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.

The Ultimate Guide to Stroke Exercises

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
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5020059/#B100]. 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
[https://www.neofect.com/us/blog/tips-for-unlocking-neuroplasticity-after-stroke-part-1]
) 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
[https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/stroke-risk-factors-and-prevention#:~:text=Lifestyle%20factors%20that%20increase%20your,diet%20and%20lack%20of%20exercise.] 
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.

Post-Stroke

Having good balance after a brain injury is crucial. Here are 5 sitting and standing exercises that you can start today for improved performance and safety.

10 Exercises to Improve Balance After Brain Injury

A brain injury can be a life-changing event, in ways both big and small. There
are many different causes of brain injuries, which include not only concussions
and traumatic brain injuries, but also events such as a stroke. Depending on the
severity of the brain injury and where in the brain the injury occurred, the
ability to balance may be affected. It is important to address balance issues to
decrease the risk of falls and other associated injuries, such as broken bones.


Balance Problems After Brain Injury: An Overview
 * How a Brain Injury Affects Balance
 * How to Improve Balance After Brain Injury
 * 5 Seated Exercises to Improve Balance
 * 5 Standing Exercises to Improve Balance

Balance problems including dizziness or lightheadedness may come on suddenly
after brain injury. You can make your daily activities safer by inviting a
supportive companion and identifying places to rest if needed. Post-Brain Injury Balance Disorders
Balance is a key part of everyday life and involves the coordination of many
different systems within our bodies. We use our ability to balance for
everything; from sitting and standing upright to walking and performing daily
tasks such as, cooking, cleaning, and self-care. Common balance disorders after
a brain injury may include:

 * A sensation of dizziness where it may seem as if you or your surroundings are
   moving.
 * Unsteadiness when standing upright and walking
 * Lightheadedness and associated unsteadiness

Issues with balance can occur as a result of damage to structures within the
inner ear (vestibular system), difficulty with eyesight (vision), or damage to
parts of the brain that help us sense where our body is in space
(proprioception). After a brain injury, most patients will work with their
doctor to determine the specific cause of imbalance. The doctor will monitor
things such as blood pressure and medication use, to ensure that these are not
contributing factors to a patient’s symptoms.



 Improving Balance After a Brain Injury
Some patients may attend physical therapy to begin working on improving their
balance. A therapist will perform a detailed evaluation in order to establish a
personalized treatment plan for each patient. Prescribed treatment and exercises
will then be performed to help improve symptoms. It is important to address both
strength and flexibility when exercising, since our bodies use different
strategies from various muscle groups to help us stay upright.



 5 Seated Strengthening Exercises to Improve Balance
 1. Practice sitting upright without support so that you have to use your core
    muscles. If this is easy, you can attempt to reach up, down, and to the
    side, and then return to center.



 2. If sitting on a stable surface (such as a hard chair) and reaching is also
    too easy, you can practice sitting on a less stable surface to further
    challenge your balance. For example, sit on a soft cushion, then progress to
    something like a big therapy ball. Be sure to stay in a corner or near a
    stable surface, so that you may have something to hold onto for safety as
    needed.
    
    
 3. Ankle exercises are also important because the muscles in our ankles are
    often some of the first to contract when we experience a loss of balance.
    Ankle exercises include performing heel raises and toe raises when sitting.
    You can also make circles, or trace the alphabet with your foot. Just be
    sure to hold your leg still so the movement is isolated only to the ankle
    joint and not the hip or knee joints.
    
    
    
 4. Practice moving from sitting to standing to strengthen your hip muscles.
    Use a light resistance band placed around the upper thighs to practice 
    clamshells
    [https://www.healthline.com/health/fitness-exercise/the-clamshell-exercise].
    A clamshell exercise can be performed by opening and closing the legs to
    work the outer hip muscles.
    
    
 5. Place a pillow between your knees and practice squeezing the pillow. Hold
    each squeeze for five seconds. This exercise will work the inner thigh
    muscles. Work up to performing three sets of ten repetitions of each
    exercise.
    
