You can now help stroke survivors directly with each purchase you make with Amazon! It takes just a quick step – below!
AmazonSmile is a charitable version of the normal Amazon website. It has the same products and prices but the difference is that when you shop on AmazonSmile, a donation of 0.5% of the net purchase price will be made to a charity of your choice. It’s free to set up an AmazonSmile account and very simple! You just need an Amazon account (and it doesn’t matter if it’s Prime or not).
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Thank you so much!
Note: If you have already chosen to support a different charity, you can change your charity any time by logging into AmazonSmile and clicking “Accounts & Lists,” then scrolling down to “Your AmazonSmile.” From there, click “Change charity” under “Your current charity” on the top right.
Arm impairment is the most common type of disability for stroke survivors, affecting 450,000 people in the UK alone, with persisting problems for between a half and three quarters of survivors.
This can be partly explained by where the injury is in the cortex. But because regaining lost function in the upper extremities has been found to be more difficult to achieve than return of normal function in the lower extremities, only 14% will regain any useful function.Between 55% and 75% continue to experience upper extremity functional limitations after 6 months.
Research reveals that from admission to discharge, survivors receive a fractional dose of rehabilitation for this area compared to what your brain requires at this critical time in order to stimulate new connections and adapt others.
Plasticity theory tells us that neuronal structure is altered and refined by experience. Movements highly related to particular activities that are experienced and practiced intensively pre-stroke will excite and interest the brain if introduced into rehabilitation post-stroke.
Repetitive activity therefore is critical for recovery, but research also shows people struggle with knowing what or how much to do after hospital finishes and then keeping track of their progress.
Working with more than 100 therapists (occupational therapists and physiotherapists) and 200 stroke patients, ‘OnTrack’ has been developed by Imperial College London’s Helix Centre.
This combined software for smart devices with coaching support, is ultimately designed to support the patient in the manner detailed below. The idea is hopefully to improve their particular targeted outcomes.
What is OnTrack?
OnTrack is a digital rehabilitation tool which is designed to facilitate the self-management of stroke recovery.
This platform includes a smartwatch app with tailored coaching to help people own their rehabilitation journey and inform their clinicians on their progress. The smartwatch app works like a step counter, it tracks minutes of arm activity through an algorithm developed for stroke survivors.
The purpose of OnTrack Rehab is to support and motivate stroke survivors to improve their recovery through daily activities.
How you can get involved.
Imperial College London’s Helix Centre is looking for stroke survivors with an arm impairment (18+ years old, living in London and more than 6 months post-stroke) to help them develop a new digital rehabilitation tool.
This will involve wearing wrist-based sensors and motion trackers during a 2 hour session at Imperial’s White City Campus to carry out tasks of daily activities such as using a knife and fork, reading a book and more.
They will then record this data to improve the technology behind OnTrack which will be anonymous. They will also provide a Participant Information Sheet for you, so you know what to expect.
What support will there be?
They will make sure to consider any accessibility needs you may have and work with you to best support you to attend, including providing interpreter services. They have wheelchair access on site as well as space for a carer to be in the session if you need to bring someone with you. They will also provide a break for you during the session.
Will there be a reimbursement?
This involvement is paid at £25 per hour as per INVOLVE guidelines, meaning that it is £50 per session paid to you. They will contribute £10 towards your travel also.
I am interested. When are the sessions?
The in-person sessions between April 2022 and May 2022, and you only need to attend one slot for 2 hours.
Where are the sessions?
They are at the White City Lab, Imperial College London, White City Campus, London, W12 0BZ.
How confident are you in doing your home exercises provided by your therapist or ARNI instructor?
Rehabilitation after stroke is a partnershipbetween you and your ARNI instructor or therapist. You’ll know that regular practice of techniques and exercises is necessary to optimise progress after stroke, but during the times that your Instructor isn’t present, these may or may not be difficult to perform.
So, have you ever been given exercises to do at home after your stroke?How confident did you feel to do those exercises without guidance? Or how confident would you feel doing them?
