Rehabilitation after stroke:
There are two types of stroke, hemorrhagic and ischemic. Hemorrhagic strokes are less common, in fact only 15 percent of all strokes are hemorrhagic, but they are responsible for about 40 percent of all stroke deaths.
A hemorrhagic stroke is either a brain aneurysm burst or a weakened blood vessel leak. Blood spills into or around the brain and creates swelling and pressure, damaging cells and tissue in the brain. There are two types of hemorrhagic stroke called intracerebral and subarachnoid.
Intracerebral hemorrhage: The most common hemorrhagic stroke happens when a blood vessel inside the brain bursts and leaks blood into surrounding brain tissue (intracerebal hemorrhage). The bleeding causes brain cells to die and the affected part of the brain stops working correctly. High blood pressure and aging blood vessels are the most common causes of this type of stroke.
Sometimes intracerebral hemorrhagic stroke can be caused by an arteriovenous malformation (AVM). AVM is a genetic condition of abnormal connection between arteries and veins and most often occurs in the brain or spine. If AVM occurs in the brain, vessels can break and bleed into the brain. The cause of AVM is unclear but once diagnosed it can be treated successfully.
Subarachnoid hemorrhage:This type of stroke involves bleeding in the area between the brain and the tissue covering the brain, known as the subarachnoid space. This type of stroke is most often caused by a burst aneurysm. Other causes include:
Ischemic stroke occurs when a blood vessel carrying blood to the brain is blocked by a blood clot. This causes blood not to reach the brain. High blood pressure is the most important risk factor for this type of stroke. Ischemic strokes for about 87% of all strokes. An ischemic stroke can occur in two ways.
Embolic stroke:In an embolic stroke, a blood clot or plaque fragment forms somewhere in the body (usually the heart) and travels to the brain. Once in the brain, the clot travels to a blood vessel small enough to block its passage. The clot lodges there, blocking the blood vessel and causing a stroke. About 15% of embolic strokes occur in people with atrial fibrillation (Afib). The medical word for this type of blood clot is embolus.
thrombotic stroke: is caused by a blood clot that forms inside one of the arteries supplying blood to the brain. This type of stroke is usually seen in people with high cholesterol levels and atherosclerosis. The medical word for a clot that forms on a blood-vessel deposit is thrombus.
Two types of blood clots can cause thrombotic stroke: large vessel thrombosis and small vessel disease.
Your stroke rehabilitation program involves working with a team to guide you. This usually includes physical and occupational therapists. The rehab team will likely recommend combining a variety of exercises and other techniques to help your arm recover. Two big goals of stroke rehab are to enhance muscle control and reduce spasticity. This is a constant contraction of muscles that can lead to pain and other problems.
Stroke rehabilitation for your hand and arm includes passive movements or exercises that are movements done with the help of a therapist and more active exercises you do with little or no assistance.
Stroke rehabilitation can be tiring. It may also help to be active during times of the day when you have more energy. Set realistic goals.
Stretching Arm Exercises After a Stroke continued…
Your therapist will teach you range-of-motion stretches. Some of these involve using your other arm to produce the forces needed to move the disabled arm. Called passive exercises, these can help prevent muscle shortening and joint stiffness.
“Taking the arm and stretching it with the other arm is the bedrock of spasticity self-management,” Stein says. You can also use the unaffected hand to stretch the thumb and all the fingers on the affected hand.
Arm-Strengthening Exercises After a Stroke
In the past, there has been some controversy about strength trainingfor the arm and hand after a stroke. It was thought that strengthening spastic muscles might do more harm than good. Now research indicates that strengthening spastic muscles can even reduce spasticity.
A recent review of 13 studies including 517 stroke patients with mild to moderate impairment of their arms found that strengthening hands and arms with small weights, resistance bands, and pulley weights could be done without increasing spasticity and pain.
Other Techniques to Help With Arm Recovery
In addition to stretching, functional, and strengthening exercises, other techniques may also help you recover use of your arm after a stroke. The effectiveness of some of these techniques and devices is still being explored.
Active-passive bilateral therapy. A stroke upsets the balance between the two sides of the brain. Active-passive bilateral therapy involves performing a task by using the non-affected and the affected hand together.
Functional electrical stimulation. This technique involves generation of an ELECTRICAL current that stimulates nerve ACTIVITY in limbs affected by stroke, strengthening weak or spastic muscles. Ryerson says this technique may be helpful for opening a contracted hand.
Brain stimulation. Magnetic or direct current stimulation of the healthy hemisphere of the brain is a technique that can reduce the activity of overactive neurons. This may help restore balance in the brain after a stroke.
Biofeedback. Although biofeedback is not well researched, this technique provides a sound or light signal that shows if muscles are active. This might help by creating greater awareness of muscle contractions, which is impaired after a stroke. With greater awareness, it may become easier to relax muscles and coordinate hand movements.