    

 5 Standing Exercises to Improve Strength and Balance
 1. Stretch your calf muscles to provide enough motion at the ankle joint for
    walking and balancing. You can use a stair at home and let one heel hang off
    the stair while holding onto the railing. Or you can perform a “Runner’s
    Stretch
    [https://www.popsugar.com/fitness/photo-gallery/3102547/image/3102808/Wall-Calf-Stretch]
    ” at the wall. Hold each stretch for 30-60 seconds.
 2. Perform the heel and toe raises for ankle strengthening in standing vs.
    sitting for added resistance.
    
 3. Perform “mini squats [https://www.youtube.com/watch?v=X8XutSsocx4]” at a
    support surface, such as the counter or back of a sofa. Be sure to send your
    bottom backwards as if you are sitting in an invisible chair, so that your
    knees do not go over your toes.
 4. Challenge your balance in standing. First, stand with your feet together. If
    this is easy, you can switch your foot position and place one foot in front
    of the other so the heel of your front foot touches the toes of your back
    foot. Progress to standing on one foot
    [https://www.youtube.com/watch?v=7SF7AYh2_Yw] when you are ready. Try to
    hold each position for at least 30 seconds. You can make this activity even
    more challenging by closing your eyes, or performing head turns or nods
    while attempting to balance.
 5. Perform reaching in standing and try to move your arms and body over your
    feet without moving your feet. You can practice reaching up, down, and side
    to side. To make exercises four and five even more challenging, you can try
    standing and reaching on an unstable surface. For example, place a couch
    cushion on the floor and try balancing and reaching while standing on the
    cushion.

Always have family member or friend supervise for safety during balance
exercises.
As with any physical activity, please make sure you have been cleared by your
doctor before starting a new exercise routine. Also, because you will be
challenging your balance, please make sure that you perform these activities
with a caregiver or near a stable surface that can provide support to prevent
falls or additional injury.  Balance work can be challenging, but it will make a
difference in your ability to perform daily activities safely and independently.


Call (888) 623-8984 or email info@neofect.com to rehab smarter with Neofect
today!

Balance

Research shows that practicing arm movements related to daily living goals may be more effective at improving arm function than standard exercise. Maximize your post-stroke rehab routine by incorporating task-specific training.

Rehab with Real-World Objects for Improved Hand Use After Stroke

If you've been through stroke rehabilitation, chances are that you're familiar
with the phrase, "use it or lose it". Your therapist likely told you this while
explaining the principle of neuroplasticity
[https://www.neofect.com/us/blog/tips-for-unlocking-neuroplasticity-after-stroke-part-1]
, the brain's potential to reorganize after damage to regain lost functions.
Hopefully "use it or lose it" has helped you remember to engage your weaker arm
throughout the day in order for it to make progress!

Here's another catchy rehab phrase for your repertoire: "you gain what you
train". Research shows that practicing arm movements related to daily living
goals may be more effective at improving arm function than standard,
non-goal-directed arm exercise. Basically, if you want to be able to hold eating
utensils or write with your affected arm, you're better served by putting a fork
or a pen to use than you are by lifting a dumbbell or pinching putty.

"You gain what you train" seems obvious, right? So, why belabor the point? 
Because many stroke survivors are not practicing real-world skills with their
affected arm on their own time. Learning a new skill requires hours of practice
and thousands of repetitions. Stroke survivors must ensure they are dedicating
sufficient time at home to addressing their specific arm use goals in order to
improve.

Think about your current post-stroke home exercise program. Does it go beyond
basic stretching and strengthening? If not, consider incorporating task-specific
training into your routine to maximize arm and hand function.



Task-specific training overview
 * What is task-specific training (TST)?
 * Who can do TST?
 * How can I do TST at home?
 * How much should I do TST?
 * What if I can't do TST?
 * Do I have to do TST after stroke?
 * TST: The Bottom Line

What is task-specific training (TST)?
Task-specific training is a therapy technique focusing on improving function of
a hemiplegic (weakened)
[https://www.neofect.com/us/blog/hemiplegia-vs-hemiparesis] arm through repeated
activity practice. Just like how you learned to tie your shoes or ride a bike, 
TST requires consistent performance of the component steps of a task to help the
brain re-learn the big-picture skill.

