Posts Tagged stroke recovery

[WEB PAGE] The Truth about the Plateau in Stroke Recovery

As a stroke survivor, you may have heard someone say, “You’ve reached a plateau,” or “You’re plateauing.” A plateau is high flat land, so what does it have to do with your stroke recovery?

Immediately after you have a stroke is when everything is at the very worst. You may be paralyzed, confused, and unable to speak. Each day you get better as your brain heals, recovering from the shock of the stroke. The progress in the first few weeks or months is often rapid— a steadily upward line on the recovery chart.

But then the slope of that line may start to grow more horizontal. The change doesn’t come as fast or as spontaneously. As that line flattens out, you’ll start to hear about a plateau in your progress. After you’ve reached it, it may feel like you’re stuck—unable to climb any higher. Therapists may start to suggest your therapy will end. Doctors might say this is the best you’ll ever be. And you know what? They might be right— if you believe them.

The Myth of the Plateau in Stroke Recovery

Lots of stroke survivors keep improving, years after their stroke. They say the plateau doesn’t exist – it’s a myth! But doctors are saying it’s real – that recovery slows or stops. So is the plateau in stroke recovery true, or is it a myth?

It’s both. While it’s true that spontaneous recovery in the brain does slow down after a period of time post-stroke, the key word there is spontaneous. That means it happens without you even trying. If you’re riding the wave of recovery, thinking each day is going to be better than the last, there will come a point when that stops being true. When you see that you’re not getting better, you may start to feel sad and hopeless. And then things really stop getting better. In fact, they may start to get worse because you’re depressed.

Related Article: The Under-Recognized Connection between Aphasia and Depression

The myth part of the plateau concept is that there’s nothing you can do about it. The brain can and will continue to change and improve if you work at it. Progress is absolutely possible years after stroke with focused exercises toward specific goals. It’s just not as easy as it was early on. You have to set a target, break it down into steps, and work on it repetitively. You may need to work on just one goal at a time. But you can make progress. You have to maintain your hope and motivation, and you’ll start to see change again.

Plateau in stroke recovery means something different than you might think. Focused effortful progress comes after rapid spontaneous recovery.

Ups and Downs in Stroke Recovery

There are always ups and downs in stroke recovery. Some days your skills may take a dip, or even a dive. If you’re tired, sick, overwhelmed, or stressed, your speech or mobility may suffer. These downturns may last a few hours, a few days, or even a few weeks. But over time, they’ll get better. If they don’t, it’s a good signal to go talk to your doctor or therapist to see if something else may be causing the decline. Usually, you’ll return to your best abilities once you’re rested or relaxed.

Plateau means flat. Recovery is always up and down, but generally up.

There are also exciting upturns, like when a full sentence comes out perfectly, or your finger moves in a way it never has before. This spark of recovery may only last a moment, but it’s good news. It often means your brain is ready for the next step.

With all the daily ups and downs, the important thing to focus on is the overall trend of recovery. What can you do today that you couldn’t do a month ago? How much better do you sound now than six months ago? Keeping a journal, a video diary, or weekly recordings of yourself can really help you to see the progress over time that you may not notice day-to-day.

Tactus Therapy apps make it easy to track your progress. You can send detailed reports after each session, then compare when you’re ready. Try our aphasia apps for free to see how you can keep your stroke recovery going. Not sure where to start? Our App Finder can help!

What to Do When You Reach a Plateau in Stroke Recovery

Since we know that progress can stall out, it’s important to understand how to jump-start recovery again. Here are some things you can try to get things moving again:

Set a new functional goal

Learn to set SMART goals: specific, measurable, achievable, relevant, and time-bound. When you’re working systematically toward something that matters to you, your motivation will stay high.

Use a new evidence-based technique

Research tells us what works and for whom. Ask your therapist about techniques that are proven, or start with our How To guides for evidence-based speech therapy treatments and our Language Therapy app that has been proven to help people make progress, years after stroke.

