how to improve stroke

by sultan
(uk)

How do you improve patient's hand, fingers, and leg movement? Please tell me some exercises for my mother. Thanks.

Answer: If your mother already has some movement in her hand and fingers then I would recommend some of the exercises from this website's hand exercises page at www.stroke-rehab.com/hand-exercises.html.

If she does not have any movement or only little movement in her hand, then I recommend doing some weight bearing exercises which can help facilitate return of movement and decrease tone if there is any. Weight bearing can be done on the hand while sitting at the edge of the bed or it can be done with the hand on a ball.

Some simple hand and arm exercises I use after a stroke are as follows (stretch the hand prior to exercises):

1) Place patient's open hand on ball and have them work on just keeping the hand on the ball without assistance

2) Once they can keep the hand on the ball, try rolling the ball gently side to side and forward and back

3) Once they can roll the ball, place both hands on the sides of the ball (soccer ball works well) and try to lift the ball off their lap using both hands and without the weak hand falling off

4) As they are able to lift the ball, work on lifting the ball higher or moving it side to side

5) Work on taking weak hand off the ball slowly and with controlled movement


6) Once they can move hand off/on ball with some control, work on placing hand on smaller objects such as a plastic cup and letting go. Progress to trying to lift the cup.

Some other options to help facilitate return of the hemiplegic arm include using e-stim with a therapist or tapping the muscles you are trying to stimulate. If trying to close the hand, turn the palm up and tap the forearm muscles. If trying to open the hand, turn the palm down and tap the back of the forearm.

Weight bearing is also good for the leg. If your mother is able to stand, have a therapist show her how to shift weight onto the weak leg and work on weight bearing on the affected side. A physical therapist can also show you tapping techniques to help facilitate movement. For example, to elicit straightening the knee, you would tap the top of the thigh.

I am still working on developing exercise examples on my website and will eventually have pictures and videos of various exercises. If you are looking for therapy ideas, I suggest looking on You Tube for stroke rehab exercises. Many therapists and patients have recorded their therapy sessions which might give you ideas on what would work for your mother. You should always consult a therapist or physician that has worked with your mom to make sure any exercises would be appropriate for her.

Gaining Strength After Stroke

by Jayesh Mehta
(Wellingborough in UK)

Question: I suffered a hemorrhagic stroke in April 2009 and subsequently got senses back in all of my body. As an effect of the stroke, my left side, even though movement feels OK, is a bit weak due to prolong time in bed (8 months in hospital+rehab). My body has lost its strength and hence I can't get up from a sitting position. I have joined a gym to gain strength and am a full time worker post stroke. The reason for this note is to see what you can suggest to get some strength back - to be able to get up by myself and take a few steps, etc. (not looking for running down the street). Please share anything that you think might help.

Thanks
Jayesh

Answer: I like to use hi-lo mats to help patients improve their ability to stand from a sitting position. A hi-lo mat can be adjusted to a low or high position. I will have my patients sit on the mat and then raise the height. We will practice weight bearing through the legs with the mat elevated (with the buttocks still on the mat) and then will practice sit to stand from this position. I will block the knee on their weak side if necessary to prevent the leg from buckling. An air splint can also be used to help keep the leg from collapsing. Once a patient has gained confidence in standing then I work on the patient shifting weight side to side and learning to take more weight through the weak leg.

A physical therapist should be able to help you with the techniques described above. I don't know about equipment in the UK but hi-lo mats are standard equipment in a US therapy clinic.

One might could use a hospital bed or lift chair to achieve the same effect as a hi-lo mat, however, I haven't tried this out. You should always check with your medical provider before attempting any exercises and also have a therapist or trained caregiver with you when attempting such exercises as described above.

Below are examples of hi-lo mats. One can purchase these mats, however, they are expensive. You can click on the pics below which will take you to an outside website that has pricing information.

Stroke Rehab Plan

by Anna
(NEW ZEALAND)

Question: What does a typical rehab plan look like for a stroke victim?

Answer: There is no typical rehab plan. Each stroke is different and can affect persons differently. One may experience mild stroke syptoms while another person has complete paralysis. These two scenarios would require two completely different rehab plans.

