Stroke survivors face a unique and difficult challenge: repairing and remodeling their bodies, minds, and lives. The process can often seem like mapping out a brand new course through totally uncharted waters.

Why Are Repetitive Motions Important After a Stroke?

In the beginning

Stroke survivors face a unique and difficult challenge: repairing and remodeling
their bodies, minds, and lives. The process can often seem like mapping out a
brand new course through totally uncharted waters. Survivors are charged with
figuring out how to do basic tasks like getting dressed, brushing teeth, and
using the restroom, while also focusing on standing up straight and not falling.
Often, all of these things must be done while using only one hand, because the
affected arm becomes weak and hard to control. Activities that once came
naturally and were programmed into habits are suddenly very challenging and
frustrating. The affected arm can become such a frustration that survivors may
start to only use their stronger arm to get things accomplished, even if that is
not normally their dominant arm.

There is good news, though!

Research has taught us a lot about how amazing our brains truly are. Now we know
that when we go through a neurological event (such as a stroke), we actually
have the ability to regrow and work around many of the connections in our brain.
We can actually repair and remodel our brains and bodies. We can remap our
brains to help us to function again. Another word for this is neuroplasticity
[https://www.neofect.com/us/blog/tips-for-unlocking-neuroplasticity-after-stroke-part-1] 
(1).



What does this mean for stroke recovery?

When a person suffers a stroke, he may notice that certain body parts are no
longer functioning correctly. Often the arm and leg on one side of the body
become weak or paralyzed. This is because the motor control center of the brain
has become “injured,” and with this injury, it now has difficulty sending out
strong signals to the arm and leg to tell them how to move. Essentially, the
brain needs help to get reorganized and get back to work controlling the rest of
the body.

When we talk about repairing and reorganizing our brains after a stroke, there
are two huge players in the game: time
[https://www.neofect.com/us/blog/how-to-quickly-recover-after-stroke] and brain
activity. Though we can’t control the time variable (exactly how long the
recovery process will take for each individual), we can definitely play a large
hand in the brain activity variable. The sooner we do this following a stroke,
the better, BUT, changes can still continue to take place months and even years
later. In fact, we now know that progressive motor practice is essential for
gains at any point after stroke onset (5). This is where high repetition comes
into play: our brains have an area where motor control, learning, and shaping
happens, and research shows that the more intensely and often we practice, the
more this part of the brain recovers, and the better we can get! (1). Tasks that
encourage repetitive practice using the arm can actually improve both strength
and activity (2).



What needs to happen next?

If the person is able to provide opportunities for the arm and leg to try to
move again, it is possible to reconnect some signals and also to form new
connections all around the injury to help the brain regain control. The key to
this is massed practice, or many, many, many repetitions. The more times the
body tries to move the arm or leg, the more opportunity for neuroplasticity. It
is noted that high numbers of repetitions are required to make an impactful and
lasting change in the brain (6). In other words, repeating a motion over and
over helps with learning and remembering that motion, because the signals from
our body parts become more connected to the brain.

Another important reason to repeatedly attempt to use the affected limb is to
prevent “learned nonuse.” When a person tends to use the stronger limb more
often because it’s easier and more efficient, the weaker limb starts to “forget”
what it is supposed to do, thereby becoming even weaker and less functional. In
fact, focusing on using only the non-affected side can actually hinder the brain
from recovering connections with the weak side (3). Instead, using the weaker
arm or leg many, many times can promote awareness of the limb, increased
strength, and overall functional use in the same ways - fixing old and making
new connections to the brain.