Task-specific training activities for the post-stroke hemiplegic arm incorporate
a real-world object and involve the following four steps:

 1. Reaching for the object
 2. Grasping the object
 3. Moving or manipulating the object
 4. Releasing the object

Ideally, a participant will repeat this sequence many times over multiple
sessions to show skill improvement. Research studies generally indicate that
more repetitions and a greater frequency of training are better.

 Who can do TST?
Stroke survivors with sufficient movement to repeatedly reach for an object,
hold on to it, and release it using their affected arm are good candidates for
TST.

Anyone with activity restrictions on their affected side, or those who
experience pain when using their affected side should consult with their medical
team before attempting TST.



How to do task-specific training at home:
First, think about what you would like to be able to do better using your
affected arm and hand. TST goal activities should be centered around a task that
has clear and consistent steps and also involves an object. Although that might
sound complicated, there are countless TST possibilities available in your home
using your everyday belongings. Any of the following ideas make for great TST
goals:

 * Using a cup, fork, or spoon
 * Brushing your hair
 * Pulling your pants up
 * Turning a book page
 * Opening a door handle
 * Writing your signature
 * Putting coins into a piggy bank
 * Hammering a nail
 * Putting laundry into a basket

TST skills can also involve your unaffected hand. Consider using your affected
hand in the dominant role of a two-handed task, while letting your stronger hand
play the role of helper or stabilizer.

 * Fastening buttons or zippers
 * Tying shoelaces
 * Opening containers
 * Pouring liquid from one container into another
 * Putting credit cards into a wallet
 * Wringing out a wet washcloth
 * Putting a stamp on an envelope
 * Folding laundry into halves or quarters

Because TST involves repeating the steps of an activity using your affected arm,
we need to think about how to measure performance. Completing a reach, grasp,
manipulate, release sequence is considered one repetition of a task. The goal of
TST is to complete as many repetitions as possible. View the examples of
measuring one repetition from the TST tasks on our list above:

Using a spoon: Pick up the spoon from the tabletop, bring it up to your mouth,
put it back on the tabletop, return hand to starting position
Writing your signature: Pick up the pen from the tabletop, bring it to paper to
write your full name, put the pen back on the tabletop, return hand to starting
position
Note: The affected arm starts and ends in the same position relative to the task
object/s (e.g. on the tabletop next to the object)

Putting credit cards into a wallet: One repetition = pick up credit card from
tabletop, insert and remove credit card from wallet (held by unaffected hand),
place credit card on tabletop, return hand to starting position
Note: For a two-handed task, you may choose to repeatedly pick up the stabilized
object using your unaffected hand, or hold it throughout the task

After you have defined your activity and what a repetition looks like, you're
ready to go! You may choose to practice one activity in a TST session, or, for a
longer session, you may pick two or three goal areas.



 How much and how often should I do TST?
Studies show that between one and five repetitions of a task per minute may be
ideal to promote improved arm function. Gauge your performance by performing a
15-minute TST test. Have a helper time the number of repetitions you can do
during this period. If you have achieved between 15 and 100 repetitions, you're
in the TST sweet spot: continue practicing the skill! If you are over 100
repetitions, it is time to make the task more difficult by adding more complex
elements (e.g. using heavier objects, attempting the task from standing as
opposed to sitting). If that is not possible, try practicing a different, harder
skill.

Research has also demonstrated that completing 60 minutes of task-specific
training four times per week can produce significant arm function improvements.
This is an amount that you may have to build up to. If one hour seems daunting,
try to ease into TST by attempting increasingly longer intervals, aiming for 5
more minutes of TST each time you practice.

 What if I can't do task-specific training?
Stroke survivors who have some but not all required arm functions to perform TST
may choose to perform a modified version incorporating only the elements within
their capabilities. For instance, TST might consist of repeatedly reaching to
tap an object with the hand as opposed to grasping and releasing it.

If you have minimal to no movement in your affected arm, you will not be able to
perform TST. However, your affected side can still play a role in your daily
living tasks. Use your stronger side to place your affected arm within your
field of vision during tabletop tasks. If you are doing a two-handed task, use
the stronger arm to place the weaker arm to hold or stabilize objects. Even
though doing this is not TST, you are still promoting function of your affected
side while preventing learned non-use.

