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Stroke Smart Magazine

Winter 2010

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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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National Stroke Association’s mission is to reduce the incidence and impact of stroke by developing compelling education and programs focused on prevention, treatment, rehabilitation and support for all impacted by stroke.

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