Therapy evaluations are done to determine a plan of care for stroke patients. Therapy evaluations often involve examining the following areas:

1. Range of motion
2. Strength
3. Sensation
4. Cognition (problem solving, memory, etc.)
5. Swallowing function
6. Balance
7. Vision
8. Activities of Daily Living (ADLs)
9. Proprioception (sense of body position)
10. Fine and Gross Motor Skills or Coordination
11. Muscle Tone
12. Speech
13. Endurance
14. Need for Adaptive Equipment
15. Need for Splinting/Braces
16. Need for Positioning Devices

Once a therapist has gathered data on the effects of a stroke, the rehab plan of care can be written. The plan will be made up of goals that address the patient's weaknesses and exercises will be done to improve the patient's status. You can look around the stroke-rehab.com website for specific exercises used for each of the areas above.

Exercises to Build Up Core Muscles to Enable Sitting Up

by Pat
(Batavia, Ohio)

Question:What exercises should one do for strengthening core muscles to enable a stroke patient to be able to sit up?

Answer: Initially a therapist will help a patient sit up on the side of a bed or mat and help support the patient while working on sitting balance. Sometimes it takes two individuals to help the patient safely maintain sitting depending on the size of the stroke patient and severity of stroke. The patient will work on maintaining sitting in neutral with support, shifting weight forward and back over the pelvis, shifting weight side to side and various other directions, as well as leaning forward and back up. As the patient gets stronger, less support will be provided from the therapist or therapists, and eventually the patient will be able to maintain their own sitting balance.

Some examples of balance exercises can be seen at www.stroke-rehab.com/balance-exercises.html. These exercises are shown without the assist of others, but the exercises can be adapted by having the therapist assist the patient in maintaining balance so they do not fall.

Physical Exercise and Fatigue After Stroke

by Emebet
(California)

Question:Is not daily physical exercise for stroke victim too much and is not a break needed every other day to let muscles rebuild? Also how much sleep is good for person with right hemisphere stroke?

Answer: Honestly, the amount of exercise that a stroke patient can tolerate depends on the type of exercise, severity of stroke, and the person's recovery from stroke. Some individuals experience stroke, recover quickly and then return to their normal activities including daily exercise. Others are affected more severely and may not be able to participate in even simple exercise programs. Most individuals who experience stroke fall somewhere in between these two extremes. After stroke, it is important to consult your physician prior to initiating an exercise routine especially to determine if there are any cardiac conditions to consider.

The AHA Scientific Statement regarding Physical Activity and Exercise Recommendations for Stroke Survivors states that 3-7 days of aerobic exercise per week for 20-60 minutes (or multiple 10 minute sessions), 2-3 days of strength training per week, 2-3 days of flexibility training per week, and 2-3 days of coordination and balance activites per week are recommended.

The type of exercise in which a stroke victim can participate of course will depend on the physical capabilities of the person. Examples of aerobic exercise might include walking, stationary bike, arm bike, chair aerobics, or pool exercise. The more severe the stroke, the harder it is to participate in such activites and this is when it may be necessary to divide exercise into 10 minute intervals as well as find the right activity that involves moving large muscle groups. Exercise will often have to be adapted for stroke victims.

When you ask if a day in between is needed to let muscles recover, it depends on what you are talking about. Traditional strength training involves giving muscles a day or two of rest between workouts. This isn't necessarily the type of workout that a stroke victim is getting during rehabilitation though. Often, the stroke victim is doing range of motion exercises or very light resistance which would not fall under the realm of strength training that requires time for muscles to recover. If the stroke victim is truly participating in strength training with significant weight then yes, it would be necessary to spread out workouts and allow time for muscle recovery.

I don't know of any specific sleep requirements for persons who have experienced stroke. Stroke victims do fatigue more easily so taking naps during the day can be helpful to overcome fatigue, but I would not recommend excessive sleeping throughout the day. It is not uncommon for stroke victims to sleep a lot in the immediate days or sometimes weeks after a stroke, but once the patient has stabilized and is able to participate in the rehab process, a more normal sleeping pattern should be resumed. The healthy adult need for sleep usually ranges from 7-10 hours/day. The stroke victim will sleep more than this in the beginning and will most likely continue to require nap breaks during the day to battle fatigue rather than trying to achieve all their sleep during the evening.

