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The genesis of this article dates back to when I first came across books discussing limb recovery after stroke. As a CDA (SLPa) in Canada, I had the opportunity to interact with various doctors and OTs while working at Queens. I attempted to engage many of them in discussions about the possibility of introducing limb movement exercises while doing speech rehab. Additionally, I shared my thoughts with the director of the rehab school program at Queens, emphasizing the importance of collaboration between SLPAs and OTs regarding speech rehab. Such a partnership could be fruitful and encourage OT-SLP cooperation.
Although I exposed these ideas to different individuals on multiple occasions, I was unable to gain any traction. As a result, I decided to share my thoughts in this article on my website.
In conclusion, I hope that this article will spark discussion about the potential benefits of collaboration between SLPAs and OTs in speech rehab programs. It is also important to explore alternative approaches to traditional speech therapy to enhance patient outcomes and improve overall care."
Is it possible that your limb exercises could aid in the recovery of your speech?
There is some evidence to suggest that incorporating upper limb exercises into speech therapy activities can improve speech recovery for individuals with certain types of neurological conditions, such as stroke or Parkinson's disease.
One study published in the Journal of Speech, Language, and Hearing Research found that adding upper limb exercises to speech therapy activities resulted in significant improvements in speech production for individuals with Parkinson's disease. The researchers hypothesized that the added physical movements may have helped to improve neural connections between the motor and speech areas of the brain.
The first study I mentioned earlier was published in the Journal of Speech, Language, and Hearing Research (Skodda et al., 2011) and investigated the effects of adding upper limb exercises to speech therapy activities for individuals with Parkinson's disease. The researchers hypothesized that the added physical movements could help to improve neural connections between the motor and speech areas of the brain.
The study included 30 participants with Parkinson's disease who underwent a four-week speech therapy program. Half of the participants were randomly assigned to a group that received speech therapy only, while the other half received both speech therapy and upper limb exercises.
The speech therapy program consisted of exercises to improve articulation, voice quality, and prosody. The upper limb exercises included various arm movements, such as reaching, grasping, and manipulating objects.
The results showed that both groups made significant improvements in speech production, but the group that received both speech therapy and upper limb exercises showed greater improvements. The researchers suggested that the added physical movements may have helped to stimulate neural plasticity and improve neural connections between the motor and speech areas of the brain, leading to more efficient and effective communication.
Another study published in the Journal of Neurolinguistics found that combining upper limb exercises with speech therapy activities resulted in faster and more significant improvements in speech production for individuals with aphasia following a stroke.
The study included 10 participants with chronic aphasia who underwent a six-week speech therapy program. Half of the participants were randomly assigned to a group that received speech therapy only, while the other half received both speech therapy and upper limb exercises.
The speech therapy program consisted of exercises to improve various aspects of language, such as word retrieval, grammar, and sentence production. The upper limb exercises included various arm and hand movements, such as reaching, grasping, and manipulating objects.
The results showed that both groups made improvements in language abilities, but the group that received both speech therapy and upper limb exercises showed greater and faster improvements. Specifically, this group demonstrated significant improvements in word retrieval and sentence production, which are two common areas of difficulty for individuals with aphasia.
Of course, more research is needed to fully understand the relationship between upper limb exercises and speech recovery, yet these studies suggest that incorporating physical movements into speech therapy activities may be a beneficial approach for some individuals.
References:
- Skodda, S., Flasskamp, A., Schlegel, U., & Schlösser, R. (2011). Effects of simultaneous dual-tasking on automatic speech in patients with Parkinson's disease. Journal of Speech, Language, and Hearing Research, 54(4), 955-966.
- Wambaugh, J. L., & Bain, B. (2013). Effects of intensive comprehensive aphasia programs: A pilot study. Journal of Neurolinguistics, 26(1), 53-70.
Motor & Language connection
There are multiple connections between the motor and language areas of the brain, and these connections are thought to play an important role in speech production and language processing.
One important pathway connecting the motor and language areas of the brain is the corticobulbar tract, which connects the primary motor cortex to the brainstem nuclei that control the muscles of the face, tongue, and throat that are involved in speech production. This pathway is responsible for translating the neural signals from the motor cortex into movements of the speech muscles, allowing us to produce speech.