Do I have to do task-specific training after stroke?
TST is just one tool in your upper extremity stroke rehab toolbox. There are
several other evidence-supported activities
[https://www.neofect.com/us/blog/the-top-5-evidence-based-treatments-for-improving-hand-function-after-stroke] 
that may improve arm and hand function. Some people may not be able to perform
TST without the guidance of a therapist, while others may not be motivated by
the intervention. If you have questions on how to perform TST at home or whether
it is the right option for you, consult with your therapy team.



The bottom line: practice means progress
We'll conclude with one final catchy rehab phrase: "practice means progress".
Needless to say, improving weakened arm function after a stroke can be a long
and sometimes frustrating ordeal. However, additional keys to success are right
in front of you in the forms of your daily tasks and personal belongings. With
practice and repetition, your goals are within reach!

References

French B, Thomas LH, Coupe J, McMahon NE, Connell L, Harrison J, et al..
Repetitive task training for improving functional ability after stroke.Cochrane
Database Syst Rev. 2016; 2016:CD006073. doi: 10.1002/14651858.CD006073.pub3.

Hatem, Samar M et al. “Rehabilitation of Motor Function after Stroke: A Multiple
Systematic Review Focused on Techniques to Stimulate Upper Extremity Recovery.”
Frontiers in human neuroscience vol. 10 442. 13 Sep. 2016,
doi:10.3389/fnhum.2016.00442

Lang, Catherine E et al. “Counting repetitions: an observational study of
outpatient therapy for people with hemiparesis post-stroke.” Journal of
neurologic physical therapy : JNPT vol. 31,1 (2007): 3-10.
doi:10.1097/01.npt.0000260568.31746.34

Waddell, Kimberly J et al. “Does Task-Specific Training Improve Upper Limb
Performance in Daily Life Poststroke?.” Neurorehabilitation and neural repair
vol. 31,3 (2017): 290-300. doi:10.1177/1545968316680493

Waddell KJ, Birkenmeier RL, Moore JL, Hornby TG, Lang CE. Feasibility of
high-repetition, task-specific training for individuals with upper-extremity
paresis. Am J Occup Ther. 2014;68(4):444-453. doi:10.5014/ajot.2014.011619


--------------------------------------------------------------------------------

Call us (888) 623-8984 [tel:+18886238984] or email us at info@neofect.com to 
rehab smarter with Neofect today.


--------------------------------------------------------------------------------

Hand Rehab

Rehab With Real-World Objects for Improved Hand Use After Stroke

We sifted through the research for you to explain the top 5 medically proven methods for hand rehabilitation: Constraint‐induced movement therapy (CIMT), Mental practice, Mirror therapy, Virtual reality, High dose repetitive task practice.

Hand Rehab after Stroke: The Top 5 Evidenced-Based Methods

After a stroke, it’s challenging enough to navigate the medical system to find
what services you need, let alone the right treatment approach for you. 

You've probably heard a lot of recommendations on how to recover hand function
after stroke, and everyone seems to give different advice. That's why we sifted
through the research for you. We'll explain the top 5 evidence-based methods for
hand rehabilitation, why they work, and who they work for.

The top 5 evidence-based treatments for improving hand function after stroke:
 1. Constraint‐induced movement therapy (CIMT)
 2. Mental practice
 3. Mirror therapy
 4. Virtual reality
 5. High dose repetitive task practice

Constraint-Induced Movement Therapy
You can restrict your unaffected side at home by wearing an oven mitt or placing
it inside your pants or sweatshirt pocket. This will help remind you to rely on
your affected side when completing therapy tasks.
What it is:

Constraint-Induced Movement Therapy (CIMT) is a neuro-rehabilitation method
where the non-affected hand is constrained or restricted in order to force the
brain to use the affected hand, thereby increasing neuroplasticity.

There are two key components: constraint and shaping.

Constraint refers to the way in which the hand is restricted. Therapists have
used casts, splints, and mitts to restrict the use of the non-affected hand.
None of them have been shown to be more effective than the other.

