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Stroke Smart Magazine

May/June 2008

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Moving and Shaking: Arm and Hand Mobility

By Pete Lewis

Judi Johnson recently met someone at church and instinctively stuck out her arm to shake hands. What may seem like an everyday occurrence had special significance for Johnson. It was the first time in 16 years that she was actually able to do it.

Johnson had a stroke when she was in her early 50s. Despite years of physical therapy and exercise, she continues to have weakness and partial paralysis on her right side. And like many stroke survivors, Johnson suffers from shoulder subluxation, a partial dislocation of the shoulder joint. For years she hasn’t been able to extend her arm.

Two advancements in  rehabilitation therapy, robotics and electrical stimulation, are now helping stroke survivors.

Robotic rehabilitation therapy is set up like a video game. Patients move their arms in  response to simple instructions. The device senses what the arm is doing and assists when the patient is unable to perform.  "If you show the muscle how it’s supposed to work, it’s easier to teach the muscle to work on its own," said Matt White, Johnson’s occupational therapist at Sister Kenny Rehabilitation Institute in Minneapolis, Minn.

Through task-specific practice and repetition, the brain can sometimes reprogram itself, either accessing unused connections or developing new pathways between the brain and the muscles in the limb. More research is needed to determine how effective robotic therapy can be for stroke survivors. But Johnson’s range of motion did improve with this approach.

Johnson said that she couldn’t tell when the device was doing the work or when she was. But as she improved, her chair was repositioned so that her arm did more work.

Electronic stimulation therapy also helped Johnson. This involves two pads that are attached to the skin on the shoulder. The pads are connected to a small battery pack that sends a painless electrical current to the shoulder. The electrical signal relieves pain by competing with the body’s neurological "pain signal." Johnson did the treatment for 20 minutes at a time, four times a day.

Other research at MetroHealth Medical Center in Cleveland also may help. Tiny wires are implanted under the skin of stroke patients.  The procedure reduced shoulder pain in 94 percent of the patients treated within a year and a half of their stroke, and in 31 percent who received treatment later in their recovery.

"It doesn’t make any difference when you had your stroke," Johnson said. "If you don’t give
up and you work hard, there is opportunity for improvement. The key is you have to invest in your own recovery."


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