It’s well known that confidence is something many people may struggle with when exercising, especially when starting a new exercise programme. For instance, you may worry that you are doing the exercises incorrectly, or find it hard to make yourself practice as often as you know you should. Researchers use the term self-efficacy to describe how confident we feel to successfully carry out a particular action; in this case retraining home by ourselves.
Research has found that people with a high level of self efficacy aremore likely to regularly practice their home exercises, especially without motivation or supervision from others. Research also shows that many stroke survivors find it difficult to access home retraining, for many reasons.
Theoretically therefore, it may be possible, by attaching measures to a number of stroke survivors’ levels of self efficacy (for carrying out home retraining independently), it may be possible to identify those survivors who are not so confident… and therefore highlight the requirement for additional help (and in what ways) for these people.
Currently there is no stroke specific measurement tool available to do this. This study aims to address this gap in stroke rehabilitation.
Can you help the researchers by giving approximately 30 minutes of your time and completing an online questionnaire?
Working under the supervision of Dr Cherry Kilbride and Dr Elmar Kaland with ethical approval from Brunel University London, Dylan Kerr and Kevin Murray are carrying out research to help develop a stroke-specific self efficacy measure for doing home exercises.
CALLING ALL STROKE SURVIVORS – PLEASE HELP BY GETTING INVOLVED IN THIS STUDY IF IT IS APPROPRIATE TO YOUR SITUATION!
What will I need to do if I would like to help, and take part in the study?
Read the Participation Information Sheet for more information and give your consent
Complete the background questionnaire (questions about living with stroke, mentally and physically) followed by 2 quick self-efficacy scales
One week later, we will send you a short version of the questionnaire (10 minutes) to complete. This is to see if anything has changed in your self-efficacy scores
A tip: For the best display of the questionnaire graphics, use a laptop/desktop computer or tablet.
Your responses will be anonymised prior to the analysis. The results of the study will be reported in the form of a written MSc dissertation, and may be published in international scientific journals. Please note that your information will kept confidential at all times, and no identifying information will be reported.
Tiredness is something we all experience in our everyday lives. But how about the sort of tiredness which seems to be unrelated to physical or mental exertion, and does not seem to be alleviated by rest? This is a real problem for many stroke survivors on top of the many other problems they may face – and is called ‘fatigue’.
Fatigue is one of the most commonly reported symptoms after Stroke with a prevalence of up to 80%, characterised by overwhelming physical and/or mental tiredness or exhaustion.
For many the symptoms dissipate and lessen over time. Others continue to experience these symptoms at a high level many years after their stroke. This is called chronic fatigue.
Chronic Fatigue has a major impact on Quality of an individual’s life, making everyday tasks feel overwhelming and unachievable, or just plain exhausting. Despite the high prevalence, what causes fatigue to persist for months or years after a stroke remains an open question.
Researchers continue to try and get a better understanding of the mechanisms that underlie fatigue in order to answer this question. Understanding more about it may in turn can maybe lead to the development of effective interventions which may significantly alleviate the condition.
The Effort Lab, led by Dr Anna Kuppuswamy, based at the Institute of Neurology, UCL, in London, has been studying fatigue over the last 10 years to better understand the brain mechanisms that underlie this highly debilitating symptom, not only after Stroke but across other neurological conditions such as Multiple Sclerosis and Parkinson’s Disease.
Their work suggests that altered perception of various sensations can explain the onset and persistence of fatigue.
When performing day to day tasks for example, altered perception will make the tasks feel more effortful. And when in a busy environment with background noise, altered perception results in being overwhelmed and brings on fatigue.
What remains unclear is the relationship between fatigue and visual perception.
They have designed a way that stroke survivors can feedback their experiences to the research team in order to gather important information from various neurological conditions so that they can better understand the possible links.
CALLING ALL STROKE SURVIVORS – PLEASE HELP BY GETTING INVOLVED IN THIS IMPORTANT STUDY IF IT IS APPROPRIATE TO YOUR SITUATION!
