Stroke Rehabilitation

Sean McDonaldStony Brook University, OTSSpring 2016

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A stroke, or CVA, is defined as an “acute neurological dysfunction of vascular origin with symptoms and signs

corresponding to the involvement of focal areas of the brain.” (The World Health Organization)

Ischemic (87%) – Insufficient blood flow to the brain to meet metabolic demand caused by a blocked artery or obstruction such as a clot or fatty deposit.

Hemorrhagic (13%) – Subarachnoid and intracerebral bleeding of the brain.

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Rank as third leading cause of death behind heart disease and cancer 795,000 people suffer a stroke per year 72% are older than 55 / After this age the incidence of stroke more than doubles with

each decade 1.25 X greater risk in men than women Among people who have suffered a stroke:

- 50% have hemiparesis- 30% cannot walk - 19% are aphasic- 35% are clinically depressed- 26% require home nursing care

(Pendleton & Schultz-Krohn)

Stroke Statistics

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Modifiable Risk Factors

Hypertension is the single most important- BP 120/80 or lower has about half the lifetime risk of

stroke to those that are higher Management of cardiac disease (Afib), diabetes,

and glucose metabolism Cigarette smoking Excessive alcohol and drug use (e.g. cocaine) Lifestyle factors such as obesity, diet, stress and

physical inactivity

(Pendleton & Schultz-Krohn)

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Low Tone Stage

Joints tend to become misaligned secondary to loss of muscular stabilizationGlenohumeral and wrist joints are most at risk

Passive Range of Motion (PROM) is used in an attempt to maintain joint flexibility after stroke

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Benefits of Joint Mobility

Early mobilization helps prevent DVT, skin breakdown and contracture formation

Allows for better orthostatic tolerance and earlier improvement of ADL performanceMobilizing the scapula helps alleviate pain and allow for more shoulder movement

(strokeassociation.org)

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Shoulder Flexion and Extension

Keep arm straight with palm facing body, raise arm up to patient’s tolerance and lower back down. Support given at elbow and wrist.

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Shoulder Abduction

Raise patients arm out to the side within tolerance and lower back down.

Support given at elbow and wrist.

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Shoulder Internal / External Rotation

Keeping elbow at side, bring patient’s forearm away from body and back to abdomen within patient’s tolerance.

Support given at wrist and elbow.

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Elbow Flexion and Extension

Bend and straighten elbow within patient’s tolerance.

Support given at elbow and wrist.

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Wrist Flexion and Extension

Move hand up and down keeping fingers in extension.

Support given at wrist and PIP joints.

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Wrist Radial / Ulnar Deviation

Move hand sideways toward pinky and then back toward thumb.

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Supination / Pronation

Turn palm up and down supporting at wrist and elbow.

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Finger Flexion / Extension

Open and close fingers while supporting wrist.

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Finger Abduction / Adduction

Spread fingers apart and back together.

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Thumb Movement

Move thumb across palm and back out to side.

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Involves the patient using the unaffected arm to move the affected arm

Strengthens recovery process

Increases patient’s awareness of the affected arm

Self Passive Range of Motion

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Shoulder Flexion Forward

Clasp hands together, then raise hands straight up toward the ceiling using your strong arm to help lift the weak arm.

Then, bring hands back down to chest.

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Straight Arm Punches

Keeping arms straight, try to lift shoulder blades off the bed while not moving head.

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Shoulder Flexion / Extension

Brings hands to forehead, bending at the elbows, then straighten arms with hands pointed at the ceiling.

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Wrist Flexion / Extension

Bend the wrist slowly from side to side.

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Wrist Supination / Pronation

Turn weak hand palm up and then palm down.

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Finger Flexion / Extension

Bend fingers of weak hand into palm and then straighten.

If fingers tend towards flexion, then only work on straightening fingers.

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Sitting balance plays a major role in performing ADL’s such as dressing, bathing, and toileting. It’s also important to establish sitting balance before standing balance.

The therapist should guard the patient on the weak side during these exercises.

Sitting Balance Exercises

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Weight Shifting Side To Side

Shift weight over right hip then the left hip. Do not bend at the waist or lean to the side. Books can be placed under the hands

to allow weight bearing through the arms.

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Weight Shift Forward and Back

Shift weight forward and back by arching and rounding the lower back.

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Weight bearing strengthens limbs which in turn strengthens bones.

Many stroke patients are at risk for broken bones on the affected side due to lack of weight bearing and disuse.

Weight Bearing Exercises

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Leaning on Hand

Place the affected hand on a book without the hand falling off.

Support the patient’s elbow so the arm does not buckle and have the patient lean and put weight down through the affected arm and hand.

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Leaning Down on Elbow

Lean down on to right elbow, then push back up to center.

Lean down on left elbow, then push back to center.

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Controlling A Ball

As weight bearing through the hand improves, you can progress to trying to keep their hand on a ball without falling off.

You can also have them try to move the ball forward and back and side to side.

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Controlling A Cane

Place the affected hand on a cane and push the cane forward and back, and side to side.

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Depression can be caused by biomechanical changes in the brain due to stroke, or a normal psychological reaction to the losses from stroke. Depressed patients may have difficulty in finding the motivation to work in rehabilitation.

Depression and Stroke

Symptoms include:- Feeling discouraged- Hopelessness- Fatigue- Sleeping poorly- Not eating well- Having a hard time concentrating in rehab(stokeassociation.org)

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