[ARTICLE] Effectiveness of Rehabilitation Exercise in Improving Physical Function of Stroke Patients: A Systematic Review

Abstract

Rehabilitation is a crucial part of recovery for stroke survivors, and numerous studies have examined various exercises and treatments of stroke. In addition, it is very important for patients to choose the timing of rehabilitation and what kind of rehabilitation they will proceed with. The purpose of the current study is to examine research investigating the effects of rehabilitation exercise programs in recovery of physical function in patients with stroke, based on aspects of their physical function, physical strength, and daily activities, and systematically examine their effects. Therefore, through systematic review, we have investigated the effects of interventions in rehabilitation exercise programs for recovery of physical function in patients with stroke. We collected relevant publications through the databases MEDLINE/PubMed and Google scholar. Twenty-one articles were ultimately selected for the analysis. We classified the rehabilitation programs and identified the trends of treatment for stroke survivors. Our review indicated that task-oriented therapy is still dominant, but various types of combined rehabilitations have been attempted. In addition, it was identified that physical and active rehabilitation were required rather than unconditional rest, even at an early stage. Home-based treatment was used for rapid recovery and adaptation to daily life during the mid-term period.

1. Introduction

Stroke is a cerebrovascular disease that occurs when blood supply to the brain is interrupted, or when bleeding occurs in brain tissue, resulting in loss of brain function [1]. Stroke is a terrifying disease occurring every two seconds, with people dying every six seconds due to stroke worldwide, and 15 million new cases occurring yearly. Approximately 40% of patients suffer from functional impairment after stroke onset, and 15–30% experience severe motor, sensory, cognitive, perceptual, and/or language impairments [2,3]. In particular, more than 85% of patients with stroke experience hemiplegia, which results in impaired upper limb function and decreased motor ability [4]. This impairment is a major factor that affects the ability to balance, and the levels of daily and social activities [5].

Rehabilitation is vital for minimizing sequelae after stroke, and patients who undergo continuous professional and systematic rehabilitation following the acute phase tend to recover rapidly [6,7]. Drug and rehabilitation therapy are currently practiced rehabilitation treatments for stroke. Various interventions can be applied for recovery, such as bilateral training, repetitive task training, constraint-induced movement therapy, electrical stimulation, robotic therapy, and exercise [8]. Among these, exercise is crucial because it helps patients return to activities of daily life by restoring the function of impaired muscles and improving physical function. Exercise is also essential for preventing secondary complications, as was reported in a study determining that continued exercise and physical activity after a stroke reduce the risk of recurrence of cardiovascular disease and mortality [9].

Commonly used rehabilitation exercises include those for central nerve development, passive or active exercise, progressive resistance exercise, mat exercise, and balance, postural, mobility, and gait training. According to previous studies, the approaches to rehabilitation exercises are different depending on the stage of the stroke and the types of exercise (passive, isometric, isokinetic, and isotonic) [10]. In particular, studies show that applying rehabilitation exercise early after stroke is effective [11]. However, as physical or occupational rehabilitation therapy is mainly focused on the early-onset stage, essential exercise is rarely applied in the early stages of rehabilitation. In addition, rehabilitation exercise is effective if it is utilized at the appropriate time in accordance with individual functional suitability [12].

Therefore, guidelines for each type of exercise (passive/isometric/isokinetic/isotonic) are necessary, as well as programs tailored to the individual functional levels of patients, such as the time since the injury occurrence. This customized approach will help patients with stroke recover quickly even after discharge, which will save time and cost. While there are numerous studies on restoring function in patients with stroke, systematic comparative analysis studies on the effectiveness of rehabilitation exercise interventions that consider the timing of the occurrence of impairment and the type of exercise in the clinical field are difficult to find. Therefore, a systematic analysis of studies applying rehabilitation exercises for physical function recovery in patients with stroke is necessary.

This study aims to examine research investigating the effects of rehabilitation exercise programs in recovery of physical function in patients with stroke, based on aspects of their physical function, physical strength, and daily activities, and systematically examine their effects. Based on the study findings, we will present the types and programs of exercises optimized for the phase of injury in patients with stroke. […]

Source

[WEB PAGE] The Ultimate Guide to Stroke Exercises

Functional recovery is possible, even years after a stroke. Learn how to harness neuroplasticity through repetitive exercise, and the all-around health benefits of staying active after stroke or brain injury.

By JUNE LEE, 21 SEP 2020 

Having a stroke is a mentally and physically taxing experience. According to the World Health Organization (WHO), 15 million people suffer from stroke worldwide each year. Of these, 5 million people die, and many survivors are left permanently disabled.

Stroke survivors may lose physical abilities and cognitive skills or undergo behavioral changes because strokes cause temporary or permanent damage to the brain areas that control those functions.

