EXERCISES FOR

STROKE VICTIMS

NOOR MAZIAH BINTI ISMAIL

2009420814
FACTS ABOUTS STROKE
 stroke is the third most common causeof death, after cancer and ischemic
heart disease.
 It is also the most prominent cause of physical deformity
 Stroke has a yearly incidence of180-300 per 100,000,in the United States.
 Its incidence is accelerating in developing countriesdue to unhealthy
lifestyles.
 2/3 of stroke victims are above60 yearsold.1/5 of the victims die within a
monthof its occurrence. Half the survivors become physically deformed.
 A damage in the left side of the brain may result in paralysis of the right
side of the body;a damage on theright side, paralyzes the left side.
 Hypertensionaccounts for 30-50% of stroke risk.
 Patients with diabetes mellitus are 2-3 times more predisposed to stroke.
 Stroke can occur due to adisruption in blood supplyor due to a blood
vessel damage
HOW STROKE OCCURS
 Who has Strokes
 Strokes most often occur in the elderly, people
with high blood pressure, obesity and diabetes.
Smoking and alcohol use also increase the risk for
strokes. Diets high in cholesterol can contribute to
the build of blockages in the arteries. Lack of 
exercise can lead to hypertension and poor
circulation, both of which can contribute to
strokes. Patients suffering from atrial fibrillation
(irregular pulse) are the most at risk to suffer
from a stroke.
 Bleeding Into the Brain
 There are two types of strokes. The first is a hemorrhagic
stroke. This occurs when a blood vessel inside the brain
ruptures and causes bleeding. This type of stroke is usually
the result of a head injury. Another reason a hemorrhagic
stroke can occur is if the blood vessels grow too thin--this
may cause a bulge, called an aneurysm. Aneurysms can
develop slowly over several years and will eventually grow so
weak that they break, causing bleeding. If the bleeding is
near the surface of the brain it is called a subarachnoid or a
subdural hemorrhage. If the bleeding is deeper inside the
brain it is called a intracerebral hemorrhage. Hemorrhagic
strokes are less common than ischemic strokes, but they are
more likely to result in death.
 Blocked Artery
 The second type of stroke is an ischemic stroke. This
results when an artery in the brain becomes blocked. One
possible cause of the blockage is thickening of the blood
resulting in a blood clot. The clot can travel through the
circulatory system until it becomes lodged in a narrow
artery in the brain. The other cause is if the arteries
become weakened, narrowed or hardened. Cholesterol
can form plaque that sticks to the walls of the artery,
gradually making the artery narrower over time. Plaque
usually builds up in the arteries of the neck, so when they
become fully blocked one entire hemisphere of the brain
is affected by the stroke.
 Brain Damage
 Without blood oxygenating the brain, the cells suffer
damage. In an attempt to compensate, the body will
enlarge other nearby blood vessels to try and restore
blood flow to the affected areas. If blood flow is blocked
for more than four minutes brain cells begin to die. The
brain can not regenerate dead brain cells. Because
different areas of the brain control different functions,
symptoms of a stroke may vary. Paralysis may occur on
one side of the body, there may be blurred or lost vision,
trouble communicating or drooping on one side of face.
Even if treated quickly the patient may still suffer long
term disability.
HAND EXERCISES FOR STROKE PATIENTS
 Hand exercises for stroke patients is the most practical approach to hand recovery after stroke as it can
be done at home. It is composed of a range of motions focused on one area, the hand, as with other
exercises for stroke patients. Meant to retrain the brain, hand exercises should be done several times a
day for mastery and to redevelop coordination.
 Here are some hand stretching exercises, arranged sequentially, that you might want to try:
 1. Massage the affected hand with the unaffected hand, beginning with the base of the thumb by the
palm, to the tip of the thumb. Repeat for all fingers.
 2. Stretch each finger of the affected hand with the unaffected hand. You could also move each finger of
the affected hand in circular motions with the unaffected hand.
 3. Close and open the affected hand, beginning one finger at a time until you form a fist and vice versa.
Alternate by closing and opening all fingers at the same time to form a fist and vice versa.
 4. With palms face down on a flat surface, lift thumb and gently return to position. Repeat on all fingers.
 5. With palms face down again, lift hand while bringing each finger tip slowly gliding towards each other
to a close. Reverse action. Repeat 5 times.
 6. Stretch fingers as far as you can while palm is faced down on flat surface. Hold in position for 5
seconds. Release. Repeat 5 times.
 Once you're done stretching, here are hand activities to practice your grip and enhance flexibility:
 1. Practice counting with your fingers in sets of 5. From a closed fist, count with the pinkie first going to
the thumb. Begin the next set of numbers with an open hand. Then close the hand to form a fist
beginning with the thumb going to the pinky.
 2. Form the letters of the alphabet using your hand. Also known as finger spelling, here's a chart you can
follow.
 3. Crumple pieces of paper. Throw them all in the air as you would with confetti, such that they fall on
the table. Pick each crumpled paper and throw into a trash can as you would in basketball.
 4. Play pickup sticks or pickup objects of various sizes.
 5. Play with a stress ball.
WHAT IS POST-STROKE
REHABILITATION?
 Rehabilitation helps stroke survivors relearn skills that are
lost when part of the brain is damaged. For example,
these skills can include coordinating leg movements in
order to walk or carrying out the steps involved in any
complex activity. Rehabilitation also teaches survivors
new ways of performing tasks to circumvent or
compensate for any residual disabilities. Patients may
need to learn how to bathe and dress using only one hand,
or how to communicate effectively when their ability to
use language has been compromised. There is a strong
consensus among rehabilitation experts that the most
important element in any rehabilitation program is
carefully directed, well-focused, repetitive practice - the
same kind of practice used by all people when they learn a
new skill, such as playing the piano or pitching a baseball.
 Rehabilitative therapy begins in the acute-care hospital after the patient's
medical condition has been stabilized, often within 24 to 48 hours after the
stroke. The first steps involve promoting independent movement because many
patients are paralyzed or seriously weakened. Patients are prompted to change
positions frequently while lying in bed and to engage in passive or active range-
of-motion exercises to strengthen their stroke-impaired limbs. ("Passive" range-
of-motion exercises are those in which the therapist actively helps the patient
move a limb repeatedly, whereas "active" exercises are performed by the
patient with no physical assistance from the therapist.) Patients progress from
sitting up and transferring between the bed and a chair to standing, bearing
their own weight, and walking, with or without assistance. Rehabilitation
nurses and therapists help patients perform progressively more complex and
demanding tasks, such as bathing, dressing, and using a toilet, and they
encourage patients to begin using their stroke-impaired limbs while engaging in
those tasks. Beginning to reacquire the ability to carry out these basic
activities of daily living represents the first stage in a stroke survivor's return
to functional independence.
 For some stroke survivors, rehabilitation will be an ongoing process to maintain
and refine skills and could involve working with specialists for months or years
after the stroke.
WHAT DISABILITIES CAN RESULT FROM A STROKE?