Shaping involves repetitive movements or activities at the patient’s ability
level which become progressively harder. Therapists use shaping techniques to
avoid overwhelming the motor system.

Why it works: 
Our brain automatically completes a task in the easiest way possible. Our brain
is more interested in completing a task than in how it is accomplished.

After a stroke, it’s easier for our brain to do tasks one-handed. This leads to
“learned non-use”.

When we constrain our non-affected hand, suddenly our stronger hand becomes the
weaker, less functional hand and we’re forced to use our affected hand. Our
affected hand might not have much movement, but to our brain any movement is
better than no movement, and the brain is highly motivated to figure out how to
accomplish a task. 

This is where the "shaping" piece is so important. If you are presented with
rehab tasks that overwhelm the motor system or are higher level than your
affected hand can functionally do, you'll be more likely to knock the table over
than to participate in picking up pennies from the table. 

If you knock the table over with your affected hand, your occupational therapist
might actually be excited about it; but in practical life finding that balance
of not being too easy and not being so hard that you give up is an important
lesson for every human being, not just those after stroke.

Who it’s for: 
This approach is used for people who have at least 10 degrees of active wrist
and finger extension, as well as 10 degrees of thumb abduction (the ability of
the thumb to move out of the palm).

It’s been shown to be effective even years after stroke. Lower intensity CIMT is
better than higher intensity in the very early stages after stroke. 

Mental Practice
You might listen to an audio recording describing the sequence of throwing a
ball, imagining yourself doing it. After listening, actually practice throwing
the ball the way you envisioned!


What it is:
Mental practice, sometimes called motor imagery or mental imagery, is a training
method for improving your hand and arm function without moving a muscle!

Mental practice is typically done by listening to pre-recorded audio that
describes in detail the motor movement of a specific task. The listener imagines
their hand and arm moving in a “typical” way, and the instructor provides cues
to extend their arm or open their fingers, as well as the entire sensory
experience of the task.

While it’s true that you can do mental practice on its own, it's best combined
with physical practice immediately following.

Why it works:
Brain scans show that similar parts of the brain are activated whether movement
is actual, observed or imagined.

It’s a separate area of the brain that’s responsible for actually triggering the
muscle movement, but it goes to show that there’s a lot more required of the
brain to complete a task than just sending a signal to the muscle.

Who it’s for:
Mental practice has been shown to improve arm movement and functional use in
patients after stroke of all levels of abilities and as a treatment approach for
people months or years after stroke!

Mirror Therapy
It is critical to stay focused on the reflected image of your hand during mirror
therapy, imagining that it is your affected side performing the target
movements.
What it is:
Mirror therapy is another voodoo-seeming approach that has a lot of scientific
evidence to back it up. It essentially tricks your brain into thinking your
affected hand is moving.

You position a mirror to reflect your non-affected hand, while hiding your
affected hand. Any movement of your non-affected hand will be reflected in the
mirror and make it seem as though you are actually moving your affected hand.

Why it works:
The approach is centered around mirror neurons, which fire in your brain when
you see your arm move. Typically, we think about motor neurons being sent from
the brain to the muscle, but we don’t realize that mirror neurons are connected
to the motor neurons.

After a stroke you lose the ability to access your motor neurons, but not your 
mirror neurons. By accessing your mirror neurons through seeing your movement
(even if the movement is fake), you are tapping into the network between the
neurons. 

It’s like trying to reconnect with an old friend on Facebook by finding the
friends they’re connected with. It might not be the most direct approach in a
real life situation, but in stroke rehab that friend of a friend might be your
strongest connection. 

Who it’s for: 
Mirror therapy can be used for people with no movement of the hand or smaller
movements of the hand and shoulder, but not functional movement of the hand. 

If you have functional movement of your hand, meaning individual finger movement
and wrist movement, you have surpassed the benefit that mirror therapy can
provide.

It can be used early after stroke, as well as in the chronic stages of stroke.