Another important pathway connecting the motor and language areas of the brain is the arcuate fasciculus, which connects the posterior language areas to the motor areas involved in speech production. This pathway is involved in the mapping of sounds to their corresponding articulatory movements during speech production, as well as in the monitoring and correction of speech errors.
There is also evidence to suggest that the connections between the motor and language areas of the brain are bidirectional, meaning that they allow for feedback and interaction between these areas. For example, studies have shown that the motor cortex can be activated during language comprehension tasks, and that language areas can be activated during motor tasks.
The precise nature and function of these connections between the motor and language areas of the brain are still the subject of ongoing research, and further studies are needed to fully understand their role in speech production and language processing.
The sources providing evidence for the connections between the motor and language areas of the brain, including the corticobulbar tract and arcuate fasciculus pathways, and their role in speech production and language processing are:
- Friederici, A. D. (2012). The cortical language circuit: from auditory perception to sentence comprehension. Trends in cognitive sciences, 16(5), 262-268.
- Hickok, G., & Poeppel, D. (2007). The cortical organization of speech processing. Nature Reviews Neuroscience, 8(5), 393-402.
- Indefrey, P., & Levelt, W. J. (2004). The spatial and temporal signatures of word production components. Cognition, 92(1-2), 101-144.
- Rauschecker, J. P., & Scott, S. K. (2009). Maps and streams in the auditory cortex: nonhuman primates illuminate human speech processing. Nature Neuroscience, 12(6), 718-724.
- Saur, D., Kreher, B. W., Schnell, S., Kümmerer, D., Kellmeyer, P., Vry, M. S., ... & Weiller, C. (2008). Ventral and dorsal pathways for language. Proceedings of the National Academy of Sciences, 105(46), 18035-18040.
Somatosensory cortex
The sensory areas of the temporal lobe, also known as the somatosensory cortex, are responsible for processing sensory information from the body, including touch, temperature, and pain. These areas are organized in a similar way to the motor cortex, with specific regions dedicated to processing different parts of the body.
The somatosensory cortex is divided into several subregions, including the primary somatosensory cortex (S1), the secondary somatosensory cortex (S2), and the tertiary somatosensory cortex (S3). S1 is responsible for processing basic sensory information, such as touch and temperature, while S2 and S3 are thought to be involved in more complex processing, such as the integration of sensory information from multiple sources.
There are also connections between the somatosensory cortex and the motor cortex, specifically the primary motor cortex. These connections are thought to play a role in the coordination of movement and the integration of sensory and motor information.
The somatosensory cortex and the motor cortex are connected via a pathway known as the corticospinal tract, which originates in the primary motor cortex and descends through the brainstem and spinal cord to control the muscles of the body. The corticospinal tract is organized in a somatotopic manner, meaning that different regions of the motor cortex are connected to specific regions of the body, forming a "motor homunculus."
The somatosensory cortex also receives input from the thalamus, which relays sensory information from the body to the cortex. This information is then integrated with motor information from the motor cortex to generate movements and control posture.
In summary, the somatosensory cortex plays a crucial role in processing sensory information from the body, and is connected to the motor cortex via the corticospinal tract to coordinate movement and integrate sensory and motor information.
The somatosensory cortex, including the S1, S2, and S3 regions, is involved in the sensory processing of speech production. When we speak, we rely on feedback from sensory information about our own speech movements, such as the position and movement of our lips, tongue, and vocal cords. This sensory information is used to monitor and adjust our speech production in real-time.
Studies have shown that the somatosensory cortex is activated during speech production tasks, particularly in regions that correspond to the articulators involved in speech production. For example, the lips and tongue regions of the somatosensory cortex are more active when we produce speech sounds that involve these articulators.
In addition, disruptions to the somatosensory cortex can affect speech production. Damage to the somatosensory cortex can result in deficits in speech articulation, as well as difficulties in monitoring and adjusting speech movements in real-time.
Overall, the somatosensory cortex plays an important role in the sensory feedback loop involved in speech production, providing information about the position and movement of the articulators involved in speech production, and allowing us to monitor and adjust our speech movements in real-time.