Sign up for a research study

Get the latest cutting-edge treatments by being part of the research studies that will inform therapists. It may not always work, or you may be part of a control/placebo group, but it feels good to help others and you may just luck out with a great new treatment.

Try a new therapist

It may not be you who’s stuck— it may be your therapist. Starting therapy with a new clinician can bring fresh eyes and a different bag of tricks to help you solve your problems.

Join a stroke or aphasia group

Support groups can help in so many ways: friendship, inspiration, and exercises. It helps to know you’re not alone in stroke recovery. If there are none in your area, try an online group, like #2 on this list.

Learn a new hobby or skill

Using your mental and physical abilities in fun activities can reap benefits in other areas of your life. Take up the piano and you may see improvement in buttoning your shirt. Join a bridge group to strengthen your math and attention skills you need to manage your finances.

Volunteer

Get out and help others to add purpose to your life. Babysitting, dog walking, or visiting lonely elders can give you more chances to speak without feeling judged. Community gardens and food banks offer a chance to get out of the house and help.

Take a break

Sometimes taking a break from therapy can let your brain recharge and refocus, while giving you time to do things you enjoy. Having fun is therapeutic too, and it can inspire new functional goals.

Don’t get discouraged

Everyone recovers at different rates. Don’t compare your recovery to others. Hope is the most powerful drug there is, so do everything you can to hold onto it.

Stroke recovery isn’t easy, and it isn’t fast, but you can always make progress. Henry Ford famously said, “Whether you think you can, or think you can’t– you’re right.”

Source: https://tactustherapy.com/stroke-recovery-plateau-truth-myth/

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[Abstract + References] Assessment of Sex Differences in Recovery of Motor and Sensory Impairments Poststroke

Abstract

Background. Understanding potential sex differences in stroke recovery is important for prognosis, ensuring appropriate allocation of health care resources, and for stratification in research studies. Previously, functional measures have shown poorer outcomes for females, however, little is known about sex differences that may exist in specific motor and sensory impairments. 

Objective. The aim of this study was to utilize robotic assessments of motor and sensory impairments to determine if there are sex differences at the impairment level in stroke recovery over the first 6 months poststroke. 

Methods. We used robotic and clinical assessments of motor and sensory impairments at 1, 6, 12, and 26 weeks poststroke in 108 males and 52 females. Linear mixed models were used to examine the effect of sex on recovery poststroke, controlling for age and lesion volume. 

Results. In general, we did not find significant sex differences across a range of assessments. The exception to this was a sex × age interaction for the Purdue Pegboard Assessment, where we found that females had better performance than males at younger ages (<62 years), but males had better performance at older ages. 

Conclusions. While recruitment biases need to be acknowledged when generalizing our results to stroke recovery at-large, our results suggest that sex differences do not exist at the impairment level poststroke.

References

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Source: https://journals.sagepub.com/doi/abs/10.1177/1545968320935811

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[ARTICLE] Pushing the Rehabilitation Boundaries: Hand Motor Impairment Can Be Reduced in Chronic Stroke – Full Text

Abstract

Background. Stroke is one of the most common causes of physical disability worldwide. The majority of survivors experience impairment of movement, often with lasting deficits affecting hand dexterity. To date, conventional rehabilitation primarily focuses on training compensatory maneuvers emphasizing goal completion rather than targeting reduction of motor impairment. 

Objective. We aim to determine whether finger dexterity impairment can be reduced in chronic stroke when training on a task focused on moving fingers against abnormal synergies without allowing for compensatory maneuvers. 

Methods. We recruited 18 chronic stroke patients with significant hand motor impairment. First, participants underwent baseline assessments of hand function, impairment, and finger individuation. Then, participants trained for 5 consecutive days, 3 to 4 h/d, on a multifinger piano-chord-like task that cannot be performed by compensatory actions of other body parts (e.g., arm). Participants had to learn to simultaneously coordinate and synchronize multiple fingers to break unwanted flexor synergies. To test generalization, we assessed performance in trained and nontrained chords and clinical measures in both the paretic and the nonparetic hands. To evaluate retention, we repeated the assessments 1 day, 1 week, and 6 months post-training. 

