Stroke Smart Magazine
Winter 2010
REHABILITATION & RECOVERY
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Strength Therapy
Focus on Using Weak Limbs to Regain Mobility
Many stroke patients experience arm and hand weakness even
months after a stroke. While many people think that strength in the hand and
arm will come back on its own, thats not always the case. You need to use your
muscles as much as you can, even if there is only a slight amount of movement,
in order to gain back strength. Once your brain and muscles reconnect and begin
again to communicate, it is time to start trying to use your hand and arm
again.
Research shows that intense use of a persons weaker hand and
arm after stroke can improve strength and function. While this technique might
not apply to stroke survivors without any strength, it is valuable for those
with even a small amount of active movement. Some people are first able to move
the fingers or wrist; others see movement return first in their elbows or
shoulders. You do not have to be able to move in all areas in order to start
becoming more active on your weaker side.
Constraint-induced movement therapy (CIMT) is used to
encourage the patient to use the weaker hand and arm after stroke by limiting
the use of the stronger hand and arm. In CIMT programs, a mitt is worn on the
stronger hand to prevent the patient from using the stronger hand or arm. Using
the weaker arm for everyday tasks helps to strengthen the weaker arm. Very
intense CIMT programs require patients to use their weaker limb 90 percent of
their waking hours. Less intense - or modified CIMT (mCIMT) — programs have the
patient use of the weaker limb only six hours every day. Typically, structured
therapy is a part of these formal programs in addition to the mitt-wearing
schedule, which continues a minimum of 10 days. Not everyone can use these
programs because of cost, time and limited availability.
You do not need to participate in a formal program in order
to benefit from this therapy technique. Although research is limited on the
outcomes of mCIMT outside of a structured therapy program, gains might still be
made using similar principles at home. The basic concept is to force yourself
to use your weaker arm in everyday tasks as often as possible. When taking part
in these activities at home remember:
- Modify the activities according to hand and arm strength.
- Never try activities that could compromise your balance or
safety.
- If you have reduced sensation in your weaker hand or arm,
avoid handling warm or hot items.
- Never use your weaker hand to control the use of a straight
cane, quad cane or walker.
- Check with your doctor to see what exercises might be most
beneficial and safe for you.
People with mild stroke will benefit most from mCIMT or CIMT
because they will likely have more movement in their weaker hand and arm.
People with moderate to severe stroke can still benefit from active hand and
arm movement at some point in their recovery, however, activities might be more
frustrating and it can take longer to see gains.
For more information on the benefits of CIMT contact your
doctor for programs in your area.
Move It!
- Here are some examples of ways to incorporate your weaker
hand and arm into daily activities:
- Hold containers while opening (toothpaste, bottled water, medicine
bottles, deodorant).
- Open/close cabinets, appliances or doors.
- Turn on the faucet.
- Eat finger foods (pretzels, bite-size carrots, grape
tomatoes, cubes of cheese).
- Carry a light bag either in your hand or on your forearm.
- Button, zip, tie shoes and clothing.
- Dial or answer the phone.
- Hold utensils or your toothbrush with built-up foam handles.
- Type on the computer.
- Fold clothes or towels.
Lori Ann Bravi, MS,
OTR/L, works at the Rehabilitation Institute of Chicago. She can be reached at
lbravi@ric.org.
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