Foot drop—when the foot cannot lift properly during walking—affects up to one in five stroke survivors and dramatically increases fall risk and energy cost. This long-form guide offers an in-depth look at the neurophysiology, precise assessment techniques, and the latest rehabilitation tools—from functional electrical stimulation to robotic assistance. You will gain a clear framework to select and combine interventions, monitor progress, and sustain engagement for real-world gains.
Advanced CIMT: NMES, VR & Modified Dosing for Stroke Arm Rehab
NeuroRehab Team
Tuesday, July 29th, 2025
Introduction
Regaining meaningful use of a paretic arm after stroke is both a challenge and an opportunity. Constraint-Induced Movement Therapy (CIMT) has emerged as a cornerstone intervention, forcing the affected limb into action and reshaping cortical maps. In the past five years, refined protocols, modified dosing, and adjunctive pairings have expanded CIMT’s reach. This article unpacks the latest evidence, clinical indications, and practical strategies—so you can deliver high-value, patient-centered therapy.
Foot Drop and Stroke Recovery: In-Depth, Evidence-Backed Strategies for Restoring Gait
NeuroRehab Team
Thursday, July 24th, 2025
Stem Cell Therapy for Stroke Recovery: A Simple Guide to Restoring Brain Function
NeuroRehab Team
Tuesday, July 22nd, 2025
Stroke can leave lasting damage in the brain, leading to weakness, difficulty speaking, and other long-term problems. Traditional rehab helps survivors make the most of remaining function—but what if we could actually repair the injured tissue? Modified mesenchymal stem cells (hMSC-SB623) offer that promise. This article explains in easy terms how stem cells work, reviews their development, and highlights the latest preclinical findings.
Upper Limb Recovery After Stroke: Evidence-Based Benchmarks for FMA-UE and ARAT
NeuroRehab Team
Thursday, July 17th, 2025
Understanding the natural trajectory of upper-limb motor recovery after stroke is essential for setting realistic goals and optimizing rehabilitation.
Kolmos et al.’s recent systematic review and meta-analysis synthesizes outcomes from usual-care groups to quantify expected gains on two gold-standard measures: the Fugl-Meyer Assessment of Upper Extremity (FMA-UE) and the Action Research Arm Test (ARAT) during the subacute phase of recovery.
These benchmarks provide clinicians with an evidence-based reference point for tracking progress and help researchers design adequately powered clinical trials.
Why Recovery Benchmarks Matter
Each year, more than 13 million people experience a stroke worldwide. Nearly half of survivors live with persistent arm and hand paresis that limits independence and quality of life.
Advanced interventions such as constraint-induced movement therapy, robotics, and neuromodulation receive significant attention. However, usual care remains the foundation of rehabilitation globally.
Until recently, clinicians lacked consolidated data describing what “typical” recovery looks like under standard rehabilitation conditions.
Benchmarks matter because they help answer key questions:
- Is my patient progressing as expected?
- Should therapy intensity be modified?
- Are we seeing clinically meaningful change?
Study Objectives
The review aimed to:
- Quantify the magnitude and rate of upper-extremity improvement during the first six months post-stroke under usual care
- Identify covariates that influence recovery, including baseline severity and lesion characteristics
Reliable recovery estimates allow therapists to counsel patients more accurately and enable researchers to calculate appropriate sample sizes for future trials.
Methods Overview
Search Strategy and Inclusion Criteria
Following PRISMA guidelines, the authors searched major databases through December 2024 for studies reporting FMA-UE or ARAT scores at two or more time points in usual-care groups.
Inclusion criteria required:
- Adults within six months post-stroke
- Upper-limb paresis
- Usual-care cohorts of at least ten participants
- Reported baseline and follow-up outcome scores
Thirty-five randomized trials and nineteen observational cohorts were included, totaling nearly 2,800 participants.
Data Analysis
Meta-analysis calculated mean changes in FMA-UE and ARAT scores at 4, 12, and 24 weeks post-stroke.
Meta-regression explored the influence of baseline motor severity, corticospinal tract lesion burden, and initial functional scores.
Key Findings: Expected Gains Under Usual Care
Recovery follows a nonlinear but predictable trajectory during the subacute phase.
At 4 Weeks
- FMA-UE: approximately +10 points
- ARAT: approximately +8 points
Importantly, the minimal clinically important difference for FMA-UE is approximately 5 points. This means most patients achieve clinically meaningful improvement within the first month.
At 12 Weeks
FMA-UE gains average approximately +12 points from baseline.
At 24 Weeks
FMA-UE gains reach approximately +16 points on average.
Recovery is most rapid early and slows over time, consistent with known neuroplasticity patterns.
Severity Matters
Baseline impairment strongly predicts recovery magnitude.
Patients with mild to moderate deficits improve faster and achieve larger gains than those with severe paresis.
Higher initial FMA-UE scores and smaller corticospinal tract lesion volumes were associated with better outcomes.
This reinforces the importance of early assessment and realistic prognostic counseling.