It has been shown that “high repetition” is most successful when hundreds of
repetitions of a particular movement happen during the day (6). Motor rehab
after a stroke helps promote reorganization of important areas of the brain that
control movements. Completing exercises set by your Occupational or Physical
Therapist help strengthen and retrain how your muscles work together to create
functional movements. Some types of activities and tools you may see during
therapy include Constraint Induced Movement Therapy (CIMT), Mirror Therapy,
neuromuscular electrical stimulation or Bioness, and massed task practice. All
of these have a component of high repetition to drive more significant change in
the brain and body. Engaging your affected arm in regular, routine
[https://www.neofect.com/us/blog/importance-of-setting-up-post-stroke-routine],
functional tasks is also very helpful -- the more that arm gets the opportunity
to do what it is meant to do, the greater the chance it has to recover.

Recovery Mode: ON!

It can certainly be challenging to carry over such a demanding high repetition
exercise program at home. It may be hard to find time in an already busy
schedule, or it may be hard to find motivation when your therapist is no longer
present to cheer you on. One of the best things you or your loved one can try to
do is to figure out what types of activities and strategies are the most
motivating and engaging, because that will help to stick to the plan and see
real results. In fact, the brain needs to be motivated, engaged in learning, and
paying good attention to the task in order to make real change happen (5).



Use of the NEOFECT Smart Glove and/or Smart Board can be added to your
repertoire to help keep you motivated and excited to work on these repetitions -
when you’re having fun, seeing visual responses to the movements you make, and
tracking your own progress, you may be more likely to stick with it, and enjoy
the process! While you are searching for more options for you or your loved one
to add to your stroke recovery toolkit, don’t forget to check out NEOFECT Home
Rehab Solutions, clinically proven to improve hand and arm function at home. To
learn more, call 888-623-8947 or email info@neofect.com. Here at Neofect, we are
here to support you on this journey.

References

 1. Nudo RJ. Adaptive plasticity in motor cortex: Implications for
    rehabilitation after brain injury. Journal of Rehabilitation Medicine, 2003;
    41: 7-10.
    
    
 2. De Sousa DG, et al. Interventions involving repetitive practice improve
    strength after stroke: a systematic review. Journal of Physiotherapy, 2018;
    64(4): 210-221.
    
    
 3. Allred, RP, et al. Use it and/or lose it -- Experience effects on brain
    remodeling across time after stroke. Frontiers in Human Neuroscience, 2014;
    8: Article ID 379.
    
    
 4. Duncan P, et al. Randomized clinical trial of therapeutic exercise in
    subacute stroke. Stroke, 2003; 34: 2173-2180.
    
    
 5. Dobkin, BH, and Dorsch, A. New Evidence for therapies in stroke
    rehabilitation. Current Atherosclerosis Reports, 2013; 15 (6): 331.
    
    
 6. Kimberley, TJ, et al. Comparison of amounts and types of practice during
    rehabilitation for traumatic brain injury and stroke. Journal of
    Rehabilitation Research and Development, 2010; 47 (9): 851-862.
    
    

All content provided on this blog is for informational purposes only and is not
intended to be a substitute for professional medical advice, diagnosis, or
treatment. Always seek the advice of your physician or other qualified health
provider with any questions you may have regarding a medical condition. If you
think you may have a medical emergency, call your doctor or 911 immediately.
Reliance on any information provided by the NEOFECT website is solely at your
own risk.

Stroke Recovery

About 2/3 of stroke survivors receive rehabilitation services. Depending on the level of medical care required, a patient can receive inpatient, outpatient, or home therapy. 

Outpatient Rehab: Outpatient or At-Home Therapy

About two-thirds of stroke survivors receive some type of rehabilitation
services. Depending on the level of medical care required, a patient can receive
inpatient, outpatient, or home therapy.

 * The primary goal of inpatient rehab is to return the patient to their home
   environment in a safe manner as independently as possible. They typically
   focus on getting in and out of bed safely and functional mobility. Some
   patients qualify for acute rehab, which is intensive inpatient therapy after
   a person is medically stable and who will benefit from 3 hours of therapy a
   day.
 * Home therapy will be recommended if the patients have difficulties getting in
   and out of their home as well as with performing activities of daily living
   within their home. Home care therapist will work with the patient in their
   own home in order to assist the patient with becoming more independent and
   safe in their own environment. Typically, home health therapy is provided
   1-3x week.
 * Outpatient therapy will be recommended once the patient is safe and able to
   leave their own home. Outpatient therapy continues to work on increasing
   independence in daily self-care skills, as well as higher level skills within
   the home and community.



