#exercise for stroke

[philipppilz]

Exercising with Stroke Victims – Considerations for Family Members

By Philipp Pilz, MA, CSCS, ACE-PT

Every year over 800.000 people experience an ischemic or hemorrhagic stroke (i.e., blocked blood vessel or burst blood vessel respectively) in the United States. Two thirds of the victims suffer stroke-related disabilities including limb paralysis (hemiparesis), loss of feeling (hemiplegia), or expressive or receptive aphasia (difficulty speaking or comprehending speech).

Stroke recovery outcomes depend on the severity and location of the brain damage and a multitude of factors decide whether the symptoms are temporary or permanent. While a low-level stroke, such as a transient ischemic attack may cause only minor temporary problems (e.g., weakness in limbs), more sever strokes can leave permanent symptoms.

An average stroke damages around 2% of the brain’s 100 billion neurons and the goal of occupational and physical rehabilitation as well as continued physical exercises is the facilitation of neuroplasticity – the brains ability to heal itself by redirecting neural signals from the damaged or killed neurons to the unaffected parts of the brain.

Whenever I’m working with stroke victims, I always like to include family members into the exercise-related rehabilitation effort because exercise frequency and consistency are critical for the patient’s return to independent, active, and functional daily living.

Here are some of the core considerations that I share with family members who want to exercise with a stroke victim.

1.      Although the wish for a full recovery is understandable, goals of returning the client to a before-stroke ability level might be too ambitious and therefore frustrating and demotivating for everybody involved. Outpatient training results should establish baseline training goals for home exercise.

2.      As motivation and tenacity is important for long-term training adherence, I always discuss with family members the victim’s personality and mentality before the stroke. This consideration allows me and the assisting family member to relate effectively to the victim in the training effort. Motivation and tenacity is usually high in the early stages of training but can begin to fluctuate and drop when perhaps more permanent limitations emerge.

3.      Exercise sessions can be two to three times as difficult for stroke victims as they are for traditional training clients. Seemingly simple tasks like getting out of bed or forming words can be physically, mentally and emotionally fatiguing. Being patient and allowing sufficient strategic breaks is crucial to keep the patient motivated to exercise consistently and to continually make the effort toward progress.  

4.      In terms of physical, cognitive, and emotional ability, everyday can be radically different for people who suffered a stroke. Being flexible in the daily exercise format and goals is important for long-term training adherence and recovery. In my training with stroke victims, I always try to be extra creative and beside regular resistance and non-resistance exercises, I include gentle assisted stretches for the affected areas (against involuntary contracture); manual resistance exercises, standing and walking exercises with or without support (also to improve cardiovascular capacity);  and even neuromuscular electronic stimulation (especially for active breaks); and mirror boxes that enhance neuroplastic rewiring by stimulating the sensory connection between the affected limb and brain through an optical illusion.

Being considered, patient, and flexible are core components for success in working with stroke victims, regardless of their stroke severity and disability level.