Clinical Implications
Goal Setting
Benchmarks allow therapists to establish data-driven SMART goals. For example, a patient with moderate impairment might reasonably target a 10-point FMA-UE improvement within the first month.
Therapy Planning
Patients predicted to recover more slowly may benefit from increased dosage or adjunctive strategies such as mental practice, task-specific training, or neuromuscular electrical stimulation.
Progress Monitoring
Comparing individual progress against benchmark curves helps identify deviations early. Slower-than-expected improvement should prompt reassessment of intensity, adherence, comorbidities, or secondary complications such as spasticity.
Limitations to Consider
Usual care varied across countries and settings in therapy content and intensity. This introduces heterogeneity into pooled results.
The findings apply specifically to subacute hemiparetic stroke within six months of onset. Chronic stroke trajectories may differ substantially.
Clinicians should apply benchmarks thoughtfully within the context of individual patient characteristics.
Integrating Benchmarks Into Practice
To apply these findings clinically:
- Assess baseline FMA-UE and ARAT within the first two weeks
- Set intermediate goals at 4 and 12 weeks
- Re-evaluate at standardized intervals
- Adjust intervention intensity based on measured progress
- Document objective outcomes to support quality assurance and reimbursement
Standardized measurement strengthens clinical reasoning and supports evidence-based decision making.
Future Directions
Future research should focus on:
- Standardizing usual-care protocols to reduce variability
- Identifying biomarkers that improve individualized recovery prediction
- Comparing emerging therapies directly against benchmark trajectories
- Extending follow-up beyond six months to map long-term recovery
Conclusion
Upper limb recovery after stroke follows a measurable trajectory during the first six months.
Under usual care, clinicians can expect approximately 10 FMA-UE points at four weeks and up to 16 points by 24 weeks on average.
Using these benchmarks enables more precise goal setting, better therapy planning, and improved research design.
Objective measurement is not optional in modern stroke rehabilitation. It is the foundation for optimizing outcomes.
- Kolmos M, Munoz-Novoa M, Sunnerhagen K, Alt Murphy M, Kruuse C. Upper-extremity motor recovery after stroke: A systematic review and meta-analysis of usual care in trials and observational studies. J Neurol Sci. 2025;468:123341. doi:10.1016/j.jns.2024.123341
- Page SJ, Fulk GD, Boyne P. Clinically important differences for the Fugl-Meyer Assessment in stroke: Validation of minimal detectable change and clinically important difference. Phys Ther. 2012;92(3):618–625. doi:10.2522/ptj.20110271
- Lang CE, Bland MD, Bailey RR, Schaefer SY, Birkenmeier RL. Assessment of upper extremity impairment, function, and activity after stroke: Foundations for clinical decision making. J Hand Ther. 2013;26(2):104–115. doi:10.1016/j.jht.2013.01.008
- Lyle RC. A performance test for assessment of upper limb function in physical rehabilitation treatment and research. Int J Rehabil Res. 1981;4(4):483–492. doi:10.1097/00004356-198112000-00005
- Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLOS Med. 2009;6(7):e1000097. doi:10.1371/journal.pmed.1000097
Post-Stroke Shoulder Pain and Frozen Shoulder: Evidence-Based Rehabilitation Strategies
NeuroRehab Team
Tuesday, July 15th, 2025
Shoulder pain and limited mobility are among the most common complications following stroke, affecting up to 70% of survivors and interfering with daily activities and quality of life.
Occupational therapists play a critical role in restoring functional range of motion, reducing pain, and preventing secondary complications such as frozen shoulder. Early, targeted intervention not only improves physical outcomes but also boosts patient confidence and participation in therapy.
Mental Practice After Stroke: How Motor Imagery Rewires the Brain for Recovery
NeuroRehab Team
Thursday, July 10th, 2025
Mental practice works wonders for stroke recovery, though it might seem too simple to work. Our brains respond in amazing ways as we imagine doing movements that we can’t physically perform. Research shows that mental exercise creates changes in brain areas that associate with movement, like the primary motor cortex . The strongest scientific evidence confirms that mental practice helps improve upper body movement function .
Top Evidence-Based Strategies for Upper Extremity Recovery After Stroke
NeuroRehab Team
Tuesday, July 8th, 2025
Stroke can severely limit arm and hand function, affecting up to 80% of survivors early on and nearly 40% chronically. Restoring upper extremity movement is critical for independence and daily tasks — but which rehab methods actually work best?
A major systematic review analyzed over 5,700 studies to pinpoint the most effective, science-backed techniques for upper extremity stroke recovery. Here’s a clear breakdown for therapists, caregivers, and patients.
Dual Task Training for Older Adults: New Research Confirms Gains in Balance, Gait, and Confidence
NeuroRehab Team
Thursday, July 3rd, 2025
Many older adults lose confidence when walking in busy places or trying to do two things at once, such as talking and moving at the same time. This difficulty with “dual tasking” raises the risk of tripping, slowing down, or freezing in place — all of which can increase falls and limit independence.
