Physiotherapy for Stroke Rehabilitation
Stroke Rehabiliation
Physiotherapy for stroke rehabilitation positively affects the extent of your recovery from a stroke. This article describes the importance that a physiotherapist plays in your recovery from a stroke.
Almost immediately after suffering a stroke and during your hospital stay, you will encounter a rehabilitation expert known as a physiotherapist. While in the hospital, physiotherapists will assess your movement, measure your motor function, and design a therapeutic exercise program to increase strength and restore movement.
Once released from the hospital, physiotherapy continues to improve motor function and independence. The physiotherapist’s goal is to help the client return to normal activities as soon as possible.
In-home Physiotherapy
Upon discharge from the hospital, in-home physiotherapy might suit your recovery. The primary role of physiotherapy is to help you regain movement and function. To do this, the physiotherapist will use a variety of exercises and activities which promote physical and mental well-being. It is important to note that at least two home visits per week may be required to keep the momentum going for your rehabilitation.
The time of an in-home visit depends on the severity of your stroke and your mobility factors. Some patients may require daily visits, while others require only once or twice weekly.
Physiotherapy might include walking with you to ensure balance and stability, using a walker, using weights, practicing sitting to stand, or simply working on how to get out of bed.
Physiotherapy Assessment
One of the first tasks assigned to a physiotherapist when working with stroke patients is the assessment process. Gathering information about your medical history, including any pre-existing conditions or medications, will be discussed. Your physiotherapist will also ask you to complete various tests and measurements. Thsse tests may include:
Range of Motion and strength testing:
measuring the range of your joints and the power of your muscles
Gait analysis/ Gait speed and distance:
A 10m or a 6 min walking test might be indicated.
Grip Strength:
the amount of force you can use to squeeze a dynamometer device.
The Berg Balance Scale:
Scores the patient’s ability to maintain balance during various tasks (looking behind you/ shifting weight/ raising afoot to meet the first step on a set of stairs, etc.), and much more.
Gait:
How do you walk? What compensatory patterns do you use? How many steps can you take? What aids do you use? Etc. During the assessment process, your physiotherapist will also take note of any pain or discomfort you are experiencing to determine how this may affect your rehabilitation efforts.
The Importance of Goal Setting in Stroke Rehabilitation
Your physiotherapist will sit down and discuss realistic and achievable goals. After consultation, the physiotherapist will better understand what you want to achieve from your therapy sessions. Given that stroke is a traumatic event that impacts all aspects of life, it is vital for both the patient and therapist to understand a range of factors during goal setting. These factors include: Physiological – refers to physical characteristics such as mobility, coordination, and balance. Social – family and social events.
Participation in recreational activities.
Family and friends
Returning to work or school.
Psychological – such as depression, anxiety, and stress.
Physiotherapy Treatment Plan
The treatment plan is the blueprint for achieving your goals. The treatment plan sets out your physiotherapist’s path with your rehabilitation, starting with the initial assessment and goal-setting process.
The treatment plan is unique to each patient; however, there are three main stages in stroke rehabilitation
1. Early – when you return home from the hospital, your physiotherapist will see you regularly. During these early visits, your physiotherapist will assess your needs and create a treatment plan designed to meet these needs. Activities may include a range of motion exercises for the arms, legs, or neck; weight shifting activities where you are required to sit in a chair and shift your weight from one side to another; walking and managing stairs; the need for assistance or supervision; and much more.
2. Active – this period allows you to maintain your mobility with minimal physiotherapy contact independently. Reducing physiotherapy visits does not mean that your physiotherapist will stop collaborating with you. During the active stage, patients continue to see their physiotherapists likely monthly to discuss progress, manage challenges, and review and progress exercises.
3. Rehabilitation Maintenance – once you can independently conduct activities of daily living (ADLs), such as dressing yourself, bathing yourself, cooking your meals, and much more, your physiotherapist will gradually reduce the frequency of visits over time. This reduction in services may result in a physiotherapy session every three months or a phone call between sessions to address challenges and discuss progress. A video call might also be beneficial, as it provides an option to demonstrate your gains.
The goal of physiotherapy treatment is to maximize function and independence for everyone. Your physiotherapist will collaborate with you during all stages of rehabilitation to ensure that you meet goals and progress to the next step of treatment.
Treatment plans are often adjusted as progress is made. New goals come into focus, and innovative programs are put in place.
