Hand Therapy for Post Stroke Patients
Stroke affects everyone differently. It has a wide range of residual effects, and the loss of hand function is one of them. As one of the most important parts of your body, a loss of hand function can be overwhelming. So how do we regain the function of the hand after a stroke?
Hand therapy after stroke is one of the most organic and effective ways to regain hand function. These exercises come in many forms, and you can perform them in the comfort of home. Here is a closer at how stroke affects your hand function along with the right exercises to perform:
How Stroke Affects Your Hand Function
The brain and nervous system are interconnected. Your muscles respond to the signals sent by the brain, controlling the way they move. A stroke can damage your brain and disrupt the way it sends signals to your muscles, causing a muscle disorder called spasticity.
Muscle spasticity can affect different parts of the body and in this case, your hands. Spasticity causes the muscles to become overactive which leaves them in a state of involuntary contraction.
The severity of muscle spasticity differs and stroke survivors may experience varied levels of stiffness and spasms. At its worst, spasticity can lead to clenched hands which can be painful. Spasticity can also worsen into a condition called contractures, a severe form of spasticity.
This can be avoided when managed early and that is where hand therapy after stroke comes in.
The Importance of Hand Therapy After Stroke
Hand strength exercises for stroke survivors are meant to rewire the connection between the brain and muscles. This process is called neuroplasticity. A damaged brain cannot be reversed but neuroplasticity can rewire your hand functions to healthy areas of the brain.
The best time to begin is immediately after a stroke and the process involves repetitive practice. This will stimulate the brain to rewire itself and strengthen connections. Starting immediately will also maximise recovery.
The following exercises are easy to follow but they do differ in terms of complexity. They will be categorised into 3 levels, level 1 being the easiest. Patients with limited hand movement should start with level 1 and work their way onto the next.
These exercises should also be done at least 5 times a week. Start at a repetition that you are comfortable with and slowly increase over time. Hand function primarily focuses on gross and fine movement of the hands.
Gross motor is defined as bigger movements that involve the shoulders and upper body. A fine motor is defined as the smaller movements that involve the hand, elbow and fingers.
Level One
These exercises can be performed with the help of your other hand. Simply use your other hand to guide the affected one through these exercises. You should also gauge the level of assistance required so you can apply the right amount of force.
This will slowly strengthen your hands without dependency on the other.
- Ulnar Deviation/Radial Deviation With Stable Support:
Start this exercise with your hand facing palm down on a table. With the help of your other hand, slowly slide your wrist from left to right.
Repeat the process and focus on making your affected hand work as much as possible.
Aim for 2-4 groups of 10 repetitions
- Wrist Flexion/extension :
Place your elbow on the table as a starting position. Slowly move your wrist up and down and repeat the process.
With the help of your other hand, stretch your affected hand from the palm to put more emphasis on your wrist.
- Weight Bearing Over Affected Hand:
Putting weight on the affected hand to manage the spasticity. This activity can be performed with the affected hand placed palm down with fingers spread out evenly as much as possible.
The weight that will be used would come from your own body weight so perform this activity while sitting with your affected hand for safety reasons.
Gradually increase the pressure that your affected hand can endure and this would allow the stretch reflex to be managed. You should feel a gradual pressure over your wrist joint and it should not be painful.
Aim for 5- 10 repetitions daily with 20-30 seconds hold
- Opening and Closing of fingers:
To train your fingers, your palm should be facing away on a table. Hold your affected hand by the fingers and thumb to close and open your hand.
Do this exercise slowly and do not apply too much pressure. You can also do it on a cloth if your hand tends to stick on the table.
Aim for 2-4 groups of 10 repetitions
Level Two
These exercises are for those with mild spasticity. They are more advanced than the first and you do not need assistance from your unaffected hand. However, you must be able to grab objects in order to perform these exercises.
- Wrist Curl:
Place your elbow on the table with your palm facing outwards, allow your wrist to dangle over the edge of the table. Hold onto a 500ml bottle of water, let your wrist bend towards your elbow crease and slowly curl it back up.
This is a great way to build the muscles around your forearm.
Aim for 2-3 groups of 10 repetitions. - Supination/Pronation Hand Flips/Rotation:
This exercise targets the forearm. With your arm resting on the table palms up, turn your hand over to each side and make sure your thumb touches the table.
Repeat the motion with a 200-500ml water bottle to add more resistance and build strength.
Aim for 3 groups of 10 repetitions. - Finger Movements:
You need a bunch of coins to perform this exercise. Start with a single coin and place it under your finger. You then move the coin from side to side and proceed to do the same on the rest of your fingers.
To challenge yourself, try moving the coins at a greater speed so you might need a phone or stopwatch to time the duration taken.
Level Three
The following exercises are for patients with close to normal hand functions. As with the 2nd level, everyday items are incorporated into these exercises. Perform them regularly to build strength and boost fine motor skills. The main goal of the exercise is to improve the precision of the hand.
- Deck of Cards:
A deck of cards can be used in many different ways. Stacking, arranging or shuffling cards will work different areas of your hand muscles. Above all, you can perform this exercise anywhere.Try shuffling or stacking a bunch of cards while watching TV. You can also engage in a card game with your family member.
- Stress Ball:
A stress ball is another item that can be used in many different ways. You can start by squeezing the ball with your hands and fingers. Gradually increase the speed and you will get a great hand workout. Alternatively, can use a soft ball to start.
To build coordination and timing, try rolling the ball from one hand to the other.
- Pen Spin:
Pen spinning can build the strength and flexibility in your wrists. Place the pen on a table and lightly hold it by your fingers and thumb. Spin the pen in one direction and change its direction after a few spins.
Gradually increase the speed over time.
Post-stroke recovery is a challenging period for all survivors. For those with hand impairments, doing these hand therapy techniques can help improve fine motor skills and boost recovery. So do not neglect your hand function recovery and remember to get help when needed.
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