Dual task training is an evidence-based method that teaches the brain and body to handle physical and mental challenges simultaneously. A recent randomized controlled trial (RCT) explored how adding dual task exercises to typical balance and gait therapy benefits older adults with mild balance or cognitive concerns.
Long-Term Stroke Recovery: New Study Shows Functional Gains Plateau After 6 Months
NeuroRehab Team
Tuesday, July 1st, 2025
Stroke recovery is often described as a race against time. The biggest improvements usually happen early — but a landmark European study shows that without the right strategies, functional gains can fade over time.
This multi-center study followed over 500 stroke survivors for five years, measuring how well they recovered motor skills and daily function. The results remind therapists, patients, and caregivers that recovery doesn’t stop at discharge.
Understanding Spasticity After Stroke: Causes, Treatment, and What Actually Helps
NeuroRehab Team
Thursday, June 26th, 2025
Spasticity affects up to one-third of stroke survivors, turning simple daily activities into frustrating struggles against stiff, uncontrollable muscles.
How to Maximize Stroke Recovery and Prevent Learned Non-Use
NeuroRehab Team
Tuesday, June 24th, 2025
Recovering from a stroke is a marathon, not a sprint. Yet the first few weeks, particularly during inpatient rehabilitation, often set the trajectory for long-term recovery.
Free CEU: Vagus Nerve Stimulation Improves Arm & Hand Function Following Chronic Stroke
NeuroRehab Team
Thursday, June 19th, 2025
Electrical Stimulationvagus nerve stimulation
What Is Vagus Nerve Stimulation?
Vagus Nerve Stimulation (VNS) uses a small, surgically implanted pulse generator placed under the chest skin. Electrodes connect to the vagus nerve in the neck. When patients perform targeted arm or hand movements, the device delivers precise electrical pulses. As a result, it activates the brain’s learning pathways and reinforces motor circuits.
Free Stroke Rehabilitation CEU: Using FES With Task-Specific Training
NeuroRehab Team
Tuesday, June 17th, 2025
Functional electrical stimulation (FES) has been used in stroke rehabilitation for decades. Yet outcomes vary widely depending on how and when it is applied.
Free Stroke Rehabilitation CEU: How Making Mistakes and Error Augmentation Training Drives Neuroplasticity
NeuroRehab Team
Thursday, June 12th, 2025
For decades, rehabilitation focused on reducing mistakes. Therapists were trained to guide, assist, and correct movement as quickly as possible.
But neuroscience has taught us something critical.
Errors are not the enemy of recovery. In many cases, they are the engine that drives it.
Understanding how mistakes influence learning has reshaped modern stroke rehabilitation and led to the emergence of approaches such as error augmentation training. These strategies intentionally allow, amplify, or manipulate errors to stimulate neuroplastic change.
This article explains why making mistakes matters after stroke, how error-based learning works, and how therapists can harness errors to improve recovery.
Why Mistakes Matter in Stroke Rehabilitation
After a stroke, the brain must relearn how to control movement, posture, and coordination.
Learning requires feedback. Errors provide that feedback.
When a movement attempt fails, the nervous system receives information about what did not work. This information is essential for refining future attempts and strengthening neural pathways.
Without errors, the brain has limited opportunity to adapt.
Neuroplasticity Thrives on Error-Based Learning
Neuroplasticity refers to the brain’s ability to reorganize itself in response to experience and practice.
Error-based learning is a powerful driver of neuroplastic change because it:
- Engages active problem-solving
- Enhances attention and motor planning
- Strengthens synaptic connections through feedback
- Encourages adaptive movement strategies
When patients are allowed to explore movement rather than being over-assisted, the brain is forced to adjust, recalibrate, and learn.
What Is Error Augmentation Training?
Error augmentation training intentionally increases or exaggerates movement errors to amplify sensory feedback.
This can be achieved through:
- Robotic resistance or force perturbations
- Visual distortions or altered feedback
- Task constraints that challenge accuracy
- Reduced physical guidance from the therapist
By making errors more noticeable, the nervous system becomes more responsive to correction and adaptation.
Mistakes vs. Maladaptive Movement
It is important to distinguish between productive errors and maladaptive movement patterns.
Productive errors occur when a patient actively attempts a task and learns from the outcome.
Maladaptive patterns occur when compensation replaces recovery and limits future potential.
Effective rehabilitation allows errors within a structured framework that still promotes quality movement and functional goals.
Motor Learning Principles Support Error-Based Training
Research in motor learning consistently shows that learning is enhanced when individuals:
- Actively attempt tasks
- Experience variable outcomes
- Receive feedback after performance
- Are challenged at an appropriate level
Error augmentation aligns with these principles by keeping patients cognitively and physically engaged in the learning process.
How Therapists Can Use Errors Therapeutically
Therapists do not need advanced technology to apply error-based learning principles.
Practical strategies include:
- Reducing physical assistance when safe
- Allowing patients time to problem-solve
- Using task constraints instead of verbal correction
- Encouraging multiple solution attempts
- Providing feedback after, not during, movement
These approaches shift therapy from correction-driven to learning-driven.