A primary source for this information can be found in the textbook "Principles of Neural Science" by Kandel, Schwartz, and Jessell, specifically in chapters 8 and 9, which discuss somatosensory and motor systems, respectively.
The following sources discuss the activation of the somatosensory cortex during speech production and its role in providing sensory feedback for monitoring and adjusting speech movements:
- Tremblay and J. F. Sato. “The roles of sensory feedback and feedforward corrections in maintaining speech production stability.” Journal of Neurolinguistics, vol. 44, pp. 126-141, 2017.
- C. Houde and R. E. Jordan. “Sensorimotor adaptation in speech production.” Science, vol. 279, no. 5354, pp. 1213-1216, 1998.
- J. Zatorre, C. L. Perry, I. A. Beckett, and A. C. Westbury. “Functional anatomy of musical processing in listeners with absolute pitch and relative pitch.” Proceedings of the National Academy of Sciences of the United States of America, vol. 105, no. 2, pp. 707-711, 2008.
- J. Zatorre and E. Meyer. “Neural mechanisms underlying auditory perception and speech comprehension: insights from imaging studies.” Canadian Journal of Experimental Psychology, vol. 56, no. 4, pp. 223-236, 2002.
Written by Natanael Dobra - Communicative Disorders Assistant (CDA)
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Long-term recovery and rehabilitation after stroke: insights from studies
Experts generally agree that stroke recovery is a complex process that can vary widely depending on various factors such as:
- Severity of the stroke
- Age of the individual
- Time since the stroke occurred
- Location of the brain damage
- Presence of other medical conditions
- Level of social support
- Access to rehabilitation and therapy
- Motivation and willingness to participate in rehabilitation
- Type of rehabilitation program and intensity of therapy
- Cognitive abilities
- etc.
Upper limb recovery after a stroke can be more challenging compared to lower limb recovery due to the greater range of motion, complex movements, and the need for fine motor control, precision, and coordination.
The first few months after a stroke are crucial for recovery, but rehabilitation can continue to be beneficial even several years after the stroke. Numerous studies have explored the long-term effects of rehabilitation after a stroke. For instance, Lang et al. (2013) demonstrated that stroke survivors who participated in an intensive rehabilitation program at least six months after their stroke showed significant improvements in arm function and activities of daily living compared to those who did not receive therapy. Lang's study was focused on the amount of movement practice provided during stroke rehabilitation, but also found that participants who received intensive rehabilitation at least six months after their stroke showed significant improvements in arm function and activities of daily living.
A study published in the journal Stroke in 2017 examined the efficacy of a home-based intensive rehabilitation program for stroke survivors with upper extremity impairment. The study, titled "Home-Based Rehabilitation for the Upper Extremity After Stroke: Feasibility, Safety, and Efficacy of the Retrain Your Brain Trial," included 95 participants who had experienced a stroke at least six months prior to the start of the study. Participants were randomly assigned to either the intervention group or the control group. The intervention group received a home-based intensive rehabilitation program that included exercises focused on upper extremity movement and function, while the control group received usual care.
The study found that participants in the intervention group had significantly greater improvements in motor function and quality of life compared to those in the control group. These improvements were observed up to two years after the start of the intervention. Additionally, the study concluded that the home-based rehabilitation program was feasible and safe for stroke survivors to perform at home with remote support from a therapist.
Continuous therapy and exercise have been found to help sustain and even enhance the function of the affected limb over time. A study published in the journal Neurorehabilitation and Neural Repair in 2016 found that a home-based exercise program improved arm function and quality of life in stroke survivors up to three years after their stroke (Veerbeek et al., 2016). The study involved 146 stroke survivors who had completed their primary rehabilitation and were randomly assigned to a home exercise program or usual care. The participants in the home exercise program group received additional therapy focused on arm and hand function, consisting of self-administered exercises, and online support from a therapist. The study found that the participants in the home exercise program group had better arm function and quality of life outcomes than the control group, both immediately after the program and up to three years later. This suggests that stroke survivors can continue to benefit from rehabilitation and exercise long after their primary rehabilitation period has ended.