It takes no more than 45 minutes on an online combined quiz and questionnaire:
online quiz: completing a couple of questionnaires
online task: identifying shapes and responding by pressing the appropriate buttons on your keyboard.
A tip: For best display of the questionnaire graphics, use a laptop/desktop computer or tablet…
Strong evidence exists that physiotherapy improves the ability of people to move and be independent after suffering a stroke. But at six months after stroke, we know that many people remain unable to produce the movement needed for every-day activities such as answering a telephone. So, what can be done?
1. First, it’s important to be able to recognise if a physiotherapy intervention is really aiding a survivors’ abilities to undertake everyday activities or whether the intervention is doing less than it than it purports to/would ideally do.
This requires a deeper knowledge of the biological underpinnings of neuromuscular function. Neuromuscular function includes the ability to use weak muscles in the right order and at the right time during movement and performing everyday tasks in the same way as you did before the stroke.
2. Second, to optimise a physiotherapist’s chances to advise/work on an optimal combination of rehab interventions for each individual after stroke, it would be ideal to find out what kinds of sleep patterns are most beneficial for them.
Physiotherapists need to be able to have the same opportunity to diagnose how to help each stroke survivor gain the kind of very accurate movement measures at any point in their rehabilitations that currently, only specialist University facilities can routinely produce. This equipment is obviously expensive and can only be used in large specialised laboratories.
Ideally, more portable equipment should also be able to be accessed by therapists, which would cost less and is designed for use in small spaces. But such equipment would have to also be sensitive enough to provide meaningful feedback for therapists in a similar way to those used by the specialist labs. Such feedback could then be very useful for therapists and survivors to create optimal rehab plans together which would really enable the survivor to work on his/her edges of current ability.
A School of Health Sciences research team at the University of East Anglia (UEA) headed up by Professor Valerie Pomeroy have been attempting to find out if this can be done and have also been examining how sleep patterns affect rehabilitations.
Following on from a request last year, the UEA would like to invite YOU to come TWICE to theirMovement and Exercise Laboratory (MoveExLab) to get involved with this Project if you can/if it’s appropriate for your circumstances.
Dr Balchin says: you never know how such involvement can directly or indirectly push your own rehab forward, at whatever time away from stroke you are. Knowledge is power, Anything that can give you clues and cues about the state of your rehab and current/future interventions can be useful.
Go for it if you can/if it’s appropriate for you!
Inclusion criteria: you need to be 18 or above, have had a stroke at any point in the past, be discharged from NHS stroke services and be without an allergy to latex.
What you’ll be doing:
Upon application, if no contra-indications are revealed, you’ll be invited to undertake 2 assessments at the MoveExLab.
These assessments (around 90 mins to complete each) will be between 2 and 4 months apart. In each, you’ll have EMG electrodes placed on your skin using hypoallergenic sticky tape. These will measure your muscle activity as you move and don’t hurt at all, but just record your natural muscle activity during movement.
They’ll then place reflective markers on your skin. These markers are tracked by infra-red cameras placed at the top of the walls of the MoveExLab.
You’ll then be asked to pick up a telephone several times, which is placed a number of different positions, whilst your performance on the tasks is recorded (and reconstructed on the computer).
Then you’ll complete some questionnaires about how you sleep.
Then you’ll wear a motion watch on each wrist for 7 days to measure your everyday activity, which you’ll then send back in an SAE.
No sort of ‘therapy’ is implemented to project participants.
The Team will be in contact with you throughout the period of your involvement.
Travel expenses can be reimbursed for return journeys of up to 50 miles (ie, 25 miles each way).
If you are travelling in from further away, you can claim travel expenses for your journey up to 50 miles in total as well.
Apply now by speaking with the principal investigator: Professor Valerie Pomeroy..
It’s probably true to say that a lack of motivation is one of the more serious factors involved in unsuccessful rehabilitations. A gradual diminishing of motivation is also a really normal reaction to setbacks, and stroke is one SERIOUS set-back.