 The types and degrees of disability that

follow a stroke depend upon which area of
the brain is damaged. Generally, stroke can
cause five types of disabilities: paralysis or
problems controlling movement; sensory
disturbances including pain; problems using
or understanding language; problems with
thinking and memory; and emotional
disturbances.
PARALYSIS OR PROBLEMS CONTROLLING
MOVEMENT (MOTOR CONTROL)
 Paralysis is one of the most common disabilities resulting
from stroke. The paralysis is usually on the side of the
body opposite the side of the brain damaged by stroke,
and may affect the face, an arm, a leg, or the entire side
of the body. This one-sided paralysis is
called hemiplegia (one-sided weakness is
called hemiparesis). Stroke patients with hemiparesis or
hemiplegia may have difficulty with everyday activities
such as walking or grasping objects. Some stroke patients
have problems with swallowing, called dysphagia, due to
damage to the part of the brain that controls the muscles
for swallowing. Damage to a lower part of the brain, the
cerebellum, can affect the body's ability to coordinate
movement, a disability called ataxia, leading to problems
with body posture, walking, and balance.
SENSORY DISTURBANCES INCLUDING PAIN

 Stroke patients may lose the ability to feel touch, pain, temperature, or position. Sensory
deficits may also hinder the ability to recognize objects that patients are holding and can
even be severe enough to cause loss of recognition of one's own limb. Some stroke patients
experience pain, numbness or odd sensations of tingling or prickling in paralyzed or
weakened limbs, a condition known as paresthesia.
 Stroke survivors frequently have a variety of chronic pain syndromes resulting from stroke-
induced damage to the nervous system (neuropathic pain). Patients who have a seriously
weakened or paralyzed arm commonly experience moderate to severe pain that radiates
outward from the shoulder. Most often, the pain results from a joint becoming immobilized
due to lack of movement and the tendons and ligaments around the joint become fixed in
one position. This is commonly called a "frozen" joint; "passive" movement at the joint in a
paralyzed limb is essential to prevent painful "freezing" and to allow easy movement if and
when voluntary motor strength returns. In some stroke patients, pathways for sensation in
the brain are damaged, causing the transmission of false signals that result in the sensation
of pain in a limb or side of the body that has the sensory deficit. The most common of these
pain syndromes is called "thalamic pain syndrome," which can be difficult to treat even with
medications.
 The loss of urinary continence is fairly common immediately after a stroke and often results
from a combination of sensory and motor deficits. Stroke survivors may lose the ability to
sense the need to urinate or the ability to control muscles of the bladder. Some may lack
enough mobility to reach a toilet in time. Loss of bowel control or constipation may also
occur. Permanent incontinence after a stroke is uncommon. But even a temporary loss of
bowel or bladder control can be emotionally difficult for stroke survivors.
PROBLEMS USING OR UNDERSTANDING LANGUAGE (APHASIA)

 At least one-fourth of all stroke survivors experience language impairments,

involving the ability to speak, write, and understand spoken and written
language. A stroke-induced injury to any of the brain's language-control centers
can severely impair verbal communication. Damage to a language center located
on the dominant side of the brain, known as Broca's area, causes expressive
aphasia. People with this type of aphasia have difficulty conveying their
thoughts through words or writing. They lose the ability to speak the words they
are thinking and to put words together in coherent, grammatically correct
sentences. In contrast, damage to a language center located in a rear portion of
the brain, called Wernicke's area, results in receptive aphasia. People with this
condition have difficulty understanding spoken or written language and often
have incoherent speech. Although they can form grammatically correct
sentences, their utterances are often devoid of meaning. The most severe form
of aphasia, global aphasia, is caused by extensive damage to several areas
involved in language function. People with global aphasia lose nearly all their
linguistic abilities; they can neither understand language nor use it to convey
thought. A less severe form of aphasia, called anomic oramnesic aphasia, occurs
when there is only a minimal amount of brain damage; its effects are often
quite subtle. People with anomic aphasia may simply selectively forget
interrelated groups of words, such as the names of people or particular kinds of
objects.
PROBLEMS WITH THINKING AND MEMORY

