After a stroke, most survivors experience a change in arm strength or impairments that cause mild to severe difficulty with daily tasks, mobility, transfers, or everyday activities such as returning to work, driving, or cooking. In today’s world, tools are readily available to increase safety, independence, and overall function to improve strength and function after a stroke. This article provides an overview of the importance of post-stroke rehabilitation to regain optimal arm mobility.
Five tools to promote improved arm function after a stroke
Table of contents
- 1 Five tools to promote improved arm function after a stroke
- 2 Splints and functional orthoses:
- 3 Adaptive gear for one-handed tasks or to ease the difficulty of an activity
- 4 metronomes and music
- 5 Advanced technology such as robotics and brain-computer interface systems
- 6 Inferior technology such as electrostimulation or mirror therapy
Splints and functional orthoses:
A stroke survivor may have flexion or extension tone in the upper extremity. Sometimes, prolonged positioning of the wrist, hand, or elbow in flexion or extension can cause discomfort or deformity. Special splints and orthoses allow prolonged positioning in a neutral position for all joints affected by tone in the weak arm. They also allow prolonged stretching with low stress on the tendons of tight muscles in flexion. Splints can range from off-the-shelf, off-the-shelf hand splints to custom static progressive splints if the deformity is severe enough to warrant fitting. Speak to your occupational therapist or physical therapist for guidance on wearing schedule and recommendations for type of brace. Here are some examples:
While some splints promote alignment and positioning of joints and muscles to optimize range of motion, upper extremity functional orthotics aim to improve function while wearing the dynamic device. In other words, the person can move and function better with the functional orthosis worn than without it. Specialized neurorobotic systems (powered by motors) or non-motor systems (e.g. mechanical springs and roller systems) are used in various rehabilitation programs around the world. These types of functional orthotics are often custom made, require a prescription, and should have some training from a knowledgeable occupational or physical therapist. The NeuroRehab Directory can be a very helpful resource!
Adaptive gear for one-handed tasks or to ease the difficulty of an activity
The use of adaptive equipment that allows for greater independence in daily activities can be incredibly helpful in restoring strength and function to the affected limb. As the old saying goes, “if you don’t use it, you lose it”. Research shows that high repetition and functional use of the affected limb is essential to regain function. It is important to attempt daily tasks with the affected limb as often as possible, even if this is not the usual way of completing the activity.
Adaptive gear can allow use of the arm but support any activity. Adaptive equipment ranges from commodity items to medical devices. An example of a commercial item is an electric toothbrush, which allows the survivor to hold a larger toothbrush and not have to twist their hand as much to brush their teeth. Adaptive medical equipment is generally designed for users who have a specific problem to solve due to a limiting or unique condition. An example of this is a universal cuff that allows a stroke survivor to hold a fork or spoon without a handle in the palm of their hand and bring their hand to their mouth with only elbow flexion. The links below show common adaptive devices that can help increase the independence and functional use of the affected limb. Your occupational therapist can help train you on how best to incorporate the use of adaptive devices into your daily activities.
metronomes and music
Strong evidence shows the need for mass exercise or high repetition of the affected arm after a stroke. It has been found that most stroke survivors only move the affected arm 32 times during a typical therapy session, but improved arm function requires at least 100 repetitions of the arm daily to produce a change in neuroplasticity and a change in the brain. Using a metronome to tap or clap in time with a metronome to allow maximum repetitions tolerated by the patient is a fun and easy way to accomplish this.
Traditional metronomes provide great visual and audio cues to help guide arm movement. Free smartphone apps are available and also provide the same audio and visual cues.
Create a playlist of music you enjoy to set the tone and pace for exercises and to challenge your arm during rehabilitation. Studies have shown that music can affect how long a person works (perceived fatigue) and how hard they work. Therefore, you can take your arm rehabilitation to the next level by overlaying music that affects and increases heart rate/beats per minute (BPM), fun and challenging
Finally, there is growing support among rehabilitation and medical researchers and practitioners that music therapy can help improve cognition and motor skills, alleviate negative mood, and speed neurological recovery in stroke victims.
Advanced technology such as robotics and brain-computer interface systems
Advanced technologies such as upper limb robotics, virtual reality, and brain-computer interface systems allow for high repetitive and mass practice of the affected upper limb and can produce changes in neuroplasticity in the brain. Virtual reality allows multiple sensory systems, such as visual, tactile, and motor systems, to work together to promote better motor learning.
Upper extremity robotics can provide full joint support using an actively assisted range of motion and a passive range of motion with visual guidance to targets. Brain-computer interfaces allow for mass repetition with the power of thought. The stroke survivor imagines using their affected upper limb, which is then interrupted by an orthosis and creates the movement.
Over time, the use of all advanced technologies has shown upper extremity improvement when combined with traditional therapy or used individually without traditional therapy, as well as long-term results beyond the use of technology. It is best to seek out a therapist who has either advanced knowledge or certification in the use of this technology before beginning use as some are very complex and require training to use.
Inferior technology such as electrostimulation or mirror therapy
Low-grade technology, such as the use of electrical stimulation or mirror feedback, can provide different inputs to muscles to evoke movement. Low-tech requires little equipment and is much easier to use than advanced technologies, as discussed earlier.
Most therapists are familiar with low-tech interventions because they are standard of care in most situations. It is important to note that although effective when using low tech such as electrical stimulation or mirrors, during use, more often than not when you remove the stimulus the transmission of motion returns to baseline as it reduces neuroplasticity like brain -Computer does not affect interface or virtual reality.
It is recommended to work with a therapist to track any electrostimulation or other low-tech devices such as mirror therapy for guidance on optimal use and safety, as while low-tech requires less advanced knowledge and equipment, a Guidance needed to be most effective and used correctly.
In summary, a number of tools can be incredibly effective in assisting with arm recovery after stroke. Depending on the overall goal of the tool, they can either help compensate for the movement to practice using the weak arm, or they can help fix and regain strength through mass exercises or assisted movements. This is not an all-inclusive list, but is intended to provide a basis for guidance on how to discuss managing arm function after a stroke with your occupational therapist or physical therapist. There is much that can be done to facilitate better functional recovery and taking action to provide guidance is important.