Regaining Arm Sensations Post-Stroke: A Comprehensive Guide

A stroke occurs when the blood supply to the brain is blocked or reduced, causing brain cells to be deprived of oxygen and nutrients. This can lead to a loss of function in different parts of the body, including the arms. Many people experience arm weakness or paralysis after a stroke, which can make daily tasks challenging. However, there are effective methods for regaining arm movement and sensation. Rehabilitation and physical therapy play a crucial role in recovery, with exercises focused on stretching, strengthening, and improving range of motion. Additionally, electrical stimulation, sensory retraining, and mirror therapy can help improve numbness and restore function. The key to success is consistent practice, repetition, and a supportive team of healthcare professionals, family, and friends.

Repetition is key to recovery

Regaining arm movement after a stroke is all about forming new neural pathways in the brain. The brain's neuroplasticity is activated through the dedicated practice of rehabilitation exercises. This is where repetition comes in.

The Importance of Repetition

High repetition of the affected upper extremity is key and required for improvement. It doesn't matter if the movement feels or looks sloppy or silly; the most important thing is to move the affected limb as much as possible. This is because the brain's neuroplasticity occurs based on your experiences and practices. The more you repeat a movement, the stronger the neural pathways become.

Active Arm Exercises

Active arm exercises refer to tasks where the arm muscles are engaged and movement is voluntary. These exercises stimulate the brain and encourage neuroplasticity. When creating a rehabilitation exercise regimen, it's important to find a balance between challenging yourself and not becoming frustrated. It's also crucial to pay attention to the quality of your movements. While the quantity of exercises helps form and solidify neural pathways, practicing good quality movement patterns is essential to recovering optimal arm mobility.

Passive Arm Exercises

If your affected arm has no movement, you can still benefit from passive exercises. These can be performed independently by using your non-affected arm to move your affected arm. A therapist or trained caregiver can also move your affected arm for you. Passive exercises help stimulate the brain and activate neuroplasticity. With consistent practice, you may be able to regain arm movement, although this takes time and dedication.

Constraint-Induced Movement Therapy

This type of therapy involves restricting your non-affected arm to encourage increased use of your affected arm. For example, you can place an oven mitt over your non-affected hand while performing an activity to encourage the use of your affected hand. This technique is proven to be effective but can also be frustrating as you're unable to use your non-affected side.

Electrical Stimulation

Electrical stimulation is another research-backed technique to help gain arm movement. It is applied through electrodes on the skin, causing the intended muscles to contract and resulting in arm movement. Studies have shown that pairing electrical stimulation with rehabilitation exercises leads to better results than electrical stimulation alone.

Fine Motor Skills Practice

Practicing fine motor skills is another important aspect of recovery. Fine motor skills are small, precise movements made with your hand and fingers. You can build this skill by tracing a design with a pen, shuffling cards, using a pegboard, or picking up small beans and putting them in a cup. Repetition is crucial for retraining your brain, so it's important to practice these movements daily.

Focus on stretching and range of motion exercises

Stretching and range of motion exercises are an important part of stroke recovery. They help to improve blood flow, making it easier to move your arm, and increase your range of motion. Here are some tips to focus on stretching and range of motion exercises:

• Start with gentle, pain-free stretching: It is important to begin with gentle stretches that do not cause pain. A therapist can guide you through these stretches, which may include moving your hand, arm, and shoulder through a full range of motion.
• Focus on comfortable, full range of motion before strengthening: Before starting strengthening exercises with weights, ensure you have a comfortable and full range of motion to prevent injury.
• Address tightness in joints and muscles: Lack of use after a stroke can lead to tightness in the joints and muscles. Gentle stretching helps lengthen the tissue and improve joint mobility.
• Find a therapist with the right expertise: The shoulder joint is complex, so it's crucial to work with a therapist who understands both neurological and orthopedic conditions. They can help target safe and effective exercises to prevent further damage during recovery.
• Incorporate stretching into your daily routine: Include stretching in your daily activities, such as leaning on your affected arm while brushing your teeth or placing your affected arm on the armrest of your chair while chatting.
• Practice sensory retraining exercises: These exercises help retrain the brain to interpret senses by engaging in touch-focused activities, such as feeling objects of different textures.
• Utilize mirror therapy: Place a mirror over your affected hand and practice hand therapy exercises with your unaffected hand. This activates mirror neurons in the brain, encouraging neuroplasticity and improving numbness and hand function.

Try electrical stimulation therapy

Electrical stimulation therapy is a safe and effective method to improve arm function and movement after a stroke. It involves the application of electrical current to the affected area via electrodes, stimulating muscle contraction and facilitating movement of a weakened or paralysed limb.

Electrical stimulation therapy can be applied by qualified health professionals, including physiotherapists and occupational therapists. Electrodes are placed on the skin, generating an electrical field and causing the muscles to contract. This method has been used since the mid-1960s and can aid mobility by addressing foot drop. More recently, it has been considered a promising treatment for upper-limb recovery.

Benefits

The benefits of electrical stimulation therapy include:

• Strengthening weak muscles
• Increasing range of motion
• Reducing spasticity
• Improving motor control
• Reducing shoulder subluxation
• Reducing pain associated with shoulder subluxation and spasticity
• Improving sensory and proprioceptive awareness
• Enhancing the effects of botulinum toxin for spasticity management

Guidelines for use

The Scottish Intercollegiate Guidelines Network, National Institute for Health and Care Excellence, and Intercollegiate Stroke Working Party guidelines all recommend electrical stimulation therapy for the treatment of shoulder subluxation. However, electrical stimulation therapy is not routinely recommended for improving arm function, and more research is needed to verify its effectiveness in this area.