 Stroke can cause damage to parts of the brain responsible for

memory, learning, and awareness. Stroke survivors may have
dramatically shortened attention spans or may experience
deficits in short-term memory. Individuals also may lose their
ability to make plans, comprehend meaning, learn new tasks, or
engage in other complex mental activities. Two fairly common
deficits resulting from stroke are anosognosia, an inability to
acknowledge the reality of the physical impairments resulting
from stroke, and neglect, the loss of the ability to respond to
objects or sensory stimuli located on one side of the body,
usually the stroke-impaired side. Stroke survivors who develop
apraxia lose their ability to plan the steps involved in a complex
task and to carry the steps out in the proper sequence. Stroke
survivors with apraxia may also have problems following a set of
instructions. Apraxia appears to be caused by a disruption of the
subtle connections that exist between thought and action.
EMOTIONAL DISTURBANCES
 Many people who survive a stroke feel fear, anxiety,
frustration, anger, sadness, and a sense of grief for their
physical and mental losses. These feelings are a natural
response to the psychological trauma of stroke. Some
emotional disturbances and personality changes are
caused by the physical effects of brain damage. Clinical
depression, which is a sense of hopelessness that disrupts
an individual's ability to function, appears to be the
emotional disorder most commonly experienced by stroke
survivors. Signs of clinical depression include sleep
disturbances, a radical change in eating patterns that may
lead to sudden weight loss or gain, lethargy, social
withdrawal, irritability, fatigue, self-loathing, and suicidal
thoughts. Post-stroke depression can be treated with
antidepressant medications and psychological counseling.
"PASSIVE RANGE OF MOTION
EXERCISES"
 if the stroke victim has suffered paralysis of one side of the
body, passive range of motion exercises are done for the
shoulder, elbow, wrist, fingers, hip, knee, ankle, foot, and toes
by the physical therapist at bedside. Passive range of motion
means that the therapist supports and moves the body part
through the full range of motion. These exercises maintain good
blood flow and keep the muscles and tendons flexible,
preventing the joints from tightening. For example, if the
shoulder joint is not stretched, the patient can develop a "frozen
shoulder syndrome" which can be very painful. It is important to
prevent range of motion limitations because this impairs function
and tends to cause pain. After the patient is discharged, a Home
Health Physical Therapist will provide a Home Exercise Program
with clear written instructions and illustrations and will train a
family member how to carry out these exercises.
"ACTIVE RANGE OF MOTION
EXERCISES"
 If the stroke victim starts to recover and
begins to have voluntary muscle strength on
the involved side then the physical therapist
may instruct the individual in active
exercises. "Active exercise" means the
patient will lift or move the body part
through the range of motion against gravity
without help. These exercises help to
strengthen the muscles on the weak side, but
also should be done on the good side
"CONSTRAINT-INDUCED
MOVEMENT THERAPY (CIMT)"
 CIMT is being used in some stroke
rehabilitation centers. It involves
constraining the unaffected limb in order to
force the patient to use the affected limb.
"BALANCE AND TRANSFER
EXERCISES"
 With the assistance of a physical therapist,
the patient will practice moving from lying to
sitting position and then practice sitting
balance. Next they will learn to transfer
from bed to wheelchair and back to bed
sometimes using a sliding board if necessary.
"GAIT (WALKING) TRAINING
EXERCISES"
 The patient generally starts practicing standing up in
the parallel bars with the assistance of a physical
therapist. Next the patient learns to shift weight from
one leg to the other, shifting both from side to side
and from front to back. After this the patient walks a
short distance between the parallel bars using the bars
for support. Next, with the assistance of a physical
therapist, the patient will walk outside the bars using
a quad cane or walker if needed. The therapist places
a wide canvas belt, called a "gait belt", around the
patient's waist to provide a way of holding on to him or
her and a way to adjust balance and prevent falls.
"HOME ASSISTIVE DEVICES"
 Once the patient is at home, a Home Health
Physical Therapist will visit and make
recommendations for creating a safe and
supportive environment. Items of concern
might be the need for hand-hold bars and/or
seats in showers and tubs, toilet adapters to
raise the seat level, clear areas around beds
and through the house so that the patient
does not fall, etc.
HOW TO USE PHYSICAL THERAPY
TO REHABILITATE A STROKE VICTIM
HOW TO GET A STROKE VICTIM TO EXERCISE
 Encourage, encourage, encourage. There is
nothing worse for a person that is in a bad
situation then when they get no
encouragement from the people around
them, especially their loved ones. If a stroke
victim is partially paralyzed, the smallest
triumph deserves praise. It’s not a situation
for anyone involved in it, but a little
happiness and a lot of positive reinforcement
can go a long way.
 Give them a stress ball. After a stroke victim’s
body has become weakened, it can be a long and
arduous task to getting it back on track so it’s a
good idea to start off small and simple. That
little stress ball can do wonders, especially
between physical therapy and/or when the
person is confined to their bed. Not only is the
stress ball good for their hands, but it’s good for
the persons arm muscles. A stress ball is easily
accessible to do at any time and it's small so they
can do it wherever they are.
 Consider giving them small 1 lb. weights.
While it may not seem like much, after the
muscles are weakened, having them use a 1
lb. weight can be quite a bit of help. There
are 1 lb. ankle weights and 1 lb. arm weights
which can be bought for very cheap. Give
them a certain amount to do and count down
with them as they finish their reps. Be there
with them and cheer them on as they finish.
 Consult the stroke victims doctor and see what
you can have your loved one use on their off
physical therapy hours to help them work out
their body. Sometimes you have to ask in order
to get any answers. Also, if you see anything
that you think would be beneficial for your
loved one to use, don’t hesitate to ask their
doctor if it would be appropriate for them.
Make sure you ask the doctor first before having
the stroke victim do any type of exercise.
 Have patience, show compassion, but exhibit
tough love. You don’t totally know what the
stroke victim is going through unless you’ve
been in their position. However, sometimes a
little tough love is needed. Your loved one
may need a reminder that they need to work
harder in order for them to get better at all,
so a little kick in the butt by the people that
they care about may be needed.