Stroke rehabilitation has long been a passion of mine. More than a decade ago I remember speaking with a stroke consultant around the need for people with stroke to access exercise and fitness environments so they could self-manage on a longer-term basis. We discussed the many barriers in place; people with stroke feeling they can’t attend such venues, exercise professionals feeling they’re not experienced enough to monitor people with neurological problems, specialist stoke teams feeling that people wouldn’t be safe enough attending such venues, the lack of evidence around the safety of people with stroke exercising, the list goes on.
We are now in a much better place, fitness venues are much more able and inclusive to welcoming all members of communities, collaborative relationships between exercise professionals and stroke teams are being forged and encouraged by the likes of professional bodies such as The Chartered Society of Physiotherapy and most recently has been the release of the 2023 National Clinical Guideline for Stroke (strokeguideline.org) which has updated recommendations relating to stroke rehabilitation and exercise, stating that:
Cardiorespiratory or mixed training should be adopted to improve and maintain fitness and lower the risk of further stroke
People should be encouraged and supported to have their own self-management plan
Reviews beyond 6 months post stroke are recommended and therapy interventions should be offered if further goals are identified
However, there are still mindsets to change, confidence to build and knowledge to pass on. Exercising safely can be achieved after a stroke and there is increasing evidence for exercising producing a neuroprotective effect for the brain, whereby molecules are produced that help with healing and preserving memory (Dalgas 2019) We need to listen to the person with stroke, really listen to what they need/enjoy/struggle with and work with them to develop a plan whereby they can take ownership of their condition and live well.
Stroke rehabilitation isn’t solely exercising in a gym however, and for some it may just not be a feasible option. Instead, other techniques and approaches have mounting evidence as to the benefits they can effect. For instance, leading Pilates provider APPI has adapted and developed their exercises for people with neurological conditions and evidence shows that pilates training is effective in people with stroke in improving functional balance and quality of life compared with conventional therapy (Sahala, 2014 and Lim, 2017)
What about those individuals where this type of activity is difficult? During my neuro-physiotherapy career I have utilised a range of methods to provide rehabilitation for people with stroke, with the foundation of my knowledge based on the Bobath Concept. This focusses on maximising an individuals’ movement control for enhanced functional recovery (Michielsen et al, 2017). The approach lends itself well to one-to-one rehab sessions, whereby therapeutic handling can be used to help at all stages of stroke rehabilitation, even if it is many months/years after the initial stroke or if the condition has plateaued and symptoms are staying the same. This is because neuro-physiotherapy can help the brain and nervous system form new synaptic connections, known as neuro-plasticity, so it can rewire the brain and nervous system to learn, or re-learn, movements and tasks.
So, no matter how long ago a stroke was, or the level of impairment experienced, I have many approaches and much experience to draw upon. Whether it’s exercising in a gym, attending classes or a more individualised approach, with the changing landscape of health care and the ever increasing pressures on services, neuro-physiotherapists have much to offer. Our Liverpool Stroke community need and deserve rehabilitation options to make and reach their goals and I can offer those, should you or someone you know want to give it a try.
Hannah Rooney HPCP Specialist Neuro-physiotherapist.
References
Dalgas U, Langeskov-Christensen M, Stenager E, Riemenschneider M, Hvid LG. Exercise as Medicine in Multiple Sclerosis-Time for a Paradigm Shift: Preventive, Symptomatic, and Disease-Modifying Aspects and Perspectives. Curr Neurol Neurosci Rep. 2019 Nov 13;19(11):88. doi: 10.1007/s11910-019-1002-3.
Lim HS, Yoon S. The effects of Pilates exercise on cardiopulmonary function in the chronic stroke patients: a randomized controlled trials. J Phys Ther Sci. 2017 May;29(5):959-963. doi: 10.1589/jpts.29.959
Michielsen M, Vaughan-Graham J, Holland A, Magri A and Suzuki M(2017). The Bobath concept – a model to illustrate clinical practice. Disability and Rehabilitation DOI: 10.1080/09638288.2017.1417496
Shea S, Moriello G. Feasibility and outcomes of a classical Pilates program on lower extremity strength, posture, balance, gait, and quality of life in someone with impairments due to a stroke. J Bodyw Mov Ther. 2014 Jul;18(3):332-60. doi: 10.1016/j.jbmt.2013.11.017