A result of stroke is that muscles may not remember how to perform tasks that were once simple, like sitting and cycling. A stroke patient needs to, with the help of a physical therapist, relearn these skills. Muscles will be retrained and be reminded how cooperate again with physical therapy.

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Regaining mobility with physical therapy
Physical therapy focuses on getting the stroke patient to use arms and legs that have been affected or paralyzed by the stroke.

While occupational therapy concentrates on helping post-stroke patients learn to feed themselves, chew and swallow, and groom themselves, the main goal of physical therapy is mobility. Physical therapy goals are making the stroke patient able to walk, sit, stand, and get in and out of bed, a chair, and a car all on their own.

The procedure in the Frazier Rehab Institute, a service of Jewish Hospital and St. Mary’s HealthCare in Louisville, Ky is explained by Mary Ann Owsley, PT, supervisor of the physical therapy stroke team for inpatient rehab. Physical therapists evaluate and treat the dysfunctions that stroke patients are coping with, the musculoskeletal deficits. Therapy will start in acute care, with early mobilization training and exercises.

They get them out of bed and moving around as soon as possible, even if initially all they are able to do is sit up on the side of the bed and train sitting balance. They progress to being more independent with all of their basic mobility, from getting in and out of the wheelchair to the bed, to walking with different types of aids, like canes and walkers.

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Success through strength
Physical therapy involves using the muscles and strengthen them, even before the patient can do this on his own. Therapy contains both active and passive range-of-motion and strengthening exercises. Active exercises are ones the patient performs on his own strength; passive exercises are performed by the physical therapist or with help from the therapist. Both types of exercises help to make the muscles stronger.
The physical therapy contains an exercise plan for the patient which makes sure that muscle strength can be maintained and new skills will be repeated..

Educate the family
Training the family members and caregivers is also a part of physical therapy.. Start working with the families as soon as possible. So the family can help with any of the techniques for positioning and range of motion. Educate the family togehter with the stroke patient as far as the limitations that they may be left with.”

Follow a plan
Physical training often starts while the stroke patient is still in the hospital. It is useful to continue to work with the same physical therapist once you return home or move to the inpatient stroke rehab centre as in the hospital. However, if your initial rehabilitation was not at a primary stroke centre with health providers specifically trained in stroke, try to find a physical therapist to help with your stroke recovery at a certified stroke rehab centre.

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Cost management
Often, private health insurance plans will not cover all of your expenses. Health insurance often cover either a percentage of the therapy costs or a set number of therapy sessions. Usually Medicare pays for post-stroke physical therapy. Check out your coverage before physical therapy begins so you understand what costs you will be responsible for yourself.
Physical therapy works best when it starts in an early stage and is continued regularly. Follow sessions a few times each week. Your muscle will start to remember and respond and your body will repair the damage done by stroke, but it takes time.

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Become Active!
The best medicine you can get without a prescription may be physical activity. Frequently exercising can reduce stress and help relieve depression. It improves the strength of your heart. Even your blood pressure will drop. Always talk with your doctor before you start a new exercise. Make sure the new exercise is suitable for you. The risk of high blood pressure, high blood cholesterol, diabetes, heart disease and stroke can be increased by being inactive, obese or both.
So go on a brisk walk, take your bicycle out, and do whatever you can to make your daily routine more active for a total of at least 30 minutes every day.

How to start?
Even moderate exercise, such as strolling or cycling, can improve your health. Here are three simple ways to start with, for a more active life.
• Do, throughout the day, small amounts of activity. For example, stretch your arms and legs while sitting. Or, wash the dishes in a standing position.
• To start, add each day a 10-minute walk to your actual level of activity. After two weeks, add on a few minutes more. You can build this overtime up to walking 30 minutes per day.
• Join scheduled courses or participate in sports.

How to stick with it
• Find a group of activities and exercises you like. Choose activities which are fun and that you enjoy. Add variety. That makes that exercise won’t seem boring or routine.
• Ask your physical therapist or doctor to prescribe muscle-strengthening exercises.
• Find a favourable time and place to exercise. Try to make it a habit to exercise, but stay flexible.
• Wear decent and properly fitted footwear and comfortable clothing. Make sure you adjust your shoes and clothes to the weather and the activity.
• Keep yourself entertained and motivated with music while you do home exercises.
• Surround yourself with supportive people and share your activities with others. Make a date with family members, friends or colleagues. Decide what type of support you need. Do you need others to remind you to do your exercise? Inform about your progress? Join you with your exercises regularly or occasionally? Allow you take your time to exercise by yourself?
• Record your activity in a chart. Reward yourself for accomplishing a special milestone, such as three weeks cycling without missing a day.
• Join a health and fitness club or centre. A proper fitness centre should have qualified instructors who can help you find the best exercises for accomplishing your specific goals. But remember to ask your physical therapist or doctor before starting a new exercise program.

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It is for your own good to get at least 30 minutes of moderate physical activity on every day of the week. You can start cycling 10 minutes at a time, working your way up to 30 minutes a day.
Besides helping you control your weight, cycling may…
• Help you giving up smoking..
• Decrease your blood pressure.
• Raise your HDL (“good”) cholesterol value.

