RECOVERY POST STROKE
Cerebrovascular Accidents (CVA), also known as strokes, can be very serious and scary events. The 2 types of strokes are hemorrhagic (weakened blood vessel ruptures) and ischemic (a blocked blood vessel), with ischemic being the most common making up 87% of strokes. Both cause damage to brain cells that can greatly affect a person’s body function. Early recognition is key to limiting this damage. Knowing and using the acronym FAST helps to simplify a potentially difficult situation.
Face-is smile symmetrical
Arm-is there weakness or drift when attempting to raise it
Speech-is there slurred speech when answering a question
Time-be quick to call 911 if any of the above are present
Most strokes require some sort of hospitalization depending on the extent of the injury to the brain. After suffering a stroke, someone may demonstrate varying weakness on one side of the body including face, arm, trunk and leg. There also may be incoordination with movements on the affected side. It is common to have vision changes, as well as slurred speech and swallowing difficulties, as the muscles of the tongue and mouth are affected. The deficits post stroke will depend on the area of the brain involved and the extent of the damage to the brain.
Recovery post stroke can be a difficult and emotional time for those who have suffered the stroke and family members walking through the process with them. Fortunately, the brain is a complicated and amazing organ that has the ability to heal. This process is known as neuroplasticity. Neuroplasticity involves actual adaptive structural and functional changes in the brain. “It is defined as the ability of the nervous system to change its activity in response to intrinsic or extrinsic stimuli by reorganizing its structure, functions, or connections after injuries, such as a stroke” (Puderbaugh, 2023). This article will focus on 2 highly researched recovery interventions that Physical Therapists and Occupational Therapists utilize in their practice to promote neuroplasticity to optimize recovery and improve quality of life.
Initiating rehabilitation as soon as possible after a stroke is key to recovery. Per John Hopkins Medicine, “rehabilitation starts around 24 hours after a stroke” (Raghavan, 2022). Evaluation and treatment plan development are collaborative processes between the therapist and the patient to identify the deficits and create functional goals. The therapist is responsible for applying specific interventions that are research based to help patients meet the goals that are meaningful to them.
The first intervention that will be discussed today can be initiated very early on in the recovery process and can be progressed as the patient’s abilities improve. This is Constraint-Induced Movement Therapy (CIMT). During this intervention, the arm or leg that is affected is the focus, while the stronger arm or leg is constrained. This can be a very big challenge for patients as moving the weaker arm may feel daunting or impossible. However, repeated forced use of the affected limb has a significant effect on the brain’s ability to heal and undergo neuroplasticity. Research as shown that “original and modified versions of CIMT have a robust, clinically meaningful impact on patient's outcomes for arm-hand activities, self-reported amount and quality of arm-hand use in daily life, and basic ADL, making (m)CIMT one of the most effective interventions for the upper paretic limb post stroke” (Kwakkel, 2015). Mass practice and forced use of the affected limbs promote brain healing and this in turn results in functional gains as well. Encouraging patients to utilize the weaker side is key to stroke recovery and future ability to utilize the affected limbs.
Another very important, if not the most important, intervention post stroke is promotion of the Brain-Derived Neurotrophic Factor (BDNF). This “is the most abundant neurotrophin in the adult brain, which possesses a remarkable capability to repair brain damage” (Liu, 2020). BDNF promotes neuroplasticity, which in turn enhances the brain and body’s ability to recover. Physical and Occupational Therapy can significantly enhance the production of BDNF through exercise. Multiple studies have shown the benefit of exercise on the levels of BDNF, but one study in particular “demonstrated that a single session and a program of high-intensity aerobic exercise can elicit significant increases in BDNF concentration” (Ashcroft, 2022). Studies have shown repeatedly that the best exercise to affect BDNF is that of high intensity, which is described as any exercise that gets your heart rate up above 75% of your max heart rate. During the rehabilitation process, therapists will monitor vital signs including heart rate to determine an appropriate exercise program. Many are surprised at how much exercise and work it actually takes to get the heart rate up high enough to affect the BDNF concentration. If there is not a significant amount of aerobic exercise during stroke rehabilitation, then there is potentially less neuroplasticity and recovery taking place. Let’s optimize recovery with high intensity aerobic exercise during therapy!
It is so important to get guidance from a skilled professional post stroke to enhance recovery through specific exercises to promote BDNF and task oriented training with CIMT. These 2 key interventions are crucial during the recovery process to allow for brain healing and overall increase in functional independence, which improves quality of life for stroke survivors. If you or a loved one has questions or would be interested in an evaluation, please reach out to Movement Matters PT OT.
Puderbaugh, Matt and Prabhu, Emmady. “Neuroplasticity - Statpearls - NCBI Bookshelf.” Neuroplasticity , 1 May 2023, www.ncbi.nlm.nih.gov/books/NBK557811/.
Raghavan, Preeti. “Stroke Recovery Timeline.” JHM, 31 Oct. 2022, www.hopkinsmedicine.org/health/conditions-and-diseases/stroke/stroke-recovery-timeline.
Kwakkel G, Veerbeek JM, van Wegen EE, Wolf SL. Constraint-induced movement therapy after stroke. Lancet Neurol. 2015 Feb;14(2):224-34. doi: 10.1016/S1474-4422(14)70160-7
Liu W, Wang X, O'Connor M, Wang G, Han F. Brain-Derived Neurotrophic Factor and Its Potential Therapeutic Role in Stroke Comorbidities. Neural Plast. 2020 Jan 27;2020:1969482. doi: 10.1155/2020/1969482
Ashcroft, Sarah K., et al. “Effect of Exercise on Brain-Derived Neurotrophic Factor in Stroke Survivors: A Systematic Review and Meta-Analysis.” Stroke, vol. 53, no. 12, 24 Oct. 2022, pp. 3706–3716, https://doi.org/10.1161/strokeaha.122.039919.
