In the days and months after a stroke, individuals may experience any number of physical conditions and limitations. Among the most common are a loss of dexterity in one or both hands and weakened handgrip. These changes are a result of disrupted connections between the brain and the muscles of the hand. Without a strong neural connection, simple movements, like fully straightening your fingers or grasping objects, can become difficult and daily tasks can be challenging if not impossible.
The good news is the brain is highly adaptable and is it is possible to restore the necessary connections or create new ones. But it does take time and patience.
Assessment: a first step toward recovery
According to Kevin Smith, an Occupational Therapist and Certified Hand Therapist with Baystate Health, the process of regaining mobility and strength is different for every patient. “The first step in ‘getting back to normal’ is assessing a patient’s abilities. Some may be fine on strength but lacking in coordination while others have good control but very little strength. Regardless of where they start, the goal is always to achieve full function again. Beginning a therapy program as soon as possible after a stroke and sticking with it for at least a year is one of the biggest keys to success.”
Capitalizing on strengths
Smith notes that most hand therapy begin with capitalizing on a patient’s strengths while simultaneously working to improve weaknesses.
“Typically, the most improvement occurs in the first six months after a stroke. Most patients engage in on-site occupational therapy two times a week in our office. We work on their range of motion, coordination and strength. We’re constantly looking for improvements and fine-tuning the program to help them make the most advancements possible."
Rehab Exercises for Stroke
There’s a LOT of repetition but repetition is what helps to restore the messaging pathways that may have been impacted in the stroke. In instances where a path can’t be restored, the brain can often adapt and create a new path to achieve the same motion or action. But repetition is key. You have to keep knocking on the brain’s door to say, ‘Hey, I want to pick up this pen or turn this doorknob.’ There’s often swelling in the brain after a stroke. It can take a while for it to go down so that the message can get through or for the brain to realize a new path is needed. But it is possible. You just have to be persistent and patient.”
As patients move through their program, new exercises and functional activities are added to expanded and restore capabilities.
Exercise at Home: practice, practice, practice
In order to get best results from hand therapy, patients are encouraged to do basic exercises at home. “Again, it’s about training the brain as much as your hand,” says Smith. “We teach patients how to perform daily exercises at home and provide visual guides to ensure they’re doing them correctly. We also encourage patients to engage in as many day-to-day tasks as possible. If you want to get back to normal, you’ve got to practice at normal. Honestly, emptying the dishwasher can be as beneficial as, say, squeezing a ball. Plus, there’s a sense of accomplishment that comes with once again doing basic tasks that serves to motivate patients and lift their spirits.”
Simple Movements You Can Do at Home
Occupational therapist Michelle Lantaigne demonstrates 5 simple hand exercises you can practice at home:
1. Card Flipping
Use your affected arm to grasp and pinch the card with your hand. Flip the card to turn it face up. Repeat for the whole deck of cards.
2. Face Cloth Scrunch & Squeeze
Lay a face cloth flat on a table. Place your hand on top of the cloth (palm down) with your fingers spread in an open position. Use your hand to scrunch up the cloth, gathering the material into your palm, and squeeze. Use your hand to push open the face cloth and focus on extending your fingers.
3. Water Bottle Pick-Up
Start with a full water bottle standing upright on a flat surface. Use your affected hand to grasp the bottle with your whole hand. Then try to pick up the bottle and bring it to your chin. Repeat. To make this harder, try to take a drink from the water bottle.
4. Face Cloth Roll & Squeeze
Start with a rolled facecloth. Place rolled face cloth into your affected hand. Then squeeze the facecloth with all fingers and thumb. To make this harder, wet the face cloth and use your hand to squeeze all of the water out into the sink or into a bowl.
5. Put Away Groceries
This exercise involves picking up grocery items like soup cans. Use your affected arm to grasp a can with your whole hand. Pick up the can and reach to place it onto a turntable (like one you would store spices on) placed flat on the counter. To make this exercise harder, try to grasp the can and lift it onto a more elevated surface (like a low shelf or other flat surface on the counter). Once you are able to lift the can to an elevated surface, reach and put the cans onto over-the-counter cabinets or shelving.
You can see Michelle demonstrate these exercises, and download exercise instruction sheets, below.
Finding success through stroke support
While the physical impact of a stroke is often obvious, the emotional toll it takes tends to be invisible by comparison but can be equally devastating. “It’s hard to appreciate just how much you use your hands every day,” says Smith.
“To lose any ability of either your dominant or non-dominant hand can be incredibly challenging. It’s easy to get discouraged with the often slow pace of recovery. Having support, be it from a family member or friend, can be the difference between someone pushing themselves to do more and simply giving up. And it’s not about just nagging someone to do the work; it’s also about helping them recognize the progress their making. Progress is hugely motivating and extremely rewarding when it’s shared.”
LEARN MORE ABOUT COMPREHENSIVE STROKE CARE AT BAYSTATE HEALTH
We provide expert stroke treatment and rehabilitation at Baystate Medical Center and at locations across western Massachusetts. Learn more about stroke signs, symptoms, and treatment, and occupational therapy to help get you back to everyday activities.