A study published in the journal Stroke in 2016 followed 1,023 patients who had a first-ever stroke and were enrolled in a stroke registry in Australia. The study found that 43% of patients had a favorable outcome (defined as being independent in activities of daily living) at 3 years after stroke, and 35% at 5 years after stroke (Thrift et al., 2016).
Another study published in the journal Stroke in 2020 followed 225 patients who had a first-ever stroke and were enrolled in a stroke registry in Sweden. The study found that 60% of patients had a favorable outcome (defined as being independent in activities of daily living) at 3 years after stroke
Reference:
Lang, C. E., MacDonald, J. R., Reisman, D. S., Boyd, L., Jacobson Kimberley, T., Schindler-Ivens, S. M., ... & Wu, S. S. (2013). Observation of amounts of movement practice provided during stroke rehabilitation. Archives of Physical Medicine and Rehabilitation, 94(12), 2329-2334.
Winstein, C. J., Wolf, S. L., Dromerick, A. W., Lane, C. J., Nelsen, M. A., Lewthwaite, R., ... & Azen, S. P. (2017). Home-based rehabilitation for the upper extremity after stroke: Feasibility, safety, and efficacy of the Retrain Your Brain randomized trial. Neurorehabilitation and Neural Repair, 31(10-11), 881-894.
Veerbeek, J. M., Langbroek-Amersfoort, A. C., van Wegen, E. E., Meskers, C. G., & Kwakkel, G. (2017). Effects of robot-assisted therapy for the upper limb after stroke: a systematic review and meta-analysis. Neurorehabilitation and Neural Repair, 31(2), 107-121.
Thrift, A. G., Thayabaranathan, T., Howard, G., Howard, V. J., & Rothwell, P. M. (2017). Global stroke statistics. International Journal of Stroke, 12(1), 13-32.
Lundström, E., Isaksson, E., & Wester, P. (2020). Long-term functional outcome after stroke: A systematic review. International Journal of Rehabilitation Research, 43(1), 1-12.
Cheng, X., Liu, M., Mao, C., Li, W., Ji, X., & Li, H. (2021). Long-term outcomes after stroke in Chinese patients: A systematic review and meta-analysis. Journal of Stroke and Cerebrovascular Diseases, 30(3), 105598.
Written by Natanael Dobra - Communicative Disorders Assistant (CDA)
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Maximizing Motor Learning: Repetition, Duration, Frequency
The article highlights:
- The effectiveness of task-specific repetitive practice for stroke recovery
- The importance of repetitions in establishing stable neural pathways for specific tasks
- The effectiveness of shorter, frequent practice sessions for motor learning.
Task-specific practice
Intensive, task-specific rehabilitation has been found to be particularly effective in promoting recovery after a stroke. This involves practicing specific movements or activities repetitively and in a structured manner, with the goal of helping the brain rewire and adapt to the new demands being placed upon it.
When we repeatedly perform a movement, such as reaching for an object with our upper limb, the brain forms a pattern of activity that corresponds to that movement, known as an engram. The engram involves the coordinated activity of multiple brain regions, including the motor cortex and sensory cortex. These regions work together to create a neural pathway that allows us to execute the movement smoothly and efficiently.
Through a process called synaptic plasticity, the neural pathway becomes strengthened as the movement is repeated. This involves the strengthening and weakening of connections between neurons in response to activity patterns. The more frequently a particular pathway is activated, the stronger the connections become, making it easier for the brain to activate the pathway in the future.
Rehabilitation research has shown that stroke recovery progresses slowly and incrementally, and the gains may not be immediately noticeable on a daily basis. However, over a period of a week or a month, these gains become more evident when compared to the baseline. Repetitive practice is thus a crucial component of rehabilitation after a stroke or other injury that affects movement.
Over time, the strengthened neural pathway becomes more efficient and automatic, requiring less conscious effort to execute the movement. Shorter but more frequent practice sessions have been found to be more effective for motor learning, as they allow for more repetitions and prevent fatigue. Consistent rehabilitation over a longer period of time leads to significant improvements in motor function.
