Each year more than 600 patients arrive in Meritus Medical Center's emergency department with signs and symptoms of stroke. If you have suffered a stroke, then you and your loved ones need to know that there are many modalities and therapies that are involved in regaining arm movement after stroke.
In this podcast Patty Runkles, MS, OTR/L, speaks about regaining arm and hand movement after stroke, and what you can expect from therapy at Meritus Health.
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Regaining Arm and Hand Movement After Stroke
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Learn more about Patty Runkles, MS
Patty Runkles, MS, OTR/L
Patty is an occupational therapist with over 20 years of adult rehabilitation experience. For the past 8 years, she has primarily worked with adults who have experienced neurological injuries and illnesses such as stroke, head injury and multiple sclerosis. She has her master of occupational therapy degree from Shenandoah University. She has received specialty training in the use of the Bioness H200 hand orthosis, Restorative therapies RT300 cycle, Saebo orthosis devices and working with patients with brain injuries.Learn more about Patty Runkles, MS
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Regaining Arm and Hand Movement After Stroke
Melanie Cole (Host): Each year more than 600 patients arrive in Meritus Medical Center’s Emergency Department with signs and symptoms of stroke. If you have suffered a stroke, then you or your loved ones need to know that there are many modalities and therapies that are involved in regaining arm and hand movement after a stroke. My guest today, is Patty Runkles. She’s an occupation therapist at Meritus Health. Welcome to the show Patty. How does stroke affect a person’s hand and arm?
Patty Runkles, MS, OTR/L (Guest): Well we know that a stroke affects the brain because a blood vessel is blocked by a clot or a bleed. The area of the brain that is blocked can control the arm or the hand. Typically, on the left side of the brain affects the right side of the body, right side of the brain affects the left side of the body. Often the arm can be completely paralyzed. It can be what we call flaccid or just kind of limp and hanging at the side. It could just be weak. Or you could experience lack of coordination. So, you can imagine many of your tasks throughout the day, you use both hands. Imagine trying to put on your clothes without using both hands. It’s very difficult to do all of your activities of daily living such as getting dressed, brushing your teeth, going to the toilet, taking a shower, even things like fixing a cup of coffee, being able to feed your cat; those are all things that we rely on both arms. If you have one arm that’s not working properly, or at all, that’s going to be very difficult.
Melanie: How soon after a stroke does someone know that one of their limbs is affected?
Patty: Having weakness on one side of the body is often a sign that a person is having a stroke. The American Stroke Association recommends remembering the word FAST to remember some of the symptoms of a stroke. And the F is facial drooping and A is arm weakness. So, right away, someone can experience that arm weakness.
Melanie: That was an excellent answer. And a great explanation. So, if somebody has had a stroke, they have gotten their TPA, they have gone through all of their treatments, what’s the number one focus in rehab that you concentrate on when you are working with someone post-stroke?
Patty: When I’m working with helping the person regain use of their arm, oftentimes in the hospital, a focus may be on compensatory strategies or learning how to do activities such as getting dressed or brushing your teeth or going to the toilet; even though that arm is not working very well. That’s a very good treatment strategy and it’s very important. However, research shows that you need to use that affected arm. Even if it is completely hanging at your side. The worst thing you can do is to ignore that arm and not use it at all. Not only should you be doing arm exercises that incorporate that affected arm; but you should also be using that arm to try to do things, such as drink out of a cup or brush your teeth. Even if it doesn’t move, you can use your nonaffected arm to hold that arm or hand to hold the device to get the job done. What you are doing is you are promoting other areas of your brain taking over the operation of getting that arm to move again.
Melanie: So, how does that work? If you are rewiring your brain, working on that neuroplasticity; is this something you can think about to try and to do these exercises? How does somebody do that at home? What exercises can they be doing?
Patty: Again, the best thing you can do is to use both arms together. Certainly, you can visualize, and research has shown that visualizing has a true benefit. There is something called mirror box therapy that you can use, which is basically putting your affected arm behind a mirror, moving your nonaffected arm and practicing trying to move your affected arm in the same manner, such as making fist and extending your fingers with your affected arm behind the mirror. So, you are in essence, tricking your brain visually by seeing your no affected hand open and close. You can also put both arms on the table and use your nonaffected arm to draw circles on the table or draw a semicircle. Putting your arm on the table, is helpful because it eliminates gravity and it allows your shoulder muscles and upper arm muscles to be more efficient and not have to worry about holding your arm up against gravity.