Results. Our results showed that finger impairment assessed by the individuation task was reduced after training. The reduction of impairment was accompanied by improvements in clinical hand function, including precision pinch. Notably, the effects were maintained for 6 months following training. 

Conclusion. Our findings provide preliminary evidence that chronic stroke patient can reduce hand impairment when training against abnormal flexor synergies, a change that was associated with meaningful clinical benefits.

Introduction

Stroke is one of the leading causes of death and disability globally,1,2 resulting in a wide range of physical, emotional, and cognitive consequences.3 Among the most common physical sequela of stroke are hemiparesis and spasticity, two forms of motor impairment that affect daily living and overall quality of life in approximately 80% of survivors.3 Hand impairment, in particular, is often present in the chronic stage after stroke, frequently manifesting itself as both a decrease in finger strength, loss of dexterity (negative signs), and abnormal hand flexion synergy, characterized by a pattern of involuntary motor activation resulting in finger and hand flexion (positive signs).4,5 Indeed, one of the most prominent deficits in hand dexterity is increased finger enslaving, or unintended force produced by the uninstructed fingers. This hand function abnormality is thought to be a direct result of lesions to the motor cortex and corticospinal tract,5,6,7,8,9 as these are known to be critical for the control of independent finger movements (i.e., finger individuation).5,1013

Previously, we have shown that stroke patients recover both finger individuation and strength relying on separable recovery processes.5 Recovery asymptotes after the first 3 to 6 months, although typically remains far from the level of performance of healthy individuals, especially for the individuation component. Over the past few years, different training and rehabilitation strategies have assessed the effect of finger and hand training as well as virtual reality environments in chronic stroke patients in an attempt to improve deficits in dexterous movement.1420 Some of these works reported positive gains in clinical measures of hand dexterity. However, these studies cannot distinguish between compensatory maneuvers versus true impairment reduction as the mechanism underlying clinical benefits. Specifically, these studies did not fully assess force control in the finger individuation tasks,14,1820 used gross measures of hand dexterity and did not report a detailed individuation metric,14,16 and/or did not report post-training long-term retention of clinical outcomes or retention of improvement in finger individuation.14,18,20 In the present study, we use a direct and quantitative measure of finger dexterity5.

The goal of this study was to discern whether true hand motor impairment can be reduced in the chronic phase after stroke following personalized multidimensional training targeting finger dexterity that minimizes the use of compensatory maneuvers to facilitate performance. To this end, we modified a previously published piano-chord-like task13,21 to train finger dexterity by asking participants to practice in an intense manner against their baseline flexion synergy. Task difficulty during practice was adjusted for each participant based on baseline ability, controlling for individual differences in initial weakness and performance. Participants cannot perform this task by recruiting actions beyond their fingers. We tested both the short- and long-term retention of trained and nontrained hand-chord postures. We quantified hand dexterity by measuring finger individuation and also gauged the impact of the training on clinical outcome measures of impairment, activity, and participation. We hypothesized that intensive training focused on moving fingers against abnormal synergies while minimizing compensatory movements, would improve the ability of patients with chronic stroke to individuate their fingers and perform functional tasks better.