Loss of speech and body movement

by Jay
(USA)

My father (very healthy and clean habits person) had a minor Tumor surgery in his head,6 months ago. After surgery, he was in coma for a month and he lost his voice and body movement. Now he is able to move only his arms and legs,not the body. He still didn't get his voice back. We are so upset. Please suggest some exercise and home equipment to improve his health.

Thanks!!

Answer Hopefully, he has been receiving some therapy over the past 6 months. Usually one can begin to regain sitting balance with therapy. I think it's very important to have a therapist involved when the patient lacks trunk control because the patient is at a much higher risk of falling and needs a professional with experience. If your father was discharged from therapy but has started to make gains in movement (i.e. arms and legs) then ask the physician to write a new prescription for therapy to start again.

If therapy is not an option, I would work on sitting balance activities from the wheelchair. Sitting balance activities such as shifting weight side to side and forward/back, reaching for items, and trying to lean forward and back up. Examples of these activities can be viewed at www.stroke-rehab.com/balance-exercises.html. If there is no trunk control, then it is imperative to have a caregiver (maybe even two) present to prevent the patient from falling. You could even go in for a few therapy visits just to have the therapist instruct the caregivers on balance activities and exercises to do at home if the expense of multiple therapy visits is an issue.

For speech, you could attempt making or purchasing a communication board. A communication board has pictures of various activities that a patient may want to communicate such as wanting food, needing to use the bathroom, expressing pain, wanting to go to bed, etc. There is also a website, www.speech-therapy-on-video.com, that has dvds you can purchase to work on speech therapy activities at home.

I think my main advice to you would be to continue to seek therapy as you are able for your father. Sometimes therapy isn't as effective in the beginning for individuals with severe impairment because they need more time for their medical condition to stabilize and to build up their endurance from being hospitalized for so long. It's not usually the case, but therapy can be more beneficial later in the process for some individuals.

Trouble Putting Weight Through Weak Leg to Balance

by Danni

Question: Hi there, my mum had a sub arachnoid hemorrhage in August 2010, and after 6 months of rehab regained the ability to stand and walk short distances with the use of a quadstick (one person to helped in case she lost her balance). She maintained severe left sided weakness. Periodically, since leaving rehab in March 2011, she had seizures which left her quite immobile and tired for a week or two after, but then she would regain her ability to walk and carry on. Her most recent seizure was the 7th of December 2011. Since then she has been unable to straighten her left leg and put her heel to the floor when standing. The left leg has pain in the groin area when standing (this has happened periodically since her stroke when she has long periods of inactivity). Her knee is in a constant bend, and she is unable to put her heel to the floor when standing. This makes balancing and holding her own weight impossible, and she ends up almost sitting on my hand as I hold her up at the back.. then, after a while, I give up trying and put her back down in her wheelchair. She only had botox in December (5th) for spasticity in her leg and this batch has been wasted; her leg is almost impossible to bend without injury when she's sitting and just as impossible to straighten when standing. I'm at a loss as to how to fix this. How can I get her to put weight through her left leg to straighten it enough to weight bear and balance?

Please help!

Answer: If she has not had therapy recently, get her back in therapy. Since she is having seizures that are making her worse, she should qualify for more therapy if she is not already getting it. I would probably look into a dynamic knee brace to increase the extension in her knee. If you are unable to straighten the knee, and she is unable to straighten it, then it may be contracted. If this is the case, she needs prolonged stretch which can be accomplished with bracing. If there is severe spasticity, then bracing may not be appropriate so you should check with your therapist and physician to see if she is a candidate. You have to treat the knee contracture or spasticity in order for her to balance. Most often this is treated with bracing. The earlier bracing is done, the more effective it will be so I would look into it now. There are also surgeries to correct knee contractures so this is something to ask your physician about as well if the condition persists.

