How to Get Your Hand Working After a Stroke



Why Do Your Hands Get Weak After a Stroke?

When you have a stroke, it interrupts the blood supply to your brain. This can lead to a number of complications such as weakness, numbness, and paralysis. Sometimes these symptoms affect one of your hands and make it difficult for you to use it properly.

The effects of a stroke depend on where the blockage occurs in the brain and how severely it affects the brain tissue. The most common type of stroke is called an Ischemic stroke which is caused by a blocked artery (usually from a clot). This type can be either minor or major depending on how long it takes to seek medical help, and how much tissue is affected.

Strokes most often affect one side of your body or one part of your body, such as your hand or arm.

What Is Good for Hand Rehabilitation After Stroke?

Many people who have had a stroke experience weakness in one hand, both hands, or legs. Weakness occurs due to damage or occlusion in an area of the brain that controls muscles. The signals between the brain and the muscles have become weakened or lost, most notably if the motor cortex is damaged or involved. Sometimes it can be helpful to think about the brain as a freeway with cars passing quickly on a highway; however, after a stroke, there is now a traffic jam where previously cars were passing freely in essence this “traffic jam” disrupts the signals from firing from the brain to make the muscles work.

This can be incredibly frustrating and confusing when this “traffic jam” now causes arm weakness. It can be difficult to find the best way to address hand weakness as it can be very difficult to more your hard after you have had a stroke.

Sometimes, especially if the weakness caused by the stroke is on the more mild side, you may not receive formal guidance on how best to address the weakness such as beginning traditional physical or occupational therapy. If the weakness is much more extensive, most likely you will be referred to acute care therapy, inpatient therapy, or outpatient therapy where the upper extremity can be addressed. Although it is optimal to have the guidance of a trained neurorehabilitation professional, it is very critical to your recovery to address the weakness no matter the degree of your weakness.

Getting Stuck During Stroke Recovery – Say NO to Plateau

Historically, rehabilitation professionals thought that recovery of the hand stopped at 6 months following a stroke, presently research demonstrates motor recovery can be continued for up to 20 years following the onset of the stroke through the use of functional movement and exercises.

Improve Your Hand, by Using Your Hand

This speaks to the importance of continually trying new things to address hand weakness over time, the most important thing you can do no matter the extent of your weakness or tone, it is imperative to USE, USE, USE your hand as much as you can.

High Repetition is Key

It is also very important to use your hand in high repetition circumstances, such as flipping over cards or stacking plastic cups. The more the better. The brain will learn by repeated trial and error over time how to be more efficient. It will also lock in a “motor memory” of hand movement. This means that the individual will not have to think as hard about how to do the movement and it will become more automatic. Hence, repetition helps refine skills and makes movement easier.

Challenge to Change

Repetition is one of the principles of neuroplasticity but it is challenging. These two agents of change go hand-in-hand. Once the brain has learned how to do something very well from doing it over again, the learning curve drops. This can be a good thing for learning, but it is then time to advance to the next level by leveraging additional challenges. Make it harder- but not impossible. Find the “sweet spot” level of difficulty for your hand. It is recognized among rehabilitation experts that once 7 of 10 trials are done successfully, it is time to make it harder. For example, if your hand can now successfully pick up 8 of 10 wide markers without dropping, challenge yourself by doing it faster (e.g. speed challenge), picking up thin pencils (e.g. motor challenge), or adding a weight cuff around the wrist (e.g. resistance challenge). There are many ways to change the dial on the difficulty level using a little creativity and critical thinking about normal scenarios that your hand would do before the stroke.

Function After a Stroke Paves the Way to Progress

No matter how much movement you have, research shows that you should continue to attempt to integrate the use of your weak hand into all functional activities. Give your hand a job in every task you do. Even a very weak hand can be useful for certain tasks, such as stabilizing a towel while a strong hand folds the corners together.

Range of motion and resistance training is beneficial, but brain recovery thrives the most on trying to do tasks that have a functional purpose and are internally motivating to the individual. The brain recognizes familiar movements better than rote exercises, but the best outcomes are from the combined use of exercises and the functional use of the hand. Therefore, good rehabilitation programs should incorporate both traditional exercises and functional retraining of real-world tasks.

“Failing” Leads to Success – Don’t Give Up

Trying to use a weak or clumsy hand can be very frustrating because it will not look or feel normal. Research shows it doesn’t matter how “pretty” the movement is- it just matters that you are trying to use it. Just as a basketball player will miss more shots than the player makes, you too will also make many errors. As long as trying something even though you know you might “fail” does not affect your safety, try…and try again. The stroke survivors who are the most successful in their rehabilitation efforts are usually the ones who adjust to being comfortable to make mistakes. Develop a mindset that celebrates perseverance rather than perfection.

Stroke activities and exercises examples:

  • Active range of motion (good for spasticity and low tone)

  • Passive range of motion (good for spasticity and low tone)

  • Stretching and prolonged low load stretching (best for spasticity)

The above exercises can also be paired with the following rehabilitation techniques and technologies such as:

  • Electrical stimulation (best for low tone)

  • Vibration (best for low tone)

  • Orthotics and splints (good for spasticity and low tone)

  • Mirror therapy (good for spasticity and low tone)

  • Graded motor imagery (good for spasticity and low tone)

  • Brain-computer interface (good for spasticity and low tone)

Additionally, some stroke survivors have pain associated with tightness or spasticity which can interfere with the functional use of the hand, increasing weakness. Techniques with pain can include active and passive range of motion, stretching, the use of splints, moist heat, and even ice.

Many stroke survivors benefit from both guidance and the use of stroke recovery technologies to address weakness in the hand. Ask your doctor or caseworker for assistance to guide you to therapy that specializes in both stroke and advanced technology to treat stroke symptoms. There are also multiple free resources that can help guide recovery. Please see below for links to the following resources.

https://www.stroke.org/en/life-after-stroke