Collaboration Between Yourself and Your Physiotherapist
Nothing is more critical to your overall recovery than forming a partnership with your physio. A close collaboration between yourself and your physio means that you agree on realistic goals and agree to the treatment plan to get there. As well as working with your physiotherapist, take an active role in your treatment. An active role means attending all scheduled therapy sessions, completing any homework given by the physiotherapist, and following any advice or instructions. It is also vital for you to be open and honest with your physiotherapist about your progress with your rehabilitation.
The Importance of Exercise in Stroke Rehabilitation
After a stroke, neuropathways may have broken down, and the brain must begin the process of rewiring itself. Exercise is vital to the rewiring process as it promotes neuroplasticity or new cell growth in parts of the brain. Specific parameters must be considered for exercise to be effective after a stroke. Considering this, your physiotherapist will have prescribed activities designed to meet your individual needs and goals. Your physiotherapist will be there to monitor your progress and provide you with a safe environment for this to take place. You may find that there are times when your physiotherapist will ask you to go beyond what is comfortable or even possible to reach your goal. In these circumstances, your physiotherapist will collaborate with you to ensure the exercises are adapted to meet the level of function. Your physiotherapist will work with you to design an overall exercise plan that is safe, progressive, and effective. The overall goal of rehabilitation is to maximize strength, coordination, mobility, and balance.
Techniques and Modalities Used in Stroke Rehabilitation
To meet the goal set by your physiotherapist, a variety of techniques may be used throughout your sessions. These techniques can include manual therapy, therapeutic exercise, and even electrical stimulation in some cases. Here are some techniques and modalities that a physiotherapist might employ.
Manual Therapy
Manual Therapy is when your physiotherapist uses their hands to provide therapeutic techniques. These techniques may include joint mobilizations, massage, or deep tissue work. Manual therapy lengthens shortened structures and breaks down adhesions in the muscles, tendons, and fascia.
Constraint-induced Movement Therapy
Constraint-induced movement therapy is a technique where the therapist restrains the movement on the unaffected (healthy) side of your body to stimulate your body’s affected (weak)side.
Electrical Stimulation
Electrical Stimulation is delivered through a small hand-held device and electrodes placed on the muscle belly to improve muscle contraction and power. Additionally, electrical stimulation sometimes reduces muscle spasticity associated with movement difficulties following a stroke.
Therapeutic Exercise
Therapeutic exercise refers to all forms of physical activity you undergo throughout your rehabilitation program. These therapeutic exercises may include pool therapy, cycling on a stationary bike, walking on a treadmill, resistance training, step-ups, stair climbing, walking, sitting to stand or squats, manipulating balls, etc. All forms of exercise improve overall cardiovascular health while also promoting neuroplasticity.
Mirror Therapy
Mirror therapy utilizes a specific set of boxes where mirrors are arranged to mimic normalized movement in the affected hand when you move your unaffected hand. This exercise trains the brain to fire new pathways to move the affected hand.
Motor Imagery
Motor imagery is a technique that involves the mind reacting to visual input of a task that you are familiar with. Your physiotherapist will ask you to imagine performing a specific task, such as walking upstairs or eating with a spoon. Motor imagery and mental practice can generate similar neural activity to actual physical exercise.
Gait Training
Gait training is another exercise you will undergo as part of your stroke rehabilitation program. As the name suggests, gait training is meant to normalize walking patterns and is often referred to as gait re-education or relearning. This type of therapy aims to improve your ability to walk. It also supports balance training, coordination, and strength of the lower limbs.
Balance and Coordination Training
Balance and coordination exercises help improve balance, posture, gait, and gross and fine motor control of the upper extremities. These exercises might include walking and stopping, increasing your step length, or decreasing your step width. As your skills improve, we might work on standing while writing on a board or using target training with pods that light up.
Exercises for the Upper Limbs
Exercises for the upper limbs might involve strengthening and range of motion. These exercises may include squeezing a small ball, grasping and manipulating different-sized balls, or placing an item in a specific target basket. Strengthening exercises improve overall motor function while also reducing contractures and spasticity.
