Upper limb management after stroke fact sheet
- Your upper limb (arm) can be affected in several ways after a stroke.
- There are many treatments to improve your ability to use your arm and these should be started as early as possible. Talk to your physiotherapist and/or occupational therapist.
- You may not regain ‘normal’ arm movement after your stroke rehabilitation. But there are many things you can do to manage these difficulties.
How does a stroke affect my arm?
There are several ways that a stroke can affect your arm. Usually only one side of your body will be affected.
- Weakness. Your arm may be paralysed completely or your shoulder, elbow, wrist and/ or hand may be weak. This means you may have difficulty reaching, picking things up or holding onto things.
- Co-ordination problems. You may have difficulty planning or coordinating the movements of your arm, meaning your arm doesn’t move in the way you want it to.
- Swelling. If your hand or arm doesn’t move as well as it used to, fluid may build up in your hand or arm causing swelling (called oedema).
- Changes in muscle tone. You may have high tone (called hypertonia or spasticity) which makes your muscles stiff or tight. You may have low tone (called hypotonia) which makes your muscles floppy or loose.
- Subluxation. Weakness or low tone may allow the top of your arm to drop out of the shoulder socket slightly. This makes arm movements difficult and can be painful.
- Contracture. Weakness or high tone may make your muscles shorter or joints less flexible. This makes movements difficult and can be painful.
- Changes in sensation. You may have changes to the feeling in your arm or hand, or other parts of your body. You might lose feeling, feel ‘pins and needles’ or have an increased feeling (called hypersensitivity) which can make light touches painful.
What will help my arm recover?
Your physiotherapist and occupational therapist will assess your arm strength, feeling and movements. They will then recommend a range of treatments (therapy). This therapy will be based on your individual problems and goals.
Upper limb therapy should start as soon as possible after your stroke, ideally in the first few days after the stroke.
It is also important to get as much practice as possible. Ask your therapist about activities that you can do outside your therapy times and when you go home. You may find it helpful if your family or friends help you with some of these activities.
Therapy will be different for everyone. It usually involves a number of different types of exercises and treatments. Some of the possible treatments include:
- Repeated practice of every day tasks. Practice activities like drinking from a cup or brushing your hair, or small movements like pushing your arm forward, many times.
- Mental practice/mental rehearsal. Imagining you are doing an activity, such as drinking a cup of tea, without actually doing it.
- Constraint-induced movement therapy (CIMT). Putting a mitt or sling on your unaffected arm so that you are more likely to use your weak arm.
- Electrical stimulation. Using a low-level electrical current to stimulate a weak muscle. Electromyograph (EMG) biofeedback. A machine produces a light or sound when you correctly move a muscle to help you practice correctly, especially if it is difficult to see the muscle itself move. This should always be used in conjunction with other therapies.
- Mirror therapy. A mirror is placed between your arms on a table. When you move your unaffected arm while looking in the mirror it ‘tricks’ your brain into thinking your affected arm is also moving.
- Sensory retraining. Feeling different materials, objects and textures to ‘re-learn’ what these feel like. You may also need to practice doing things with both hands or arms, or your therapist may teach you how to protect your hand and arm from injury.
- Botox injections. An injection of botulinum toxin A (botox) into a muscle with high tone may improve movement. This should always be used in conjunction with other therapies.
- Treatment for oedema. Your occupational therapist or physiotherapist may recommend a range of treatments to push the swelling from your hand or arm back toward your body. This may include exercises, electrical stimulation, pressure garments, massage and raising your arm when resting.
- Treatment for subluxation and shoulder pain. Your doctor, occupational therapist or physiotherapist may recommend a range of strategies to assist with pain. These may include electrical stimulation, slings, wheelchair attachments, strapping and strategies to move and protect your arm. If pain is persistent your doctor may refer you to a specialist pain management team.
What if I don’t get full movement back in my arm?
Even with intense therapy some people do not regain full or ‘normal’ use of their arm.
It is possible for some people to have small improvements in their arm for many years after a stroke. It is important to keep doing your exercises and using your arm as much as possible. To help you keep going with this, make it part of your daily routine. You may join an exercise group or ask your family/friends to help you. They can help you notice and celebrate small achievements.
If you have ongoing trouble using your arm/ hand you may need to use equipment or find different ways to do everyday tasks. This is called compensation. Your therapist will help you find ways to do this.
You may also need to protect your arm from injury. For example some people with a weak shoulder use a sling when standing or walking, or have an arm trough on their wheelchair
Where can I get help?
If you have any questions about upper limb management you can ask you physiotherapist or occupational therapist.
Dr Tammy Hoffmann
Senior Lecturer The University of Queensland
Location: Room 716, Therapies Annexe (84A), The University of Queensland, Q 4072
National Stroke Foundation
Stroke Management Guidelines 2010
Evidence-Based Review of Stroke Rehabilitation
For more information visit the enableme resource topic on Arm and hand function