Stroke Recovery – Functional Training for Stoke Rehabilitation

 

Recovery

A Stroke is a Game Changer

Recovery from a stroke can feel daunting. Retraining the brain to complete actions that it used to take for granted means intense rehabilitation in hospital, with a therapist, and at home. While strokes are game changers, they don’t have to be a life sentence. The brain is adaptive and resilient, and with a focused stroke recovery plan, there is hope.

It’s a Marathon, Not a Sprint

Stroke rehab with a physical therapist is a well-supervised process, but rehab doesn’t end at discharge. Empowered independent rehab at home is a must to continue to improve mobility, strength and endurance to enhance the ability to perform activities of daily living (ADL).

High level goals of a post-stroke rehab program include improving functional ability, range of motion, balance, strength and cardiovascular endurance. Independent rehab training should be vetted and monitored by your medical team to ensure it is safe and effective given the effects of the stroke. That said, there is so much a stroke survivor can do at home to help their own recovery.

Set Realistic Goals and Set Yourself Up for Success

After setting stroke treatment goals with the health care team, some good options for post-stroke equipment include:

  • A rubber ball
  • Exercise bands or tubing
  • A set of ankle weights or light hand weights
  • A balance board
  • Portable exercise cycle

Below are some ways to incorporate this equipment and common household items into your stroke recovery program.

Functional Ability: Repetition and Coordination

Similar to learning a musical instrument or learning to drive, practice and repetition strengthens the muscle-mind connection after a stroke. Repeated use and practice will help regain functional ability in the affected side.

Some examples for upper body include:

  • Rolling a ball back and forth on a table with the affected arm
  • Gripping a door or drawer handle and opening it repeatedly
  • Squeezing a tube of toothpaste with the affected hand while holding your toothbrush with the unaffected hand
  • Turning on and off a light switch with the affected hand

Be aware of avoidance patterns! In other words, don’t stop using the affected side – practice to improve.

Range of Motion (ROM)

Prior to incorporating resistance training into the stroke rehab program, active range of motion exercises will improve joint flexibility, strengthening and increased muscular endurance.

Examples of lower body ROM include:

  • Heel slides laying on your back or sitting in a chair
  • Wrist and ankle circles
  • Toe raises using a chair with or without weight
  • Assisted or passive stretching of warm muscles and joints

Balance

Balance training is paramount to a post-stroke rehab program to improve unassisted mobility and reduce the risk of falls.

Balance training may include:

  • Supporting oneself against or near a counter, wall or walker for stability and lifting one foot off the ground and holding for 20 seconds.
  • For more advanced stroke recovery, try standing with two feet on a balance board in between a doorframe, bracing the doorframe for stability. Keep the board level, balanced and still; remove one hand; and then the other.

Strength: Resistance Training

Preventing secondary weakness due to inactivity is important in any rehab program, particularly post-stroke. Adding in resistance training 3-5 days a week will improve strength, reduce atrophy and promote recovery.

Resistance training can be incorporated at home using resistance bands or tubing, light hand or ankle weights, or by simply performing body weight exercises like squats, hip bridges or wall push-ups.

Fine motor skills can benefit from grip strength training. Try squeezing a rubber or stress ball with your affected hand for 15 reps a few times a day.

At the gym, weight machines or pulleys that isolate specific muscles are good options for strengthening and conditioning.

To begin the rehab resistance training program, choose a weight or resistance that allows for 6 to 15 repetitions with good form and will challenge the muscle without overtaxing the recovering muscular and nervous system.

Start with one set, eventually working up to three sets with a 15 – 60 second rest period between sets. During the rest period, it’s important to listen to the body and check in. While challenging recovering muscles is important, resting when needed is more important to avoid injury or overuse.

Cardiovascular Endurance

While functional training to improve ADLs is primary to recovery, preventing recurrent strokes through improved cardiovascular function is also important to long-term health and quality of life.

When coordination and function have improved enough to explore cardiovascular training, some options include:

  • Walking (assisted or unassisted) on solid ground
  • Supervised swimming (possibly with floatation support)
  • Indoor cycling with a portable exercise cycle (it rests on the floor or tabletop to allow for pedaling with either legs or arms while sitting safely in a chair) or on a recumbent bike.

Set small, realistic cardiovascular goals. For example, walking with or without a walker to the end of the driveway and back or doing 5 minutes on the portable exercise cycle, adding more time as you continue to improve.

No One Size Fits All Program for Stroke Recovery

Ultimately there is no one size fits all rehab protocol for stroke recovery as the variables are individual, but please consider that some movement, exercise or training is better than none at all.

While post-stroke rehab may be tiring or frustrating at times for the stroke survivor, by taking action every day in the journey to recovery, improved health, fitness and functional ability is within reach.