Tuesday, January 14th, 2020
Launching a hand exercise program begins with understanding how a stroke that happens in your brain can cause problems with your hand. A stroke is basically an injury to the brain due to limited blood flow. The symptoms in the body reflect the area of injury in the brain. So a stroke survivor with hand issues, experienced an injury to the area of the brain that controls the hand.
Loss of hand function is common after a stroke. Every stroke survivor is different. Stroke survivors can experience a wide range and combination of problems based on the size and location of the injury to the brain.
Some people might notice a loss of a specific skill of the hand such as coordination or strength. A recent study found the area of the brain that controls coordination of the hand was different than the area that controlled larger movements of the hand.
The good news is that new connections in the brain can form. While many people don’t regain every ability, many people make significant improvements after a stroke. The ability of the brain to learn and form new connections is called neuroplasticity. Exercises are a great way to use neuroplasticity to help the brain form new connections.
Our hands do so many amazing things. You may not realize all the daily tasks your hands complete. Or, you might not notice how much you use your non-dominant hand until you experience a stroke or an injury.
The systems of the hand include sensation, coordination and strength. Any of these systems can be impacted after a stroke and make it more difficult to perform daily activities. Addressing the area of skill loss can help improve your ability to use your hand.
Some people may have altered sensation after a stroke. This might be numbness, pain or tingling. This makes it difficult to know where the hand is or what objects it is touching.
Fine motor coordination is the name for the small motions of your hand. This allows you to write, pick-up small items, and move each finger individually.
Both grip and pinch strength are important for daily tasks. Grip strength gives you the ability to grasp objects with weight or force. For example, holding a bag of groceries or opening a jar. Pinch strength gives you the ability to turn a key or close a ziplock bag. Research has shown that grip strength improves the most in the first 6 months after a stroke but slow improvement continues for up to a year.
Because of the brain’s ability to learn and make new connections, exercises can help improve skills after a stroke. One study showed that repetition encouraged the brain to form new connections. Repeating your exercises helps your brain to learn. Also, research suggests daily hand function is improved with exercises that include tasks or activities. In summary, research suggests exercise programs should include repetition and performing tasks or activities with your hand.
Physical or occupational therapy can be beneficial following a stroke to improve strength and learn new skills. If your therapist has provided a custom exercise program for you, it is a good idea to continue that program.
However, some people look for new ideas as their needs or abilities change. Or maybe, your program got lost or you never received one. Whatever the case, remember that these exercises aren’t for everyone and are not a substitute for advice from qualified health professionals.
It is good to have a starting place. These four exercises activate different muscles of the hand and get the circulation going. If you are just beginning to regain hand motion, your entire program could focus on these exercises. If you are ready for some more advanced hand exercises, this list makes an excellent warm-up.
These exercises work best for stroke survivors who don’t have:
A different program might be more helpful if you have a lot of tightness or limited active motion in your hand.
The following section describes different ability levels of the hand following a stroke. Each level provides suggestions for exercises that may work well. Since every person is different, some exercises in different categories may or may not apply to your particular situation. Read through the exercises and try some new ideas. You may surprise yourself with what you can or can’t do.
This stage can be both frustrating and exciting. It is exciting to see a finger wiggle for the first time. But it is also frustrating because there are still so many things that are difficult. Be patient and begin exercises slowly because the muscles (and brain) can get fatigued easily.
Stroke survivors with hand function in this stage are typically working on regaining the ability to perform motions of the hand and wrist. For instance, they may have difficulty opening and closing the fingers or bringing the thumb to the fingertips.
Stroke survivors in this category have basic motions of the hand. This means they can pick-up objects (maybe clumsily) and can replicate most hand motions with extra time. Daily activities can still be a challenge because of limited coordination and strength. For instance, they might be able to put on clothes but it might take extra time. Or, they might be able to pick up an empty glass but don’t feel confident lifting a full glass.
Some exercise suggestions for this stage include:
Depending on the size and location of the stroke, some people might start at this stage. Other stroke survivors might not see this level of skill return. These exercises are recommended for stroke survivors who have good control over the motion of their hands and fingers. The exercises for this stage focus on challenging strength and coordination to fine-tune the muscles and the brain.
If your hand is mainly lacking strength and coordination, here are some exercise ideas:
Stroke recovery is a journey. It takes time and patience to regain skills and learn a new normal. But, you can do it! Start with a few exercises and activities that match the abilities of your hand right now. Remember, our brains are amazing and continue to heal, learn, and grow. It takes time and consistent practice to maximize the return of hand function. The key is to pick exercises that are challenging and interesting to get the most of your hand exercise program.
Birchenall J, Térémetz M, Roca P, Lamy JC, Oppenheim C, Maier MA, Mas JL, Lamy C, Baron JC, Lindberg PG(2019). Individual recovery profiles of manual dexterity, and relation to corticospinal lesion load and excitability after stroke -a longitudinal pilot study. Neurophysiol Clin, 49(2), 149-164. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/30391148?log$=activity.
Dobkin, B. (2005). Rehabilitation after Stroke. New England Journal of Medicine, 352(16), 1677-1684. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4106469/.
Israely S, Leisman G, Carmeli E. (2017). Improvement in arm and hand function after a stroke with task-oriented training. BMJ Case Report, March 17, 2017. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28314812.
Mawase, F., Uehara, S., Bastian, A.J., Celnik, P. (2017). Motor Learning Enhances Use-Dependent Plasticity. Journal of Neuroscience, 37(10), 2673-2685 https://www.ncbi.nlm.nih.gov/pubmed/28143961.
Stock R, Thrane, G, Askim T, Anke, A. Mork PJ. (2019). Development of Grip Strength One Year after Stroke. Journal of Rehabilitation Medicine 51(4), 249-256. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/30848829