Why Avoiding Mistakes Can Limit Recovery
Over-guidance and constant correction can unintentionally reduce learning.
When the therapist solves every problem, the brain does not have to.
This can lead to:
- Reduced engagement
- Slower skill acquisition
- Limited carryover outside therapy
Allowing safe, purposeful mistakes helps transfer skills from the clinic to real life.
Error-Based Learning Builds Confidence and Independence
Beyond neurological benefits, learning through errors builds confidence.
Patients learn that they can try, fail, adapt, and succeed. This mindset is critical for long-term recovery and independence.
Recovery becomes an active process rather than a passive one.
Free CEU: Error Augmentation and Neuroplasticity in Stroke Rehabilitation
For clinicians who want to deepen their understanding of error-based learning and neuroplasticity, we offer a free continuing education course focused on modern stroke rehabilitation strategies.
The course explores:
- Error augmentation training principles
- Motor learning science in stroke rehab
- Clinical decision-making for safe challenge
- Practical application across therapy settings
Clinical Insights: Why It Works
EAT challenges the brain to actively adjust, making it a powerful driver of neuroplastic change. Instead of compensating for errors, patients learn to correct them on the fly—leading to meaningful, long-term improvements in function.
Implementing EAT in Practice
- Work with a skilled therapist or smart device that can amplify movement error.
- Incorporate EAT into both arm and gait training protocols.
- Use high repetition—minimally dozens per session—to reinforce learning pathways.
- Measure outcomes like Fugl-Meyer upper limb scores or gait symmetry to track progress.
Expand Your Neurorehab Toolkit
To explore Error Augmentation Training and other cutting-edge rehab strategies, enroll in our FREE CEU course here. Learn to harness the power of mistakes and drive robust neuroplastic outcomes—one corrective rep at a time.
FREE CEU: Early Motion, Better Outcomes: The Power of Motorized Arm Cycling in Stroke Recovery
NeuroRehab Team
Tuesday, June 10th, 2025
Early rehabilitation is critical after stroke—and motorized arm cycling is emerging as a highly effective intervention. By combining guided, repetitive movement with muscle activation, this approach strengthens motor recovery, reduces complications, and improves functional outcomes.
Free CEU: How Different Diseases Impact Attention
NeuroRehab Team
Sunday, June 8th, 2025
Attention is a finite cognitive resource that becomes especially vulnerable when other systems falter. Across neurological and systemic conditions, the brain often compensates for deficits in processing, sensation, or memory by reallocating attentional resources—leading to fatigue, errors, and cognitive overload.
Free Neuroplasticity CEU: How the Brain Rewires After Stroke
NeuroRehab Team
Saturday, June 7th, 2025
Stroke recovery does not happen because damaged brain tissue magically heals. It happens because the brain adapts.
This adaptive process is known as neuroplasticity. Neuroplasticity is the brain’s ability to reorganize, form new connections, and assign new roles to undamaged areas in response to injury, experience, and neurorehabilitation after stroke.
Free Vision Rehabilitation CEU for Occupational Therapists
NeuroRehab Team
Saturday, June 7th, 2025
Vision plays a critical role in nearly every daily activity. Reading, cooking, navigating a room, managing medications, and driving all depend on the brain’s ability to interpret visual information accurately and efficiently.
Why Therapists Aren’t Utilizing Biofeedback as Often as They Should
NeuroRehab Team
Wednesday, August 28th, 2024
Introduction
Biofeedback is a powerful therapeutic technique that provides patients with real-time information about their physiological processes, empowering them to actively monitor and regulate their own bodily functions. Yet, despite its proven benefits, biofeedback remains significantly underutilized in the therapy world. In this comprehensive article, we’ll explore the reasons behind this underutilization and uncover the compelling advantages that make biofeedback a must-have tool in every therapist’s arsenal.
CEU: Improving Dynamic Balance After Neurological Injury
NeuroRehab Team
Thursday, May 11th, 2023
Improving Dynamic Balance Following Neurological Injury
Overview:
This AOTA approved continuing education class will introduce you to efficacous evidence-based interventions that drive neuroplastic change resulting in improved balance following neurological injury.
Stroke Hand Simplified: Evidence-Based Strategies for Better Recovery
NeuroRehab Team
Friday, March 10th, 2023
Restore • Rewire • Recover — Proven Approaches for Upper Limb Function
👉 Register Now
Salia Rehab is proud to be an AOTA Approved Provider of high-quality professional development.
Course Approval ID: #6686
This online, self-paced activity offers 0.125 CEUs (1.25 contact hours) and is designed for occupational therapists, physical therapists, assistants, physicians, and other rehab professionals who directly treat clients recovering from stroke.
Please note: The assignment of AOTA CEUs does not imply endorsement of specific course content, clinical methods, or products by AOTA, nor does it indicate AOTA’s approval of a certification or other professional recognition.