Repetition: The Key to Quickest Improvement
The key to the quickest improvement following a stroke is training repetitions.
The ideal length of a rehab session in order to maximize functional improvement
after stroke or brain injury is 80 minutes per day according to recent research
(Schneider et al, 2016). If you're receiving home health services or outpatient
therapy, you still need to dedicate time at home for rehabilitation on your own.
60 minutes 1-3x week is not enough to see changes. Regardless of outpatient vs.
home care services, it is very important to exercise 80 minutes per day in order
to allow for the correct amount of repetitions.



Neofect Home: Rehab Therapy Anywhere, At Anytime
International clinical experts with years of patient care experience
specializing in strokes have developed Neofect Home [https://www.neofect.com/us] 
― an at-home rehab platform that enables you to receive therapy anywhere and at
anytime.

 * With various gamified contents, patients can be more engaged and motivated
   while performing their rehab program. CNN journalist, Selena Larson mentions
   that the glove helps patients perform repetitive movements in the forearm,
   wrist, and fingers while keeping it fun and motivating by utilizing
   activities such as playing cards, pouring wine, or tossing a baseball.
 * Patients’ families can assist the patients with the Neofect Home program.
   Patients and their families can work with their therapist to set goals. And
   RAPAEL’s cloud system allows patients and their families to share how they
   are progressing with their therapist.

According to Stanford Medical Center, “All patients agreed that they liked the
glove and most of them were strongly satisfied with their overall
experience...Patients can use the Neofect device for home therapy with high
satisfaction.”
Milissa Louwart, a user of Neofect Home says, “My favorite thing about the
RAPAEL program is that I can do it at home at my convenience and it is very
entertaining. I have noticed that it’s benefiting my flexibility and decreasing
the spasticity in my wrist and hand.”

Able to Improve Even 20 Years After Stroke
Lauren Sheehan, Senior Clinical Therapist at NEOFECT stated, “research revealed
that patients can achieve improvements even 20 years after their incident with
therapy devices such as the RAPAEL Smart Glove.”


Please visit the Neofect Home website [https://www.neofect.com/us] for more
information and resources about the program.

*Neofect Home Inquiry:
-www.neofect.com [https://www.neofect.com/us]
-Phone: (888) 623-8984 [tel:+18886238984]


All content provided on this blog is for informational purposes only and is not
intended to be a substitute for professional medical advice, diagnosis, or
treatment. Always seek the advice of your physician or other qualified health
provider with any questions you may have regarding a medical condition. If you
think you may have a medical emergency, call your doctor or 911 immediately.
Reliance on any information provided by the NEOFECT website is solely at your
own risk.

Home Rehab

Electrical stimulation therapy consists of taking electrodes and attaching them on to the skin over a muscle.  

How Can Electrical Stimulation Help After a Stroke?

Electrical stimulation therapy consists of taking electrodes and attaching them
on to the skin over a muscle. Once the electrical stimulation unit is activated,
it sends electrical currents to the muscle causing it to contract. Sending these
electrical currents to the muscle and forcing the muscle to contract repeatedly
will, in short, help the brain to create new neuro pathways which will in turn
allow for muscle re-education. This happens through neuroplasticity
[https://www.neofect.com/us/blog/why-neuroplasticity-matters-to-post-stroke-rehabilitation]
. The principles behind neuroplasticity state that in order for the brain to
rewire itself, it requires repetitive exercises to be done in order to build new
neuro pathways. Therefore, it is very important to perform repetitive exercises
with the affected limb or find a device that incorporates repetitive movements
passively if you can not perform them actively.