You can bet that I’ve met quite a few stroke survivors over the years who’ve become prone to anxiety, depression and/or anger because of the condition they have found themselves in.
I hope that I’ve been able to facilitate at least some of these people towards the benefits of maintaining a ‘growth mindset’ concerning their recovery, despite their difficulties.
For example, there is a question that is often asked after a while if successes become imperceptible or grind to a halt. It is: ‘why bother to try retraining when nothing more seems to be happening, despite everything I’m doing so far?’
There are a number of instant answers that a neurologist would give you to this. Primary among them would be the point that even though changes may not be visibly occurring as a result of your efforts, your rehab training will still be as essential for warding off decline as well for driving positive functional change.This is why getting an ARNI trainer to tackle this with you is even more important.
So a good battle-plan is to find out more and more about your presentation (as it stands RIGHT NOW) and available treatments (AS THEY STAND RIGHT NOW), via as many knowledge-sources, is key.
For example, most people don’t understand (forget, aren’t told, or don’t read about the) need to continually promote an increase in active range of movement (AROM) in as many planes and pivots as possible.
Increase in non-functional AROM increases strength and muscle bulk, encourages muscular activity which promotes vascular return, decreases the potential for soft-tissue shortening and damage with resultant pain and stiffness and increases osteoblastic activity on your more-affected (and also possibly osteoporotic) side. Also, by doing this, you’ll render yourself more eligible for new technologies and/or medical options and emerging treatments to augment your retraining.
So, by steering you toward the potential inherent in effective retraining, I hope to promote a ‘growth mindset’ in you, if you’re not already ‘on-board’. You are a learner. And so am I, as a stroke survivor of what is now a full 25 years. You and I have to keep learning and keep retraining as stroke survivors, keep exploring and keep innovating over the long term. Easy to say, harder to do. But you MUST please, please write down a few things and start doing them. Then make a pattern of them day by day, which you don’t want to break, because it’s what you ‘do. And trust me, people will respect you for that.
Do MORE than able bodied people training-wise. Show them up!! Make them wish they WERE YOU!!
Ultimately you may want to pass the things you’ve learned and constructed onto other survivors so that they can make of them what they will. I will show you how you can get motivated by getting successful; on what I call the ‘big fixes and the small steps’. This is, of course, only done by getting busy and starting to retrain with sensible staging posts. You’ll find your way through.
Have you thought about becoming an ARNI Stroke Rehab Instructor or nominating a colleague of yours to enter on the Course in order to Accredit/Qualify in Functional Rehabilitation After Stroke?
If not, please read on…. or please help if appropriate, by forwarding to a suitable colleague or two as a suggestion for consideration.
We have a couple of places left on forthcoming ARNI Stroke Rehabilitation Standard 6-Day Qualification Course… which is for the moment (due to Covid) available largely ONLINE.
Accredited by ARNI Institute, Middlesex University and very kindly assisted by the Institute of Neurology, UCL, and other experts in neurorehabilitation including from Oxford University. The Course has run 3 times per year for 15 years.
ARNI is well-known around the UK as a ‘go-to’ for stroke survivors and families when considering requesting an excellent instructor or therapist who will help survivors to rehabilitate in the community.
All dates are 10.15am – 5pm on Saturdays, for easiest access.
Day 1: January 22nd
Day 2: Feb 12th
Day 3: Feb 22nd
Day 4: March 12th
Day 5: March 26th
Day 6: April 9th
(Also practice training/shadowing days: March 22nd, April 1st, April 8th)
2. ADVANTAGES OF COMPLETION:
Learn how to really train stroke survivors: what they actually need from you in the community to recover as much function as possible.
Learn evidence-based skills, knowledge, retraining know-how and ‘tricks of the trade’ that you can offer and over again to stroke survivors (and families) to help them with ongoing rehab and self-management.
Be sent repeated referrals over time from ARNI Charity for rehab training.
Use the ARNI tele-rehabilitation system.
