Exercises after Stroke

Exercise 4
To improve hip control in preparation for walking activities

1. Start with your unaffected leg flat on the floor and your affected leg bent.
   
2. Lift your affected foot and cross your affected leg over the other leg.
   

c. Lift your affected foot and un-cross, resuming the position of step b.
d. Repeat the crossing and un-crossing motion several times.

Exercise 5
To enhance hip and knee control
a. Start with your knees bent, feet resting on the floor.
b. Slowly slide the heel of your affected leg down so that the leg straightens.
c. Slowly bring the heel of your affected leg along
the floor, returning to the starting position. Keep
your heel in contact with the floor throughout the exercise.
Note: Your foot will slide more smoothly if you do this exercise without shoes. 

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Exercise 6
To improve control of knee motions for walking
a. Lie on your unaffected side with the bottom knee bent for stability and your affected arm placed in front for support.

2. Starting with your affected leg straight, bend your affected knee, bringing the heel toward your buttocks, then return to the straightened position.
   
3. Concentrate on bending and straightening your knee while keeping your hip straight.
   

Exercise 7
To improve weight shift and control for proper walking technique
a. Start with your knees bent, feet flat on the floor and knees close together.
b. Lift your hips from the floor and keep them raised in the air.
c. Slowly twist your hips side to side. Return to center and lower your hips to the floor.
d. Rest. Repeat motion.
Note: This exercise may be difficult for some stroke survivors and it may worsen back problems. Do not do it if you experience pain.
Exercise 8
To improve balance, weight shift and control to prepare for walking activities

1. The starting position is on your hands and knees. Weight should be evenly distributed on both arms and both legs.
   
2. Rock in a diagonal direction back toward your right heel as far as possible, then as far forward toward your left hand as possible.
   
3. Repeat motion several times, slowly rocking as far as possible in each direction.

Exercise 9
To simulate proper weight shift and knee control necessary for walking

1. Stand with your unaffected side next to a countertop or other firm surface. Rest your unaffected arm on the surface
   for support.
   
2. Lift your unaffected foot from the floor so that you are standing on your affected leg.
   

c. Slowly bend and straighten the leg on which you are standing through a small range of motion. Try to move smoothly, not allowing your knee to buckle when you bend, or to snap back when you straighten.
d. Repeat the knee bending and straightening several times, slowly.

Exercise 10

To simulate proper weight shift while strengthening hip and pelvis muscles
a. Stand facing a countertop or other firm surface for support.
b. Shift your weight onto your right leg and lift your knee straight.
c. Return to center with both feet on the floor.

4. Shift your weight onto your left leg and lift your right leg out to the side keeping your back and knee straight.
   
5. Repeat several times, alternating lifts.
   

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Exersices after Stroke

Exercise 2

To strengthen the shoulder muscles as well as those which straighten the elbow

1. Lying on your back, grasp one end of an elasticized band* in each hand with enough tension to provide light resistance to the exercise, but without causing undue strain.
   
2. To start, place both hands alongside the unaffected hip, keeping your elbows as straight as possible.
   
3. Move your affected arm upward in a diagonal direction, reaching out to the side, above your head, keeping your elbow straight**. Your unaffected arm should remain at your side throughout the exercise.
   

d. During the exercise, stretch the band so that it provides resistance.
*Elasticized bands are marketed as Theraband. They are available in varying strengths (color- coded) to provide progressive resistance. Initially, a three or four foot length band – perhaps with the ends knotted together to improve grip – is sufficient for the exercise. To increase resistance as strength improves, the next density of Theraband can be purchased, or two or more bands of the original density can be used at once. Theraband can be obtained from a medical supply company. Similar elastic bands or cords are also available at many sporting goods stores where exercise equipment is sold.
**If it is too difficult to keep the elbow straight, the exercise can be done with the elbow bent. If you cannot grip with your hand, a loop can be tied at the end to slip your hand partially through the loop, leaving the thumb out to “catch” the loop during upward movement.

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© 2010 NATIONAL STROKE ASSOCIATION

Exercise 3
To strengthen the muscles which straighten the elbow

1. Lie on your back with your arms resting at your sides and a rolled towel under the affected elbow.
   
2. Bend affected elbow and move your hand up toward your shoulder. Keep your elbow resting on the towel.
   

c. Hold for a few seconds.
d. Straighten your elbow and hold. e. Slowly repeat several times.
Note: Try not to let the hand roll in towards your mid-section/stomach. Exercise 4
To improve hip control in preparation for walking activities

1. Start with your unaffected leg flat on the floor and your affected leg bent.
   
2. Lift your affected foot and cross your affected leg over the other leg.
   

c. Lift your affected foot and un-cross, resuming the position of step b.
d. Repeat the crossing and un-crossing motion several times.

