Regaining Finger Movement Post-Stroke: Effective Strategies For Rehabilitation

Stroke survivors often experience weakness in their hands, which can make it difficult to use them properly. This is due to damage in areas of the brain that control hand function, disrupting communication between the hand and the nervous system. The effects of a stroke depend on the location and severity of the brain tissue blockage, with the most common type being an ischemic stroke caused by a blocked artery.

Hand recovery after a stroke can be a slow process, but it is possible to regain function through consistent rehabilitation and repetition of exercises. Basic hand exercises are encouraged as soon as the recovery process begins, with the aim of improving strength and motor skills. Mirror therapy is one such method, where the reflection of the unaffected hand performing exercises tricks the brain into thinking the affected hand is moving, helping to create new neural pathways.

High repetition of hand exercises is key to recovery, as it helps the brain learn and lock in motor memory. Combining these exercises with functional retraining of real-world tasks is also beneficial. Electrical stimulation and Botox injections are additional methods that can be used to relax the muscles and improve hand function.

Overall, the best treatment for hand recovery after a stroke is exercise, as movement helps rewire the brain and restore communication with the hand.

Hand Rehabilitation Exercises

• Basic hand exercises: Simple, repetitive movements such as picking up small objects, stringing beads, or assembling puzzles can help reinforce strength and motor skills. These exercises can be modified to suit the individual's level of hand function.
• Gross motor exercises: For those with little to no hand function, gross motor exercises such as steadying a rolling ball on a table or performing various stretches can help decrease spasticity and improve hand function.
• Stretching exercises: Stretching the hand muscles and connective tissue can help prevent spasticity and improve tendon recovery, sensation, and mobility in the hands and fingers. It is important to stretch within a pain-free range and gradually increase the duration and intensity of stretches as flexibility and comfort improve.
• Mirror therapy: This technique involves placing a mirror over the affected hand so that it reflects the unaffected hand. By performing rehabilitation exercises with the unaffected hand while watching the reflection, the brain is "tricked" into thinking the affected hand is moving, stimulating neuroplasticity and the creation of new neural pathways.
• Electrical stimulation: This technique uses electrical currents via electrodes placed on the skin to provide stimulation to the nerves and muscles. It can help amplify the stimulation the brain receives and enhance neuroplasticity, leading to improved motor function.
• Constraint-induced movement therapy (CIMT): This approach involves restraining the functional limb during waking hours, forcing the individual to depend more on the affected hand and strengthening it. CIMT discourages "learned non-use," where the individual relies solely on the healthy limb.
• Active-passive bilateral therapy: This method uses repetitive motions between the two sides of the brain to rebuild the affected side. Simple movements are mimicked back and forth between the hands, activating similar neural patterns and promoting neuroplasticity.
• Functional electrical stimulation (FES): FES uses low-energy electrical pulses to generate movement and increase muscle growth. Small electrodes are placed on the affected muscles, sending light pulses to direct muscle contraction and restore voluntary function.

It is important to work with a therapist to determine the most suitable rehabilitation exercises and create a consistent routine. Additionally, combining different techniques and progressing from basic to more complex exercises can help maximize the recovery process.

Mirror Therapy

This technique can spark neuroplasticity and help you create new neural pathways, allowing you to regain movement or fine motor skills in your affected hand. As with other techniques, repetition and consistency are necessary for mirror therapy to be an effective treatment.

Electrical Stimulation

ES is commonly used to help stroke patients recover from paralysis and can be applied to the hands, wrists, and arms to promote muscle activation and stimulation. There are different types of ES, including:

• Neuromuscular electrical stimulation (NMES): This involves sending electrical impulses to the muscles to imitate signals normally sent from the nervous system, causing the targeted muscle to contract. NMES can be used for muscle strengthening and motor recovery of paralysed or weakened limbs.
• Functional electrical stimulation (FES): This is a type of NMES commonly used in stroke rehabilitation, where e-stim is combined with a functional movement, such as contracting the fingers to help a survivor grasp an object.
• Transcutaneous electrical nerve stimulation (TENS): This type is often used to treat and manage post-stroke pain. Instead of causing muscle contraction, TENS blocks pain signals by sending impulses to nerve cells. This creates a tingling sensation and helps prevent pain messages from reaching the brain.

ES can be used to address hemiplegia or hemiparesis (weakness or paralysis on one side of the body) by sending electrical impulses to introduce movement into paralysed muscles. It can also help reduce spasticity, even after a massive stroke, by restoring communication between the brain and spastic muscles, allowing them to relax and lengthen.

