The use of your hands is vital in maintaining your independence. You use your hands to dress, eat, and perform many other daily tasks. A stroke can severely impair the functionality of your hands and take away your independence. Luckily, there are ways to regain your hand movement. 

Suffering a stroke is doubtlessly a life-changing event. However, you do not have to be passive in the face of that change. Keep reading to learn what steps you can take to restore your hand movement and independence after surviving a stroke.

How Does a Stroke Affect Your Hand?

To understand what techniques to apply and how you need to know how a stroke affects your hands in the first place. A stroke occurs when the blood flow to the brain is blocked or restricted, so what does this have to do with your hand?  

A stroke damages your brain, so any resulting problems in other areas of the body are because the part of the brain that controls that area of the body has been damaged. Your hand loses mobility after a stroke because the section of your brain that controls your hand is injured.

Because the damage is in the brain rather than the hand, the damage of a stroke can impact your hand in several different ways. The type of impact will determine what rehabilitation techniques are doable and what will best restore your hand’s movement.

Spasticity

Spasticity occurs when the mechanisms which control voluntary movement are damaged. This damage causes muscles to become stiff or tightened. This results in extreme pain because of an inability to release tension, muscle spasms, and simply the inability to stretch or use the muscle.

Spasticity in the hand after a stroke indicates a broken connection between the brain and hand. Repetitive movements help to re-establish this connection.

Since spasticity involves stiff or tight muscles, stretching and relaxing the hand are key components in recovering.

Weakness

After suffering a stroke, you may find that your hand seems weaker. It may be difficult to grasp or lift objects. Everyday tasks like opening jars or carrying bags can become challenging.

Impaired Fine Motor Control

The part of your brain that controls large hand movements such as gripping differs from that which controls fine motor movements such as finger tapping. Thus fine motor coordination can be affected differently than other hand functions by a stroke.

Sensory Problems 

Strokes can also affect the sensation in your hands. You may feel numbness, pain, or tingling. These sensory changes can make it difficult to sense where your hand is and to feel when you are touching objects.

Stretches

The importance of stretching for restoring hand movement after a stroke cannot be ignored. The more range you can achieve while stretching, the more overall movement you can regain. Stretching is especially essential for those suffering from spasticity.

For those beginning to stretch their hand from a very tight position, stretches will be performed with the aid of the unaffected hand. Stretches should be done on a flat hard surface such as a table.

Check out this video for a detailed explanation of some stretches that can help your hand recover after a stroke. Please remember to follow all guidelines suggested by your doctor and that these stretches should never be done to the extent of causing extreme discomfort.

Exercises

When trying to rehabilitate any muscle, exercise is vital, and your hand is no exception. Exercise in this context does not refer to working out at the gym or going for a run but rather to simple repetitive movements that help rebuild your hand’s strength and movement.

Repetitive exercise is also crucial for helping to rewire your neural connections. A stroke disrupts the pathways from your brain to your hand, and exercises help to carve these paths out again.

Basic Exercises

Here are a few common hand rehabilitation exercises. Remember to ask your therapist about what will work for you. All of these exercises are designed to be repeated. They should be done ten times in two sets.

• Make a Fist: This is an exercise for someone starting with extremely limited mobility. Practice closing your fingers into a ball and opening them again.
• Spread Your Fingers: Spread your fingers as far apart as you can and then bring them back together.
• Wrist Curl: Hold a water bottle. Use the non-affected hand to support the other one. Let your wrist stretch down, and then curl it up.
•  Wrist Extend: Hold a water bottle. Use the non-affected hand to hold your affected hand with the palm facing down. Extend your wrist.
• Pinch and Release: Practice pinching a pen between your fingers. Slide the pen across the table and then let go.
• Spin a Pen: Spin a pen using your index finger and thumb.
• Finger Opposition: Make a ring by bringing the tip of your index finger to the tip of your thumb. Repeat with all your other fingers on the affected hand.
• Coin Drop: Place coins (quarters will be easiest) in a row on your palm. Slide a coin towards your index finger with your thumb, and then pinch it between your index finger and thumb without dropping the other coins. Put the coin on the table and repeat with the remaining coins in your hand.

