with dysphagia, as they can assess both muscle mass and BMI. The components of the GLIM criteria include a nutritional screening tool, BMI, anthropometric measurements, body composition, dietary assessment, and the impact of disease. These criteria contain five of the seven categories identified in a scoping review of nutritional assessment items in adult patients with dysphagia. The remaining two categories are blood biomarkers and "other."

Serum visceral proteins, such as albumin, pre-albumin, and transferrin, were also measured in the nutritional assessment of adults. However, these proteins can have low serum concentrations independent of the actual nutritional status and should be interpreted with caution in patients with infections, acute inflammation, and trauma. Dysphagic patients are at high risk for developing pneumonia, which is often an acute inflammatory condition. Therefore, blood biomarkers should not be used as nutritional assessments by themselves but rather as an adjunct or additional indicator.

In summary, malnutrition can speed up muscle atrophy, and dysphagia is a condition that can lead to malnutrition. It is important to assess the nutritional status of dysphagic patients and provide appropriate treatment and interventions to prevent or manage malnutrition. The GLIM criteria can be used as a minimum standard for nutritional assessment in adults with dysphagia, and additional comprehensive assessments should be conducted in the presence of malnutrition.

Strength training is recommended to reverse muscle atrophy

Muscle atrophy, or a decrease in muscle mass, is a common occurrence after a stroke, especially after long hospital stays or for those with severe secondary stroke effects. This can lead to reduced strength and an increased risk of injury. However, strength training is an effective way to reverse muscle atrophy and is recommended by the American Heart Association.

Strength training exercises should be performed 2-3 times a week and should consist of 8-10 exercises targeting major muscle groups. Each exercise should include at least one set of 10-15 repetitions, and resistance should be increased over time as strength and endurance improve.

• Scooting in Bed (Bridges): Lie on your back with your knees bent and heels close to your hips. Lift your buttocks off the bed, shift your hips to one side, and then lower your buttocks. Repeat this movement, alternating sides. This targets the glutes, abs, and hip flexors and improves your ability to get in and out of bed.
• Standing Up From Bed (Squats): Sit on the edge of the bed with your feet flat on the floor. Lean forward, press your feet into the floor, and stand up without using your hands for support. This targets the glutes, hamstrings, and quads and also improves balance.
• Pushing Up from a Chair (Tricep Dips): Sit on a chair with armrests and press your hands into the armrests to push yourself up to a standing position, targeting your arm muscles. Then, slowly lower yourself back down and repeat.
• Lifting a Cup (Bicep Curls): While sitting, grasp a cup and bring it up to your mouth as if drinking, then lower it back down. This targets the biceps, triceps, wrists, and finger flexors and can help with drinking, even if you have reduced finger dexterity.

It is important to work closely with your doctor and physical therapist to develop a strength training program that is tailored to your specific needs and abilities. Additionally, it is recommended to combine strength training with aerobic exercise and stretching to improve overall recovery and prevent further strokes.

Gait training is important to help patients get back to pre-stroke levels of activity

Gait training is an important aspect of stroke rehabilitation and can help patients get back to pre-stroke levels of activity. Gait refers to the pattern of walking, and gait training is the process of improving walking function and mechanics through practice and specific exercises.

After a stroke, a patient's ability to walk may be impaired due to weakness, imbalance, or coordination issues. Gait training exercises can help improve muscle strength and mobility in the legs, as well as balance and coordination, and increase cardiovascular fitness.

• Seated leg lifts: Lift your affected leg into your chest and then place it back down. Repeat with the other leg, doing 20-30 reps.
• Single-leg stance: Stand on one leg for 30 seconds, then switch.
• Knee extensions: Extend your leg out in front of you, then slowly bring it back down. Do 10 reps.
• Leg lifts: Lift your leg out to the side and hold, then bring it back down. Do 15 reps on each side.

In addition to gait training exercises, other rehabilitation methods such as strength training, balance and core training, functional electrical stimulation, and high-tech home exercise equipment can also help improve walking ability.

Gait training is an important component of stroke recovery, and a consistent rehab exercise program can help patients get back on their feet and resume their pre-stroke activities.

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