Precautions

Before commencing electrical stimulation therapy, it is important to consider any contraindications and precautions to ensure patient safety. It is also crucial to obtain the patient's verbal consent and provide them with information about the treatment, including expected skin sensations and how to operate the device.

Dosage and parameters

The frequency, pulse amplitude, pulse width, and length of treatment may vary depending on the patient's needs and the specific device used. A typical frequency range is between 10 and 60 Hz, and a standard pulse width is recommended at 300 µs. The length of treatment can range from 30 minutes to 6 hours per day, with longer durations recommended for treating shoulder subluxation.

Electrical stimulation therapy is a valuable tool in the rehabilitation of arm function after a stroke, especially for shoulder subluxation. However, further research is needed to establish its effectiveness in improving arm function and motor control.

Practise fine motor skills

Practising fine motor skills is an important part of stroke recovery, as it helps improve hand and finger mobility, coordination, and strength. Fine motor skills are small, precise movements made with the hand and fingers. The more you practise, the more you stimulate the brain to make adaptive changes and strengthen functions. Here are some exercises to try:

Therapy Ball Exercises

Hand therapy balls are great for those with hand weakness or clenched hands. Some exercises involve squeezing or pinching a therapy ball, which helps strengthen the finger flexors, the muscles that allow you to bend your fingers and make a fist. For those with severe spasticity, you may need to use your unaffected hand to help place the spastic hand around the ball.

Therapy Putty Exercises

Therapy putty is a popular hand rehabilitation tool. You can practice finger extension by wrapping the putty around your index finger and then extending your finger, pushing through the resistance of the putty. As your hand strength improves, increase the resistance of the putty.

MusicGlove Hand Therapy

MusicGlove is a high-tech home therapy system that incorporates gaming and music into your hand exercises. It is clinically proven to improve hand function in just 2 weeks, as patients are motivated to achieve higher repetition.

Tabletop Exercises

You can use everyday household items like coins, paper clips, cutlery or pens to practice a variety of fine motor skills. For example, practice gripping a pen, sliding it across a table and releasing it. You can also spin the pen in a circle on the table, in both clockwise and counterclockwise directions. Practising tracing and writing can also improve fine motor coordination skills.

Beans

Pour some dried beans onto a table and practice moving them into a cup, one by one. Once you've mastered this, try using smaller beans, or attempt to pick up multiple beans in your hand and then manipulate them to your fingertips one at a time to place into the cup.

Rubber Band Resistance

Place a rubber band around your thumb and index finger and try to push the band apart. You can do this with all four fingers.

Piano

Learning to play a simple tune on the piano is an excellent way to develop your fine motor skills. By pressing the correct keys, you’ll not only improve your precision but also develop a new hobby.

Board Games

Most board games require you to manoeuvre a small object across the board to keep track of your position. This is a fun and engaging way to practice holding onto small objects and moving them in small increments. Board games can also involve rolling dice, pressing buttons, flipping cards, and spinning a wheel, all of which help develop fine motor skills.

Cards

There are endless ways to work on developing your fine motor skills with a deck of cards. Lay the cards out on a table and flip each one over, one by one. Pick a card out of the middle of the deck, or stand the cards on end to make a house of cards, which is great for those looking for a challenge. Cards are thin, which helps you develop your grip and precision.

Set goals and stay motivated

Setting goals and staying motivated is a crucial aspect of recovering arm function after a stroke. Here are some tips to help you stay focused and determined throughout your rehabilitation journey:

Set Realistic Goals:

It's important to set realistic and achievable goals that are tailored to your specific needs and abilities. Discuss your goals with your therapist, who can help you break them down into smaller, manageable tasks. For example, your goal might be to regain enough arm function to make a cup of coffee or brush your teeth using your affected hand.

Find Meaningful Motivation:

Find something that truly motivates you and incorporate it into your therapy and daily life. Whether it's a long-term goal like getting back to driving or golfing, or small daily victories like performing personal care tasks independently, having meaningful motivation can help keep you on track.

Connect with Others:

Build a supportive network of people who can encourage and motivate you throughout your recovery. This might include physicians, therapists, family members, friends, and even other stroke survivors who can offer healing messages, healthy perspectives, and helpful advice. Let them know your goals so they can support you and hold you accountable.

Embrace Challenges:

Rehabilitation can be frustrating and challenging, but it's important to embrace these difficulties as opportunities for growth. Remember that your "struggle" is an essential part of the brain's process of forming new connections and restoring function. However, be mindful of not pushing yourself too hard and taking breaks when needed.

Seek Inspiration:

Connect with other stroke survivors, whether through social media, support groups, or rehabilitation centres. Reading or listening to their stories and experiences can provide valuable insights and inspiration for your own journey. It can also remind you that you're not alone in this challenging time.

Stay Positive:

Maintaining a positive mindset can have a significant impact on your recovery. Focus on your progress and celebrate even the smallest achievements. Remind yourself that recovery takes time and that setbacks are a normal part of the process. Surround yourself with positive influences and practice self-compassion to stay motivated and optimistic.

Frequently asked questions