Stroke patients can improve their walking ability by doing arm exercises!

By: Mohan Garikiparithi | Health News 

Researchers worked with volunteers who had suffered strokes seven to 17 months prior to the study. They taught them moderate intensity arm cycling exercises, which they did three times a week for 30 minutes over a period of five weeks.

To assess the effect of the exercises, researchers tested the walking abilities, electrical activity, and stretch reflexes in the lower leg and wrist muscles. This was done before the training sessions began, during the study, and after the five weeks.

Walking tests included the following:

  • A six-minute walk where distance covered was measured.
  • A timed 10-meter walk to measure speed.
  • Another test called Timed Up and Go measured the time taken for a seated person to stand up, walk 10 feet, return, and sit again.

Researchers observed that arm exercises helped the volunteers improve their performance in all the walking tests. However, the most improvement (up to 28 percent) was seen in their performance in the Timed Up and Go test. According to researchers, arm cycling training helped to activate the nerve networks that connected their limbs, allowing for better coordination. When the arm nerves were activated and adapted, the spinal cord function improved, which improved the functioning of the legs.

Muscle tests revealed that there were no major changes in the grip strength of participants. However, their muscles were more relaxed after they completed the arm exercises.

The experiment proved that arm exercises could be included in stroke rehabilitation to improve post-stroke leg function.

Other exercises to improve walking after stroke

Experts recommend several stroke recovery exercises that can help to improve gait (the manner of walking). These include foot exercises, leg exercises, and balance and core work.

Foot exercises can help improve the ability of stroke survivors to walk. They’d be better able to strike the ground with their heels, follow through, and use the toes to push the foot off the ground. Sample exercises that can improve these functions include heel raises, assisted toe raises, and ankle dorsiflexion with the help of the unaffected hand. Each of these should be repeated 10 times.

Leg exercises are essential to improve leg movement. They include knee extensions and seated marching, where the patient is advised to raise the affected leg to the chest and place it back while being seated. To make them more challenging, patients can pause for a second or two when the leg is above the floor.

Core training includes toe taps and knee-to-chest exercises that are done in a lying-down position. These exercises help to strengthen and engage the core muscles while walking to improve gait.

Flamingo stands (standing on one leg for 30 seconds and repeating with the other leg) and side leg raises (about 45 degrees to each side) help to improve balance.

Leg exercises, core training, and balancing exercises require 20 repetitions (10 for each leg) to be effective.

Stroke recovery is a long process that involves stroke rehabilitation through exercises to improve walking. Toe exercises, leg exercises, core training, and balancing exercises help to strengthen the muscles and improve their movement. These are typical stroke recovery exercises as they help to improve gait. However, due to lack of coordination and damage to nerves, complete recovery in walking ability is not possible unless the nerve connections that help to coordinate the movements function better. The latest research proves that this can be achieved through moderate intensity arm cycling exercises.

 

Nerve ‘zap’ treatment may speed stroke recovery

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An implanted device that provides electrical stimulation of the vagus nerve leading to the brain enhanced arm movement in a small group of stroke patients, researchers report.

Evaluating 17  with chronic arm weakness who also received intense , scientists found that three-quarters improved with vagus nerve stimulation (VNS), while only one-quarter of those receiving “sham” nerve stimulation did.

“Arm weakness affects three of every four of our  patients and persists to a disabling degree in at least 50 percent of them, so it’s a hugely important problem in the long term,” explained study author Dr. Jesse Dawson. He’s director of the Scottish Stroke Research Network and a clinical researcher at University of Glasgow.

“A unique aspect of this [device] is that patients can deliver the brain stimulation technique in their own home during exercise . . . which is an important breakthrough that opens a huge number of possibilities for increasing patient access to this potential treatment,” Dawson added.

The study was funded by the VNS device’s manufacturer, MicroTransponder Inc., based in Texas.

About 700,000 Americans suffer a stroke each year, two-thirds of whom need post-stroke rehabilitation to help them regain skills lost due to stroke-related brain damage, according to the U.S. National Institute of Neurological Disorders and Stroke.

The vagus nerve is the longest nerve leading to the head, which passes through the neck and down into the abdomen. Surgically implanted just below the collarbone, the VNS device stimulates the brain with small electrical pulses through an internal wire as patients simultaneously move.

All 17 study participants (average age nearly 60) had the device implanted, but Dawson and his team randomly assigned half to receive VNS and half to receive “sham” stimulation. All had suffered clot-caused strokes and took part in six weeks of intensive physical therapy. Their strokes had occurred up to five years prior to the study and had caused chronic arm weakness.

Not only did more patients receiving VNS experience enhanced , but those patients continued to improve throughout the 90-day study period, Dawson said.

Stimulating the vagus nerve, Dawson said, triggers the release of various chemicals in the brain, two of which are known to increase the brain’s potential to recover after injury.

“We can conclude that VNS does drive a change and have an effect for patients recovering from stroke, but we can’t [yet] conclude there’s magnitude enough to introduce it into clinical practice,” he said.

A larger clinical trial enrolling 120  from the United States and the United Kingdom will begin this summer, Dawson added.

Dr. Daniel Labovitz is director of the Stern Stroke Center for the Montefiore Health System in New York City. He said the new research was promising, but the study’s design and small number of participants made it difficult to discern if results are “sustainable.”

“I think it’s exciting to at least be working toward proof of concept—that we can influence the brain to organize itself and enhance recovery long after a stroke occurs,” said Labovitz, who wasn’t involved in the new research.

“This is the holy grail of rehabilitation,” Labovitz said. “And this technique may be the first time where we can actually get the brain to heal itself better than just having the patient move their limb around [during physical therapy].”

Dawson pointed out that implanting the VNS device does carry certain potential risks, such as infection around the device; anesthesia complications; and temporary hoarseness due to vocal cord trauma.

The study was presented at the recent International Stroke Conference in Houston. Research presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.

Explore further: Study shows stimulation helps stroke patients

More information: Jesse Dawson, M.D., director, Scottish Stroke Research Network, and clinical researcher, University of Glasgow, Scotland; Daniel Labovitz, M.D., director, Stern Stroke Center, Montefiore Health System, New York City; Feb. 24, 2017, presentation, International Stroke Conference, Houston

Read more at: https://medicalxpress.com/news/2017-03-nerve-zap-treatment-recovery.html#jCp