Regaining Leg Movement After A Stroke: Tips For Recovery

Stroke survivors often experience muscle weakness and loss of control in their arms and legs, with around 70% experiencing arm weakness. Rehabilitation is an important step in the recovery process, and survivors often work with therapists to restore strength and control through exercise programs. These exercises can include stretching, strengthening, and range-of-motion exercises. In addition to physical therapy, other treatments such as electrical stimulation, constraint-induced movement therapy, and botulinum toxin injections may be used to improve mobility and reduce spasticity. The road to recovery is different for everyone, but consistent practice and repetition are key to regaining movement in the arms and legs after a stroke.

How to Get Movement from SSRM and Leg After Stroke

Passive exercise for those with hemiplegia or severe hemiparesis

Passive exercises are performed without active muscle contraction, meaning no effort is exerted by the person being exercised. Passive exercises are often used to help stroke survivors with hemiplegia (paralysis on one side of the body) or hemiparesis (weakness on one side of the body). They are also an effective treatment for spasticity, which refers to tight, stiff muscles caused by neurological injury.

Passive exercises can be performed with assistance from a therapist or caregiver, or they can be performed independently by using an unaffected limb to move the affected limb. For example, an individual's non-affected arm can be used to move their affected arm.

Passive exercises are particularly beneficial in the early stages of stroke recovery when movement may be more limited. They are a great way to perform early mobilization, which is recommended in the acute stages of stroke recovery. Passive exercises improve blood flow in the affected areas and provide sensory stimulation to the limb. They also help prevent spasticity from worsening and leading to other complications such as curled fingers after a stroke.

Passive exercises are most beneficial when they are used consistently over a long period. Consistent repetition of therapeutic movements helps spark neuroplasticity, the mechanism the brain uses to rewire itself. It's important to pay attention to the movement when performing passive exercises, as they won't be as helpful if done while distracted or disengaged.

Passive range-of-motion exercises are commonly used to improve a joint's range of motion. These exercises are often performed by a physical therapist or with the assistance of a partner or machine. They can help keep joints mobile and decrease the likelihood of any long-term decrease in the overall range of motion.

• Shoulders: Doorway chest stretch—bend your elbow to 90 degrees and line your forearm in an upright position against a doorway opening, then lunge your torso forward to open up your chest and create a stretch.
• Neck: Rotation stretch—while seated, rotate your nose toward your armpit and use your hand to push the back of your head downward.
• Legs: Piriformis stretch (Pigeon pose)—lay your leg in front of you in a bent position and lean over your hips to stretch the piriformis muscle.

Passive exercises are a great starting point for individuals with no movement in their affected limbs. They can be combined with mental practice techniques, such as visualizing oneself performing a skill, to further enhance recovery.

Active assisted exercise using your non-affected side

Active-assisted range of motion exercises, or AAROM, can help restore or maintain the full range of motion after a stroke. These exercises are performed with the assistance of a physical therapist or helper, who supports the individual in completing the movement. Unlike passive exercises, where the provider moves the limbs for the patient, AAROM requires the activation of the patient's muscles to help with the movement.

If you are experiencing a loss of movement in your arm and leg after a stroke, active-assisted exercises can be performed to regain movement. Here are some examples of active-assisted exercises using your non-affected side:

Shoulder Abduction and Adduction: Stand with your arm at your side and elbow bent at a 90-degree angle. Your helper will assist in raising your arm to the side, ensuring it does not go higher than shoulder height. Return to the starting position.

Shoulder Flexion and Extension: Start with your affected arm bent at your side. Your helper will assist you in reaching your arm forward and then returning your elbow back to your side. Keep your body still and focus on the movement in your arm.

Elbow Flexion and Extension: Begin with your affected arm straight and by your side. With the assistance of your helper, bend your elbow, bringing your hand toward your shoulder. Then, straighten your elbow back to the starting position.

Internal and External Arm Rotations: Bend your affected arm and keep your elbow at your side. Your helper will assist as you rotate your hand and forearm out to the side and then return to the starting position.

It is important to consult with your doctor or physical therapist before starting any new exercise program. They can advise you on the most suitable exercises for your specific needs and abilities. Additionally, your therapist can guide you on the proper positioning and strategies to help prevent injuries and promote recovery.

The key to successful rehabilitation is consistency and repetition. By practicing these active-assisted exercises regularly, you will be able to see improvements in your range of motion and overall recovery.

Physical therapy and home exercise routines to prevent spasticity

Physical therapy and at-home exercises are key to preventing spasticity after a stroke. Spasticity is a condition characterized by muscle stiffness or spasms, which can negatively affect mobility and the performance of daily activities. It is a common secondary effect following a stroke, with an estimated 20-50% of stroke survivors experiencing some degree of spasticity.

Physical therapy can help to restore or maintain movement and typically focuses on reducing muscle tone, improving range of motion, increasing strength and coordination, and improving comfort. A physical therapist will assess your joint motion, muscle strength, and endurance, among other factors, to develop an individualized program. This may include stretching, strengthening, and aerobic exercises, as well as gait training and the use of assistive devices such as canes, braces, and walkers.

