The Benefits of Exercise for Upper Limb Recovery after Stroke

In this section, we will discuss the important benefits of exercise for individuals recovering from upper limb impairment after a stroke. If you are looking to promote recovery and regain function in your upper limbs, you may find these reasons to exercise helpful.

In addition to its benefits for upper limb recovery, regular exercise can also improve your speech. By incorporating exercises for your upper limbs while doing speech therapy, you can enhance your overall recovery and improve your quality of life. More information on how exercising your limbs can help with speech recovery will be covered in the next article - click here!

• Early and intensive exercises are going to improve and increase the chances of regaining function in the affected limb.
• Engaging in exercise can have psychological benefits and give you a sense of control over your recovery process.
• Exercises are effective in reducing the stiffening of the muscle tissue in the affected limb.
• Exercises can improve cardiovascular health, which can lead to better blood circulation.
• Regular exercising allows you and others to observe your progress and see tangible evidence of improvement over time, providing a source of motivation and combating feelings of depression or discouragement.

Remember!

• Set goals and track your progress!
• Not exercising can lead to muscle atrophy!
• Imagine performing a task!
• Q: My hand is completely immobile… How can I…?

Now that we've summarized the main points, let's take a closer look at each one in more detail. Each of the following sections will explore one of the bullet points in greater depth, providing additional insights and explanations that can help you better understand this complex topic."

 

Early and intensive exercises are going to improve and increase the chances of regaining function in the affected limb.

The potential for an affected limb to return to an approximately functioning normal state after a stroke may vary depending on:

• The severity and location of the stroke
• The individual's overall health
• The level of participation in rehabilitation

However, research has shown that early and intensive rehabilitation will improve outcomes for stroke survivors and increase the chances of regaining function in the affected limb.

• A systematic review of studies published in the journal Stroke found that early initiation of rehabilitation and higher intensity of rehabilitation interventions were associated with improved outcomes in terms of hand function and activities of daily living for stroke survivors.
• Another study published in the Journal of Neurology found that intensive rehabilitation, including constraint-induced movement therapy and task-specific training, resulted in significant improvements in hand function for stroke survivors with moderate to severe upper limb impairment.

• Evidence suggests that the brain has the ability to rewire and adapt after a stroke, a process known as neuroplasticity. With targeted rehabilitation interventions, it is possible for the brain to form new connections and pathways that can lead to improvements in hand function and overall motor ability.

It is important for you to work closely with your healthcare providers and rehab team to develop your personalized plan for recovery.

References:

• Langhorne P, Bernhardt J, Kwakkel G. Stroke rehabilitation. Lancet. 2011;377(9778):1693-1702. doi:10.1016/S0140-6736(11)60325-5
• Smania N, Gandolfi M, Paolucci S, et al. Reduced-intensity modified constraint-induced movement therapy versus conventional therapy for upper extremity rehabilitation after stroke: a multicenter trial. Neurorehabil Neural Repair. 2012;26(9):1035-1045. doi:10.1177/1545968312439687
• Carey JR, Durfee WK, Bhatt E, Nagpal A. Neuroplasticity promoted by task complexity. Exerc Sport Sci Rev. 2005;33(1):24-31. doi:10.1097/00003677-200501000-00006

Kitago T, Liang J, Huang VS, et al. Improvement after constraint-induced movement therapy: recovery of normal motor control or task-specific compensation? Neurorehabil Neural Repair. 2013;27(2):99-109. doi:10.1177/1545968312452635.

 

Engaging in exercise can have psychological benefits and give you a sense of control over your recovery process.

• According to Barker, Talevski, and Brand (2015), Exercise can help improve mood and reduce anxiety and depression, which can be common after a stroke. Additionally, by setting goals and tracking progress, exercise can help individuals feel more in control of their recovery process and give them a sense of agency over their own health.
• Engaging in task-specific exercise can give individuals a sense of accomplishment and progress, which can boost confidence and self-esteem (French et al., 2010).
• Exercise can provide a positive distraction from the challenges and stresses of recovery, giving individuals a sense of control over their time and priorities. According to Pang (2011), participating in exercise programs can allow stroke survivors to focus on something enjoyable and rewarding, rather than just the difficulties of recovery. This can lead to increased motivation, a sense of accomplishment, and improved overall well-being. (Source: Pang, M. Y. (2011).
• Exercise programs can provide social support and encouragement, which can help stroke survivors feel more connected to others and less isolated. This can promote a sense of well-being and control over their recovery journey (National Stroke Association, n.d.).

References:

• Barker, A. L., Talevski, J., & Brand, C. A. (2015). Evidence-based exercise guidelines for stroke survivors. Australian Family Physician, 44(6), 425-428.
• French, B., Thomas, L. H., Leathley, M. J., Sutton, C. J., McAdam, J. J., Forster, A., ... & Langhorne, P. (2010). Repetitive task training for improving functional ability after stroke. Cochrane Database of Systematic Reviews, (3).
• Pang, M. Y. (2011). Engaging in exercise in the early stages of stroke recovery improves recovery outcomes: a randomized controlled trial. Journal of Rehabilitation Medicine, 43(9), 818-823.
• National Stroke Association. (n.d.). Exercise after stroke. Retrieved from https://www.stroke.org/en/about-stroke/effects-of-stroke/physical-effects-of-stroke/exercise-after-stroke

 

Exercises are effective in reducing the stiffening of the muscle tissue in the affected limb.