Course Overview
This evidence-based online CEU will teach you the most effective interventions proven to promote neuroplasticity and restore meaningful hand and arm function after a stroke. You’ll learn practical techniques to break learned nonuse, encourage active movement, and help patients maximize recovery.
Participants have 90 days to complete this intermediate-level course and must achieve an 80% passing score on the quiz to earn their certificate.
What You’ll Learn — Learning Outcomes
- Analyze recent stroke outcome data and key recovery trends.
- Explain the difference between the umbra and penumbra and how each impacts brain recovery after stroke.
- Identify how learned nonuse limits upper limb function and how to overcome it in therapy.
- Differentiate interventions that do and do not drive meaningful neuroplastic change.
Key Questions Answered
- What spontaneous recovery mechanisms naturally occur after stroke?
- Which factors best amplify neuroplasticity and recovery?
- How does learned nonuse develop and how can it be reversed?
- What treatment strategies produce the best functional gains for the hand and arm?
Ready to level up your upper limb rehab skills?
👉 Click here to register for Stroke Hand Simplified and gain practical, evidence-based strategies you can apply immediately.
6 Tips to Build Trust with Stroke Patients
NeuroRehab Team
Friday, March 3rd, 2023
Suffering from a neurological injury such as stroke can be a long and hard battle. Having the right team in place can make a significant impact on the success of one’s recovery. Being comfortable with one’s clinical team can set patients up for great success. Health professional building that immediate trust is key to a positive outcome.
Stroke Therapy Research. What works?
NeuroRehab Team
Friday, January 13th, 2023
Arm and HandElectrical StimulationHand Function SplintsMental PracticeMirror TherapyNeuroplasticityStroke Statistics
Every 2.1 seconds, someone in the world suffers a stroke. Stroke is the #1 cause of long-term disability worldwide. Globally, there are over 15 million stroke survivors. With respect to the United States, there are approximately 5.1 million stroke survivors alive today in the US. It is the third leading cause of death in USA and the numbers are expected to double by 2030.
How Long Should I Use Electrical Stimulation for My Stroke?
NeuroRehab Team
Monday, January 9th, 2023
Electrical Stimulation. How much is enough?
Over the years, many stroke survivors have stated that their therapist recommended 20-30 minutes of electrical stimulation to a targeted area for daily home use. Are we are missing an opportunity to maximize the therapeutic benefit of stimulation by limiting the total treatment time under 30 minutes?
Free Constraint-Induced Movement Therapy CEU Course for OT’s
NeuroRehab Team
Wednesday, December 28th, 2022
Course Title:
Constraint-Induced Movement Therapy. Understanding the Facts and Myths.
Overview:
This AOTA approved online self-study continuing education class will introduce you to evidence-based practice surrounding Constraint-Induced Movement Therapy to the stroke population.
The online class is intended for medical professionals (e.g. OT/OTA, PT/PTA, Physicians, etc.) directly related to the rehabilitation of a patient or client. To participate in this CEU and receive credit, the participant must be a licensed, treating clinician. Completion of this course will reward the participant with .1 CEUs or 1 contact hour, following completion of the presentation and a ≥80% score on the quiz. You will have 90 days to complete this course.
Free Online CEU Electrical Stimulation Course for OT’s
NeuroRehab Team
Monday, December 26th, 2022
Course Title:
Electrical Stimulation for Stroke Recovery. A review of evidence-based clinical considerations.
Overview:
This AOTA approved online self-study continuing education class will introduce you to evidence-based practice surrounding electrical stimulation to the stroke population.
The online class is intended for medical professionals (e.g. OT/OTA, PT/PTA, Physicians, etc.) directly related to the rehabilitation of a patient or client. To participate in this CEU and receive credit, the participant must be a licensed, treating clinician. Completion of this course will reward the participant with .1 CEUs or 1 contact hour, following completion of the presentation and a ≥80% score on the quiz. You will have 90 days to complete this course.
Stop Learned Non-Use to Improve Stroke Recovery
NeuroRehab Team
Wednesday, December 21st, 2022
If one asked 10 new stroke survivors the following question, what do you think they would say?
“Would you rather spend most of your time learning compensatory one-handed strategies with your unaffected side, or would you rather focus on improving strength, range of motion and function in your affected limb?” That’s a big question.
Stroke Shoulder Online CEU Course Now Available
NeuroRehab Team
Thursday, December 8th, 2022
Stroke Shoulder Simplified.
Demystifying subluxation, pain and stiffness.
Robotic Therapy for Stroke. Is it Overrated?
NeuroRehab Team
Friday, December 2nd, 2022
Robot-assisted therapy has become increasingly popular over the last 2 decades. In fact, it is so well-known that out of the 1,300 RCT’s in UE stroke recovery, robotic research leads the pack with 112 RCT’s! There is no doubt robotic therapy, in some form or fashion, is here to stay, however is it a MUST-HAVE or a NICE-TO-HAVE intervention?