Materials and Methods

Participants

We recruited a cohort of eighteen participants with ischemic stroke and hemiparesis (5 female, 13 male; age 61.3 ± 2.1 years, mean ± SEM). We administered multiple screening assessments during the pretest session to determine participant eligibility. We included participants if they met the following inclusion criteria: (1) age 21 years and older; (2) ischemic stroke at least 6 months prior (time poststroke of 49.7 ± 11.4 months, mean ± SEM), confirmed by computed tomography, magnetic resonance imaging, or neurological report; (3) residual unilateral upper extremity weakness; (4) ability to give informed consent and understand the tasks involved; (5) appearance of flexion synergy in the hand, evaluated by observation of a trainee and/or neurologist; and (6) the ability to extend fingers ≥5° from resting position, as evaluated by a stroke specialist. We excluded participants with one or more of the following criteria: (1) cognitive impairment, as seen by a score of <20/30 on the Montreal Cognitive Assessment (MoCA); (2) history of a physical or neurological condition that interferes with study procedures or assessment of motor function (e.g., severe arthritis, severe neuropathy, Parkinson’s disease); (3) inability to sit in a chair and perform upper limb exercises for one hour at a time; (4) participation in another upper extremity rehabilitative therapy study during the study period; (5) terminal illness; (6) social and/or personal circumstances that interfere with the ability to return for therapy sessions and follow-up assessments; (7) pregnancy; and (8) severe visuospatial neglect, as seen by a score of <44/54 on the Star Cancellation Test. Among the screened patients, 3 patients were excluded from the study. One participant had hemorrhagic stroke, one showed cognitive-related issues in understanding the task and could not sign the informed consent, and the third patient did not show residual unilateral upper extremity weakness. For detailed participant characteristics, see Table 1.

Table 1. Patient Characteristics in the Trained Cohort.a

Table 1. Patient Characteristics in the Trained Cohort.aView larger version

Apparatus to Measure and Train Finger Dexterity

We tested participants’ hand function using an ergonomic device, designed and published previously5, that measures isometric forces produced by each finger (Figure 1A). The hand-shaped keyboard was comprised of 10 keys with force transducers (FSG-15N1A, Honeywell; dynamic range 0-50 N) underneath each key at the position of the fingertips. Downward flexion force exerted at each fingertip was measured at a sampling rate of 200 Hz. The data were digitized using National Instruments USB-621x devices interfacing with MATLAB (The MathWorks, Inc) Data Acquisition Toolbox. Visual stimuli were presented on a computer monitor (22 inches), run by custom software written in MATLAB environment using the Psychophysics Toolbox (Psychtoolbox).22


                        figure
Figure 1. Experimental apparatus and protocol. (A) Ergonomic hand device. Force sensors beneath each key measured the force exerted by each finger in real time. (B) Computer screen showing the instructional stimulus, which indicates both which fingers to press and how much force to produce (height of the green bar). (C) All possible combinations of 2-finger and 3-finger chords tested at baseline and in all post-training sessions. (D) Experimental protocol. During the pre-test, clinical assessments and baseline performance on maximal voluntary contraction force (MVF), individuation, and chord tasks (all possible combinations) were assessed in both hands. During the 5 days of training, participants practiced 6 chords (3 two-finger and 3 three-finger) with the paretic hand (420 trails per day). During post-tests, clinical assessments and performance were reassessed in both hands.

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Source: https://journals.sagepub.com/doi/full/10.1177/1545968320939563

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[BLOG POST] What is Neuroplasticity? A Psychologist Explains [+14 Exercises]

What is Neuroplasticity? Definition + 14 Brain Plasticity Exercises

Our brains are truly amazing, aren’t they?

Have you ever watched one of those specials on someone who experienced an amazing, unexpected recovery after a traumatic brain injury, stroke, or other brain damage? Some of those stories seem like the only explanation is magic.

Although it certainly seems inexplicable, scientists have been hard at work studying exactly these cases over the last several decades, and have found the explanation behind the magic: neuroplasticity.

Before you read on, we thought you might like to download our 3 Positive Psychology Exercises for free. These science-based exercises will explore fundamental aspects of positive psychology including strengths, values and self-compassion and will give you the tools to enhance the wellbeing of your clients, students or employees.

You can download the free PDF here.

What is the Meaning of Neuroplasticity?

Neuroplasticity refers to the brain’s ability to adapt. Or, as Dr. Campbell puts it:

“It refers to the physiological changes in the brain that happen as the result of our interactions with our environment. From the time the brain begins to develop in utero until the day we die, the connections among the cells in our brains reorganize in response to our changing needs. This dynamic process allows us to learn from and adapt to different experiences” – Celeste Campbell (n.d.).