Also, I'm sure it has been addressed, but there are medicines to help control seizures so if she is not currently taking meds for this, ask her physician if meds can be prescribed. You can also ask about oral meds to help control spasticity and tight muscles.

Recovery from Stroke

by Lisa
(NSW)

Question: My mother is 78. She had a stroke 3 years ago. She cannot move her left arm and can lift her left leg only a little and shuffle it if she really tries. Other than that she is physically well but is always depressed and crying. Will my mum ever get better or ever smile again?

Answer: I suggest that you read the following page on stroke and personality changes: www.stroke-rehab.com/personality-changes.html. I encourage you to have your mom see a physician or neuropsychiatrist to see if they can help her with the depression symptoms. I also encourage you to get some support by reaching out to other caregivers who are going through the same thing as you. You can find a list of various online support groups at www.stroke-rehab.com/stroke-support-groups.html. You don't necessarily have to ask questions, but you can read through countless conversations and questions of others that you will find helpful.

As far as the physical aspect of her stroke, I cannot predict the outcome, but I will say that stroke rehabilitation requires much determination and effort to improve in most instances. If she is involved in an exercise or rehab program, she will have a much better chance of improving or sustaining her physical well being. From your submission, I really feel that both your mom and you need to address emotional well-being which in return will put your mom in a better state of mind for physical rehabilitation.

Any Treatment if Stroke Happened Years Ago

by Christa
(Colorado)

Question: My father had a stroke several years ago. The stroke occurred during heart surgery. While we understand now that a stroke can occur after surgery we were unaware of that at the time.

Since we were unaware of the signs and symptoms of stroke we, (nor the doctors) gave him any treatment for the stroke. The realization that he had a stroke came after questioning the doctors why he would be so quiet since his surgery.

My dad spent several weeks not communicating after the surgery. Months later he mentioned that when ever he wanted to talk he couldn't figure out how to speak. The doctors said this was a side affect of the anesthesia from the heart surgery. We now know different.

Anyway my question is...
After such a long time (6 years) is there anything, exercises etc. that he could to to help him. He has loss of strength in his right hand. Occasionally stumbles due to loss of strength in his right foot. And has trouble remembering things.

I know that time is against him in the sense that the sooner you treat a patient that had a stroke the better. However are there things he can do to improve his strength and coordination now.

Thanks for the help.

Christa

(sbi forum www.thecookingblock.com)


ANSWER:Christa, your father could definitely benefit from therapy. I am wondering if he ever had any treatment for his stroke. If not, I would have the physician write a prescription for occupational and physical therapy (possibly speech therapy as well). We see stroke patients all the time that come back for therapy years after having their stroke due to decrease in function or ability to walk. If therapy isn't an option at this time, I would refer you to my page on fine motor exercises to help improve hand function. It can be found at www.stroke-rehab.com/hand-exercises.html

You mention that your father has trouble with stumbling. Does he have foot drop by chance? If he can't lift the front part of his foot completely due to muscle weakness, this could cause him to stumble or drag the foot. He may need to be evaluated for an ankle foot orthoses (AFO brace). This type of brace can help prevent from dragging the foot. They also have electrical stimulation devices such as Bioness and Walkaide to help with foot drop, but they are more expensive.

Last of all, cognitive function can be improved or maintained through playing games, doing memory exercises, working puzzles, playing online games specifically developed for improving memory,and reading. Studies have show that eating a diet with omega-3 fatty acids and staying physically active can help maintain/improve memory as well. Physical activity can be maintained through stationary bikes or pedal exercisers for the arms/legs if other means of physical exercise are too strenuous.

These are just a few ideas, but I believe your father would definitely benefit from doing some of the activities above. Some stroke patients feel like they don't have enough time to perform all the different exercises/activities in a day. My response to that is to incorporate two tasks together such as fine motor activities with cognitive games and so forth to more effectively manage time. Thanks for your question!

Equipment used to open fingers after a stroke

by Maurice Cox
(West Wickham, UK)

Question: My friend had a stroke which left the fingers of one hand clenched. She had treatment using a wooden ? piece of equipment which forced open the fingers a little bit more each week. It was then stopped but she wishes to obtain that equipment to carry on with self treatment. Do you know what it is called, please?