Therapy Tools

Besides using everyday objects like pens, water bottles, and coins, you can also buy items specifically designed to be used for exercises to restore hand movement.

• Therapeutic Balls: You can get one of these small squishy balls to aid you in your recovery for a little over ten dollars. Exercises with a ball would involve squeezing, pinching, rolling, and more.
• Therapeutic Putty: Of all the objects you can exercise with, therapeutic putty provides the widest range of different exercises. It can be pinched, stretched, rolled, pressed, squeezed, and much more. Costing between five to fifteen dollars, therapeutic putty is a wonderfully versatile tool to increase your hand mobility.

Daily Tasks

Besides regimented exercises, you can also incorporate improving your hand mobility into your daily routine. Do not shy away from tasks that require you to use your hand. You can easily teach yourself to function without your affected hand rather than teaching your affected hand to function.

The types of daily tasks you should continue to do will vary depending on your case’s severity. Below are the extreme ends of hand function and likely corresponding activities. Your case will most likely fall somewhere between these two extremes.

• Severe Restriction: Focus on tasks such as folding clothes (simple things like washcloths and towels) and picking up objects like cups.
• Low Restriction: Practice more intricate movements like writing, playing board games with small pieces, knitting, playing piano, drawing, or any other hobby that uses your hand.

How to Make Sure Your Exercises Are Effective

Like most things, practice is the key to success. Practice your exercises and repeat them as prescribed by your doctor. If you do not fully devote yourself to your exercises, they stand little chance of being helpful.

Put together an exercise regime that fits your needs. Instead of simply trying every exercise you can find, you need to compile a sequence that fits your needs and capabilities. Remember that strokes affect people differently, and thus different treatment plans are required.

If you would like more detailed explanations of individual exercises and step-by-step guidance, check out these videos. There are exercises for:

• Stage 1: These exercises are for people who have just started to use their affected hand. Stage 1 would be when you can move your affected hand but still require the aid of your unaffected hand to complete actions.
•  Stage 2: These exercises are for people who have fair movement in their affected hand. You need to be able to grasp objects for Stage 2. If you cannot, return to Stage 1 exercises.
•  Stage 3: These exercises are designed to improve fine motor coordination and increase hand strength. They are for when you have recovered your movement and wish to work on coordination and strength.

Rehabilitation Techniques

Many simple techniques can be used at home to improve hand mobility after a stroke. These techniques are to be used along with exercises for the best results, and are designed to help the exercises, not replace them.

Mirror Box

This is a simple technique that can be done at home. Place a mirror on a medium side box facing your non-affected hand. Place your affected hand inside the box. Then perform ordinary actions with the healthy hand.

This technique helps the mind to visualize both hands responding. While this may seem strange, remember that after a stroke, it is the brain you are truly working to restore. You can even buy ready-made mirror boxes if you are unsure how to create one. I use this mirror box from Amazon (link opens in new tab). You can also check the resources page for more details.

Active-Passive Bilateral Therapy

While this may sound complicated, Active-Passive Bilateral Therapy is a simple technique and works on the same concept as the mirror box. Switching between your affected and non-affected hand, you perform simple movements. The affected hand mimics the healthy hand.

This technique has the damaged half of your brain mimic the healthy side. Similar neural patterns are activated on both sides of the brain. Doing this helps to rewire the damaged half of the brain.

Constraint-Induced Movement Therapy (CIMT)

Constraint-Induced Movement Therapy or CIMT centers on the fact that strokes tend to affect one side of the body. A stroke patient will thus have a healthy side that retains its function while the other side is severely impaired.

CIMT is a therapy that restricts a patient’s use of the healthy side of their body. This would mean restraining the non-affected hand. CIMT works to prevent a patient from learning non-use of their affected hand. By restraining the healthy hand, you force yourself to exercise and strengthen the other.

CIMT is best applied soon after a stroke. Its use is to prevent a stroke survivor from learning to not use their affected hand and thus needs to be started before this behavior becomes ingrained.

Mental Imagery

The use of mental imagery as part of the treatment for stroke rehabilitation is becoming more widespread. Mental imagery is exactly what it sounds like. It involves imagining yourself performing the physical activity that you wish to achieve.