Our brains are truly extraordinary; unlike computers, which are built to certain specifications and receive software updates periodically, our brains can actually receive hardware updates in addition to software updates. Different pathways form and fall dormant, are created and are discarded, according to our experiences.

When we learn something new, we create new connections between our neurons. We rewire our brains to adapt to new circumstances. This happens on a daily basis, but it’s also something that we can encourage and stimulate.[…]

Continue —-> What is Neuroplasticity? A Psychologist Explains [+14 Exercises]

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[ARTICLE] Nervous System Pathophysiology: A critical time window for recovery extends beyond one-year post-stroke. – Full Text

Abstract

The impact of rehabilitation on post-stroke motor recovery and its dependency on the patient’s chronicity remain unclear. The field has widely accepted the notion of a proportional recovery rule with a “critical window for recovery” within the first 3–6 mo poststroke. This hypothesis justifies the general cessation of physical therapy at chronic stages. However, the limits of this critical window have, so far, been poorly defined. In this analysis, we address this question, and we further explore the temporal structure of motor recovery using individual patient data from a homogeneous sample of 219 individuals with mild to moderate upper-limb hemiparesis. We observed that improvement in body function and structure was possible even at late chronic stages. A bootstrapping analysis revealed a gradient of enhanced sensitivity to treatment that extended beyond 12 mo poststroke. Clinical guidelines for rehabilitation should be revised in the context of this temporal structure.

NEW & NOTEWORTHY Previous studies in humans suggest that there is a 3- to 6-mo “critical window” of heightened neuroplasticity poststroke. We analyze the temporal structure of recovery in patients with hemiparesis and uncover a precise gradient of enhanced sensitivity to treatment that expands far beyond the limits of the so-called critical window. These findings highlight the need for providing therapy to patients at the chronic and late chronic stages.

 

INTRODUCTION

The absolute incidence of stroke will continue to rise globally with a predicted 12 million stroke deaths in 2030 and 60 million stroke survivors worldwide (). Stroke leads to focal lesions in the brain due to cell death following hypoxia and inflammation, affecting both gray and white matter tracts (). After a stroke, a wide range of deficits can occur with varying onset latencies such as hemiparesis, abnormal posture, spatial hemineglect, aphasia, and spasticity, along with affective and cognitive deficits, chronic pain, and depression (). Due to improved treatment procedures during the acute stage of stroke (e.g., thrombolysis and thrombectomy), the associated reduction in stroke mortality has led to a greater proportion of patients facing impairments and needing long-term care and rehabilitation. However, prevention, diagnostics, rehabilitation, and prognostics of stroke recovery have not kept pace ().

Motor recovery after stroke has been widely operationalized as the individual’s change in two domains: 1) body function and structure (), whose improvement has been called “true recovery” () and refers to the restitution of a movement repertoire that the individual had before the injury; and 2) the ability to successfully perform the activities of daily living (). While the former is mainly due to the interaction of poststroke plasticity mechanisms and sensorimotor training, the latter is also influenced by the use of explicit and implicit compensatory strategies (). The most accepted measure for recovery of body function and structure is the change in the Fugl-Meyer Assessment of the upper extremity (UE-FM) scores (), while other clinical scales focus on the assessment of activities, such as the Chedoke Arm and Hand Activity Inventory (CAHAI) () or the Barthel Index for Activities of Daily Living (BI) ().