What is Electrical Stimulation Therapy?
Electrical stimulation therapy is a type of therapy that can be used in order to
address many different issues that one may exhibit after a stroke. Electrical
stimulation therapy can be used to address the following issues:

Edema- Electrical stimulation causes the affected limb to perform repetitive
movements which will help increase blood flow ultimately decreasing the edema.
Muscle weakness- In order to increase muscle strength after a stroke, it is
important to perform repetitive exercises in order to retrain the brain. By
performing repetitive exercises overtime it will help increase muscle strenth.
Sensory loss- Unfortunately, there is not a lot of research on how electrical
stimulation can help a stroke survivor however a lot of therapists have found it
to help their patients as it is believed to help wake up the nerves in the
affected limb.
Increased tone- In order to decrease tone, it is important to perform repetitive
exercises in order to retrain the brain through neuroplasticity. Electrical
stimulation can allow someone to perform repetitive exercises even if they can
not do it actively independently.
Prevent muscle atrophy- Electrical stimulation causes the muscles to contract
repeatedly for any given period of time. Passive muscle contractions allows the
muscles to keep working which in turn will help prevent atrophy.
Chronic or acute pain- Electrical stimulation therapy helps prevent pain signals
from reaching the brain and therefore, temporarily decreasing pain levels.
Impaired circulation- Electrical stimulation therapy causes the affected limb to
perform repetitive motions which in turn will help increase circulation by
keeping the blood flowing through the affected limb.

Electrical Stimulation Treatment Options
There are a few different types of electrical stimulation that can be used to
treat stroke survivors. The most common are:

Functional Electrical Stimulation(FES)- FES is commonly used to restore function
to a paralized limb.
Electrical Muscle Stimulation (EMS) / Neuromuscular Electrical Stimulation(NMES)
- EMS and NMES are both used to provide stimulation to muscular tissues via
electrical impulses.
Transcutaneous Electrical Nerve Stimulation(TENS)- TENS is primarily used to
address chronic or acute pain management. A TENS unit will help encourage one's
body to produce more endorphins.
EMG Triggered Stimulation(ETS)- ETS is used with stroke survivors who have some
movement in the affected limb. The ETS device will detect the stroke survivor's
movements and provide stimulation based on those movements.
Electromyogram-Triggered stimulation (EMG)- EMG is a combination of biofeedback
and stimulation. EMG uses the stroke survivor's own movements in order to
provide stimulation.
Reciprocal EMG Triggered Stimulation(RETS)- RETS is most commonly used with
stroke survivors who have increased tone or have a hard time relaxing the
muscles on the affected limb.



Although, Electrical stimulation therapy can be very helpful for many, it is
contraindicated for some. Therefore, it is very important that you get cleared
from your physician before you start using electrical stimulation therapy. Some
common contraindications are:

 * Over carotid sinus
 * Over an active deep vein thrombosis or thrombophlebitis
 * Anywhere near the uterus including the lower back during pregnancy
 * Over cancerous lesions
 * Over superficial metal such as staples, pins, or external fixators
 * Over areas of localized infection
 * Over any open wounds
 * Over the neck
 * Over the heart
 * In the presence of a cardiac pacemaker or defibrillator
 * Over untreated osteomyelitis
 * Seizures

Research has shown that in order to see the best results with electrical
stimulation therapy, you should combine it with massed practice of repetitive
functional exercises
[https://www.neofect.com/us/blog/stroke-recovery-story-using-smart-glove-for-e-stim]
. Many occupational therapists and physical therapists will utilize electrical
stimulation in their practice. Some therapists may recommend you purchase your
own electrical stimulation unit to use at home in between therapy sessions and
or once you are discharged from therapy as an outpatient therapy tool
[https://www.neofect.com/us/blog/can-e-stim-help-jumpstart-outpatient-stroke-rehabilitation]
. Your therapist will help you learn what settings to utilize. It is important
to always perform a skin check after using the electrical stimulation unit. You
want to make sure you are not having any adverse reactions. If you notice any
adverse reactions make sure to reach out to your therapist or doctor before
continuing to use the device.



