How to improve stroke
by Sultan
(UK)
Question: How do you improve patient’s hand, fingers, and leg movement? Please tell me some exercises for my mother. Thanks.
Answer: If your mother already has some movement in her hand and fingers then I would recommend some of the exercises from this website’s hand exercises page at www.stroke-rehab.com/hand-exercises.html.
If she does not have any movement or only little movement in her hand, then I recommend trying to put weight through the arm to facilitate sensory input. This can be done by placing the hand on a firm surface and helping to support her elbow while she leans into the hand. When there is little movement in the upper extremity, it’s best to eliminate gravity as much as possible and provide assist as needed. I often place the hand on a ball and see if the patient can elicit movement. If approved by her MD, you could talk to a therapist about using electrical stimulation to facilitate movement.
Some simple hand and arm exercises I use after a stroke are as follows (stretch the hand prior to exercises):
1) Place patient’s open hand on ball and have them work on just keeping the hand on the ball without assistance
2) Once they can keep the hand on the ball, try rolling the ball gently side to side and forward and back
3) Once they can roll the ball, place both hands on the sides of the ball (soccer ball works well) and try to lift the ball off their lap using both hands and
without the weak hand falling off
4) As they are able to lift the ball, work on lifting the ball higher or moving it side to side
5) Work on taking weak hand off the ball slowly and with controlled movement
6) Once they can move hand off/on ball with some control, work on placing hand on smaller objects such as a plastic cup and letting go. Progress to trying to lift the cup.
Some other options to help facilitate return of the hemiplegic arm include using e-stim with a therapist or tapping the muscles you are trying to stimulate. If trying to close the hand, turn the palm up and tap the forearm muscles. If trying to open the hand, turn the palm down and tap the back of the forearm.
Weight bearing is also good for the leg. If your mother is able to stand, have a therapist show her how to shift weight onto the weak leg and work on weight bearing on the affected side. A physical therapist can also show you tapping techniques to help facilitate movement. For example, to elicit straightening the knee, you would tap the top of the thigh.
If you are looking for therapy ideas, I suggest looking on You Tube for stroke rehab exercises. Many therapists and patients have recorded their therapy sessions which might give you ideas on what would work for your mother. You should always consult a therapist or physician that has worked with your mom to make sure any exercises would be appropriate for her.
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Gaining Strength After Stroke
by Jayesh Mehta
(Wellingborough in UK)
Question: I suffered a hemorrhagic stroke in April 2009 and subsequently got senses back in all of my body. As an effect of the stroke, my left side, even though movement feels OK, is a bit weak due to prolong time in bed (8 months in hospital+rehab). My body has lost its strength and hence I can’t get up from a sitting position. I have joined a gym to gain strength and am a full time worker post stroke. The reason for this note is to see what you can suggest to get some strength back – to be able to get up by myself and take a few steps, etc. (not looking for running down the street). Please share anything that you think might help.
Thanks
Jayesh
Answer: I like to use hi-lo mats to help patients improve their ability to stand from a sitting position. A hi-lo mat can be adjusted to a low or high position. I will have my patients sit on the mat and then raise the height. We will practice weight bearing through the legs with the mat elevated (with the buttocks still on the mat) and then will practice sit to stand from this position. I will block the knee on their weak side if necessary to prevent the leg from buckling. An air splint can also be used to help keep the leg from collapsing. Once a patient has gained confidence in standing then I work on the patient shifting weight side to side and learning to take more weight through the weak leg. I also vary the height of the hi-lo mat to work on sit to stand from different heights. As the legs and core get stronger, one will be able to get up from a lower height.
A physical therapist should be able to help you with the techniques described above. I don’t know about equipment in the UK but hi-lo mats are standard equipment in a US therapy clinic.
One might could use a hospital bed or lift chair to achieve the same effect as a hi-lo mat, however, I haven’t tried this out. You should always check with your medical provider before attempting any exercises and also have a therapist or trained caregiver with you when attempting such exercises as described above.
Below is an examples of a hi-lo mat. One can purchase these mats, however, they are expensive.
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