But here is the good news: the brain is able to recover after stroke, whether initially or months to years later. While short-term recovery after stroke (called spontaneous recovery) is limited to the first six months, long-term functional recovery can occur at any point thereafter. Stroke survivors who continue to engage their affected side in daily activity and exercise can capitalize on functional recovery potential throughout their stroke journey.

The Importance of Stroke Exercise for Rehabilitation and Recovery

The brain is capable of rewiring and repairing itself even if its cells are damaged. The undamaged parts step in to perform the tasks that the damaged parts were performing. This phenomenon (called neuroplasticity) allows stroke survivors to regain lost movement and function. The key to neuroplasticity is the consistent performance of repetitive tasks so that the brain can relearn how to perform these tasks through different neural pathways.

In simpler words, stroke exercise is one of the most effective means by which stroke patients can heal themselves, get stronger, improve the quality of their lives, and maximize their recovery from stroke. Because lifestyle factors like being overweight and having high blood pressure are a common cause of stroke, daily exercise becomes even more important in reducing the risk for recurrent stroke and other complications.

No matter the severity of the stroke, survivors can improve their quality of life through healthy lifestyle changes and engagement in restorative activities. Whether implementing big changes or small ones, the key to meaningful functional recovery is engaging in your post-stroke routine changes consistently.

The Physical and Mental Health Benefits of Stroke Recovery Exercises

Let’s look at some of the important physical and mental health benefits of engaging in stroke rehabilitation exercises. Post-stroke exercise is shown to produce many positive outcomes, which may include:

Physical benefits

1. Speeds up all-round stroke recovery
2. Recovers strength
3. Improves endurance
4. Increases walking speed
5. Improves balance
6. Boosts the ability to perform daily routine activities
7. Prevents the recurrence of strokes.

Mental benefits

1. Reduces depression and enhances mood
2. Boosts brain health
3. Relieves stress
4. Helps in increasing a sense of self-worth and self-reliance that can decrease after a stroke
5. Gives patients a sense of purpose and a goal to work towards.

Exercises to help Patients in Stroke Recovery at Home

The positive effects of post-stroke exercise are undeniable. However, when setting up an exercise routine as a stroke survivor, it is important to incorporate both cardiovascular fitness and muscle strengthening to ensure the most effective outcomes.

Stroke exercises are always safer to do with a loved one or caregiver around. However, if that is not possible, patients can modify an exercise program to ensure safe performance. For instance, completing exercises from sitting as opposed to standing to avoid loss of balance. It is also wise to consult a doctor or a therapist should any uncertainties about any of the stroke exercises arise or if you have any other underlying health condition.

Cardiovascular Fitness

Aerobic exercise is fundamental to building a healthy heart, improving endurance, and maintaining healthy lungs. Cardiovascular exercise can also improve the sensory perception and motor skills of stroke survivors. Walking outside or on a treadmill, stationary cycling, recumbent cross training and many other forms of exercise that get your heart pumping are extremely beneficial for stroke recovery.

Stroke survivors must get at least 20-60 minutes of light to moderate aerobic exercise (50 to 80% of your maximum heart rate) 3 to 7 days a week to improve the chances of stroke recovery. Patients can choose to do aerobic exercise at one go or in smaller sessions during the day.

Resistance Exercises for Strengthening Muscles

Resistance training or muscle strength training plays a crucial role in post-stroke recovery, as it helps to recover physical strength, stamina, stability, and improve range of motion.

Here are some commonly prescribed exercises for stroke recovery at home:

1. Wrist Curls

Equipment: A stable chair with armrests (preferably padded), light weights, or any household object which can provide some resistance and is easy to grip.

How To Do It: Sit up straight on the chair. Place your arms on the rests with your palms facing upward. Let your wrists dangle over the edge of the armrests. Grasp the weights firmly and comfortably, and with slow controlled movements, bend your wrist up towards your forearm and back down again (only your wrists should be moving).

Benefits: Wrist curls are isolated movements that build forearm strength, improve range of motion, and enhance gripping ability.

2. Wrist and Hand Stretch

Equipment: Stable chair with armrests.

How To Do It: With your arms facing downward and your wrists dangling over the edge of the armrest, drop your hand down and use your other hand to gently lift your wrist up and down and side to side.

Benefits: This simple movement stretches the ligaments in the wrist and forearms to maintain range of motion.

Modification: If you add a weight while completing this exercise, you are completing a reverse wrist curl, strengthening the muscles on the opposite side of your forearm.

3. Shoulder Openers

Equipment: Light weights or any light object that can be gripped easily and will provide some resistance.