Answer: Unfortunately, I do not know what specific piece of equipment you are talking about. There are some wrist hand orthoses (splints) that provide rolls that can be increased in size to help open a contracted hand more over time. One such splint is the Rolyan Kwik-Form Progressive Hand Splint. The splint is not used to make the hand functional but rather to keep the hand from contracting too much and keeping the fingers out of the palm.

If someone else knows what equipment is being described, please provide your comments!

What is missing from my list of stroke exercises?

by KHZ

Question: Hi dear therapist, this is the list of exercises I use in my treatment plan, from first stage to end of treatment:

1- Roll over (to reduce spasticity)or trunk lateral rotation
2- four foot kneeling (on hands and knees)
3- active pelvic elevation
4- active shoulder elevation
5- sitting down to standing up
6- balance in standing
7- try walking with walker, with help of family.

What is missing?
Thank you very much

Answer: Your stroke treatment plan is good in my opinion. I don't know your limitations, but if you are able, I would add fine motor coordination activities for your hand. Some examples of fine motor activities can be found at www.stroke-rehab.com/hand-exercises.html. Also, if you are able, I would add some gross motor activities for your arms such as trying to hold, bounce, toss, or catch a medium to large size ball. If that is too difficult, just try holding a ball using both hands and moving it around (i.e. lifting it overhead, pushing it out in front of you, rolling it forwards and back). I also recommend stretching for any tight muscle groups.

If you have problems with sensation (numbness, tingling, difficulty feeling touch), then sensory re-education activities would be important. Sensory re-education activities can be found at www.stroke-rehab.com/sensory-re-education.html.

The above are all physical activities of course. If you have problems with speech, swallowing, or cognition then you will want to make sure you are addressing these areas as well. Thanks for your question!

gait pattern correction

by Raghu
(hyderabad, A.P , india)

Question: Hi, how do you improve the gait in a hemiplegic patient?

Answer: This is a very broad question that could have many answers. One stroke patient may have drop foot that is causing impairment whereas another may have weak quadriceps and yet another excessive extensor tone. This means you need to evaluate the patient's range of motion, strength, sensation, and gait pattern (assuming their able to walk) to get an idea of where to start to improve gait. Usually a combination of learning to weight bear on the weak leg, strengthening the weak leg, and practicing the actual activity of gait is used to improve gait. Outside assistive devices may be needed to help a stroke patient learn to walk such as e-stim, braces, or devices that help support the weight of a patient such as specialized treadmills and other walking devices. If high tone is an issue, the patient may need meds to help control tone.

My advice to individuals who have suffered stroke is to ask your therapist your weaknesses and then work on exercises and activities that will improve your deficits. Each stroke patient will have different areas that need to be addressed to help improve gait. If you want to know more about the technical aspect of what is involved in gait then I suggest doing an online search for the terms gait cycle and gait analysis.

Limp wrist after stroke

Question: Is there anything I can do with my husband's limp wrist - post stroke? ( July 2011) He was down on the right. The leg is coming back. Right shoulder was subluxed but that seems to be improving slowly and he can move his upper arm slightly ( i.e. can move the arm slightly forward and in small circle). However, the wrist has been limp. The OT never addressed it. In fact, the home health said they couldn't do anything for him other than show me passive range of motion exercises. I just find that hard to believe. My concern: Should this limp wrist be splinted in some way? His fingers are swollen but do move with passive exercise. The thumb is very swollen and does not move very much. Of course, we elevate the hand and some days there is little swellling of the hand. The wrist does not appear swollen at all.

Answer:

1. Make sure the hand is elevated when sleeping or sitting. You especially want to make sure that the wrist is in neutral or slight extension and not flexed (or bent down) when sleeping. This can help with swelling.

2. Splinting may be an option, but you would need to consult with an OT or hand therapist so that they could evaluate your husband's hand. You can ask for a prescription for OT from your husband's physician specifically asking for a splinting evaluation. Make sure you go to someone that has experience with splinting and working with stroke patients.