Online Shoulder Stroke/Neuro Occupational Therapy CEUs
NeuroRehab Team
Saturday, November 26th, 2022
Shoulder pain resulting from stroke hemiplegia is a common clinical consequence. Hemiplegic shoulder pain can occur as early as two weeks post-stroke but an onset of two to three months is more typical. Frozen shoulder, pain and weakness can negatively affect rehabilitation outcomes as good shoulder function is a prerequisite for successful transfers, maintaining balance, effective hand function, and performing ADL’s activities of daily living.
Should You Strengthen Spastic Muscles After Stroke? What the Research Actually Says
NeuroRehab Team
Wednesday, November 23rd, 2022
Great question—and the answer is ABSOLUTELY!
For many clinicians, the idea of strengthening spastic or hyperactive muscles in stroke survivors has long been controversial. The thought of asking a patient to squeeze a spastic hand or flex a tight bicep can make some therapists cringe. Historically, such interventions were discouraged, often based on tradition and outdated clinical beliefs rather than scientific evidence.
Outdated Assumptions About Spasticity and Strength Training
Early in their careers, many therapists were advised not to “trigger abnormal movement patterns” in patients with hemiparesis. Strengthening hyperactive muscles was thought to increase spasticity, reinforce abnormal synergies, and even cause pain. But this guidance was based on anecdote, not data—passed down from one generation of clinicians to the next, without being questioned.
The reality is this: these warnings had no research backing them. They were based on assumptions and fear, not evidence.
What the Evidence Tells Us Now
Fast-forward to today, and a wealth of research supports strength training for individuals with spastic hemiparesis. According to the Evidence-Based Review of Stroke Rehabilitation (EBRSR), 33 randomized controlled trials (RCTs) have evaluated strength training for upper extremity motor recovery. The findings? Strength training is beneficial—and none of the studies concluded that it increased spasticity or pain.
In fact, strengthening programs were associated with improved function, greater independence, and better motor outcomes. As with all therapy, dosage and technique matter, but the research overwhelmingly supports strength training as a safe and effective intervention post-stroke.
From Old-School Theory to Modern Science
The neurorehabilitation landscape has shifted dramatically over the past two decades. We’ve moved away from concepts like:
- Avoiding contact on the palmar surface of a spastic hand
- Overemphasis on tone-reduction modalities
- Avoiding strengthening in fear of “reinforcing” spasticity
And we’ve embraced interventions supported by science, such as:
- Repetitive task-specific training
- Constraint-Induced Movement Therapy (CIMT)
- Functional strength training and resistance exercises
Studies by Patten, Butefisch, Sharp, Teixeira-Salmela, and Wolf have all demonstrated the benefits of these modern strategies. These techniques don’t just improve strength—they promote true neuroplastic change and real-world functional gains.
Spasticity vs. Weakness: A Critical Distinction
One of the most important shifts in perspective has been recognizing that muscle weakness—not spasticity—is often the primary barrier to movement. While spasticity can create resistance, studies show that focusing on reducing tone alone does not lead to improved function. On the other hand, targeting strength deficits often leads to better control, improved coordination, and enhanced use of the affected limb.
Research by Harris, Ada, and Patten supports this modern approach: treat weakness first.
The Future of Neurorehabilitation
Occupational therapy has come a long way. As the profession celebrates more than 100 years of evolution, AOTA’s Centennial Vision continues to ring true: “Occupational therapy is a powerful, science-driven, and evidence-based profession.” And nowhere is that more evident than in the ongoing transformation of stroke rehabilitation practices.
As we adopt smarter technology, more robust clinical trials, and modern protocols, we empower therapists and stroke survivors alike to pursue outcomes that were once thought impossible. The goal is no longer just compensating—it’s recovering.
Final Thoughts
Strengthening spastic muscles after stroke is not only safe—it’s necessary. The evidence is clear, and the tools are available. Let’s continue to challenge outdated ideas, embrace evidence-based care, and give every stroke survivor the opportunity to achieve their fullest potential.
How to Choose the Best Stroke CEU Course: 3 Red Flags to Avoid
NeuroRehab Team
Saturday, November 19th, 2022
Stroke recovery is a hard and long journey for most patients. There are therapists that “treat neuro patients” and then there are “neuro therapists”. In order for a patient to reach maximum potential with their rehab journey, they will need a clinician that understands, appreciates and knows the neurorecovery process.
Stroke Plateaus are Not Permanent
NeuroRehab Team
Friday, November 18th, 2022
Hand Function SplintsNeuroplasticity
There is no expiration date on neuroplasticity.
Just like athletes and musicians, many stroke survivors will have periodic and temporary plateaus or setbacks as they continue to improve. It is a back-and-forth process. Improve a little, then a plateau occurs. Modify the training and improve some more. Then, here comes another plateau. Modify again. You get the idea.
Occupational Therapy – OT CEUs
NeuroRehab Team
Wednesday, November 16th, 2022
Occupational Therapy CEUs!