Hand Exercises
Hand exercises improve grip strength and range of motion while reducing spasticity and contractures in the upper limbs. There are several diverse types of hand exercises that you will undergo during your stroke rehabilitation program, including Pinching small cones with the thumb and fingers Grasping small balls Picking up light objects with the fingertips Gripping a large ball
Finger Exercises
Finger exercises improve the strength and range of all your fingers. These types of exercise include activities such as picking up a small object or turning a key in a lock with your fingertips.
Weighted Objects
Weighted objects are another form of hand exercise that you will undergo during your stroke rehabilitation program. The type of objects you might use include a single dumbbell, large soup cans, or even your mobile phone or a familiar object that you might have used: a canoe paddle, a racquet, free weights, etc.
Spasticity Management
As mentioned above, spasticity is caused by increased muscle tone, affecting the range of movement within joints. If not treated, spasticity can cause sustained contractures. Your physiotherapist may treat spasticity with manual stretching and range of motion exercises. Alternatively, your medical team might use other forms of treatment such as anti-spasmodic medication or botulin toxin injections (botox) into the affected muscles.
Range of Motion Exercises
During your stroke rehabilitation program, your physiotherapist will carry out range of motion exercises to improve the flexibility and mobility of your joints. Range of motion exercises can reduce contractures and spasticity and allow for improved function and quality of life.
Ability for Self-Care
As part of your stroke rehabilitation program, you may require some help and support to carry out certain day-to-day activities such as getting dressed, preparing food, or going to the toilet. Your physiotherapist will collaborate with you to improve your ability for self-care. Including several different techniques such as prompting (providing cues to remind and encourage), shaping (breaking down complex tasks into smaller steps), and using prompts such as pictures to help you learn new skills.
Interactive Video Games
Interactive video games may play a part in your stroke rehabilitation program. These games may include Wii Sports, Kinect, and Nintendo Wii Fit. These games use virtual reality technology, which allows the individual to enjoy a wide variety of sports and exercises while promoting neuroplasticity.
Virtual Reality Training
A new and innovative form of stroke rehabilitation is virtual reality training. Virtual reality involves using a computer and a specialized head-mounted display to create an alternative world that you can explore and interact with while conducting various exercises and activities.
Treadmill Training
Treadmill training helps to improve cardiovascular fitness while also promoting neuroplasticity. Your physiotherapist will set the speed and incline according to your abilities if indicated treadmill training is beneficial for assisting individuals to maintain mobility after discharge from the hospital.
Resistance Training
Resistance training is a fantastic way to tone and strengthen the muscles of the upper and lower limbs. Training includes a variety of devices such as hand-held weights or bands, weighted balls, and resistance tubing. These simple types of exercise can positively impact overall health, fitness, and well-being.
Exercise in a Warm Pool
Exercise in a warm pool also referred to as hydrotherapy or aquatic therapy, involves exercising the body parts you control while being supported by the buoyant properties of water. This type of therapy allows joints and muscles to move through their full range of motion, improving muscle strength. Individuals who have an elevated level of spasticity may also benefit from exercise in a warm pool as water provides resistance and reduces the stretch response in spastic muscles. If indicated and within the client’s goals, pool therapy might include previously learned swimming skills using floatation equipment if needed.
Physiotherapy for Stroke Survivors Conclusion
Stroke survivors have a friend in physiotherapists. They are experts in how our bodies move. No matter what area of the body or how severe the damage is from a stroke, physiotherapists can help move you forward. Their skills and techniques improve function and quality of life after a stroke. Working with a physiotherapist during your recovery process will allow you to enjoy a better quality of life while also helping you return home sooner. Reaching your goals is achievable with your dedication to movement and the helping hand of a specialized physiotherapist.
Additional Resources
An article from Physio-Pedia on physiotherapy techniques to aid stroke recovery.
The Mayo Clinic discusses what to expect as you recover from a stroke.
About the Author
Sybille Bergin PT is a certified physiotherapist and one of the owners of Bergin Motion. Bergin Motion is a family-run Barrie Physiotherapy Clinic located in Barrie’s Southend. Sybille has been providing in-home physiotherapy for over 30 years. She specializes in treating acquired brain injuries, stroke recovery, and other related ailments. Sybille is a certified NDT practitioner. Neuro Development Therapy is a specialized hands-on treatment technique that promotes mobility, balance, core strength, and gross motor skills in a playful, fun, and dynamic way. Sybille leads a team of dedicated professionals providing first-class therapy at Bergin Motion to Barrie Ontario and surrounding areas.