Poststroke motor recovery mostly follows a nonlinear trajectory that reaches asymptotic levels a few months after the injury (). This model suggests the existence of a period of heightened plasticity in which the patient seems to be more responsive to treatment, the so-called “critical window” for recovery. Aiming at characterizing the temporal structure of recovery, animal models and clinical research have identified a combination of mechanisms underlying neurological repair that seems to be unique to the injured brain, including neurogenesis, gliogenesis, axonal sprouting, and the rebalancing of excitation and inhibition in cortical networks (). This state of enhanced plasticity seems to be transient and interacts closely with sensorimotor training to facilitate the recovery of motor function (). However, there is no clear evidence of the exact temporal structure of enhanced responsiveness to treatment in humans, and as a result the optimal timing and intensity of treatment remain unclear. A systematic review of 14 studies suggested that, on average, recovery reaches a plateau at 15 wk poststroke for patients with severe hemiparesis and at 6.5 wk for patients with mild hemiparesis (). This study however failed to conduct a meta-analysis due to substantial heterogeneity of the sample and protocols. Currently, an ongoing clinical trial is investigating the existence and the duration of a critical window of enhanced neuroplasticity in humans following ischemic stroke (). Based on the assumption of the existence of this critical period, the SMARTS 2 trial (NCT02292251) () is currently investigating the effect of early and intensive therapy on upper extremity motor recovery. Sharing the same research question, the Critical Periods After Stroke Study (CPASS) is a large ongoing randomized controlled trial that focuses on determining the optimal time after stroke for intensive motor training (). To contribute to the delineation of a temporal structure of stroke recovery in humans, we performed an analysis of individual patient clinical data from 219 subjects with upper-limb hemiparesis, who followed occupational therapy (OT) or a virtual reality (VR)-based training protocol using the Rehabilitation Gaming System (RGS) () (Fig. S1 in Supplemental Material; all Supplemental material is available at https://doi.org/10.5281/zenodo.3246368). We show that physical therapy has a significant impact on the function of the upper extremity (UE) at all periods poststroke considered, uncovering a gradient of responsiveness to treatment that extends >12 mo poststroke.[…]

Continue —->  Nervous System Pathophysiology: A critical time window for recovery extends beyond one-year post-stroke

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[Abstract + References] Cognitive Reserve as an Emerging Concept in Stroke Recovery

Stroke is a leading cause of death and disability. It is a complex and largely heterogeneous condition. Prognosis for variations in impairment and recovery following stroke continues to be challenging and inaccurate, highlighting the need to examine the influence of other currently unknown variables to better predict and understand interindividual differences in stroke impairment and recovery. The concept of “cognitive reserve,” a feature of brain function said to moderate the relationship between brain pathology and clinical outcomes, might provide a partial explanation. This review discusses the potential significance of cognitive reserve in the context of stroke, with reference to reduced burden of disability poststroke, health promotion, intervention and secondary prevention of cognitive impairment, ease and challenges of translation into clinical practice, prognosis and prediction of recovery, and clinical decisions and trial stratification. Discussions from the review aim to encourage stroke clinicians and researchers to better consider the role of premorbid, lifestyle-related variables, such as cognitive reserve, in facilitating successful neurological outcomes and recovery following stroke.

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via Cognitive Reserve as an Emerging Concept in Stroke Recovery – Emily Rosenich, Brenton Hordacre, Catherine Paquet, Simon A. Koblar, Susan L. Hillier,

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[ARTICLE] Cost Analysis of a Home-Based Virtual Reality Rehabilitation to Improve Upper Limb Function in Stroke Survivors – Full Text PDF

Abstract

Loss of arm function occurs in up to 85% of stroke survivors. Home-based telerehabilitation is a viable approach for upper limb training post-stroke when rehabilitation services are not available. Method: A costing analysis of a telerehabilitation program was conducted under several scenarios, alongside a single-blind two-arm randomized controlled trial with participants randomly allocated to control (N=25) or intervention group (N=26). Detailed analysis of the cost for two different scenarios for providing telerehabilitation were conducted. The fixed costs of the telerehabilitation are an important determinant of the total costs of the program. The detailed breakdown of the costs allows for costs of future proposed telerehabilitation programs to be easily estimated. The costs analysis found that a program supplying all required technology costs between CAD$475 per patient and CAD$482 per patient, while a program supplying only a camera would have total costs between CAD$242 per patient and $245 per patient. The findings of this study support the potential implementation of telerehabilitation for stroke survivors for improving accessibility to rehabilitation services. This cost-analysis study will facilitate the implementation and future research on cost-effectiveness of such interventions.