We may have people already on our lists who need your help, because we often have no other Instructor in specific areas to refer to or because existing Instructors sometimes find themselves unable to accept any more survivors to retrain.
Buy yourself or someone you care about some ARNI goodies TODAY: claim a huge 50% RIGHT NOW off any of the items featured below!
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See Product page 1 and Product page 2 to see usual item prices and see below the illustration pictures for HOW TO GET THE ITEMS FEATURED BELOW at 50% off!
We have no coupon facilities set up forthis Christmas offer, so just go to Product page here and choose everything you like that is featured on this page, note them down and then call us at ARNI on:
‘I’m pretty elderly now. If I have a stroke, I’m sure I won’t recover function’.
Good news though. This isn’t automatically so. The evidence reveals that overall, age is NOT considered to be a strong predictor of a better or worse functional recovery after stroke.
And elderly patients with stroke are still absolutely considered candidates for rehabilitation regardless of stroke severity, and each case needs to be considered on the basis of individual characteristics and potential. Factors such as fitness, cognitive functioning, family/community support and comorbidities (other health problems you may have had pre-stroke and may still have) are considered important in these cases.
Here is a wonderful photo of two people who are currently being retrained by ARNI Rehabilitation instructors: Harry Baker and his Grandfather! Harry, when he came to see us was just 15. His Grandfather is 95!
You probably know that stroke is most likely to occur after 55 years of age, with 38% of strokes occurring between 40-69 years and 59% of strokes occurring in people aged over 69 years. You’re most probably also aware that advancing age is considered a risk factor for stroke, with the incidence of stroke approximately doubling each year above 60 years of age. The average age of stroke is 72 years for men and 78 years for woman in the UK.
Although many people choose to ignore it, it’s very important for an older person to identify (or this being done for them by their GP) the things which increase their risk of having a stroke so that they can modify the way they live to reduce the risks.
The aging process is known to cause specific cardiovascular changes that impair heart and blood vessel function. These changes lead not only to reduced physical and mental ability, but aging is also a risk factor for cardiovascular disease (CVD). CVD is a classification term for diseases that involve the heart or blood vessels. For example: heart attack, stroke, heart failure, angina, hypertensive heart disease, rheumatic heart disease, cardiomyopathy, abnormal heart rhythms, congenital heart disease, valvular heart disease, carditis, aortic aneurysm, peripheral artery disease, thromboembolic disease and venous thrombosis.
A few lifestyle changes could reduce your risk.
Stopping smoking, reducing your alcohol intake, maintaining a healthy weight, eating healthier (high fibre, less fatty/surgery) foods and taking regular exercise can make a massive difference.
Existing medical conditions, like high blood pressure, high cholesterol, heart disease, diabetes, irregular heartbeat (atrial fibrillation), and having a transient ischaemic attack (TIA) can increase your risk of suffering a stroke. If you’ve not yet done so, you should probably ensure to consult your GP or a healthcare expert to summarise your risk factors for stroke as well as conduct a medication review for you.
Recovery after stroke
As noted above, older people are more likely to have pre-existing health conditions which can affect their ability to adjust to change and/or be the cause of functional limitations which in turn make ADLs more difficult to.
However, the brain has a life-long capacity to learn and adapt. Through processes called neuroplasticity and neurogenesis, the brain remodels itself in response to learning and experience. This allows the brain to change it’s structure and organisation; strengthening, adding or removing neural connections or creating new cells (neurons).
Neuroplasticity does decline as we age, but it doesn’t stop. It’s never to late to learn a new skill and many people use retirement as an opportunity to learn something new. This is only possible due the still present ‘plasticity’.
Does that mean that elderly stroke survivors can regain function after a stroke? Yes, and they do!
There is hope for recovery, even for elderly and previously ill stroke survivors. Specialist post-stroke care and early rehabilitation are key to gaining the best outcomes. Most improvements occur in the first 3 months after a stroke, after which they do slow down, but the brain will keep creating new neural pathways after this time: well after 6 months and in numerous cases, after many years. See how this is done in Had a Stroke? Now What? So it’s very important to begin and to continue with a tailored rehabilitation programme once no community (state given) help is available.