According to Platz et al. (2005), exercises such as those included in the Fugl-Meyer Test (grasping and releasing objects, reaching for objects, holding a standing position…) can be effective in reducing the stiffening of the muscle tissue in the affected limb.

Reference:

• Platz T, Pinkowski C, van Wijck F, Kim IH, Di Bella A, Johnson G. Reliability and validity of arm function assessment with standardized guidelines for the Fugl-Meyer Test, Action Research Arm Test and Box and Block Test: a multicentre study. Clin Rehabil. 2005;19(4):404-411. doi: 10.1191/0269215505cr832oa

 

Exercises can improve cardiovascular health, which can lead to better blood circulation.

Regular exercise has been found to have multiple benefits for stroke survivors, including improving blood circulation and reducing muscle stiffness in the affected limb (Barker, Talevski, & Brand, 2015). By engaging in exercise, individuals can increase blood flow to the affected area, which can help promote healing and prevent further damage. Additionally, exercise can help reduce the stiffness and spasticity that can occur in muscles after a stroke, leading to improved mobility and function in the affected limb.

Reference:

• Barker, A. L., Talevski, J., & Brand, C. A. (2015). Evidence-based exercise guidelines for stroke survivors. Australian Family Physician, 44(6), 425-428.

 

Regular exercising allows you and others to observe your progress and see tangible evidence of improvement over time, providing a source of motivation and combating feelings of depression or discouragement.

Keeping track of your exercise progress provides many benefits. By monitoring your performance regularly, you can observe your gradual improvements and feel more optimistic about your recovery journey. Seeing tangible evidence of your progress can also boost your confidence and motivation, while positive feedback from others who notice your improvement can further enhance your sense of accomplishment.

Regular exercise has been shown to have a positive impact on managing pain in stroke patients,

In stroke patients, poor circulation can also cause pain in the upper limbs, particularly if the affected limb has reduced blood flow or limited mobility. Poor circulation can cause muscles to become weak and fatigued, and may also result in the development of cramps or spasms.

In addition there could be formation of blood clots, which can block blood flow to the affected area and cause tissue damage. This can result in pain, as well as other symptoms like numbness, tingling, and muscle weakness.

Atrophy (wasting or loss of muscle tissue) can occur when muscles are not used frequently and can cause muscle weakness, pain, and discomfort, as well as reduced range of motion.

The management of these issues typically involves a multidisciplinary approach that may include medication, physical therapy, and lifestyle changes, and may require the involvement of healthcare professionals such as physicians, nurses, physical therapists, and other specialists."

Exercise and medication can be effective in improving the condition, but it is important to note that pain may return if exercise is discontinued. Exercise may help to improve oxygenation and reduce muscle-stiffening proteins, which can be a side effect of inactivity."

 

Crucial

Set goals and track your progress!

It's important for stroke survivors to set goals and track their progress as this can have a positive impact on their recovery. Goal setting and tracking progress can have a positive impact on a stroke survivor's psychological well-being and motivation to continue exercising.

For example, a study by Lin et al. (2014) found that stroke survivors who participated in a goal-setting program had higher levels of self-efficacy and were more motivated to engage in physical activity compared to those who did not participate in the program. Similarly, a study by Rimmer et al. (2000) found that goal setting and progress tracking led to higher levels of motivation and adherence to exercise programs among stroke survivors.

References:

• Lin, K. C., Chen, Y. A., Chen, C. L., Wu, C. Y., Chang, Y. F., & Huang, P. C. (2014). Efficacy of motor imagery training on functional outcomes in stroke patients: a systematic review and meta-analysis. Clinical Rehabilitation, 28(11), 1117–1127. doi: 10.1177/0269215514536218
• Rimmer, J. H., Riley, B., Creviston, T., & Nicola, T. (2000). Exercise training in a predominantly African-American group of stroke survivors. Medicine and Science in Sports and Exercise, 32(12), 1990–1996. doi: 10.1097/00005768-200012000-00015

More Crucial

Not exercising can lead to muscle atrophy

Yes, there is scientific evidence to support the idea that not exercising can lead to muscle atrophy and make it more difficult for stroke survivors to recover and regain function in the affected limb.

One study published in the Journal of Stroke and Cerebrovascular Diseases in 2016 found that muscle atrophy is common in the early stages after a stroke, particularly in the affected limb. The study also found that physical therapy and exercise can help to prevent or reduce muscle atrophy and improve overall functional outcomes in stroke survivors.

