A stroke is often a severely debilitating occurrence and the limitations you may have with the functional use of your hand can impact every aspect of your life. Your occupational therapist (OT) will guide you through a variety of specific and effective exercises to restore the normal range of motion to your hand, increase your strength and establish fine motor coordination. As you improve in all of these areas, you will be able to perform functional daily tasks such as handwriting, meal preparation and self care.
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Because of the neurological changes your brain and nerves have suffered from the stroke, your muscles receive inappropriate commands to either relax or contract. This process creates either increased tone, which causes your hand to hold tight into a fist or hold tight in a straight finger position, or decreased tone which results in your hand flopping around without any control. Your OT will perform daily range-of-motion excercises to your arm to stimulate normalized passive range of motion. She may use functional electrical stimulation or tendon pressure to enable your muscles to move more normally. A splint may be indicated to keep your hand open if your flexion tone is severe.
Active Assisted Movement
Once you have approximately normal passive range of motion, your OT will initiate therapy to restore active movement. Placing your hand in a gravity eliminated position for exercise to make the movements as easy as possible, your therapist will encourage you to move your hand and wrist for yourself. He may use a vibration massager over the muscle fibers to help your brain to remember which muscle fibers to stimulate. Your therapy will focus on transitioning you from almost complete dependence on your therapist for movement to significant active movement with only a modicum of assistance from your therapist.
Active Range of Motion
When you are able to move your hand consistently, your OT will push you to move your hand independently. By educating you on the quality of your movements, your OT will help you to perfect and normalize the coordination of your hand and help you to avoid developing abnormal movement patterns. You may also be instructed on proper technique with self range of motion or on usage of your unaffected hand to help move your affected hand.
Fine Motor Control
With full movement restored, your therapy will shift to focus on the fine tuning of your muscle coordination. Repetitive tasks such as putting pegs into a pegboard or screwing nuts onto bolts will challenge your impaired coordination. This frequent practice will help your brain to reorganize the motor control components to help you achieve normal use of your hand. The conclusion of your therapy will target the use of your hand in functional activities to further fine tune your physical abilities.