Occupational Therapy (OT) CEU’s are part of the necessary requirements to maintain one’s license. In addition, a clinician may seek out paid or free continuing education classes (CEU) to advance his or her knowledge and skill set.
Improve Results Following Stroke with These Simple Steps.
NeuroRehab Team
Monday, November 14th, 2022
Mental PracticeMirror TherapyNeuroplasticitypriming
Priming the Brain Works.
Better clinical outcomes following stroke are associated with interventions such as cortical priming resulting in increased excitability of the motor cortex (Catano et al).
Priming is a technique used to enhance the brain’s ability to re-balance the 2 hemispheres following a stroke. Priming interventions include invasive and non-invasive techniques and can be administered prior to or during therapy.
The Best Way to Treat Shoulder Subluxation
NeuroRehab Team
Friday, November 4th, 2022
Electrical Stimulationshouldersubluxation
The shoulder is the most complicated joint in the human body. It’s also one of the most difficult aspects of recovery for hemiplegic stroke survivors.
Why?
Be Like Mike. Mental Practice Improves Stroke Arm and Hand Weakness.
NeuroRehab Team
Friday, October 28th, 2022
Mental PracticeNeuroplasticity
Be Like Mike.
Before each race, Michael Phelps, the 28-time Olympic medalist, would sit quietly and perform mental reps, imagining his performance step-by-step.
Stroke Survivors Should Look in the Mirror – Daily.
NeuroRehab Team
Friday, October 14th, 2022
Stroke survivors are beautiful and handsome heroes. But it’s not about vanity – it’s about recovery. Mirror Therapy (MT) is a critical intervention – yet vastly underutilized.
Rewiring the Brain After Stroke: The Science of Neuroplasticity and Why Reps Matter
NeuroRehab Team
Friday, October 7th, 2022
The human brain is one of the most fascinating and complex organs in the body. It houses over 100 billion neurons and forms more than 200 trillion synaptic connections. During a stroke, approximately 32,000 neurons die every second, totaling nearly 1.2 billion neurons lost in a typical event. While this may sound catastrophic, it represents only about 1% of the brain’s total neurons.
That means 99% of the brain remains intact. And with the right approach, it can compensate, adapt, and heal.
The Breakthrough of Neuroplasticity
In the 1980s, renowned neuroscientist Dr. Michael Merzenich helped prove that the adult brain is not hardwired—contrary to what many believed. His groundbreaking work revealed that the brain is capable of reorganizing itself by forming new neural connections, a phenomenon known as neuroplasticity.
This discovery has completely shifted our understanding of stroke rehabilitation. Rather than focusing on what was lost, modern therapies focus on what can be rewired.
Why Many Traditional Stroke Therapies Fall Short
Unfortunately, many conventional stroke rehab models abandon patients too early—long before neuroplasticity has had a chance to take hold. Standard clinical tests may not detect subtle signs of brain rewiring, such as micro-movements or emerging motor patterns.
As a result, therapy may be prematurely deemed ineffective, when in fact, the brain is just beginning to change. This is one of the greatest oversights in traditional care.
Repetition: The Catalyst for Rewiring
If you’re a clinician, ask yourself: “What did I do in today’s 45-minute session to truly drive neuroplasticity?” The typical therapy session includes only about 30 repetitions. Research suggests that it takes at least 300–400 quality reps per session to begin meaningful rewiring of the brain.
Consider sports training, music practice, or skill development. A baseball pitch, a piano scale, or an ice-skating spin takes thousands of reps to master. Stroke rehab is no different. Every repetition leaves a neurological footprint—a pathway for the next rep to follow. Over time, these paths become stronger, faster, and more automatic.
Time to Rethink Outdated Approaches
With today’s evolving technology and research-backed tools, we must challenge traditional concepts that no longer serve patients. Many old-school therapy methods—especially those unsupported by evidence—need to make way for protocols that prioritize repetition, engagement, and science-based strategies.
Therapists must be bold enough to ask, “Is this intervention truly helping my patient move forward?” If not, it’s time to pivot.
Learn More About the Soft-Wired Brain
Whether you’re a stroke survivor, a caregiver, or a rehab professional, we highly recommend exploring Dr. Merzenich’s book: Soft-Wired: How the New Science of Brain Plasticity Can Change Your Life. It offers an accessible and inspiring look at how neuroplasticity works and what it means for recovery.
Rewiring the brain doesn’t happen overnight. It takes effort, consistency, and intelligent therapy. But it does happen—one rep at a time.
If you’re ready to embrace evidence-based therapy that unlocks the brain’s potential, make sure your approach is grounded in science, driven by repetition, and focused on lasting functional gains.
Fall Prevention After Stroke | Safety & Recovery Tips
NeuroRehab Team
Sunday, August 22nd, 2021
Falls can happen anytime and anywhere to people of any age. However, as people get older, or suffer neurological injuries such as stroke, the number of falls and the severity of injury resulting from falls increases. Taking precautions to prevent falling after stroke can help save a life. Falling is the leading cause of accidental home deaths, and they are a major reason for 40% of admissions to nursing homes.
