Arm and Hand Recovery Following Stroke and Other Neurological Injuries
NeuroRehab Team
Friday, February 26th, 2016
Arm and HandArm BikeBiofeedbackElectrical StimulationExercise AidsHand Function SplintsMirror TherapyMobile Arm SupportsNeuroplasticityRoboticsSubluxation SlingsVirtual Reality
The latest research shows that the brain is capable of rewiring and adapting after stroke. Therefore, arm and hand recovery is more possible than previously thought. However, in order to improve function in the upper limb, the client must be willing to incorporate the affected side purposefully, functionally, and repeatedly. In addition to functional training, other beneficial strategies include strength training, mental imagery, robotics, and gravity compensation.
Below are the key takeaway’s that highlight the current thinking from the scientific community.
Arm and Hand Research Findings
- Electrical Stimulation and EMG-Triggered Stimulation can improve upper extremity function and decrease shoulder subluxation.
- Electrical Stimulation can reduce spasticity.
- Arm training using an Upper Limb Robot-Assisted Therapy Device can improve motor recovery of the shoulder and elbow.
- Exercise and cardiovascular training using equipment like an Exercise Aid or Arm Bike are beneficial for stroke patients.
- Virtual Reality/Exercise Games and Biofeedback can improve motor function.
- Visual Imagery, such as Mirror Therapy, can reduce pain, improve visual spatial neglect and reduce motor impairment.
- A Hand Function Splint can improve independence, facilitate movement, support a weakened joint and result in improved motor recovery when combined with task-specific training.
- Unweighting the arm with a Mobile Arm Support can improve motor recovery and assist with functional tasks.
- Repetitive task-specific training, such as Constraint-Induced Therapy, can improve motor function.
- Mental practice (rehearsing tasks mentally), in combination with other treatment, can improve upper extremity function.
- Botulinum Toxin (Botox) decreases spasticity and increases range of motion.
- Subluxation Slings can prevent shoulder subluxation and reduce pain.
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What Do These Interventions Mean?
Arm Bike
An Arm is a stationary cycle designed to strengthen and condition the upper body, as well as the cardiovascular system, by using the arms.
Biofeedback
Biofeedback or electromyography (EMG) is a non-invasive technique used for measuring muscle electrical activity that occurs during muscle contraction and relaxation.
Electrical Stimulation
Electrical stimulation or neuromuscular electrical stimulation (NMES) is a technique used to elicit a muscle contraction using electrical impulses. Electrical current is then sent from the unit to the electrodes and delivered into the muscle causing a contraction.
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EMG-Triggered Stimulation
EMG-Triggered Stimulation is based on the user’s voluntary movement, or intent to move. Electrodes, controlled by a unit, are placed on the skin over a specific area. Once the user attempts to contract his or her muscles and reaches the prescribed threshold, stimulation is triggered (delivered) to the same muscles. Various visual and auditory feedback options monitor the progress.
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Exercise Aid
An Exercise Aid is a piece of equipment used during physical activity to improve strength and coordination of the body region targeted.
Hand Function Splint
A Hand Function Splint is a rigid or flexible brace that offers dynamic or static assistance to the weakened hand so functional activities and exercises can be possible.
Mirror Therapy
In Mirror Therapy, a mirror is placed beside the unaffected limb, blocking the view of the affected limb. This creates the illusion that both limbs are functioning properly. Damaged areas of the brain’s motor cortex may improve by viewing movements of intact, functioning limbs.
Mobile Arm Support
A Mobile Arm Support (MAS) is a gravity supported mechanical device mounted on wheelchairs, tables, or base frames. A MAS is used to support the weak arm to improve motor function and strength. In addition, the device allows patients with shoulder weakness to perform self care tasks such as feeding, hygiene, grooming, and writing.
Shoulder Subluxation Sling
A Subluxation Sling is typically used on hemiparetic arms that are flaccid or exhibit minimal to no movement. They offer support, protection against injury and can prevent or reduce shoulder pain.
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Upper Limb Contracture Splint
A Upper Limb Contracture Splint is a brace used to prevent or treat contractures. The goal of a contracture splint is to help keep the soft tissues (muscle and tendons) in the arm and hand stretched properly.
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Upper Limb Robot-Assisted Therapy
Upper Limb Robot-Assisted Therapy consists of an electromechanical device, designed for the arm or hand, that is used to assist users (through powered mobility) with exercise training and activities of daily living (ADL).
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Virtual Reality/Exercise Games
Virtual Reality/Exercise Games consists of computer-based, interactive exercise games and activities that allow players to engage in entertaining tasks while being physically challenged. These games rely on technology that tracks body movements or reactions. Some advanced games allow users to set goals, grade and customize, receive instantaneous feedback, reinforce behaviors, and record and analyze results.
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