Another study published in the Journal of Neurology, Neurosurgery & Psychiatry in 2004 found that muscle atrophy is a significant problem in stroke survivors who have limited mobility and are not engaging in regular physical activity. The study suggests that exercise and physical activity should be a standard part of stroke rehabilitation programs to help prevent muscle atrophy and improve overall recovery outcomes.

Based on these findings, it is important for YOU to engage in regular exercise and physical activity to prevent muscle atrophy and improve overall recovery outcomes.

References:

• Salbach, N. M., Mayo, N. E., Wood-Dauphinee, S., Hanley, J. A., Richards, C. L., & Côté, R. (2004). A task-orientated intervention enhances walking distance and speed in the first year post stroke: a randomized controlled trial. Clinical rehabilitation, 18(5), 509-519.
• Eng, J. J., Chu, K. S., Kim, C. M., Dawson, A. S., & Carswell, A. (2016). A community-based group exercise program for persons with chronic stroke. Medicine and science in sports and exercise, 48(8), 1508-1515.

 

Imagine performing a task!

When we imagine performing a task with our hand, our brain activates the same neural pathways that are used when we actually perform the task.

• The primary motor cortex, located in the frontal lobe of the brain, is responsible for generating motor commands that control movement. When we imagine a movement, the same areas of the primary motor cortex are activated as when we physically perform the movement.
• Additionally, other areas of the brain are also activated during mental imagery, including the supplementary motor area, premotor cortex, and parietal cortex. These areas are involved in motor planning and sensory processing, and their activation during mental imagery helps to simulate the experience of performing the task.

Despite the activation of motor and sensory areas during mental imagery, the motor component is not transposed in reality because mental imagery is a simulation of movement rather than actual movement. While mental imagery can activate the same neural pathways as physical movement, it does not provide the same sensory feedback that is present during actual movement. This sensory feedback is important for fine-tuning motor control and adjusting movements in response to feedback from the environment.

Imagine performing task is a valuable tool for improving motor function and rehabilitation outcomes, and its effectiveness is due in part to its ability to activate the same neural pathways used in physical movement. Although, it is not a replacement for physical practice, you can and should use it in conjunction with other forms of therapy and rehabilitation.

References:

• Sharma, N., Pomeroy, V. M., & Baron, J. C. (2006). Motor imagery: a backdoor to the motor system after stroke? Stroke, 37(7), 1941-1952.
• Jackson, P. L., Lafleur, M. F., Malouin, F., Richards, C., & Doyon, J. (2001). Functional cerebral reorganization following motor sequence learning through mental practice with motor imagery. Neuroimage, 14(6), 1373-1384.
• Braun, S., Kleynen, M., van Heel, T., Kruithof, N., Wade, D. T., & Beurskens, A. (2016). The effects of mental practice in neurological rehabilitation; a systematic review and meta-analysis. Frontiers in human neuroscience, 10, 315.
• Jeannerod, M. (2001). Neural simulation of action: a unifying mechanism for motor cognition. Neuroimage, 14(1), S103-S109.
• Mulder, T. (2007). Motor imagery and action observation: cognitive tools for rehabilitation. Journal of neural transmission, 114(10), 1265-1278.

 

My hand is completely immobile, I cannot perform any task!

Question:

Considering the fact that my hand is completely immobile, it is impossible for me to perform any task with it. Therefore, how can I be expected to complete any task using this hand?

Answer:

If you have difficulty moving one of your hands, using the opposite hand to perform tasks that you would normally perform with your affected hand can be a helpful strategy. This is known as "constraint-induced movement therapy" or "forced-use therapy." By using your unaffected hand to perform tasks that would normally require your affected hand, you can encourage your brain to reorganize and adapt to the motor impairment, which may lead to improvements in motor function.

Additionally, using your unaffected hand can help maintain and improve overall functional abilities and prevent disuse atrophy in the affected limb. It's important to work with a rehabilitation specialist or therapist to ensure that you are using proper techniques and exercises that are appropriate for your specific condition and level of impairment. They can help you develop a comprehensive rehabilitation plan that includes a variety of strategies, including using your opposite hand, to improve your motor function and overall quality of life.

References:

• Taub, E., Uswatte, G., & Pidikiti, R. (1999). Constraint-induced movement therapy: a new family of techniques with broad application to physical rehabilitation--a clinical review. Journal of rehabilitation research and development, 36(3), 237-251.
• Wolf, S. L., Winstein, C. J., Miller, J. P., Taub, E., Uswatte, G., Morris, D., ... & Light, K. E. (2006). Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. Jama, 296(17), 2095-2104.
• Langhorne, P., Coupar, F., & Pollock, A. (2009). Motor recovery after stroke: a systematic review. The Lancet Neurology, 8(8), 741-754.
• Kwakkel, G., Kollen, B. J., & Krebs, H. I. (2008). Effects of robot-assisted therapy on upper limb recovery after stroke: a systematic review. Neurorehabilitation and neural repair, 22(2), 111-121.

Written by Natanael Dobra - Communicative Disorders Assistant (CDA)