Constraint-Induced Movement Therapy (CIMT) for Stroke Therapy
NeuroRehab Team
Saturday, June 26th, 2021
Constraint-Induced Movement Therapy (CIMT) is a form of treatment designed to decrease the impact of a stroke on the upper-limb (UL) function of some stroke survivors. It is a behavioral approach to neurorehabilitation[2] based on “Learned- Nonuse”.
Gondola Medical Foot Device Helps Patients with Walking and Balance Disorders
NeuroRehab Team
Wednesday, March 24th, 2021
Electrical StimulationLegNeuroplasticity
The Gondola Medical Device provides a non-invasive mechanical stimulation based on pressure pulses. The pulses are applied in two specific areas of both feet, the head of the big toe and the first metatarsal joint. The treatment comprises four cycles of stimulation; one cycle includes a six-second stimulation of each of the four target areas (total: 24 sec). The overall treatment consists of four repetitions of the stimulation cycle (total: 2 minutes). This method of treatment is called “Automated Mechanical Peripheral Stimulation” (AMPS).
UE Ranger Helps Improve Shoulder and Arm Strength
NeuroRehab Team
Thursday, March 11th, 2021
The UE Ranger was designed to help you exercise your arm not only in the clinic during your rehab sessions, but also at home. More rehab equals more recovery, so empowering yourself with the UE Ranger at home is a game changer.
The Xtern : A Game Changer for Foot Drop Patients
NeuroRehab Team
Tuesday, February 9th, 2021
When François suffered multiple injuries from a snowmobile accident in 2001, he knew his life would change forever. After fracturing both legs and knees, he was left with a complete foot drop on one side. Over the years, he tried various ankle and foot orthosis (AFOs), but couldn’t find the one that would allow him to get his life back. That’s how Turbomed was born.
NIH Stroke Scale (NIHSS) | Stroke Severity Assessment
NeuroRehab Team
Friday, January 22nd, 2021
National Institutes of Health Stroke Scale (NIHSS) is a clinical tool that measures stroke-related neurologic deficits. This measure can be quantified. NIHSS is used in modern neurology for three main objectives;
- to evaluate the violence of stroke to its patients and document the neurological status of the patients.
- To determine the treatment to be administered to patients by planning the appropriate patient care and act as a common language for the exchange of information understood by healthcare providers.
- To predict the outcome of the patient from the illness, both long and short term outcomes. It can also indicate a lesion size and be a measure of stroke severity.
Stroke Survival Statistics: Key Facts To Know
NeuroRehab Team
Wednesday, December 23rd, 2020
Stroke Statistics
Stroke is among the leading causes of severe long-term disabilities. It reduces mobility in more than 50% of its patients who are aged 65 and above. According to NINDS, 15-30% of patients develop a permanent physical disability while most patients regain their hands and legs’ functionality. Symptoms associated with stroke vary from dizziness, fatigue, blurred vision, slurred speech, fatigue, and numbness. However, according to a survey done, only 38% of the respondents knew the stroke’s significant symptoms. The most recognized sign by 98% of the respondents was numbness on one side. Knowing these symptoms is crucial because it can reduce disability in patients. Those who start receiving treatment three hours after the first symptom show less disability than those who receive delayed care.
Top Stroke Exercise for Arm Strength
NeuroRehab Team
Tuesday, December 15th, 2020
A stroke occurs when the blood vessels in your brain bleed due to a rupture. It can also happen when the blood supply to your brain is blocked. When blood supply is blocked, or blood vessels rupture, blood, and oxygen do not reach the brain tissues, and without oxygen, these cells and tissues become damaged and start dying within a short time.
Treat Shoulder Subluxation Safely With New Therapy Tool
NeuroRehab Team
Monday, December 7th, 2020
Despite many different style arm slings for stroke, current shoulder positioning devices don’t address the numerous frustrations patients and therapists describe when trying to effectively treat a subluxed shoulder that is the result of a brain injury or spinal cord injury. Common reasons reported why existing shoulder subluxation products are less than favorable and aren’t worn regularly include:
Cognitive Neuro Therapy Tool Helps Patients Improve Function and Independence
NeuroRehab Team
Wednesday, December 2nd, 2020
NeuronUP is a 3-in-1 tool to help the neurorehabilitation specialist save time in a clinical setting. The web based platform that offers professionals activities of daily living for the rehabilitation and cognitive stimulation of people with brain damage, neurodegenerative diseases (Alzheimer’s, MS, Parkinson’s), neurodevelopmental disorders (ADHD, ASD), mental and intellectual disabilities, deficits from normal aging, etc.
Must Read Stroke Recovery Book for Caregivers and Survivors
NeuroRehab Team
Wednesday, December 2nd, 2020
Readers are calling Hope After Stroke for Caregivers and Survivors: The Holistic Guide to Getting Your Life Back, the “The Stroke Bible,” that should be in every hospital and rehab facility. It’s a must read for every caregiver and survivor.