Melanie: What are some specialty devices available today and how can they help the arm and hand recover? What do you use as an occupational therapist?
Patty: There are new devices coming on the market all the time with evidence-based treatment. Strategies that are shown to be very beneficial would be things such as electrical stimulation, motor relearning, functional training devices, so some of the devices would be a Bioness H200 and that’s a wrist, hand orthosis kind of a splint looking device that has functional electrical stimulation. And what it does is it sends a low-level stimulation to the paralyzed muscles in the forearm and it allows the person to extend their fingers or to flex their fingers to open and close the hand. This is beneficial on therapy because research shows repetitive movement of that affected arm is what promotes healing and neuroplasticity in that brain. So, with the functional electrical stimulation making the muscles act, you can practice repetitive movements such as grasp and release during therapy or at home. Another device would be a SaeboFlex or SaeboReach. This is a nonelectrical stimulation device. This is a device that is appropriate for people who have what’s called flexor spasticity or tightness in the forearm muscles. So, the person may have fingers that are curled or clenched, and they may have great difficulty with extending their fingers. The device is mechanical. It has springs on the back of it and it provides tension so that when the person grasps something; the device helps the person to extend their finger and release the object. As you can imagine, if all you could do would be grasp an object and you would have to pry it out of your hand; it is not very motivating to be able to continue to practice grasp and release tasks.
Melanie: Is weight training something with light weights that you do as an occupational therapist with stroke patients?
Patty: It can be appropriate. It depends on where the person is in their recovery.
Melanie: So, where can someone get more information about the devices you have spoken today about and also tell us about your team at Meritus Health.
Patty: Well, of course on the website, someone can get more information so Saebo.com, S-A-E-B-O Bioness.com. B-I-O-N-E-S-S. Here at Meritus at Total Rehab Care, we have a great multidisciplinary team. The neuro team in particular, has many years of neurological experience. We have a physical therapist, physical therapy assistant, occupational therapy, occupational therapy assistant, social work and speech therapy.
Melanie: Now give us your best advice on regaining hand and arm movement after a stroke and what you would like the listeners to know if they or a loved one have suffered a stroke.
Patty: My best advice to you if you have had a stroke is to use your affected arm or leg. Research shows repetitive, massive amounts of practice is what helps you to regain the ability to use your arm or hand. So, practice, practice, practice. Think of recovering from a stroke as your job. Your job is to do your exercises, use that arm and you will be rewarded with more movement of that arm and hand.
Melanie: Thank you so much Patty, for being with us today. You’re listening to Your Health Matters with Meritus Health. For more information please visit www.meritushealth.com that’s www.meritushealth.com . I’m Melanie Cole. Thanks for tuning in.
Regaining Arm and Hand Movement After Stroke
Melanie Cole (Host): Each year more than 600 patients arrive in Meritus Medical Center’s Emergency Department with signs and symptoms of stroke. If you have suffered a stroke, then you or your loved ones need to know that there are many modalities and therapies that are involved in regaining arm and hand movement after a stroke. My guest today, is Patty Runkles. She’s an occupation therapist at Meritus Health. Welcome to the show Patty. How does stroke affect a person’s hand and arm?
Patty Runkles, MS, OTR/L (Guest): Well we know that a stroke affects the brain because a blood vessel is blocked by a clot or a bleed. The area of the brain that is blocked can control the arm or the hand. Typically, on the left side of the brain affects the right side of the body, right side of the brain affects the left side of the body. Often the arm can be completely paralyzed. It can be what we call flaccid or just kind of limp and hanging at the side. It could just be weak. Or you could experience lack of coordination. So, you can imagine many of your tasks throughout the day, you use both hands. Imagine trying to put on your clothes without using both hands. It’s very difficult to do all of your activities of daily living such as getting dressed, brushing your teeth, going to the toilet, taking a shower, even things like fixing a cup of coffee, being able to feed your cat; those are all things that we rely on both arms. If you have one arm that’s not working properly, or at all, that’s going to be very difficult.
Melanie: How soon after a stroke does someone know that one of their limbs is affected?
Patty: Having weakness on one side of the body is often a sign that a person is having a stroke. The American Stroke Association recommends remembering the word FAST to remember some of the symptoms of a stroke. And the F is facial drooping and A is arm weakness. So, right away, someone can experience that arm weakness.