Virtual Reality
The Neofect Smart Board is a non-immersive virtual reality rehabilitation
system.
What it is:
Virtual reality uses a computer interface to simulate a real life objects and
events. It's become an increasingly more prevalent rehabilitation technique to
provide motivation and engagement in therapy.

There are two types:

 1. Immersive: goggles are placed over the eyes and the patient is visually in a
    different environment than their actual physical one 
 2. Non-immersive: sensors are placed on the body and track the movement of the
    body and the movements are shown on a screen 

Why it works:
Virtual reality works best when paired with traditional therapy. It's theorized
to provide more motivation and engagement for the intensity of therapeutic
exercise needed for neuroplasticity. It's been shown to beneficial in high
doses, meaning more than 20 hours.

Another possible factor of why virtual reality works are the same mechanisms
that make mirror therapy effective (tapping into the mirror neurons) could be
similar. 

Virtual reality also creates a biofeedback loop: your brain sends a signal to
the muscle, the brain receives a signal back in the form of visual or auditory
input. Basically, you get rewarded for your effort.

Who it’s for: 
Virtual reality can be used with people who have mild to severe impairments, and
from early after stroke to years out. 

When deciding what's right for you, it's important to look at the adjustability
of the device to meet you where you're at and also to increase in difficulty as
you improve. 

If you have minimal movements, you'll want a virtual reality tool specifically
for stroke rehabilitation. If you have more movement, it's possible to use
gaming systems not specifically designed for rehab, but make sure you have the
support to optimize it for rehab.

High Dose Repetitive Task Practice
There are many ways to do task-specific training at home. Placing coins into a
piggy bank is just one of them!
What it is:
Repetitive Task Practice is when you practice a task or a part of a task over
and over. Task-specific training is a type of repetitive task practice, and
refers to the task we complete that is relevant to our daily life.

"Reach to grasp, transport and release" is a type of task-specific training
because it is one of the common motor requirements for many functional daily
tasks.

The keys for repetitive task practice:

 * Task must be meaningful
 * Participant must be an active problem-solver
 * Real life objects are used
 * Difficulty level is not too high and not too low
 * Repetition is key

Why it works:
Repetitive Task Practice is based on motor learning theory. Our brains are
driven by function. We're able to achieve neuroplasticity with development of
skills, as our brain processes the demands of the task, which have motor and
cognitive components. 

It's often used with other treatments, such as virtual reality, to increase the
15 hour dosage that has been shown to be beneficial.

Who it’s for:
Task-specific practice is generally used and is studied in people who have some
functional ability of their hand. It's been shown to be beneficial throughout
the rehabilitation process.

Even though the research has been focused on "functional ability" of the hand by
practicing reach, grasp, transport, release; there's potential for recovery by
using the same principles of task-specific practice: real life objects,
functional tasks, and problem-solving even without the ability to grasp.

Functionally, we can use our affected upper extremity as a stabilizer, an
assist, or for manipulation. There are lots of ways to get that side involved to
prevent "learned non-use" and to improve your problem-solving skills. 

Now what?
There are two key factors to any hand recovery method: support and meaning.

Neofect [https://shop.neofect.com/] aims to support and inspire you to live your
best life with virtual reality tools that can be used as part of a
constraint-induced movement therapy program or with repetitive task practice. 

Our companion app to create healthy habits for stroke recovery: Rehabit
[https://apps.apple.com/kr/app/rehabit-your-recovery-habits/id1473561369] and
our YouTube Channel: Find What Works
[https://www.youtube.com/channel/UCuawDKIiCA26zF0JB_YALkQ] are based on the
principles of repetitive task practice and aim to give you the tools to live
your best life. 

Now the only question is, what are you waiting for?



Pollock  A, Farmer  SE, Brady  MC, Langhorne  P, Mead  GE, Mehrholz  J, van
Wijck  F. Interventions for improving upper limb function after stroke.
Cochrane
Database of Systematic Reviews
[https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010820.pub2/full?highlightAbstract=limb%7Cstroke%7Cstrok%7Cupper] 
2014, Issue 11. Art. No.: CD010820. DOI: 10.1002/14651858.CD010820.pub2.




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Call us (888) 623-8984 or email us at info@neofect.com to rehab smarter with
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