Exercise Rehabilitation After a Stroke
Physical therapy is critical after a stroke to regain strength, coordination, balance, motor control, and function. A stroke occurs when blood flow to an area of the brain is cut off, depriving the brain cells of oxygen and leading to physical and cognitive impairments. Using a targeted exercise rehabilitation program early in the post-stroke recovery period, a physical therapist can help stroke survivors relearn basic motor skills, maximize their functional abilities, enhance their independence, and improve their quality of life.
How Strokes Impact Physical Function
Strokes are the fifth leading cause of death worldwide and the leading cause of disability, with a new stroke happening every 40 seconds. In the United States, 800,000 people experience a stroke each year and 2/3 of those who suffer strokes in the United States need rehabilitation.
A stroke occurs when the blood flow to an area of the brain is cut off, depriving the brain cells of oxygen, and resulting in cell death. Blood flow to the brain can be obstructed by a blood clot traveling into the arteries that supply the brain (an ischemic stroke) or due to a fall or blow to the head (hemorrhagic stroke). When brain cells die, the abilities that that area of the brain controls can be impaired and contribute to disability.
Following a stroke, an individual may have paralysis (usually on one side of the body), movement and motor control issues, posture and balance problems, incontinence, blurred vision, sensory issues like limb numbness or loss of ability to feel touch or temperature, or memory and language issues. Stroke survivors may develop ataxia, which are jerky, uncoordinated movements or hemiplegia, which is weakness on one side of the body.
In fact, statistics show that about 40% of patients suffer from functional impairments after a stroke and 15-30% experience severe motor, sensory, cognitive, perceptual, and/or language impairments. More than 85% of those with stroke experience hemiplegia, which can cause impaired upper limb function, decreased motor ability, and balance problems.
Exercise Rehabilitation After a Stroke
Physical therapy is critical after a stroke to regain strength, coordination, balance, and motor control, particularly shortly after a stroke. Research has shown that the first 3-6 months after a stroke are the most vital for recovery as the brain enters a state of heightened neuroplasticity right after a stroke, allowing for adaptive changes and functional improvements more easily. Neuroplasticity is activated through repetitive practice, which builds and strengthens neural pathways in the brain to learn and relearn motor and cognitive skills.
A physical therapist plays a pivotal role in helping stroke survivors capitalize on the brain’s heightened neuroplasticity post-stroke and in safely relearning motor skills.
Physical therapy treatment post-stroke can include:
Motor skill exercises: This type of exercise focuses on improving coordination and the ability to control gross and fine motor skill movements. Gross motor skills include moving larger limbs like the arms and legs, while fine motor skills require dexterity in the hands to grasp and grip objects.
Aquatic therapy: Exercising in a warm water pool can be beneficial for stroke survivors as it allows the survivor to build strength and improve balance in a safe environment without risk of falling. The warmth of the water can reduce muscle pain and tension, the water’s resistance can improve strength, and practicing in a pool usually reduces the fear of falling.
Constraint-induced movement therapy (CIMT): This type of treatment involves restricting or constraining the unaffected arm to encourage use of the affected arm to complete certain tasks. The aim is to prevent stroke survivors from overcompensating for weakness on the affected side with the fully functioning side. By restraining the unaffected arm, this forces the patient to use the affected arm to improve muscle activation, strength, and coordination.
Functional electrical stimulation (FES): This treatment involves using low-energy electrical pulses to activate weak muscles and nerves. Electrodes are placed on certain muscles to stimulate either relaxation or contraction of those muscles. This helps to promote motor recovery by providing visual and sensory feedback and helps avoid disuse atrophy, a common stroke complication.
Range of motion exercises: These exercises improve the mobility of joints and flexibility of muscles, particularly as increase muscle tone or contractures can occur post-stroke that restrict movement in the arm, leg, hand, or ankles.
Bilateral arm training: This is a form of more intensive training that involves performing movements or activities with your arms at the same time but independently of each other.
Strength training: Resistance training of the upper and lower extremities can be beneficial for stroke survivors to progressively rebuild strength in weakened limbs post-stroke.
Gait and balance training: As the stroke survivor progresses in healing, the therapist provides retraining for a normal walking pattern and implements functional movement training like getting in and out of bed or standing up from a chair. The therapist can also help patients practice using assistive devices like a cane or walker.
Stair training: If the stroke survivor progresses towards improved balance and a normal walking pattern, the therapist may also implement a series of stair training to help the stroke survivor recover range of motion and confidence navigating stairs and slopped environments.
According to the American Stroke Association, exercise therapy is beneficial for stroke survivors with many studies reporting that gait-oriented training, aerobic treadmill training, intensive mobility training, and physiotherapeutic interventions can improve function and reduce disability in stroke survivors. A review of 21 stroke rehabilitation studies found that combining functional training and aerobic and resistance exercises was more effective for survivors than functional training alone. A recent 2022 study found that physical therapy treatment for stroke survivors improved postural control, balance, physical activity, gait, and health-related quality of life during the first 12 weeks after a stroke.
In a 2017 study investigating the effects of stair task training on walking ability in stroke patients, thirty-six patients with stroke were selected randomly and divided into two groups: the experimental group and the control group. The study reported that the gait training group that used the 10-cm high stairs showed the biggest improvement in balance and muscle activations compared to the other group.
At Mangiarelli Rehabilitation, we understand that a stroke can be a life-altering event in your family and in your life. As physical therapists, we are here to accompany you through your stroke recovery and help you regain movement, function, and the best possible quality of life.
