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 Historically, such interventions were discouraged, often based on tradition and outdated clinical beliefs rather than scientific evidence.
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.
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.
The neurorehabilitation landscape has shifted dramatically over the past two decades. We’ve moved away from concepts like:
And we’ve embraced interventions supported by science, such as:
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.
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.
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.
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.
NeuroRehab Team
Tuesday, January 14th, 2020
Exercise AidsFine Motor CoordinationStrengthening
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.