To find out about how the Neofect Smart Glove
[https://shop.neofect.com/collections/smart-rehab-solution/products/neofect-smart-glove] 
and Smart Board [https://www.neofect.com/us/smart-board] can be paired with
electrical stimulation therapy to help strengthen your upper extremities in a
fun and motivating way please call us at (888) 623-8984 [tel:+18886238984] or
email us at info@neofect.com.

All content provided on this blog is for informational purposes only and is not
intended to be a substitute for professional medical advice, diagnosis, or
treatment. Always seek the advice of your physician or other qualified health
provider with any questions you may have regarding a medical condition. If you
think you may have a medical emergency, call your doctor or 911 immediately.
Reliance on any information provided by the NEOFECT website is solely at your
own risk.

Electrical Stimulation

Move early for your stroke therapy and often to increase function.  Learn about effective stroke exercises with Smart Glove and Smart Board packages.

Stroke Therapy and Exercise: Move Early and Often to Increase Function

About Effective Stroke Exercise and Stroke Therapy


Act fast for your Stroke Therapy!

Nearly 75% of stroke survivors have difficulty with hand and arm movement after
stroke and only about 20% experience some functional recovery in the first 6
months. Focus on upper extremity exercise, particularly during inpatient
rehabilitation, is surprisingly low. In our previous post on stroke therapy dose
[https://www.neofect.com/us/blog/does-therapy-dose-really-matter-for-stroke-recovery/]
, we discussed the importance of greater intensity. When it comes to upper
extremity exercise and therapy, it seems that more is better for functional
outcomes.

Another way to increase stroke therapy dose is to apply an exercise program like 
the GRASP program [http://neurorehab.med.ubc.ca/grasp] that can be easily
self-administered and is flexible enough to work with a range of impairments.
When started early on after stroke in an in-patient setting, four weeks of GRASP
training improved arm and hand function compared to an education program.
Constraint-induced movement therapy (CIMT) can increase the dose of functional
training. Modified protocols are available to increase patient tolerance. Talk
to your therapist to see if these exercise and activity approaches would be a
good fit for your needs.

It’s also important to start moving EARLY when the brain is primed to re-wire
and re-organize itself. Neuroplasticity
[https://www.neofect.com/us/blog/why-neuroplasticity-matters-to-post-stroke-rehabilitation/] 
is the brain’s ability to find alternative pathways for the area of the brain
that was damaged due to a stroke. If we were able to encourage an intensive
therapeutic program early in stroke or brain injury recovery, using a Smart
Rehabilitation Solution like the Neofect Smart Glove
[https://www.neofect.com/us/smart-glove] or Smart Board
[https://www.neofect.com/us/smart-board], it is likely that we could improve
motor function by taking advantage of the brain’s plasticity through repetition.



Post stroke depression is a common after effect of stroke for many individuals.
Depression has been found to have negative effects on functional recovery.
Physical exercise may help in providing a supportive treatment for depression.
It has been found that those that are able to manage post-stroke depression have
greater functional outcomes as well. The take away, exercise can assist in the
management of depression and prolonged depression can keep a stroke survivor
from making the fullest recovery possible.

Move as soon as possible for your stroke therapy when you plan your exercise
program after stroke! Our Smart Glove and Smart Board packages come with
clinical support to allow you to maximize your use of our devices for your
continued stroke therapy and exercise. As you look at different options for your
stroke recovery, our Smart Rehab Solutions may be a good fit for your needs,
call us to discuss your individual rehabilitation goals: (888) 623-8984
[tel:+18886238984].