How To Do It: Grasping your weights (make fists with your fingers facing inwards), hold your arms at your sides, and bend your elbows 90 degrees. With slow controlled movements, move your fists outwards while keeping your arms in position at your sides (like you are opening a door). Bring your arms back to your starting stance. (Can be performed both sitting or standing).

Benefits: This exercise improves range of motion and strength in the shoulders.

4. Table Towel Slide

Equipment: Folded Towel and table.

How To Do It: Place the towel in front of you. With your weaker hand on the towel and your stronger hand on top of it, slide the towel away and towards you (using your stronger hand to guide and push). Apart from going back and forth, you could also go clock and counter-clockwise, forming circles on the table.

Benefits: Stretches and strengthens shoulder and arm muscles and promotes neuroplasticity through improved arm coordination.

5. Trunk Bends

Equipment: A stable chair.

How To Do It: Sit on the edge of your chair with your feet planted slightly apart but firmly on the ground. Bend forward as far as you can, and try to reach your ankles or the floor between your legs. Then use your core muscles for sitting back up as straight as you can.

Benefits: Improves core strength and helps with weight shifting.

6. Knee Rotations

Equipment: Firm, flat surfaces such as a bed or a mat.

How To Do It: Lie on your back and rest your hands by your sides. Bend your knees with your feet flat on the floor. Keeping your knees together, drop them, slowly, to the left then, bring them back to the center. Then drop them to the right and back to the center.

Benefits: Improves core, back strength, coordination, and balance.

7. Hip Abduction

Equipment: Stable chair.

How To Do It: Sit up straight on the edge of your chair. Gently tighten your abs and straighten one knee. With your toes pointed to the ceiling, slowly move your foot out to the side. Return to the starting stance, then repeat on the other side. You can decrease the intensity by lying down and performing this exercise or make it more difficult by attempting this from standing, if you are capable.

Benefits: Strengthens hips, core, leg, back, and improves coordination and stability.

8. Standing Knee Raises

Equipment: A firm surface to hold on to.

How To Do it: Stand with your back straight and hold on to a firm surface. Shifting your weight to one leg, bring the other leg up in front of you while bending your knee to a 90-degree angle. Hold for a few seconds and resume the starting position. Then switch legs.

Benefits: Strengthens upper and lower abs, hips, and back. It also helps with posture, balance, and coordination.

9. Sit to Stands

Equipment: Stable chair.

How To Do it: Sit up tall in your chair with your knees bent (90 degrees). Place your feet firmly on the floor shoulder-width apart. Slowly rise to a standing position while ensuring that your knees never cross the tips of your toes. Sit back down slowly and in a controlled manner. To make it less intense, use your arms for support, and to make it more difficult, cross your arms on your chest.

Benefits: Strengthens core and upper thigh muscles, improves weight shifting and balance.

10. Hip Thrusts

Equipment: A flat, firm surface like a bed or a mat.

How To Do it: Lie on your back with your feet flat on the ground and knees bent. Place your arms by your sides, palms down. Gently contract your abs and squeeze your glutes (backside muscles) to lift your hips and make a bridge. Hold on this position for a few seconds and lower to the starting stance. You can make it easier by straightening your legs and placing a rolled-up towel under your knees, then squeezing and lifting your hips. You could also make it more intense by lifting one foot at a time while holding the bridge.

Benefits: It boosts the strength of the core, glutes, lower back muscles, and muscles that support the spine.

Frequency and Intensity of Stroke Exercises

Stroke exercise is most beneficial if done consistently and repetitively. It is always best to consult your medical team about the type and frequency of exercises that are optimal for your unique situation. Do not risk your safety by attempting things that you are unsure about.

As a guideline, resistance exercises should be done 3-5 times a week. 2-3 sets of 12-15 repetitions (of each exercise) should be completed to achieve noticeable results. A survivor who is new to exercise post-stroke exercises may have to work up to the ideal frequency of exercise over time.

Stroke exercise should never cause pain. Pain may indicate that you are causing new or lasting damage to your muscles and joints. If your exercises produce a burning, shooting, or otherwise uncomfortable sensation, stop immediately and modify the activity (ex. reduce weight, perform the exercise within a smaller range of motion). If it is not possible to perform the activity without pain, remove it from your program and ask your doctor.

Conclusions

A stroke results in drastic and sudden changes in life that can leave survivors struggling physically, socially, and emotionally. However, proper stroke exercise is the path to reclaiming the body, mind, and quality of life. With determination and hard work, there is light at the end of the tunnel and a more promising future ahead.

For more information, support, or to know more about the latest developments in stroke recovery, give us a call at (888) 623-8984 or email at info@neofect.com.

Source: https://us.blog.neofect.com/the-ultimate-guide-to-stroke-exercises/