Mental imagery works because you activate the same part of your brain when you mentally practice doing an activity as you do when you physically perform it. Thus practicing mental visualization is additional help in rewiring your brain after a stroke.

Mental imagery is used for the same type of activities that a stroke survivor would be practicing physically, such as reaching for and grabbing a cup. To be successful, each part of the action should be broken down into steps that can be visualized.

Creating scripts for the activity can help break it into easily imagined steps. You can find examples online here and on other websites.

Mental imagery is not a replacement for physical exercises. Instead, it should be used in conjunction with your exercise. It is best to practice mental visualization either immediately before or after practicing the physical activity itself.

Treatments for Restoring Hand Movement

In addition to these easy at-home strategies, there are also more involved treatments that you can undergo to help restore your hand movement after a stroke.

Functional Electrical Stimulation (FES)

FES is a treatment that delivers electrical shocks to your affected muscles to promote movement. The electrical shocks stimulate the nerves causing the muscles to move.

FES is used to treat spasticity. If you have severe spasticity, your muscles may become so tight that you cannot stretch or move your hand. When you attempt to move your hand, the electrical shocks will cause greater movement helping to stretch and loosen your hand muscles.

FES can be done at a rehabilitation center as a therapy session. You can also purchase FES devices, but these are more commonly available for foot drop than for hand movement.

The intensity of the electrical shock with FES can vary from tingling to burning. The suitability of this treatment may depend on how you handle the shock sensation.

TENS Therapy

Similar to FES, TENS Therapy (Transcutaneous Electrical Nerve Stimulation) also makes use of electrical signals. However, TENS uses small pain-free electrical signals rather than the shocks of FES.

While FES is designed to promote movement through shock, TENS sends electrical pulses to block pain signals. TENS therapy thus decreases pain and numbness in the affected muscles.

TENS devices for the hand can be purchased and range in price from forty to three hundred dollars. You should consult with your doctor before making any purchases to see if they believe TENS therapy could help you.

Robotics

For those struggling to complete their exercises, the use of a robotic device to guide hand movement can be helpful. Robotic guides allow you to keep your recovery process consistent and stable.

These devices often cost several hundred dollars, and your therapist may or may not see fit to make use of them in your sessions.

Biofeedback

Another system that can be used to improve hand movement after a stroke is biofeedback. Biofeedback works by attaching electrodes to your affected hand. The device informs you when you complete movements correctly.

The biofeedback allows you to become more aware of your actions and muscles. It helps you to identify and control the subtle changes in your hand muscles that are required to perform various actions.

Biofeedback is available in a range of options, from wearable devices to therapy sessions. Ask your doctor if biofeedback could prove helpful and what type would best suit your needs.

Overall Things to Know About Rehabilitation

No matter what methods you chose to regain your hand strength, there are some larger things to keep in mind.

• Recovery takes dedication. The more time you devote to your therapy and exercises, the better your chances of success. This does not mean you should work to the point of extreme pain or exhaustion but that you should be prepared to push yourself some.
• Varied treatment offers more solutions. Instead of picking one technique or treatment for rehabilitation, you should consult your doctor and develop a plan targeted to your specific needs. This could include both treatments like FES and strategies like Active-Passive Bilateral Therapy.
• Remember that every situation is different. As you can see, there are a lot of options when it comes to regaining your hand movement after a stroke. Not everything works for everyone, and some cases are simply more severe than others. If you do not see the results you would like, you need to talk to your doctor about the specifics of your case and your options.  

Conclusion

Losing the ability to control your hand is extremely frustrating because of how much we depend on our hands for daily actions and independence. You do not have to surrender your hand in the aftermath of a stroke. Speak with your doctor, and put together a plan using various techniques to get your hand moving again!

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The information contained above is provided for information purposes only. The contents of this Blog article are not intended to amount to advice, and you should not rely on any of the contents of this Blog article. Professional advice should be obtained before taking or refraining from taking any action as a result of the contents of this Blog article. OccupationaltherapyBlog disclaims all liability and responsibility arising from any reliance placed on any of the contents of this Blog article.