
Strokes can cause a loss of hand function, with survivors often experiencing hand impairment and significant delays in how long it takes to grip and release objects. This can be devastating as we use our hands for nearly all activities of daily living and self-care.
Hand and wrist issues are common after a stroke due to damage to parts of the brain that control specific muscles in the body. This can lead to issues with movement, mobility and general positioning. The impact that brain damage can have on muscle control is called spasticity, and it’s something that around 30% of stroke survivors experience.
Rehabilitation after a stroke often involves high-intensity, task-specific practice to improve upper limb function. This includes hand exercises to improve mobility, strength and fine motor skills.
There are also various devices that can help restore hand function, such as a simple brace called a Wrist Hand Orthosis (WHO) or a new device called IpsiHand, which uses signals from the uninjured side of a patient's brain to help rewire circuits controlling the hand, wrist and arm.
Characteristics | Values |
---|---|
Loss of hand function | Difficulty with daily tasks such as hand washing, nail trimming, and getting dressed |
Wrist and hand contracture | Loss of passive joint range of motion |
Spasticity | Loss of muscle control |
Brace | A Wrist Hand Orthosis (WHO) can be used to address hand and wrist issues |
Rehabilitation | High-intensity, task-specific practice |
IpsiHand | A device that uses signals from the uninjured side of a patient's brain to help rewire circuits controlling the hand, wrist and arm |
What You'll Learn
Gentle hand exercises for stroke patients
Gentle hand exercises can help stroke patients improve their hand mobility, strength, and fine motor skills. Here are some Level 1 gentle hand exercises that can aid in recovery:
Pronation and Supination
This exercise involves moving the hand from a palm-down to a palm-up position, which is important for dressing, carrying objects, and turning doorknobs. Place your hand palm-down on a table, and then use your non-affected hand to turn your palm up. Repeat this motion for 20 repetitions.
Wrist Flexion and Extension
Gently bring movement to the wrist while keeping your elbow on the table. Place your non-affected hand on the palm of your affected hand and stretch backward and forward. Perform this movement slowly and within a pain-free range.
Wrist Side Movement
This exercise involves side-to-side wrist movement, known as ulnar deviation (towards the pinky) and radial deviation (towards the thumb). Place your affected hand on the table with your palm down, and then use your non-affected hand to slide it to the left and then to the right. Repeat this side-to-side motion slowly for 20 repetitions.
Therapeutic Ball Hand Exercises
Therapeutic balls are useful for building strength and dexterity after a stroke. Here are some exercises you can try:
- Ball Grip: Hold a ball tightly in your palm and squeeze, hold, and relax. Repeat 10 times for two sets.
- Thumb Extend: Place the ball between your bent thumb and extended two fingers of the same hand. Extend and straighten your thumb to roll the ball. Repeat 10 times for two sets.
- Opposition: Place the ball in the palm of your hand and bring your thumb toward the base of your little finger. Repeat 10 times for two sets.
Therapeutic Putty Exercises
Therapeutic putty is another tool for improving strength and dexterity. Try these exercises:
- Scissor Spread: Wrap putty around two fingers and try to spread them apart. Repeat 10 times for two sets.
- Thumb Press: Place putty in your palm and push into it with your thumb toward the base of your pinky finger. Repeat 10 times for two sets.
- Thumb Pinch Strengthening: Squeeze the putty between your thumb and the side of your index finger. Repeat 10 times for two sets.
Remember to perform these exercises consistently and with high repetition to maximize the benefit and stimulate neuroplasticity.
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Passive exercises for stroke patients
Passive range-of-motion exercises are beneficial for stroke patients as they help reduce spasticity and improve mobility. These exercises are performed with the help of an external force, such as a therapist or the patient's unaffected extremities, to move the affected joints. Since these exercises do not require the patient to move independently, they are especially useful for those with limited mobility and strength, or even paralysis.
Passive exercises can be combined with mental practice, where the patient visualises themselves performing the movement, to optimise brain rewiring and stimulate neuroplasticity. This can lead to lasting improvements in functional performance.
Pronation and Supination
Place your hand palm-down on a table. Then, use your non-affected hand to turn your palm up. Repeat this motion 20 times: palm up, palm down. This movement is important for dressing, carrying objects, and turning doorknobs.
Wrist Flexion and Extension
Gently bring movement to the wrist while keeping your elbow on the table. Place your non-affected hand on the palm of your other hand and stretch backward, then forward. Perform this movement slowly and only within a pain-free range.
Wrist Side Movement
This exercise involves side-to-side wrist movement, also known as ulnar deviation (towards the pinky) and radial deviation (towards the thumb). Slide your hand to the left, then to the right, repeating the movement slowly 20 times. This movement is critical for getting your wrist and hand into the correct positions for tasks like grasping, lifting, and writing.