3. Definitely continue passive range of motion to maintain range.

4. Exercises that I like to use for the wrist include:

* Tapping the back of the forearm while asking the patient to try and lift their hand extending the wrist back. This often work best when the patient is lying on their back with arm pointed up toward ceiling and supported by me.

* Electrical stimulation for wrist extensors (as long as the patient doesn't have any contraindications). A prescription would have to be issued by a physician for this.

* Placing the hand on a soccer ball with fingers spread out and have the patient try to roll the ball slightly side to side and forward/back without the hand falling off. You can kind of get an idea from viewing this video on Youtube:
http://www.youtube.com/watch?v=7l3bYncNWL0.

* Placing the hand on a soccer ball with fingers stretched out and then I apply pressure against the ball to stretch the patient's wrist back.

* Placing both hands on side of soccer ball with fingers spread out and just trying to keep weak hand/wrist on the ball without falling off. If patient is able to do this then I have them try to rotate the ball side to side using the wrists/hands.

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!

Exercises to Improve Typing After Stroke

by Peggy
(Wichita, KS)

Question: My daughter use to be a 90wpm typist. She had a stroke, and now the connection between her brain and her hand is horrible. She just failed a test at 25wpm with 13 mistakes. Her stroke was 7 years ago. Is there anything she can do to help with her typing at this point?
Thank you
Peggy

Answer Many times when therapists or stroke patients work on hand function, they focus on gross grasp or pinch activities with the index finger. These activities are good for learning to pick up objects or hold something like a pencil but aren't the most effective for learning to improve an activity like typing. During typing, the fingers have to be able to work independently of each other. This is often difficult for the stroke patient due to tone or possibly stiffness from disuse.

Exercises I would recommend to improve typing:
1)Place the hand flat on a table and try to lift each finger independently while keeping the other fingers on the table.
2) Drum fingers on table
3) Practice touching each finger to the thumb
4) Pick up small object like peg or screw with the thumb and index finger, then thumb and middle finger, then thumb and ring finger, and lastly the thumb and little finger.
5) Push each finger individually into theraputty.
6) Use Digiflex to exercise each finger individually (see below for product).
7) Pick up marble and transfer to inside of hand (same hand as picking it up). Then while keeping marble inside hand, pick up another marble. Keep doing this until you can't pick up anymore then put each marble back down one at a time.
8) Use Chinese balls or take two golf balls and rotate them in the hand.
9) Play the piano or just hit keys individually with each finger.
10) Place a piece of paper on a table. Use the weak hand to crumple the paper into a ball then try to uncrumple the ball with on the table with the same hand.
11) Use online typing games to practice. There are many online typing games that teach kids to type that would be great for stroke patients wanting to practice typing.

Those are just a few ideas for you. The main thing is to practice individual finger movements and activities that require in hand manipulation (such as the marble activity or Chinese Balls). Below are pics of theraputty and a Digiflex. Clicking the picture will take you to an outside website that offers the product.

Theraputty


Digiflex

For more hand exercises, visit www.stroke-rehab.com/hand-exercises.html

Therapy is not helping my mom , Why?

by Donna
(Fort Worth, TX)

Question: My mom had a stroke on her left side and she is always very uncomfotrable. Therapy is not working, why?

Answer: Unfortunately, I can't really answer your question because I don't know what type of treament your mom is receiving or anything about her stroke or level of impairment. Here are some reasons though that therapy might not be benefitting a patient:

1) Severe impairment from stroke - e.g. patient's level of brain damage and physical impairment is so severe that they are unable to participate in therapy

2) Post stroke pain that interferes with patient's ability to participate or tolerate therapy

3) Inexperienced therapist

4) Lack of quality of care outside of therapy (e.g. patient is laying in bed all day except when having therapy)

You mention that your mom is uncomfortable. I would check with the physician for pain management, and I would check with your therapist to make sure your mom is positioned properly when in a chair or in the bed. Improper positioning can cause her to be uncomfortable, and if she lacks movement, she may not be able to reposition herself. Someone should be repositioning your mom every couple of hours if she is unable to do so herself.

Also, make sure your mom is receiving quality care. Is she having appropriate one on one therapy that is addressing her weaknesses? If not, find another facility or therapist.