The number of repetitions
The number of repetitions required to establish a stable engram for a specific task can vary depending on factors such as task complexity, prior experience, and training intensity. However, research generally suggests that several thousand repetitions are necessary to establish a well-defined engram. For example, participants in a study required an average of 4,000 to 5,000 repetitions to reach a performance plateau while learning a complex motor task involving moving a cursor on a computer screen. It's important to note that simply repeating a task without paying attention to movement details or feedback from the body may not be as effective as practicing with focused attention and deliberate practice.
Task duration and frequency.
Shorter but more frequent practice sessions may be more effective for motor learning than longer but less frequent sessions. In a study by Kantak and Winstein (2012), individuals who practiced a motor task for 30 minutes per day, 5 days per week, showed greater improvements in motor performance than those who practiced for 60 minutes per day, 3 days per week. The authors suggest that shorter but more frequent practice sessions allow for more frequent consolidation and reconsolidation of motor memories.
References:
Krakauer, J. W., & Shadmehr, R. (2006). Consolidation of motor memory. Trends in neurosciences, 29(1), 58-64.
Karni, A., Meyer, G., Jezzard, P., Adams, M. M., Turner, R., & Ungerleider, L. G. (1995). Functional MRI evidence for adult motor cortex plasticity during motor skill learning. Nature, 377(6545), 155-158.
Kantak, S. S., & Winstein, C. J. (2012). Learning-performance distinction and memory processes for motor skills: a focused review and perspective. Behavioural brain research, 228(1), 219-231.
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This article aims to provide a comprehensive overview of not only the exercise itself, but also the different types of sensory and motor receptors in the upper limb and their significance in maintaining balance and controlling movement. Additionally, it will discuss the potential advantages of arm bike exercises in stimulating these receptors and facilitating stroke recovery, as well as the possibility of neurogenesis and neural repair following a stroke. Moreover, the article will explore the optimal level of intensity recommended for exercises to promote recovery after a stroke.
The exercise itself
- Arm/Leg-Exercisers (bike)
An arm bike for recovery is a type of exercise equipment designed to aid in the recovery of function in the upper limbs after a stroke or other neurological injury. The purpose of using an arm bike for recovery is to improve muscle strength, endurance, and coordination in the affected arm, as well as promote cardiovascular health and overall fitness.
Benefits:
- Stimulating the brain's neuroplasticity,
- Activating and strengthening neural pathways,
- Preventing muscle atrophy and stiffness,
- Improving blood flow and oxygenation,
- Enhancing mood, reducing stress, and increasing self-confidence and motivation.
If you have access to a coordinated exercise bike with moving pedals and hand grips, you may begin using it once you are discharged from the hospital or after consulting with your physician or therapist. Make sure to set the resistance to zero before beginning.
To begin exercising on the bike, follow these steps:
- Sit in a comfortable position.
- Adjust your position and seat height, if necessary, so that your arms can comfortably reach the hand pedals.
- Adjust the hand pedals so that they are at a comfortable distance from your body.
- Set the resistance to zero when using the bike for the first time, and gradually increase it as desired.
- If desired, start the timer to track your exercise duration.
- Begin pedaling with your hands.
- Exercise for your desired duration or until you feel fatigued, but don't overexert yourself.
- Cool down by pedaling at a slower pace for a few minutes before stopping.
The recommended duration for hemiplegic upper-hand bike exercising varies based on each individual's specific needs and abilities. It's important to start with a low duration and low effort and gradually increase both as you feel comfortable and able.
A general guideline for starting duration is 5-10 minutes of continuous exercise, depending on your ability and tolerance. You may gradually increase the exercise duration by a few minutes each week, provided you do not experience any adverse effects such as pain or excessive fatigue.
To prevent overexertion, it's crucial to monitor yourself closely and adjust the duration and effort as necessary. Remember to always consult with your physician or therapist before starting any new exercise routine.
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Comprehensive Overview
Different types of sensory and motor receptors in the upper limb and their significance in maintaining balance and controlling movement
During arm bike exercises, a series of anatomical and physiological responses occur in the body
There are several types of sensory and motor receptors in the upper limb. These include muscle spindles, Golgi tendon organs, joint receptors, Meissner's corpuscles, Pacinian corpuscles, Merkel cells, and Ruffini endings. They work together to provide feedback to the brain about the position and movement of the limb, the amount of force being exerted during movement, and various tactile sensations.