Along with cardiovascular benefits, regular physical activity such as cycling can help you feel and look better. You’ll probably feel better because regular physical activity…
• makes you energetic.
• improves your self-image en self-esteem.
• reduces fatigue and exhaustion.
• helps you to relax and loose tense.
• helps you to fall asleep quickly and sleep well.

You’ll look healthier and better because regular physical activity…
• Tones your muscles nicely.
• Helps you to control you weight.
• Helps you to control your appetite.

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Get up and get moving! If you are more active, you are more likely to recover fully and quickly.

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• Exercise plan. To prevent deep vein thrombosis the Veteran’s Administration recent guidelines recommend that patients get back on their feet as soon as possible. Post-stroke patients should try to walk at least 50 feet a day. Assisted devices or bracing are sometimes used to help support the legs. For patients with mild-to-moderate dysfunction, treadmill exercises can be very useful. Physical activity should be adapted to the stroke survivor’s physical condition and can include aerobic, strength, flexibility, and neuromuscular (coordination and balance) exercises.

• Muscle retraining. Helpful exercises to treat spastic muscles are stretching and range-of-motion exercises. A new approach is Bilateral Arm Training with Rhythmic Auditory Cueing a.k.a. BATRAC that may benefit patients who a paralysed arm. It may even help people who have had stroke paralysis for many years. The BATRAC method involves moving a bar with both arms in a sustained rhythmic pattern. The Journal of the American Medical Association reported that BATRAC helped patients get back use of their affected arm. The study also showed that patients who received BATRAC had more activity in the motor cortex region of the brain. The patients in this study had a stroke at least 4 years before taking part..

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• Therapy for speech and sign language. People who have experienced a stroke are often seen with aphasia, a brain condition that makes it hard to speak and understand language. There are many different forms in which aphasia may come. A person may have difficulty saying the right word or may even be unable to speak at all. Intensive speech therapy after a stroke is essential for recovery. Some specialists recommend nine hours a week of therapy for three months. A study in 2005 indicated that a shorter period (three hours a week for ten days) also works well. Language skills improve the most when the patients environment help reinforce the speech therapy lessons.

• Biofeedback methods combined with physical therapy. In certain cases this combination has been beneficial. For example, electrical stimulation of the throat, may help post-stroke patients with dysphagia recover their ability to swallow faster. Wrist and finger stimulation also shows a promise for improving motor capabilities.

• Exercises for swallowing. A promising research reported that swallowing improved when patients performed a simple exercise three times a day for six weeks. They lay flat and raised their heads, holding them up for 1 minute with a 1 minute rest in between, and repeated this three times. The following exercise was thirty consecutive head lifts.

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• Concentration training. Problems in concentration are very common stroke effects. Direct retraining teaches patients to perform specific actions using repetitive drills in response to a certain stimulus. (For example, each time they hear a specific number they have to ring a bell.) Other variants of this approach trains patients to relearn real-life skills, such as cycling, making conversation, or other daily tasks.

• Occupational therapy. Occupational training is essential and improves participation in daily living and social activities.

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The scientists realized that this would certainly increase recovery time, then they strapped the monkey’s good arm to its body, which motivated the monkey to use the free, but affected arm. This improved the recovery. The scientist called this “forced therapy.”
Since then, new names were adopted for this therapy, including constraint induced therapy (CIT) and constraint induced movement therapy (CIMT). The positive effects of CIMT were shown in a randomized control trial which was published in the Journal of the American Medical Association at the end of 2006

CIT for who?
The clinical experiment (EXCITE), which proved the effectiveness of CIMT, revealed that it performed best for persons with moderate strokes affecting the arm and hand. In the experiment, the patients moderate strokes affecting the arm and hand showed functional improvement whether their stroke occurred 3 or 9 months before the therapy started, which implies that CIMT might be effective even for patients who suffered a stroke years ago. Preserved cognition is another possible requirement, as this was a requisite for participation in the EXCITE experiment. However, as of early 2009, there has been no studie whether CIT can be used in patients with mild to moderate cognitive impairment.

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How is CIT actually performed?
As you can read from the above, the main intervention in CIMT is forcing a person to use a affected limb as much as possible. In fact, in stroke survivors who are left with a dysfunctioning arm, the goal is to “force them” to use only the dysfunctional arm to perform routine activities such as feeding or getting dressed.
The use of mittens and arm slings prevents patients from using the intact arm for at least 90% of a person’s active time. The program goes on for several weeks. In addition, patients take part in intensive physical therapy sessions of the dysfunctional limb for at least six hours per day, up to seven days a week.
That this rigorous program improves function by inducing a functional reorganization of the brain, has been shown by several studies.

Where can I receive CIT?
Not every rehabilitation centre offers CIMT, neither
does every health insurance policies cover it. Start by asking a local rehabilitation centre whether they offer CIT. You should then ask your physician whether he thinks this therapy is suitable for you. Once you get a referral (or prescription) for therapy, you should then find out if your insurance policy will cover it.

Don’t be discouraged when you are kept from the rehabilitation centre because your insurance policy doesn’t cover the costs. Specialists in this subject are now advocating for home programs with the sporadic guidance of a physical therapist. And in theory, you could do this on your own while you are doing your daily activities.

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Do you the best you can. The more time and effort you put in doing it, the better it will be for your rehabilitation. A mitten or a sling is all you need. Just discuss with your doctor about it before you start to make sure that this is a suitable therapy for you.

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