Strength Training For Stroke Recovery: A Guide

Stroke recovery is a long and challenging process that requires hard work and dedication. The recovery journey varies for each individual, depending on the extent of the stroke's impact and the person's unique circumstances. However, there are effective strategies to help stroke victims regain their strength and enhance their recovery.

One crucial aspect of stroke recovery is exercise, which plays a pivotal role in improving mobility, cognitive function, balance, and muscle mass. Exercises can be initiated within 24 hours of a stroke, starting with low-intensity movements and gradually progressing. Physiotherapy and rehabilitation exercises focus on various body parts, including legs, arms, shoulders, and the core, aiding in the restoration of physical abilities and functions. Additionally, exercises that strengthen the core improve balance, reduce the risk of falls, and facilitate everyday activities such as walking.

Another important consideration in stroke recovery is neuroplasticity, the brain's ability to reorganize and rewire itself after an injury. By engaging in consistent and repetitive tasks or thoughts, neuroplasticity is activated, enabling the brain to create new connections and improve efficiency. This helps individuals rebuild their skills and overcome the secondary effects of a stroke.

Furthermore, a healthy diet and adequate sleep are essential components of stroke recovery. Consuming foods that promote neurogenesis, such as fish, pomegranate, nuts, seeds, and blueberries, can boost the creation of new neurons in the brain. Additionally, stroke survivors often experience increased sleep requirements as the brain recovers, and sufficient sleep aids in memory consolidation and provides the brain with necessary rest.

To optimize recovery, individuals should work closely with their healthcare team to develop a personalized rehabilitation plan that addresses their specific needs and goals. This plan may include exercises, cognitive behavioural therapy, memory improvement activities, speech therapy, and bowel or bladder management. Family and friend involvement can also positively impact the recovery process.

Walking exercises

Walking is one of the most important goals in post-stroke rehabilitation. Gait training and balance training are key components of this process, helping stroke victims improve their balance and coordination, and increase the strength of their hips, knees, and ankles to support their body when they move.

Gait Training

Gait training helps stroke victims improve their walking pattern and increase their walking speed. It involves specific exercises that target the muscles and joints involved in walking.

• Walking with long steps: This exercise helps improve balance and stability by challenging the centre of mass to move over the base of support.
• Quick stepping in different directions: This exercise improves the rate of voluntary movement and the ability to weight-bear on the affected leg.
• Pushing an instructor off balance: This is a fun and interactive exercise that helps improve balance and stability.
• Walking with hands on hips: This exercise helps improve posture and balance by engaging the core and stabilising the pelvis.
• Walking with a weight vest: Adding weight to the walk increases the intensity and challenges the body, improving strength and endurance.
• Walking on a treadmill: Treadmill walking can help improve gait speed and endurance in a controlled environment.

Balance and Agility Exercises

Balance and agility exercises are crucial for improving stability and reducing the risk of falls. They include slow and fast movements that challenge the body in different ways.

• Tai Chi-like movements: Slow, controlled movements help improve balance and stability by challenging the centre of mass.
• Lunges: Lunging in different directions improves weight-bearing ability and challenges the body's sense of balance.
• Single-leg stance: This exercise involves standing on one leg while maintaining balance and stability. It improves strength and endurance in the affected leg.
• Heel-to-toe walking: Walking with the heel just touching the toes of the other foot improves balance and coordination.
• Walking with an obstacle course: Creating an obstacle course with cones or chairs helps improve agility and dynamic balance.
• Walking with a partner: Walking with a partner or caregiver can provide support and assistance, improving confidence and balance.

It is important to gradually progress these exercises, starting with simple movements and increasing the challenge as strength and balance improve. Additionally, it is crucial to have a qualified therapist supervise and guide the stroke victim during these exercises to ensure safety and effectiveness.

Foot drop treatment

Foot drop is a condition that results in the difficulty or inability to lift the front part of the foot because of fatigue or damage affecting the muscles and nerves that control its movement. This can cause difficulty walking, as the person may scuff their toes along the ground, increasing the risk of falling.