Ball Grip
Hold a therapeutic ball tightly in the palm of your hand. Squeeze, hold, and relax. Repeat this 10 times for two sets.
Thumb Extend
Place the ball between your bent thumb and extended two fingers of the same hand. Extend and straighten the thumb to roll the ball. Repeat this movement 10 times for two sets.
Opposition
Place the ball in the palm of your hand, bring your thumb toward the base of your little finger. Repeat this movement 10 times for two sets.
Roll Movement
Place your affected arm on a table and hold a water bottle in your hand, keeping your hand and fingers relaxed. Curl your fingers in, grasp the bottle, then release. Repeat this movement 10 times for two sets.
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Rehabilitation devices for stroke patients
Stroke rehabilitation is a challenging process, but various devices can help patients regain hand and wrist function. Here is a list of some of the best rehabilitation devices for stroke patients:
Hand Therapy Balls:
These balls are an excellent, affordable option for improving hand strength and flexibility. They can be used for various exercises and help prevent stiffness, relieve joint pain, and strengthen hands and fingers.
Therapy Putty:
Therapy putty is a versatile and inexpensive option for hand rehabilitation. It provides resistance training to improve fine motor skills and strengthen hand muscles, leading to the development of a stronger grip. The putty can also be squeezed for stress relief.
Finger Exercisers:
These devices help improve fine motor skills and maintain dexterity and strength in the fingers and hands. They provide resistance for isolated strengthening of each finger, helping to improve grip strength.
Tabletop Mirror Therapy:
This technique uses a mirror to reflect the movement of the unaffected hand, tricking the brain into thinking that the affected hand is also moving. This encourages neuroplasticity and can help improve hand paralysis and reduce pain.
PVC Pipe Tree:
Pipe trees are excellent for practising both fine and gross motor skills. They help improve grasping and releasing objects, fine motor precision, and upper arm movement. They can also address cognitive skills by following patterns to create shapes.
MusicGlove:
This high-tech, music-based device makes hand therapy fun and engaging. It motivates patients to perform hand exercises in rhythm with the music, leading to improved hand function in as little as two weeks.
FitMi Home Therapy:
FitMi is an interactive neurorehab tool that allows patients to target specific muscle groups, such as the legs, core, arms, and hands. It adapts to the patient's skill level and provides a challenging yet enjoyable rehabilitation experience.
Neofect Smart Glove:
This high-tech glove follows your hand motions, measuring even the slightest movements with accelerometer and bending sensors during gamified exercises. It provides instant feedback to evaluate your performance and ensures correct technique.
Neurolutions IpsiHand Upper Extremity Rehabilitation System:
The IpsiHand System is a prescription-only BCI device that uses non-invasive EEG electrodes to record brain activity and facilitate hand rehabilitation. It helps stroke patients improve grasping and is especially useful for those with upper extremity disabilities.
It is important to consult with an occupational therapist to determine the most suitable rehabilitation devices for your specific needs and ensure safe and effective use.
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Stroke impact on hand function
A stroke can have a significant impact on hand function, causing what is known as hand paresis. This can manifest as clenched fists, curled fingers, and difficulty gripping and releasing objects. The severity of hand impairment can vary, and not all stroke patients experience physical effects. However, for those who do, rehabilitation and support are crucial to aid recovery and improve hand function.
The human hand is extremely involved in our daily lives, and its function is supported by a complex neural basis. The rehabilitation of hand function after a stroke can be challenging due to the complexity of the hand's structure and function. The hand's fine control depends heavily on an intact corticospinal tract, and damage to this tract can result in abnormal involuntary coupling between shoulder abduction and wrist/finger flexion, known as the "flexion synergy". This can further constrain functional hand movements, particularly hand opening.
Hand impairment is a common effect of stroke, with many individuals experiencing issues such as clenched fists and curled fingers. This is often due to spasticity, which is caused by disrupted connections between the brain and hand muscles, resulting in involuntary contractions and muscle stiffness. Spasticity can lead to a loss of motion over time, known as contractures, which restrict mobility and cause pain and stiffness.
To prevent spasticity from progressing to contractures, early management is crucial. This can be achieved through interventions such as stretching, active hand movement, weight-bearing on the arm, Botox injections, and splinting. Stretching is essential as it helps lengthen the muscles and prevent them from shortening. Active movement, such as performing basic hand exercises, can also help minimize the strength of involuntary contractions caused by spasticity.
There are various treatment options available to improve hand function after a stroke, including hand splints, stretching exercises, electrical stimulation, and medication such as Botox injections or Baclofen. Constraint-induced movement therapy, which involves restraining the functional limb to encourage use of the damaged side, is also a common approach. These treatments may need to be combined for optimal results.
Overall, the best treatment for hand spasticity and clenched fists after a stroke is exercise. Movement helps rewire the brain and restore its ability to communicate with the hand. Passive exercise, where the hand is moved passively through each exercise, is a great starting point for most survivors with clenched hands.