In order to bring about functional change, neural pathways for desired activities need to strengthened. At a very basic level, this can be optimally achieved through repetitions (facilitated by ‘smart’ use of use of some augmentations and principles which one can ‘add’ to movements to optimise their performance over time, always trying to work ‘on the edge of your current ability. How do do this is explained in my ‘stroke rehab possibilities wheel diagram’ in Had a Stroke? Now What?. The more repetitions you can achieve in a shorter time, the better the brain can re-structure. The skill you are trying to ‘re-learn’ should be something that is relevant and meaning for you.
You’re more likely to succeed if you deem the task or tasks important and worth-while. For this reason, I’ll show you how you can set mini-plans (or goals) and identify what you want to achieve, so that you can prioritise your time. This is particularly important if you suffer from fatigue and low energy levels. Goal-setting (although to many people it sounds like a very woolly term) will help you to stay motivated and on-task if you match it with record-keeping. Actually, record keeping is the valuable one. Goals can quite vague but recording what you achieve each time you retrain is the massive biggie. So few people really do it, and it’s a shame. They really should – success lies in knowledge – knowledge is power!
So, young or old – let’s go! There’s ALWAYS a way. If you can’t locate what that way is at the moment, ask us and we’ll give you some pointers ok?
To get involved with rehab talk with other stroke survivors, please visit ARNI Facebook
The majority of stroke survivors whom I’ve met, when describing their prior physiotherapy and any other rehabilitative efforts, will report that the focus of therapy was usually on seated stabilisation, seat to stand, weightbearing and walking practice. All vital stuff. But only a small minority remembered being introduced to/practising upper limb exercises.
This happens for a number of reasons, but as time and resources are most usually limited, therapists often do not have time to devote to extensive hand-function efforts. Many receive no upper limb therapy at all. And by the time further treatment is sought, the task is all the more harder. At the height of the pandemic, many patients were told that it was safer to go home and receive no therapy or no further therapy.
This is why it’s critical that the leading edgeUpper Limb Clinicdeveloped at the Institute of Neurology at UCL by Professor Nick Ward builds up more and more a body of evidence of efficacy so that it becomes clear that a ‘3 week intensive blast’ of multi-therapies that such a Clinic can offer, with the learning for survivors and families that can accompany it, can become an effective bolt-on or plug-in funded for each hospital in the UK with a stroke unit in order to push/promote/kick-start recoveries. Maybe this will happen in due course. I hope so!sive
In the meantime, it’s vital that stroke survivors are shown what to do as far as upper limb is concerned in the community, as soon as possible after discharge, in order to continue the work of the therapists or initiate it if none has yet been done.
The reason is that all evidence points to the fact that high dosages of repetitions, over time, stand best chance of assisting upper limb recovery. This has to be done by the survivor, at their own residence. Survivors need to know what to try to do themselves and what they need to seek help with/for.
The evidence (see yearly-updated in-depth reviews of well over 4,500 studies including over 2,170 randomized controlled trials at www.ebrsr.com) reveals that:
Task-specific training, alone or in combination with other therapy approaches, may be beneficial for upper limb function.
Higher and lower intensity task-specific training may have similar effects on upper limb function.
Trunk restraint with reaching training may improve upper limb function.
Let’s discuss how you as a stroke survivor can use this evidence. Remember, high dosages of repetitions (of reach, grasp and release) are needed. Remember that all attempts at repetitions (including mental practice) drive neuroplasticity. You NEED to get it done, over and over again, even if nothing is happening: there are ‘tricks of the trade’ as it were’ that you can use.
I’m going to show you all of this in a series of Youtube clips.
Have a look at this small video I put together: this is clip 1 of 20 or so about upper limb training. Then take part with me by subscribing to the new ARNI Stroke Rehab Tips on Youtube. Upper limb rehab will come first and Video 1 is already up on there: watch and subscribe for further Youtube videos! Many other stroke rehab topics will be loaded up on there as time moves on.