ES is also beneficial for stroke patients who wish to improve their balance and gait. With the help of a physical therapist, ES can be used to help survivors practice proper gait techniques, boosting neuroplasticity and improving movement patterns.

Additionally, ES can reduce shoulder subluxation, which occurs due to weakness of the arm and shoulder muscles after a stroke. Functional electrical stimulation can reduce the severity of shoulder subluxation and associated pain, improving arm function and a survivor's independence with daily tasks.

Overall, ES is a valuable addition to many survivors' rehabilitation programs and can help boost the recovery process.

Botox Injections

Repeated treatments of BoNTA over one year after a stroke can improve muscle tone and reduce pain in the arms and hands, making it easier for patients to dress themselves and perform personal hygiene. Botox injections can also improve active hand function and impairment among patients with chronic stroke.

The benefits of Botox injections for treating stroke spasticity include:

• Improved muscle tone and range of motion
• Reduced pain and discomfort
• Increased ease of performing daily activities such as dressing, washing, and feeding themselves
• Reduced adverse events such as headaches, arm pain, or influenza-like illnesses

In one study, patients with severe spasticity and a non-functioning arm were treated with intramuscular Botox injections. The results showed improvements in hand hygiene, difficulty with sleeves, standing and walking balance, shoulder pain, and wrist pain. Additionally, passive range of movement at the shoulder, elbow, and wrist improved after treatment. The benefits of the treatment were noted within two weeks and lasted up to 11 months, with no adverse effects reported.

Another study found that Botox injections into the finger and/or wrist flexor muscles, followed by electrical stimulation of finger extensors, improved active hand function in chronic stroke patients. The combination of Botox injections and electrical stimulation resulted in significant improvements in various outcome measures, including the Box and Block test, Action Research Arm Test, and the number of repeated finger flexions/extensions.

Overall, Botox injections are a safe and effective treatment option for improving finger movement and reducing spasticity after a stroke. The treatment can help improve muscle tone, reduce pain, and make it easier for patients to perform daily activities.

Hand Therapy Exercise Devices

Hand Therapy Balls

Hand therapy balls are simple yet effective tools that offer multiple resistance levels to challenge survivors and improve hand strength and flexibility. They are affordable, portable, and can be incorporated into a variety of exercises, making them ideal for travel. Therapy balls help manage spasticity and can be squeezed to strengthen the fingers and rolled in the hand for a finger stretch.

Therapy Putty

Therapy putty is a versatile and inexpensive tool that provides resistance training to improve fine motor skills and strengthen hand muscles. It is often used for traditional strengthening exercises, but can also be used for cutting or hiding objects like pennies. Survivors can work with the putty throughout the day to gradually build hand strength.

Finger Exercisers

Finger exercisers provide isolated strengthening for each finger and can help improve grip strength. They offer more resistance than therapy balls or putty and are a great way to work on both fine and gross motor skills. The Epitomie Fitness Finger Master is a compact finger exerciser that can be used on the go.

Tabletop Mirror Therapy

Mirror therapy is a technique that uses a tabletop mirror to reflect the movement of the unaffected hand, helping survivors visualize and encourage movement in the affected hand. This activates neuroplasticity and aids in rebuilding damaged neural pathways. Professionally made mirror therapy sets are available, but a DIY mirror box can also be created at home.

PVC Pipe Tree

Pipe trees are excellent for practicing both fine and gross motor skills, as they require grasping and releasing objects, fine motor precision, and upper arm movement. They also provide cognitive benefits, as survivors can follow patterns to create different structures.

MusicGlove

MusicGlove is a premium, music-based hand therapy device that has been clinically proven to improve hand function within two weeks when used for at least 25 minutes a day. It motivates survivors to perform therapeutic hand exercises in rhythm with music, making it a fun and engaging tool for consistent practice.

FitMi Home Therapy

FitMi is an interactive full-body neurorehab tool that targets the legs, core, arms, and hands. It adapts to the user's skill level and provides just the right amount of challenge. FitMi has helped many survivors regain their ability to walk and perform daily activities like driving and typing.

These devices, along with consistent and repetitive practice, can help stroke patients regain hand function and improve their quality of life. It is important to work closely with a therapist to determine the most appropriate and effective devices for individual needs and to ensure safe and proper usage.

Frequently asked questions