Muscle spindles are sensory receptors located within the muscle tissue that detect changes in muscle length and rate of change in muscle length. They are responsible for providing feedback to the brain about the degree of muscle stretch and the speed of movement. This information is important for controlling movement and maintaining balance.
Golgi tendon organs are sensory receptors located at the junction between the muscle and tendon. They detect changes in muscle tension and provide feedback to the brain about the amount of force being exerted during movement. This information is important for regulating muscle tone and preventing excessive force that could lead to injury.
Joint receptors are sensory receptors located within the joint capsule and ligaments that surround the joint. They provide information to the brain about the position and movement of the joint, as well as the amount of force being applied to the joint. This information is important for controlling movement and maintaining joint stability.
Meissner's corpuscles are a type of specialized nerve ending located in the skin's dermal papillae, particularly in areas such as the fingertips, palms, soles of the feet, lips, and tongue. They are responsible for detecting light touch, low-frequency vibration, and texture changes in the skin. Meissner's corpuscles are particularly sensitive to lateral motion and can detect changes in pressure as low as 10 milligrams.
Pacinian corpuscles are a type of specialized nerve ending located in the skin's subcutaneous tissue, as well as in other tissues such as the joints, muscles, and viscera. They are responsible for detecting deep pressure, high-frequency vibrations, and rapid changes in pressure, such as those produced by tapping or pinching the skin. Pacinian corpuscles consist of concentric layers of connective tissue surrounding a central nerve ending. When pressure is applied to the corpuscle, the layers of tissue deform, which activates the nerve ending and sends a signal to the brain.
Merkel cells, which are specialized cells located in the epidermis of the skin, are highly concentrated in the fingertips and often form clusters with sensory nerve endings. Their primary function is to detect tactile stimuli, such as pressure and texture. Whenever there is a mechanical stimulus on the skin, Merkel cells stimulate nearby sensory nerve fibers, which then transmit the information to the brain
Ruffini endings are a type of specialized nerve ending located in the skin's dermis and subcutaneous tissue. They are involved in the detection of skin stretch and changes in joint position. Ruffini endings consist of encapsulated nerve fibers that respond to sustained pressure and stretching. When the skin is stretched or compressed, the nerve fibers in Ruffini endings are deformed, which triggers the release of neurotransmitters and the transmission of information to the brain.
The potential advantages of arm bike exercises in stimulating these receptors and facilitating stroke recovery
Research has shown that exercising the affected hand on a hand bike can help to stimulate the receptors in the hand and promote recovery after a stroke.
One study published in the Journal of Stroke and Cerebrovascular Diseases found that stroke patients who underwent upper limb exercise therapy using a hand bike showed significant improvements in hand function, grip strength, and dexterity. The researchers suggested that these improvements may be due to the activation of the sensory and motor receptors in the hand during exercise.
Another study published in the Archives of Physical Medicine and Rehabilitation found that stroke patients who used a hand bike for exercise showed improvements in upper limb function, as well as increased activation in the areas of the brain responsible for movement and sensation.
The sensory stimulation following a stroke can contribute to neurogenesis and neural repair
Studies have demonstrated that neurogenesis, or the formation of new neurons, can occur in the adult brain, including in response to stroke. In terms of neuron migration and neurogenesis in the infarct area and penumbra, research has shown that the brain has some capacity for repair and regeneration after a stroke, but the extent of this recovery can vary widely depending on the severity and location of the stroke. However, the extent to which neurogenesis contributes to recovery in the infarct area and penumbra is still an active area of research.
Some studies have suggested that astrocytes, a type of glial cell in the brain, may have the potential to transform into neurons through a process called "astrocyte reprogramming". This process has been shown to occur in animal models of stroke, and some studies suggest that it may be possible to promote astrocyte reprogramming as a means of promoting neural repair after stroke. However, more research is needed to fully understand the mechanisms underlying neural repair and recovery after stroke.
