Hand function after a stroke
Joanna Łapińska
MSc in Physiotherapy
Therapy results
What patients say about us
Paresis or paralysis of the upper limb is one of the most common problems limiting independence in patients after a stroke.
The hand performs sensory, gripping, manipulative and protective functions, and it also plays a part in keeping balance. This is why the question of how long it takes for these functions to return, and when the limb will start to help with everyday tasks, comes up very early after a stroke — especially when there is paresis of the upper limb.
The answer to this question is not clear-cut, and most honestly it is: it depends. The return of hand function after a stroke results from many overlapping factors, which have to be assessed individually in each patient.
No two strokes are the same.
To put it plainly, every stroke has its own character. They differ in the location of the areas of damage visible on a CT or MRI scan, in the extent of the death of nervous tissue and in how quickly medical help was provided.
During a stroke, as a result of bleeding or a lack of blood supply to a particular area of the brain, neurons die. If the decision to use thrombolytic treatment, neurosurgical intervention or blood-pressure-lowering treatment was made quickly, this improves the patient’s chances of regaining function thanks to the cells of the penumbra, which have not died off completely.
Neuroplasticity of the brain.
The human being has the potential to repair and reorganise the structures of the brain. With the right stimulation during well-planned neurological rehabilitation programmes, this phenomenon can be modulated as effectively as possible, which directly affects the return of upper limb function.
Neurological rehabilitation.
The basis of working with the upper limb is loading it under the right conditions and activating the “weaker” hand as therapy progresses. This calls for precisely chosen exercises, control over the quality of movement and consistent work on the function of the hand and shoulder.
The hand is a tool for very precise activities, which is why it has a larger cortical representation than the entire lower limb. In practice, this means that after a stroke a patient often manages relearning to walk after a stroke more quickly than performing complex tasks with the hand, such as writing or doing up buttons.
Good prognostic signs for the return of hand function are selective movements in the joints and early movement of the thumb. At the same time, shoulder pain, spasticity of the limb and the possible need for orthopaedic aids — for example stabilisers to prevent further partial dislocation of the shoulder joint — have to be assessed individually.
In practice, the chances of regaining function increase when rehabilitation is introduced early, carried out regularly and tailored to the patient’s actual deficits. Just as important is engaging the hand every day, because a neglected limb improves more poorly — something we write about in our piece on the neglected hand after a stroke — along with continuity of care after discharge from hospital and informed support from the family during everyday activities.
References
- Markus H, Pereira A, Cloud G. “Stroke Medicine”, vol. II, Lublin 2018.
- Opara J. “Neurorehabilitation”, Katowice 2017.
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