Cannot release weak hand 3yrs after stroke. Help.

by Alberta Carter
(Chester south carolina USA)

Question I had a stroke 3yrs ago and I still can't release my my left /weak hand . Is there any hope that I will be able to operate my hand functionally to take care of myself and my 3yr old daughter?? Therapists have told me more than likely I won't be able to and that I will always require assistance.

2. I also walk with a non quad cane and I want to know if its possible for me to regain my balance well enough to walk without assistance/my cane?
★By the way I'm only 25.......I need answers and feel like my therapists are very negative and discouraging. :-(

Answer I am sorry that you feel discouraged by your therapists. From a therapist's perspective, I think it's important to not overpromise or mislead patients. I encourage patients to learn adaptive techniques to perform their daily living skills while at the same time encouraging them to work on regaining movement and arm function. I cannot predict if someone will regain movement, but I do know that most patients do not get enough exercise or activity with their weak arm to allow for neuroplastic changes of the brain.

I do not know if your hand is contracted or if you are just unable to actively open it on its own. If your hand has high tone and is contracted then that would need to be addressed with a physician first before trying to gain movement. You can visit my spasticity page for ways to deal with tone if that is a problem.

If you can passively open the hand (meaning you can take the other hand and stretch the weak hand open) then you could try doing exercises daily (multiple times per day). The progression I take my patients through when rehabilitating the hand include:

1) Learning to weight bear through the hand to decrease any tone - this can be done on a mat, table, or on a ball.

2) Passive range of motion using the strong hand to stretch the weak hand open/close.

3) Trying to keep the hand on a surface without falling off. Once you have relaxed the hand through weight bearing then try to place it on a surface (using the other hand to help) and see if you can keep it there without it falling off. To make this harder, place the hand on a soccer ball (or similar) and try to keep it from falling off the ball. You can also progress to placing the hand on an inclined surface if a flat surface or ball is too easy.

4) Similar to number 3, I have the patient put both hands on a ball with fingers outstretched and have them first try to just keep their weak hand on the side of the ball. Once they master this, we move to trying to lift the ball with hands flat on each side of the ball.

5) I use tapping to the back of the forearm and try to have the patient open the fingers and lift the hand back. I also use electrical stimulation but a physician's prescription is required for this and the patient must not have any contraindications.

These are some of the basic exercises I start addressing with patients. One must first be able to get the hand open passively and be able to hold the hand open flat on an object then he/she can progress to more advanced exercises. One needs to do the exercises repeatedly and throughout the day to have the best chance of getting results. You should try to incorporate the use of the hand/arm in any task that you can throughout the day even if it's only placing the weak hand on an object to hold it in place.

I cannot predict if you could walk without a cane, but my suggestion is to get a physical therapy order from your doctor and let the therapist know your goal is walking without a cane. That way you could safely work on this goal. It doesn't matter if you've had therapy in the past. You can always ask for more therapy especially if you have a specific goal to address, have experienced any changes, or are trying something new like botox or medicine changes to control spasticity. I see many patients come back for therapy many years after their stroke. Good luck to you!

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