*Neofect Home Inquiry:
-www.neofect.com [https://www.neofect.com/us]
-Phone: (888) 623-8984 [tel:+18886238984]



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

References

 * The future of stroke rehabilitation: upper limb recovery ACNR (
   https://www.acnr.co.uk/wp-content/uploads/2015/09/Page-61.pdf)
 * Winstein, et al. (2016). Guidelines for Adult Stroke Rehabilitation and
   Recovery (https://www.ahajournals.org/doi/full/10.1161/STR.0000000000000098)

Repetition

"how often should I be doing my exercises?" This is one of the most frequently asked questions we hear in rehabilitation practice.  Find out whether therapy dose is so important or not for stroke rehabilitation and recovery.

Does Therapy Dose Really Matter for Stroke Rehabilitation & Recovery?

Does therapy dose really matter for stroke recovery?

Does therapy dose really matter for stroke rehabilitation and recovery?
One of the most frequently asked questions that we hear in rehabilitation
practice is “how often should I be doing my exercises”? When it comes to the
dose or frequency of therapy for gait retraining, upper extremity function and
motor relearning in general, how much is enough in terms of stroke
rehabilitation and recovery?

The more we learn about the brain and neuroplasticity
[https://www.neofect.com/us/blog/why-neuroplasticity-matters-to-post-stroke-rehabilitation/]
, the more specific we can be when it comes to understanding how much therapy
for stroke rehabilitation and recovery is needed to result in functional
improvement.

Is consistency more effective, for example, a more regular routine of therapy
activities 5-7 days per week or fewer days per week for longer sessions? How
many more repetitions do individuals need to do per session in order to see the
improvements that will allow them to use their hand and arm more effectively?

From recent research, we understand that we need to be doing about 240% more
time with task-based therapy exercises than the “norm”. A standard session is
typically about 25 minutes and based on research looking at outcomes of the same
treatment for different lengths of time, it is recommended that an individual
spends 60 minutes or more in therapy to see desired functional outcomes
(Schneider et al, 2016).



Virtual reality solutions like the Neofect Smart Glove
[https://www.neofect.com/us/smart-glove] for hand rehabilitation and Neofect
Smart Board [https://www.neofect.com/us/smart-board] for upper limb
rehabilitation training, allow for a high intensity, high repetition program in
a reasonable amount of time. A study by Stanford Medical Center, which is still
on its way to being published, showed that it was more beneficial to perform the
Smart Glove program consistently daily or at least 5 days per week versus doing
longer sessions less frequently. Consistency AND dosage are both important for
lasting change to take place in an individual’s range of motion, coordination
and timing.



> To meet the target amount of dosage, you have to be engaged in what you’re
doing, or you won’t stick with it. Look at what some of our Smart Glove and
Smart Board users had to say about how their rehabilitation program was engaging
in order to increase their dosage of therapy:

Tim G. - Stroke


> “I couldn’t depend on the therapy I had two hours a week to continue my
recovery; I needed to do more, which is where the Smart Glove came in. The Smart
Glove gives you a smart way to efficiently exercise. If you’re able to use it
regularly you’ll do a lot of good for yourself.”

Chris J.- TBI


> Before the Smart Glove, my coordination was really bad. I’ve improved
tremendously. Initially I couldn’t lift or break an egg or cut my meat and now I
have the coordination to be safe doing that. It made therapy fun and
motivating!”

Kay K.- Stroke


> “...after using the Smart Board for a month, I find myself using my affected arm
almost automatically for small tasks like turning on lights or making the bed.
The way that the training is structured, I know that I can work hard for 3
minutes or 5 minutes and then move on to a new game, so it is easy to stay
motivated.”


Call us at (888) 623-8984 [tel:+18886238984] to learn more the Neofect Smart
Rehabilitation Solutions today and increase the dosage of your therapy program
to improve your results.


*Neofect Home Inquiry:
-www.neofect.com [https://www.neofect.com/us]
-Phone: (888) 623-8984 [tel:+18886238984]