Physical Therapy’s Role in Stroke Recovery

Physical therapy is critical after a stroke to regain strength, coordination, balance, motor control, and function. 

A stroke occurs when blood flow to an area of the brain is cut off, depriving the brain cells of oxygen and leading to physical and cognitive impairments. statistics show that about 40% of patients suffer from functional impairments after a stroke and 15-30% experience severe motor, sensory, cognitive, perceptual, and/or language impairments. More than 85% of those with stroke experience hemiplegia, which can cause impaired upper limb function, decreased motor ability, and balance problems.

Using a targeted exercise rehabilitation program early in the post-stroke recovery period, a physical therapist can help stroke survivors relearn basic motor skills, maximize their functional abilities, enhance their independence, and improve their quality of life.

Research has shown that the first 3-6 months after a stroke are the most vital for recovery as the brain enters a state of heightened neuroplasticity right after a stroke, allowing for adaptive changes and functional improvements more easily. 

Neuroplasticity is activated through repetitive practice, which builds and strengthens neural pathways in the brain to learn and relearn motor and cognitive skills.

A physical therapist plays a pivotal role in helping stroke survivors capitalize on the brain’s heightened neuroplasticity post-stroke and in safely relearning motor skills. 

Physical therapy treatment post-stroke can include:

• Motor skill exercises: This type of exercise focuses on improving coordination and the ability to control gross and fine motor skill movements. Gross motor skills include moving larger limbs like the arms and legs, while fine motor skills require dexterity in the hands to grasp and grip objects.

• Aquatic therapy: Exercising in a warm water pool can be beneficial for stroke survivors as it allows the survivor to build strength and improve balance in a safe environment without risk of falling. The warmth of the water can reduce muscle pain and tension, the water’s resistance can improve strength, and practicing in a pool usually reduces the fear of falling.

• Constraint-induced movement therapy (CIMT): This type of treatment involves restricting or constraining the unaffected arm to encourage use of the affected arm to complete certain tasks. The aim is to prevent stroke survivors from overcompensating for weakness on the affected side with the fully functioning side. By restraining the unaffected arm, this forces the patient to use the affected arm to improve muscle activation, strength, and coordination. 

• Functional electrical stimulation (FES): This treatment involves using low-energy electrical pulses to activate weak muscles and nerves. Electrodes are placed on certain muscles to stimulate either relaxation or contraction of those muscles. This helps to promote motor recovery by providing visual and sensory feedback and helps avoid disuse atrophy, a common stroke complication. 

• Range of motion exercises: These exercises improve the mobility of joints and flexibility of muscles, particularly as increase muscle tone or contractures can occur post-stroke that restrict movement in the arm, leg, hand, or ankles. 

• Bilateral arm training: This is a form of more intensive training that involves performing movements or activities with your arms at the same time but independently of each other. 

• Strength training: Resistance training of the upper and lower extremities can be beneficial for stroke survivors to progressively rebuild strength in weakened limbs post-stroke.

• Gait and balance training: As the stroke survivor progresses in healing, the therapist provides retraining for a normal walking pattern and implements functional movement training like getting in and out of bed or standing up from a chair. The therapist can also help patients practice using assistive devices like a cane or walker. 

• Stair training: If the stroke survivor progresses towards improved balance and a normal walking pattern, the therapist may also implement a series of stair training to help the stroke survivor recover range of motion and confidence navigating stairs and slopped environments.