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Stroke recovery exercises
Gentle Hand Exercises (Level 1)
These exercises are suitable for those with limited hand movement or paralysis. They can be done passively, using the non-affected hand to assist the affected hand.
- Pronation and Supination: Place your hand palm-down on a table and use your non-affected hand to turn your palm up. Repeat 20 times.
- Wrist Flexion and Extension: With your elbow on the table, place your non-affected hand on the palm of your affected hand and stretch backward and forward slowly and in a pain-free range.
- Wrist Side Movement: Place your affected hand on the table with your palm down. Use your non-affected hand to slide your hand to the left and then to the right, repeating 20 times.
Moderate Hand Exercises (Level 2)
These exercises are suitable for those with some hand mobility but may still have spasticity or weakness.
- Water Bottle Curl: Place a water bottle in your affected hand and keep your hand and fingers relaxed. Curl your fingers to grasp the bottle and slowly release. Repeat 10-15 times.
- Wrist Curl: Hold a water bottle in your affected hand and use your non-affected hand to support your arm. Stretch your wrist down and then curl it up. Repeat 10-15 times.
- Pen Slide: Place a pen on a table and grip it with your affected hand, especially between the thumb and index finger. Slide the pen across the table and release. Repeat by sliding the pen back and forth.
Challenging Hand Exercises (Level 3)
These exercises are intended for those with some normal hand movement and dexterity but want to improve fine motor control.
- Pen Spin: Place a pen on the table and use your thumb and fingers to spin it. Focus on isolating your thumb, index, and middle fingers. Challenge yourself with speed and spin in both directions.
- Coin Manipulation: Place 8 quarters in a row in your affected hand. Use your thumb to move one quarter and grip it with your index finger and thumb. Place the quarter on the table while keeping the other quarters in your hand. Repeat with each quarter.
- Cup Transfer: Take two cups, one filled with water, and hold one in each hand. Slowly pour the water from one cup to the other without spilling. Alternate hands and also try using different types of cups or mugs.
Stretching Exercises
Stretching is important for preventing muscle stiffness and joint stiffness.
- Wrist Extension and Flexion: With your forearm on a table, let your hand hang off the side with your palm down. Move your hand up and down, bending at your wrist. Add some pressure from your other hand to extend the stretch. Repeat with your palm facing up.
- Thumb Extension and Flexion: Start with your palm open, signaling the number 5. Move your thumb over to your little finger, signaling the number 4, and then back to the starting position.
- Supination/Pronation: Place your hands in your lap and interlace your fingers. Turn your affected palm to face upward and straighten your elbows. Hold for 20 seconds, then repeat on the other side.
Strengthening Hand Exercises with Therapy Balls
Therapy balls are a great tool for improving hand strength and dexterity.
- Basic Squeeze: Squeeze a therapy ball with your fingers and thumb, focusing on pressing the pads and tips of your fingers into the ball.
- Finger Pinch: Pinch the ball with your fingers and thumb extended, bending only at the knuckles. Press your fingers down into the top of the ball and your thumb upward on the bottom.
- Thumb Roll: Roll the ball up and down your palm using your thumb.
- Finger Roll: With the ball on a table, roll it from the tip of your fingers to your palm and back.
- Inward Grip: Hold the ball in your palm and press your fingers into the ball, focusing on an inward movement.
- Thumb Circle: Use your thumb to roll the ball in a circular motion on your palm to improve dexterity and fine motor skills.
- Finger Squeeze: Squeeze the ball between any two fingers to build strength in the small muscles of your hand.
Advanced Hand Therapy Exercises
- Palm Down Wrist Flexion: Rest your forearm on a table with your hand and wrist hanging off the edge, palm facing down. Lift the back of your hand up. Try it without weight, and then add a challenge by holding a water bottle or light dumbbell.
- Rotation Exercise: Rotate a pen around your middle finger, using your thumb, index, and ring finger to manipulate the pen.
- Shifting Exercise: Hold a pen in a writing position and slide it forward until you're holding the end, then slide it back.
- In-Hand Translation: Gather 10 small objects, such as uncooked beans, and practice picking them up and holding them in your palm. Then, practice placing them down one by one.
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Frequently asked questions
Spasticity is the impact that brain damage can have on muscle control. It affects 30% of stroke survivors and can cause a deviation in the hand or wrist from a normal functional position, resulting in a loss of range of motion in the joints. This can make daily tasks such as hand washing and nail trimming difficult.
A Wrist Hand Orthosis (WHO) brace can be used to hold the hand and wrist in their optimal position and apply a comfortable stretch to the joint. This prevents the joint from tightening further and losing range of motion.
There are several gentle stretching and range-of-motion exercises that can improve wrist flexion. These include wrist flexion with and without support, wrist bend with a clenched fist, side-to-side wrist bend, and flexor stretch.