Treatment Options:

Physical Therapy

Foot drop exercises are designed to strengthen the lower limb muscles to improve the ability to lift the foot. Exercise also helps stimulate and rewire the brain, which makes it an effective way to overcome foot drop after a stroke. Physical therapists will often send patients home with a list of exercises to do at home to provide the brain with the repetition it needs to recover.

Ankle-Foot Orthosis (AFO)

An AFO is worn on the lower part of the leg to help control the ankle and foot. It holds the foot and ankle in a straightened position to improve walking.

Electrical Nerve Stimulation

In some cases, an electrical stimulation device can be used to improve walking ability. Two self-adhesive electrode patches are placed on the skin, one near the nerve supplying the muscle and the other over the centre of the muscle. The stimulator produces electrical impulses that stimulate the nerves to contract the affected muscles.

Surgery

In severe or long-term cases of foot drop that have caused permanent movement loss, surgery may be an option. This usually involves transferring a tendon from the stronger leg muscles to the muscle that should be pulling the ankle upwards. Another type of surgery involves fusing the foot or ankle bones to help stabilise the ankle.

Speech therapy

Tongue Exercises

Tongue stretches and exercises help strengthen the tongue muscles and improve oral motor skills. This includes sticking the tongue out and holding it for a few seconds before pulling it back in and repeating. Another exercise is moving the tongue from side to side, touching the corners of the mouth and holding for a few seconds. A similar exercise involves moving the tongue up and down, reaching towards the nose and then the chin.

Breathing Exercises

Breathing exercises help regulate breathing while speaking, making it easier for individuals to speak at length and be understood. This involves planning out breaths while speaking and repeating sentences with the appropriate breathing pauses.

Practicing Speech Sounds

This involves focused practice on specific sounds and words. For example, repeating similar sounds like "ah, ay, at, al, ack," etc., and then moving on to another set. This exercises the mouth and tongue, improving the ability to form sounds and words.

Sentence Practice

While singular word formation may not be an issue, forming complete and correct sentences can be challenging. This exercise involves practicing saying certain words and sounds and then trying to construct sentences. This can be done by reading aloud or using the "naming pictures" exercise, where individuals try to construct a sentence based on pictures.

Phonological Processing

This exercise involves guessing the number of syllables in words stated by a family member or caregiver. The feedback given is an essential part of this exercise, helping to improve speech production skills.

Word Games

Playing word games such as Boggle, Scrabble, or Bananagrams can be a fun way to practice speech therapy exercises. Individuals can choose to work on cognitive language skills or adapt the game to include speaking. For example, stating each word created aloud to practice speech production.

It's important to note that the effectiveness of speech therapy depends on the area of the brain affected by the stroke and the severity of the brain damage. Working with a speech therapist is ideal to determine the most appropriate exercises for the individual's specific needs.

Memory improvement

Memory loss is a common symptom of stroke, but there are ways to help stroke victims improve their memory. Here are some methods to help stroke victims enhance their memory:

Brain Exercises and Games

Playing games that require the use of memory, such as classic board games, memory games, card games, and puzzles, can be an effective way to improve memory. These games stimulate the brain and encourage neuroplasticity, helping the brain to adapt and regain functions. Additionally, memory games and exercises can be done through technology-based programs and applications, such as the CT Speech & Cognitive Therapy App, which offers exercises focused on improving cognition and language.

Speech Therapy

Speech-language pathologists (SLPs) can play a crucial role in improving memory after a stroke. They help individuals with speech and language impairments, as well as cognitive tasks. Speech therapy stimulates the brain to form new neural connections, aiding in memory recovery.

Occupational Therapy

Occupational therapists can assist stroke victims in adapting and modifying their daily activities to improve memory and cognitive function. They provide strategies to compensate for memory impairments and promote functional independence.

Healthy Lifestyle Choices

Adopting a healthy lifestyle can positively impact memory improvement. This includes a healthy diet, such as the MIND diet, which emphasizes brain-healthy foods like fresh fruits, vegetables, and fish rich in omega-3 fatty acids. Regular exercise is also crucial, as it improves blood flow to the brain and enhances cognitive function.

