How Physical Therapy Can Help After a Stroke

Physical therapists are part of the stroke rehabilitation team. Rehabilitation begins very soon after a stroke; your physical therapist’s main goal is to help you return to your activities at home, at work, and in your community.
After examining you and evaluating your condition, your physical therapist will develop an individualized plan to help you achieve the best possible quality of life. The plan will focus on your ability to move, any pain you might have, and ways to prevent problems that may occur after a stroke.
One of the first things your physical therapist will teach you is how to move safely from your bed to a chair, and to perform exercises in bed. As you become more mobile, your physical therapist will teach you strengthening exercises and functional activities.
Later, your physical therapist will:

  • Help you improve your balance and walking.
  • Fit you with a wheelchair, if needed.
  • Provide training to your family and caregivers.
  • Train you in how to use devices that can help you keep mobile when a stroke has affected your ability to move, walk, or keep your balance: orthoses, prostheses, canes, walkers, wheelchairs, and perhaps even robotics.

Treatment for stroke varies. Your specific treatment will depend on the results of your physical therapist’s evaluation, and on how long it’s been since you had your stroke. Recovery from a stroke depends on the size and location of the stroke, how quickly you received care, and your other health conditions. Your physical therapist will help you regain functional skills to allow you to participate in your specific life activities.
Relearning How to Use Your Upper Body, How to Walk, and How to Perform Daily Activities
Your physical therapist will design an exercise and strengthening program based on tasks that you need to do every day, selecting from a variety of treatments. Physical therapist researchers are at the forefront of innovating many of these techniques:

  • Constraint-induced movement therapy (CIMT). CIMT is used to strengthen an arm affected by the stroke. Your physical therapist will apply a mitten or a sling on your strong arm to keep you from fully using it. This constraint “forces” you to use your arm or hand affected by the stroke to perform daily tasks, which helps build your strength and control. CIMT requires that the constraint be used for several hours a day, several days a week to be successful.
  • Functional electrical stimulation (FES). This treatment helps move your muscles if they are very weak. For instance, your physical therapist might use FES to treat a painful or stiff shoulder.
  • Motor imagery and mental practice. These tools are used to help strengthen the arms, hands, feet, and legs. Working with your physical therapist, you will “rehearse” a movement without actually performing it, which stimulates the part of your brain that controls the movement.
  • Positioning. Proper positioning helps reduce any muscle pain, spasms, slowness, or stiffness that can result from stroke. Your physical therapist will teach you how to safely move (“transfer”) from a sitting to a standing position, and how to support yourself when sitting or lying down, using foam wedges, slings, and other aids.
  • Virtual reality and interactive video games may be used to provide experiences similar to real life. Using a keyboard and mouse, a special wired glove, or sensors on your body, you can practice daily tasks as your therapist helps you “rewire” your brain and nerve connections. Your therapist may teach you how to continue these activities at home.
  • Partial body weight support (BWS). BWS is used to help support you as you walk, usually on a treadmill. Your physical therapist will gradually decrease the amount of support as your posture, strength, balance, and coordination improve.
  • Biofeedback. This treatment helps make you aware of how your muscles work and how you might be able to have better control over them. Your therapist will attach electrodes to your skin to provide measurements of muscle activity that are displayed on a monitor. Your physical therapist will work with you to help you understand and change those readings.

Your needs will change over time, and your physical therapist may consider using aquatic therapy, robotics, or support devices to assist in your recovery. Even after rehabilitation is completed in a facility, your physical therapist will continue to see you as needed to assess your progress, update your exercise program, help you prevent further problems, and promote the healthiest possible lifestyle.

Can this Injury or Condition be Prevented?

The American Stroke Association has estimated that 80% of strokes can be prevented. Some risk factors for stroke can’t be changed—such as family history, age, gender, race (stroke death rates are higher for African Americans, even at younger ages), and previous heart attack or stroke. Many causes of stroke can be reduced by lifestyle changes:

  • Contact a physician if you suspect you have high blood pressure, and take your medication as prescribed. High blood pressure (hypertension) causes approximately one-half of all strokes.
  • If you are a smoker, join a program to quit smoking. The CDC (see below link) offers resources for quitting.
  • Reduce high cholesterol by following the recommendations of your health care provider.
  • Manage diabetes by following recommendations and taking prescribed medication.
  • Obtain treatment if you have been diagnosed with carotid artery disease.
  • Engage in daily physical activity for general health and to reduce obesity. Your physical therapist is an expert at designing a health and wellness activity plan specifically for you.
  • Reduce your alcohol intake.

*from www.apta.org