Melanie: That was an excellent answer. And a great explanation. So, if somebody has had a stroke, they have gotten their TPA, they have gone through all of their treatments, what’s the number one focus in rehab that you concentrate on when you are working with someone post-stroke?
Patty: When I’m working with helping the person regain use of their arm, oftentimes in the hospital, a focus may be on compensatory strategies or learning how to do activities such as getting dressed or brushing your teeth or going to the toilet; even though that arm is not working very well. That’s a very good treatment strategy and it’s very important. However, research shows that you need to use that affected arm. Even if it is completely hanging at your side. The worst thing you can do is to ignore that arm and not use it at all. Not only should you be doing arm exercises that incorporate that affected arm; but you should also be using that arm to try to do things, such as drink out of a cup or brush your teeth. Even if it doesn’t move, you can use your nonaffected arm to hold that arm or hand to hold the device to get the job done. What you are doing is you are promoting other areas of your brain taking over the operation of getting that arm to move again.
Melanie: So, how does that work? If you are rewiring your brain, working on that neuroplasticity; is this something you can think about to try and to do these exercises? How does somebody do that at home? What exercises can they be doing?
Patty: Again, the best thing you can do is to use both arms together. Certainly, you can visualize, and research has shown that visualizing has a true benefit. There is something called mirror box therapy that you can use, which is basically putting your affected arm behind a mirror, moving your nonaffected arm and practicing trying to move your affected arm in the same manner, such as making fist and extending your fingers with your affected arm behind the mirror. So, you are in essence, tricking your brain visually by seeing your no affected hand open and close. You can also put both arms on the table and use your nonaffected arm to draw circles on the table or draw a semicircle. Putting your arm on the table, is helpful because it eliminates gravity and it allows your shoulder muscles and upper arm muscles to be more efficient and not have to worry about holding your arm up against gravity.
Melanie: What are some specialty devices available today and how can they help the arm and hand recover? What do you use as an occupational therapist?
Patty: There are new devices coming on the market all the time with evidence-based treatment. Strategies that are shown to be very beneficial would be things such as electrical stimulation, motor relearning, functional training devices, so some of the devices would be a Bioness H200 and that’s a wrist, hand orthosis kind of a splint looking device that has functional electrical stimulation. And what it does is it sends a low-level stimulation to the paralyzed muscles in the forearm and it allows the person to extend their fingers or to flex their fingers to open and close the hand. This is beneficial on therapy because research shows repetitive movement of that affected arm is what promotes healing and neuroplasticity in that brain. So, with the functional electrical stimulation making the muscles act, you can practice repetitive movements such as grasp and release during therapy or at home. Another device would be a SaeboFlex or SaeboReach. This is a nonelectrical stimulation device. This is a device that is appropriate for people who have what’s called flexor spasticity or tightness in the forearm muscles. So, the person may have fingers that are curled or clenched, and they may have great difficulty with extending their fingers. The device is mechanical. It has springs on the back of it and it provides tension so that when the person grasps something; the device helps the person to extend their finger and release the object. As you can imagine, if all you could do would be grasp an object and you would have to pry it out of your hand; it is not very motivating to be able to continue to practice grasp and release tasks.
Melanie: Is weight training something with light weights that you do as an occupational therapist with stroke patients?
Patty: It can be appropriate. It depends on where the person is in their recovery.
Melanie: So, where can someone get more information about the devices you have spoken today about and also tell us about your team at Meritus Health.
Patty: Well, of course on the website, someone can get more information so Saebo.com, S-A-E-B-O Bioness.com. B-I-O-N-E-S-S. Here at Meritus at Total Rehab Care, we have a great multidisciplinary team. The neuro team in particular, has many years of neurological experience. We have a physical therapist, physical therapy assistant, occupational therapy, occupational therapy assistant, social work and speech therapy.
Melanie: Now give us your best advice on regaining hand and arm movement after a stroke and what you would like the listeners to know if they or a loved one have suffered a stroke.
Patty: My best advice to you if you have had a stroke is to use your affected arm or leg. Research shows repetitive, massive amounts of practice is what helps you to regain the ability to use your arm or hand. So, practice, practice, practice. Think of recovering from a stroke as your job. Your job is to do your exercises, use that arm and you will be rewarded with more movement of that arm and hand.
Melanie: Thank you so much Patty, for being with us today. You’re listening to Your Health Matters with Meritus Health. For more information please visit www.meritushealth.com that’s www.meritushealth.com . I’m Melanie Cole. Thanks for tuning in.