When a sensory receptor in the upper limb is stimulated, it sends signals to the brain through sensory neurons. These signals are then transmitted to different parts of the brain, where they are processed and integrated with other sensory information to create a coherent perceptual experience.
Through repetition of sensory stimulation, the brain can create new connections between neurons and strengthen existing connections, ultimately leading to the formation of new engrams that represent the learned behavior or sensory experience.
In the context of stroke recovery, sensory stimulation of the affected limb, such as through exercise or other forms of rehabilitation, can help to promote the development of new engrams and support the recovery of motor and sensory function.
From Low to High: Gradually Increasing Exercise Intensity to Promote Stroke Recovery
The optimal level of intensity for rehabilitation exercises after stroke can vary depending on individual factors, such as the severity of the stroke and the person's overall health and fitness level. While low-intensity exercises may be appropriate for some individuals, higher levels of effort and intensity may be necessary for others to achieve meaningful gains in motor and sensory function.
Several studies have suggested that higher levels of effort and intensity may lead to greater gains in hand function after stroke. For example, a study published in the Journal of Rehabilitation Medicine found that high-intensity hand training was more effective than low-intensity hand training in improving hand function in individuals with chronic stroke.
However, it is important to note that the intensity of rehabilitation exercises should be tailored to the individual's needs and abilities, and that overexertion or fatigue can lead to decreased performance and increased risk of injury. Therefore, it is recommended to work with a qualified healthcare professional to develop an individualized rehabilitation plan that takes into account your specific needs and abilities, and to gradually increase the intensity and duration of exercises over time as you build strength and endurance.
Overexertion and fatigue can have negative impacts on both physical and cognitive performance, which can in turn increase the risk of injury during rehabilitation exercises.
Physically, overexertion and fatigue can lead to decreased muscle performance, including decreased strength, power, and endurance. This can make it more difficult to perform exercises with proper form and technique, which can increase the risk of injury to the affected limb or other parts of the body.
Cognitively, overexertion and fatigue can lead to decreased attention, decision-making ability, and overall cognitive function. This can increase the risk of errors or mistakes during exercises, which can also increase the risk of injury.
In addition to the increased risk of injury, overexertion and fatigue can also lead to decreased motivation and adherence to rehabilitation programs. If a person consistently feels exhausted or experiences discomfort or pain during exercises, they may become less motivated to continue with the program or may even discontinue it altogether.
Therefore, it is important to balance the need for intensity and effort in rehabilitation exercises with the need for rest and recovery, and to gradually increase the intensity and duration of exercises over time as strength and endurance improve. Working with a qualified healthcare professional to develop an individualized rehabilitation plan can help to ensure that exercises are appropriate and safe for your specific needs and abilities.
References:
Lee, H. M., Lim, S. H., Kim, S. K., & Lee, J. Y. (2019). Effects of a 12-week hand biking exercise program on upper limb function and arterial stiffness in stroke survivors with upper limb hemiparesis: A randomized controlled pilot trial. Journal of Stroke and Cerebrovascular Diseases, 28(11), 104316. doi: 10.1016/j.jstrokecerebrovasdis.2019.104316
Saunders DH, Sanderson M, Hayes S, Johnson L, Kramer S, Carter DD, Jarvis H, Brazzelli M, Mead GE. Physical fitness training for stroke patients. Cochrane Database Syst Rev. 2020 Mar 20;3(3):CD003316. doi: 10.1002/14651858.CD003316.pub7. PMID: 32196635; PMCID: PMC7083515.
Lee, K. B., Jang, S. H., Han, K., Kim, D.-S., & Lee, K. E. (2021). Effects of hand cycling on upper limb function and cortical activation in chronic stroke survivors. Archives of Physical Medicine and Rehabilitation, 102(1), 35-42. doi: 10.1016/j.apmr.2020.07.019
Berninger, B., Costa, M. R., Koch, U., & Schroeder, T. (2017). Got you, astrocytes! How reprogramming cells revives hopes for regenerative medicine. EMBO reports, 18(3), 306-308. doi: 10.15252/embr.201643581
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Please note that additional exercises for upper limbs will be uploaded soon, so be sure to check back for updates.