If you do want to take part, you need only a minimum amount of kit. A short stick (cut a broomstick and chamfer the edges), a tray or book, some items with blue tack stuck to the bottom (or MUCH better a laptop board with heavy duty Velcro strips attached and some specific items with Velcro squares attached to them – click the link to get, or make your own board).
Being in a seated position is fine when doing upper limb task-specific training. But completing the reaching task by moving your trunk forward to complete a reaching activity is ‘cheating’. This is where trunk constraint works well.This is often done via a chest seatbelt/harness.
How to start retraining your upper limb after stroke? Your starter programme consists both of stretches and tasks. You may or may not have been taught how to safely self-stretch but the idea is that more is better and safety is paramount. You have to stretch your upper limb (gently), knowing at the same time simply stretching won’t bring recovery. You have to be task-focused. So, when you do a stretch, you then do something challenging and specific functionally with the stretch.
For example, stretch, then try to pick a hairbrush up and put it into a cupboard. In your retraining sessions, stretches must be considered as promoting the chances of the successful performance of the task.
Remember my upper limb catch-phrase: stretching enables the task and extends ‘time on task’.
These are very important for improving your potential ability to reach for, grasp and release items with your hand: activities that are denied to so many stroke survivors. You can use stretches daily in order keep muscles long and prevent further complications. The best results are often seen in people who have consistently stretched their wrist, fingers and thumb on their more-affected side from a very early period in the hospital.
Upper limb task-specific practice concerns reaching (which you perform mainly with your shoulder, elbow and wrist joints) and grasping/releasing (which you do mainly with your fingers and thumb joints). Stroke survivors often find it very hard to make purposeful movements requiring precise control of either; rendering movement slow, inaccurate, and usually not well directed or coordinated. Isolated recovery efforts for the upper limb, often in terms of grasping and releasing an item during a task, correspondingly demand effort and accuracy.
Unlike (to an extent), lower body, training coping strategies for and during rehabilitation of the upper limb should be largely avoided.
If you have spasticity and find it hard to reach away from your torso, you may tend to ‘throw’ your more-affected arm at a task mainly by activating your shoulder joint. This stands in contrast to a more controlled movement sequence, where your arm can move away from your torso using your shoulder, elbow and wrist joints to help position your hand to complete a task. The latter situation is better than the former.
Success at reaching therefore needs to be trained for. Building up strength and working for incremental spasticity decline can be worked on at the same time. So, trunk constraint whilst performing task-practice has strong evidence for improving outcomes, because it makes ‘cheating’ nearly impossible to do.
Also, limb de-weighting via wrist holding or using de-weighting technology is a therefore a good way of facilitating this from the start. See picture, below and left. This is because ‘heavy arm’ can render tasks very difficult to perform.
I’ll show you all this in one of the videos, and how a therapist, trainer or any family member can do this precisely to help the survivor ‘get the ‘gap’ between thumb, first finger and middle finger, in order to pick up an object.
So, arm de-weighting, often in terms of assisting in reaching for an item during a task can be used to initiate and/or extend your time practising a task.
One thing you need to know is that although there is evidence that functional control of your hand will only improve once you gain more control over joints which are closer in towards the body (proximal) rather than further away (distal), recent evidence suggests that you should be also be trying to work with your fingers and thumb right from the start rather than waiting for your arm to get stronger in order to position your hand accurately.
This might sound strange if you can’t even ‘get a gap’ between your first finger and your thumb, or that your fingers and thumb are ‘floppy’. Both states would seem to make ‘useful’ hand function non-existent.
However, it’s suggested that, via specific retraining, distal control can and should be trained for immediately after stroke, This is also because if you waited for control to return from proximal to distal, you might achieve some strength in the shoulder, elbow and wrist over time but may not have done any task-specific grasp and release attempts at all, let alone put in the very large amount of intensive retraining time that might stand a chance of helping you regain control of the main reason why you have an arm in the first place.