  • Full Text:  PDF 

via Cost Analysis of a Home-Based Virtual Reality Rehabilitation to Improve Upper Limb Function in Stroke Survivors | Veras | Global Journal of Health Science | CCSE

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[Abstract + References] Vibrotactile cueing using wearable computers for overcoming learned non-use in chronic stroke

ABSTRACT

Outpatient stroke rehabilitation is often lengthy and expensive due to patients’ lack of functional use of the impaired arm outside of the clinic caused by “learned non-use.” Learned non-use is detrimental to stroke recovery, often resulting in chronic disability. To overcome learned non-use, a wearable “personal assistant” solution is proposed that employs ubiquitous cueing to stimulate patient use of the paretic arm while outside of therapy sessions. A pilot user study is presented that evaluated stroke survivors’ tolerance and acceptance of cueing, and the usability of the proposed implementation.

References

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  3. C. E. Lang et al., “Upper extremity use in people with hemiparesis in the first few weeks after stroke,” Journal of Neurologic Physical Therapy, vol. 31, no. 2, pp. 55–63, Jun. 2007.Google ScholarCross Ref
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  5. M. S. Cameirão, S. B. i Badia, E. Duarte, A. Frisoli, and P. F. M. J. Verschure, “The combined impact of virtual reality neurorehabilitation and its interfaces on upper extremity functional recovery in patients with chronic stroke,” Stroke, vol. 43, no. 10, pp. 2720–2728, Oct. 2012.Google ScholarCross Ref
  6. J. Lieberman and C. Breazeal, “TIKL: Development of a wearable vibrotactile feedback suit for improved human motor learning,” IEEE Transactions on Robotics, vol. 23, no. 5, pp. 919–926, Oct. 2007. Google ScholarDigital Library
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  8. T. Markow et al., “Mobile Music Touch: Vibration stimulus in hand rehabilitation,” in International Conference on Pervasive Computing Technologies for Healthcare (PervasiveHealth), pp. 1–8, 2010.Google Scholar
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via Vibrotactile cueing using wearable computers for overcoming learned non-use in chronic stroke | Proceedings of the 7th International Conference on Pervasive Computing Technologies for Healthcare

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[Submissions from Readers] Stroke Recovery

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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[Abstract] Ergometer training in stroke rehabilitation: systematic review and meta-analysis

Abstract

Objective

Ergometer training is routinely used in stroke rehabilitation. How robust is the evidence of its effects?

Data source

The PubMed database and PEDro database were reviewed prior to 22/01/2019.

Study selection

Randomized controlled trials investigating the effects of ergometer training on stroke recovery were selected.

Data extraction

Two reviewers independently selected the studies, performed independent data extraction, and assessed the risk of bias.

Data synthesis

A total of 28 studies (including 1115 stroke subjects) were included. The data indicates that

(1) ergometer training leads to a significant improvement of walking ability, cardiorespiratory fitness, motor function and muscular force of lower limbs, balance and postural control, spasticity, cognitive abilities, as well as the brain’s resistance to damage and degeneration,

(2) neuromuscular functional electrical stimulation assisted ergometer training is more efficient than ergometer training alone,

(3) high-intensity ergometer training is more efficient that low-intensity ergometer training, and

(4) ergometer training is more efficient than other therapies in supporting cardiorespiratory fitness, independence in activities of daily living, and balance and postural control, but less efficient in improving walking ability.

Conclusion

Ergometer training can support motor recovery after stroke. However, current data is insufficient for evidence-based rehabilitation. More data is required about the effects of ergometer training on cognitive abilities, emotional status, and quality of life in stroke subjects.

via Ergometer training in stroke rehabilitation: systematic review and meta-analysis – Archives of Physical Medicine and Rehabilitation

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