Implementing specific techniques can aid in memory improvement:

• Using memory cues: Connecting a task or information to something meaningful, such as an image, familiar name, or song, can help trigger your memory.
• Creating routines: Establishing consistent daily routines for essential activities, such as taking medication or bedtime tasks, can reduce the cognitive load and improve memory.
• Using reminders: Leaving notes, setting alarms, or using reminder apps can help individuals stay organized and remember important tasks.
• Simplification: Simplifying complex activities, such as cooking, by using fewer ingredients or pre-cut items, can reduce the cognitive load and improve memory retention.
• Lists: Making lists for tasks, such as grocery lists or cleaning checklists, can ensure that tasks are completed and help individuals maintain their independence.

It is important to note that memory loss after a stroke can vary depending on age, stroke severity, location, and the support system of the individual. While medications may help manage related problems like anxiety, depression, or sleep issues, there is currently no medication that can directly reverse memory loss caused by a stroke. However, with consistent practice and the implementation of these strategies, individuals can improve their memory and enhance their overall cognitive function.

Regain muscle mass

Regaining muscle mass is an important part of stroke recovery. The exercises that aid in this process will often be difficult and should be approached with caution, but they will help the patient make progress.

Before beginning any exercise routine, it is important to get advice from a physician or physical therapist. It is also important to note that each patient should have a custom exercise routine, personalized to their specific needs.

• Mini squats with support: Stand facing the back of a chair and grasp either side of the top of the chair. Slowly bend the knees as if sitting down, keeping the knees, hips, and feet in line, and body weight equally distributed. Push up through the feet, straightening the knees and spine, and return to the starting position. Repeat this exercise 15-20 times.
• Side lying hip flexion: Lie on the unaffected side of the body with the head resting on a bent arm, ensuring the hips are level and the hips, legs, and feet are in line. Slowly raise and bend the affected leg inward toward the chest or belly, and then straighten it back to the starting position. Repeat this exercise 15-20 times or until the leg muscles become fatigued.
• Standing hip abduction with support: Stand facing a countertop and place your hands on top of it for support. Gently move the leg out to the side, keeping the leg straight and the foot pointing forward.
• Shoulder horizontal range of motion: Lie flat on your back on a hard, flat surface. Place the affected arm on the ground beside your body with the elbow bent so the forearm stands up. Reach the unaffected arm across the body to meet the affected arm and interlock the fingers of both hands. Using the unaffected arm, pull the affected arm across the body toward the side of the unaffected arm as far as comfortable. Repeat this exercise 10-15 times.
• Scapular protraction: Lay flat on your back on a hard, flat surface. Slowly lift and straighten the affected arm until it is perpendicular to the body. Make a fist with your hand and punch upward, lifting the shoulder blade off the ground slightly. Repeat until the arm or shoulder muscles become fatigued, then gently lower the arm and rest. Once the muscles are no longer fatigued, repeat the exercise.
• Crumpling a piece of paper: Sit with your arms supported on a hard surface, such as a table, and put a piece of paper down on the table. Pick up the piece of paper with both hands and begin to crumple it, ensuring that the shoulder stays straight and back. Slowly uncrumple the paper, making sure the shoulder blades are down and back. Repeat this exercise 10-15 times or until the hands become too fatigued.
• Supported and unsupported reaching and grasping: Sit with the affected arm lying flat on a table, with the shoulders up and back. Reach the affected arm straight outward, as if trying to reach an object, and extend the fingers as much as comfortable. Grasp the fingers together, making a fist, and then draw the affected arm back toward the body in a straight line, bending the elbow. Repeat this exercise 20 times or until the hand or arm muscles become too fatigued.

It is important to be consistent with these exercises and to approach them with a positive mindset. Recovery from a stroke is a lengthy process that requires patience and consistent effort, but considerable progress can be made.

Frequently asked questions