To prevent and treat spasticity, physical therapy may also involve electrical stimulation therapy, which helps stimulate nerves and improve muscle control. Drug therapy, such as oral muscle relaxants, can also be used in conjunction with physical exercises and stretching to reduce spasticity by interfering with nerve signals that cause muscle contractions.

At home, it is important to continue the exercises recommended by your physical therapist. These may include stretching exercises, which can improve flexibility and reduce muscle spasticity. When stretching, be sure to do so regularly, holding each stretch for around 10 seconds, and always stretch before and after other exercises to prevent muscle strain.

Aerobic exercises are also beneficial, as they strengthen the heart and lungs and improve the body's ability to use oxygen. Walking, stationary bicycling, water exercises, and chair exercises are all excellent choices for aerobic exercise.

Rehabilitation exercises to stimulate the brain and spark neuroplasticity

After a stroke, it is common to experience weakness or even paralysis on one side of the body, which can cause difficulties with movement and independence. Stroke rehabilitation can help to improve your chances of recovery, and the first three months are when most people make the most significant gains. However, it is important to remember that every stroke is different, and recovery is unique to each individual.

Passive Arm Exercises

Passive arm exercises can be performed independently by using your unaffected arm to move your affected arm. Alternatively, a therapist or trained caregiver can assist by moving your affected arm for you. These exercises help stimulate the brain and activate neuroplasticity, encouraging the brain to adapt through repetitive practice. With consistent practice, you may start to see signs of progress, such as twitches in your arm, indicating that your arm is regaining movement.

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. It is important to find a balance between challenging and frustrating when creating a rehabilitation exercise regimen. Paying attention to the quality of your movements is crucial, as practicing good movement patterns is essential for optimal recovery.

Constraint-Induced Movement Therapy

This technique involves restricting your unaffected arm to encourage the use of your affected arm. For example, you can place an oven mitt over your unaffected hand while performing an activity. This type of therapy can increase brain plasticity, helping the brain to repair itself and regain function in the affected hand. While it can be frustrating, it is most effective when used for more extended periods in conjunction with intensive therapy.

Electrical Stimulation Therapy

Electrical stimulation therapy is a safe way to stimulate the nerves and improve muscle control. It can help reduce pain and spasticity, as well as improve muscle tone and regain control of the affected limb. Consult with your therapist before attempting this, as they can guide you on the correct areas to place the electrodes and how to use the machine safely.

Weight-Bearing Exercise

Weight-bearing exercises help encourage muscle activation and improve arm movement. This can be done while sitting or standing, gradually putting weight through your affected forearm or hand on a surface. This provides input from your arm to your brain, rewiring their connection through neuroplasticity. You can incorporate weight-bearing exercises into your daily activities, such as leaning on your affected arm while brushing your teeth or playing cards.

Fine Motor Skills Practice

Fine motor skills are small, precise movements made with your hand and fingers. You can improve these skills by tracing designs, shuffling cards, using a pegboard, or picking up small objects. Repetition is crucial to help retrain your brain, so it is essential to practice these skills daily.

Using walking devices such as walkers, canes, and wheelchairs

After a stroke, you may need to use a walking device such as a walker, cane, or wheelchair to get around. These devices can provide support and stability when walking and help improve your overall mobility. It's important to get the right device for your needs and to use it safely.

Canes

Canes are a simple and effective way to lend support to the leg. They are typically held in the hand on your strong side and moved simultaneously with your weaker leg. Canes come in a variety of designs and should be sized correctly with a grip that feels comfortable for you. The distal tip of a cane should have a rubber ferrule to prevent slipping.

There are two main types of canes: single-point canes and quad canes. A single-point cane is a good choice for conditions like arthritis, where a little extra support can alleviate pain and discomfort. A quad cane offers more stability than a single-point cane and is suitable for people with neurological impairments or significant weakness.

Walkers

A walker is the most supportive walking aid, providing excellent stability for those with balance issues or limited upper body strength. Standard walkers must be lifted and moved with each step and are not suitable for use on stairs or escalators. Newer types of walkers have additional features, such as wheels, seats, hand brakes, and storage pouches. These walkers, known as rollators, are a good choice for individuals with limited upper body strength as they don't need to be lifted and can be used safely on slopes.

Wheelchairs

If you need a wheelchair, a member of your healthcare team will fit you with a chair that meets your physical and practical needs. They will ensure that you know how to sit properly and check if you require a seat cushion or backrest. Proper positioning will help prevent injuries and pressure sores. You will also need to learn how to transfer safely in and out of the wheelchair. Additionally, you should plan how to navigate your home in the wheelchair, ensuring there is enough room to pass through doorways and turn around.

Choosing and Using a Walking Device

A physical therapist or occupational therapist can help you choose the right walking device for your needs. They will assess your gait, balance, cognition, and any neurological or musculoskeletal challenges you may have. It's important to follow their instructions on how to use your walking device safely and correctly.

Frequently asked questions