After a stroke, the muscles on the affected side change. There are changes in the length and mobility of muscle fibers. Initially, the affected side is usually weak and feels sluggish and lifeless; over time, these muscles become rigid and clumsy when left untreated. Patients suffer from a limited ability to move in their daily lives. Getting up from an armchair or lifting and carrying objects may be difficult.

Therapists are aware of such muscular problems and can distinguish if a movement cannot be performed due to weakness or due to spasticity. Strength training is successfully used for both weak and spastic muscles. A successful training plan and a lot of motivation can contribute to the recovery of the diseased muscles.

Therapeutic experience and studies show that the force and strength of the affected side can be specifically trained after a stroke.
The step length and track width are increased through gait training. Walking safety is increased. At the upper extremity, improvement in the extent of movement is frequently seen. The arm can be raised higher. As a result, those affected can place a laundry basket on the table with both hands. Carrying out everyday activities without the help of others greatly increases the quality of life after a stroke.

Strength training after a stroke has a positive effect, not only on independence but also in everyday life. The pleasure of exercise increases mental health, and cognitive abilities improve. Affected people feel more joy and motivation.

Progressive resistance training is a form of strength training after a stroke. The intensity of the selected exercises increases continuously. The muscles slowly adjust to the increasing strain.

• Sit down on a chair for this exercise. A strong, firm armchair will give you more support than a soft one.
• Slide your bottom to the front edge of the chair.
• Sit straight and place your feet slightly behind your knees.
• If you have armrests on your chair, place your hands near the front of the armrests. Shoulders width apart.
• Lean forward from the hip. Be sure always to keep your back straight.
• As you are leaning forward, press your heels into the floor. Slowly stand up.
• Straighten your legs. Lift your head to straighten your hips.
• Now slowly sit back down. The deliberate, slow movements exercise the eccentric activity of the muscles. While performing the exercise, make sure you are moving symmetrically. Try to support yourself as little as possible.
• Repeat this exercise 15 times. If this movement is too much at the beginning, do only as many repetitions as you can without getting out of breath.
• Depending on how good your coordination skills are, the exercise can be performed with or without stopping.
• After 15 repetitions, take a one-minute break.
• After the break, do a second and a third set. You will want to perform the third set with as much concentration and at the same pace as the first.

The exercise should be performed two to three times a week. Take a break for one day between the workouts. The muscles need recovery to strengthen and grow.
After two to three weeks, the intensity of the exercise can be increased. For this purpose, select a lower seat or use additional weight (for example, a filled backpack).

circuit class training is used to train strength stamina. Different exercises are combined to address different muscle groups. This type of training brings variety and increases motivation. Each exercise is repeated 15 to 20 times. There are short breaks between exercises.
Below you will find some exercise recommendations for circuit class training of the lower extremities. The basis for every exercise is an upright position.

• Do alternating side taps with the left and the right leg.
• Do alternating steps forward with the left leg and the right leg, respectively, and always step back with each leg after making the step forward. The steps should be about the same size.
• Alternately rotate your toes outwards or inwards. In doing so, the weight is slightly shifted to the heels.
• Push up to tiptoe and lower again. The exercise can be performed with or without stopping.
• If your strength and coordination allow, try making small jumps with both legs. Be sure to land on the floor with both legs at the same time.

Discuss the exercises with your physiotherapist or occupational therapist to adapt them to your individual possibilities.

When speed and skill are required in everyday life, the muscles usually need to act and react rapidly. This need also applies to the impression of the forefoot during walking or running.
For this purpose, a research group proposed a so-called ballistic training in which weights are quickly pushed or thrown into a room; for example, shooting balls for leg training or throwing objects for arm training.
All of these exercises can also be carried out in a pool or with the help of special training equipment. Training devices are available in most rehabilitation facilities, along with outpatient equipment-assisted training therapies, especially for stroke patients.

In top-level sports, mental training has long been indispensable. Racing riders memorize the track guides exactly, and climbers rigidly plan every grip for challenging routes. Athletes can imagine how it will feel to win the race. Indian researchers were able to show that stroke patients also benefit from mental training. If visualizations are used in addition to strength training, the walking speed increases more than without these measures.

Patients, who have difficulty walking, imagine how they effortlessly stretch and bend the affected leg. They imagine the sequence of the movement, how they place one leg in front of the other. Imagine how you would feel doing that. What are your feelings? What are you particularly looking forward to? What will your family say? What will your friends say?

An aid in working with visualizations can be to have the movement sequence verbalized precisely by the therapist. This statement can also be recorded and played back at home as accompanying support during the training. The brain cannot distinguish whether the movements are actually carried out or merely imagined. Use this fact for your rehabilitation!

Author: Hannes Aftenberger

Sources:

Motor Imagery Training on Muscle Strength and Gait Performance in Ambulant Stroke Subjects-A Randomized Clinical Trial (2016)

Improving walking ability in people with neurological conditions: A theoretical framework for biomechanics driven exercise prescription (2019)