Exercise for Stroke Patients

Exercise for Stroke Patients

Stroke is one of the major health threats to humans, with high incidence, mortality, and disability rates. In recent years, it has shown a trend of affecting younger individuals, making it a serious public health problem. Stroke, also known as cerebrovascular accident, is a sudden onset of cerebrovascular circulation disorder, commonly referred to as a cerebrovascular accident. It occurs due to various factors leading to narrowing, occlusion, or rupture of cerebral arteries, resulting in acute cerebrovascular circulation disorders and clinical manifestations of transient or permanent brain function impairments. There are many factors that can cause strokes, such as obesity and unhealthy lifestyle habits. Strokes can be classified into ischemic strokes (cerebral thrombosis, cerebral embolism) and hemorrhagic strokes. Strokes can be divided into acute phase, recovery phase, and sequelae phase. Currently, three-level rehabilitation therapy is advocated: early rehabilitation therapy is performed in the hospital ward during the acute phase (first-level rehabilitation therapy), rehabilitation therapy is conducted in rehabilitation centers or comprehensive hospitals during the recovery phase (second-level rehabilitation therapy), and rehabilitation therapy is carried out in the community during the sequelae phase (third-level rehabilitation therapy). Early rehabilitation therapy (within six months) should be emphasized as most stroke patients achieve their highest level of neurological function recovery within this timeframe. Recovery of motor function in patients with hemiplegia gradually ceases after one year.

(1) Objectives of Exercise for Stroke Patients

The main objectives of exercise for stroke patients are to improve upper and lower limb motor functions and enhance their daily activity abilities. During the acute phase, exercise primarily focuses on preventing complications and secondary damage, regulating psychological states, and laying the foundation for functional recovery in the recovery phase. In the recovery phase, exercises mainly aim to alleviate limb swelling and pain, avoid joint stiffness, muscle spasms, and atrophy, and promote the restoration of function in the affected limbs. Depending on the disease course, early functional exercises include assisted passive movements, self-assisted passive movements, and active movements. In the sequelae phase, exercises primarily aim to improve daily life activity abilities (such as face washing, tooth brushing, eating, dressing, toileting, and mobility), prevent disuse syndrome, and improve overall physical and mental functions.

(2) Key Points for Exercise in Stroke Patients

Firstly, exercise rehabilitation for stroke patients emphasizes a comprehensive rehabilitation treatment process, and exercise is an important component of it. When implementing exercise plans, patients need to be informed about the essentials and effects of the exercises while continuously encouraging them to feel the benefits of exercise to boost their confidence.

Secondly, the first six months after the onset of stroke is a critical period for rehabilitation. After six months, it becomes the sequelae phase, during which the effect of exercise rehabilitation will be significantly reduced. Therefore, corresponding exercise rehabilitation should begin in the acute phase to reduce the occurrence and development of complications and disabilities. In clinical practice, once a patient's condition stabilizes and there is no progressive deterioration, passive limb movements should be performed. For ischemic strokes, passive and active movements can start two weeks after the stroke, while for hemorrhagic strokes, they can begin after three to four weeks, provided the condition is stable.

Thirdly, active movements are more effective than passive movements in promoting neural function recovery and activating local metabolism. Therefore, patients should be encouraged to actively participate in functional training as early as possible because completing various daily activities independently holds more positive significance. Apart from passive movements assisted by therapists in the early stages, patients should be encouraged to actively participate in exercises as much as possible to more effectively promote the regeneration and recovery of damaged nerves, accelerate brain neural functional reorganization, and speed up the recovery of limb motor function.

Fourthly, due to reduced limb motor activity caused by stroke, some joint muscles may experience disuse, resulting in joint stiffness and muscle atrophy. During exercise, joint ligaments and muscles should be protected, especially for limbs with high muscle tone, and movements should be gentle and relaxed, with the range of motion not exceeding the normal range to avoid secondary injuries.

Fifthly, during functional exercises, patients' clothing should be of appropriate size, and tight clothing should be avoided to avoid affecting circulation and hindering limb movement and functional recovery. At the same time, a good exercise environment can also have a positive effect on the effectiveness of the exercise.

(3) Selection of Exercise for Stroke Patients

The selection of exercise for stroke patients is based on their ability to perform active movements, usually starting in the late recovery phase.

Recovery Exercise for Walking Function

Following the rules of human motor development, exercises should be carried out from simple to complex, and from easy to difficult, starting with turning over → sitting → sitting balance → bilateral knee standing balance → single knee standing balance → sitting to standing → standing balance → repetitive functional movements of walking. This helps to rebuild the function of the motor central nervous system.

Upper Limb and Hand Function Exercise

Including shoulder joint movements, elbow joint movements, and hand movements. The sequence of exercises should follow the healthy side before the affected side.

Exercise with Daily Life Activities as Content

This mainly includes strength exercises on the affected side and gait recovery exercises during walking.