Exercise 5
To enhance hip and knee control
a. Start with your knees bent, feet resting on the floor.
b. Slowly slide the heel of your affected leg down so that the leg straightens.
c. Slowly bring the heel of your affected leg along
the floor, returning to the starting position. Keep
your heel in contact with the floor throughout the exercise.
Note: Your foot will slide more smoothly if you do this exercise without shoes. HOPE: THE STROKE RECOVERY GUIDE

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Exercise 6
To improve control of knee motions for walking
a. Lie on your unaffected side with the bottom knee bent for stability and your affected arm placed in front for support.

2. Starting with your affected leg straight, bend your affected knee, bringing the heel toward your buttocks, then return to the straightened position.
   
3. Concentrate on bending and straightening your knee while keeping your hip straight.
   

Exercise 7
To improve weight shift and control for proper walking technique
a. Start with your knees bent, feet flat on the floor and knees close together.
b. Lift your hips from the floor and keep them raised in the air.
c. Slowly twist your hips side to side. Return to center and lower your hips to the floor.
d. Rest. Repeat motion.
Note: This exercise may be difficult for some stroke survivors and it may worsen back problems. Do not do it if you experience pain.
Exercise 8
To improve balance, weight shift and control to prepare for walking activities

1. The starting position is on your hands and knees. Weight should be evenly distributed on both arms and both legs.
   
2. Rock in a diagonal direction back toward your right heel as far as possible, then as far forward toward your left hand as possible.
   
3. Repeat motion several times, slowly rocking as far as possible in each direction.
   

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4. Return to center.
   
5. Rock in a diagonal direction toward your right hand. Move as far back as possible in each direction slowly.
   

Note: For safety, an assistant may be nearby to prevent loss of balance. This position may not be appropriate or safe for elderly stroke survivors. Consult your doctor and/or physicaltherapistbefore attempting this exercise.
Exercise 9
To simulate proper weight shift and knee control necessary for walking

1. Stand with your unaffected side next to a countertop or other firm surface. Rest your unaffected arm on the surface
   for support.
   
2. Lift your unaffected foot from the floor so that you are standing on your affected leg.
   

c. Slowly bend and straighten the leg on which you are standing through a small range of motion. Try to move smoothly, not allowing your knee to buckle when you bend, or to snap back when you straighten.
d. Repeat the knee bending and straightening several times, slowly.

Exercise 10

To simulate proper weight shift while strengthening hip and pelvis muscles
a. Stand facing a countertop or other firm surface for support.
b. Shift your weight onto your right leg and lift your knee straight.
c. Return to center with both feet on the floor.

4. Shift your weight onto your left leg and lift your right leg out to the side keeping your back and knee straight.
   
5. Repeat several times, alternating lifts.
   

HOPE: THE STROKE RECOVERY GUIDE

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Profile

Exercise Program II
For the person moderately affected by stroke

If you were moderately affected by your stroke, you may use a wheelchair most of the time. You are probably able to walk – at least around the house – with the aid of another person or by using a walking aid. A short leg brace may be needed to help control foot drop or inward turning of the foot. A sling may be used to help the arm and aid in shoulder positioning for controlling pain. Your affected arm and leg may be stiff or may assume a spastic posture that is difficult to control. The toe may turn inward or the foot may drag. When walking, you may “lead” with the unaffected side, leaving the other side behind. Often there are balance problems and difficulty shifting weight toward the affected side.
Clothing that does not restrict movement is appropriate for exercising. It is not necessary to wear shorts, such as those shown in the illustrations. Leisure clothing such as sweat suits or jogging suits is appropriate. Sturdy, well-constructed shoes with non-skid soles, such as athletic shoes, are recommended at all times. It is important that your foot on the affected side be checked periodically for reddened areas, pressure marks, swelling or blisters – especially when there is poor sensation or a lack of sensation. Reddened areas and pressure marks should be reported to a doctor or physical therapist.
The purpose of this exercise program is to:

• Promote flexibility and relaxation of muscles on the affected side
  
• Help return to more normal movement
  
• Improve balance and coordination
  
• Decrease pain and stiffness
  
• Maintain range of motion in the affected arm and leg
  For the Stroke Survivor
  Begin with exercises done lying on your back, and then move on to those performed lying on your unaffected side, then sitting, and then standing. Make sure that the surface on which you lie is firm and provides good support. Take your time when you exercise. Don’t rush the movements or strain to complete them.
  Note: In the illustrations that follow, non-shaded areas show body position at the beginning of the exercise. Shaded areas show body position at the end of the exercise. Arrows show the direction of movement. In addition, the word “floor” has been used to simplify the instructions; the exercises can be performed on the floor, on a firm mattress or on any appropriate supporting surface.
  For the Helper
  There may be no need to assist the stroke survivor in the exercises, but you should be nearby during the exercise session. If the survivor has difficulty reading or remembering the sequence of movements, you can hold the illustration up to where it can be seen or repeat the instructions one by one. You can also offer physical assistance and encouragement when needed.
  

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© 2010 NATIONAL STROKE ASSOCIATION

Exercise 1
To enhance shoulder motion and possibly prevent shoulder pain

a. Lie on your back on a firm bed. Interlace your fingers with your hands resting on your stomach.
b. Slowly raise your arms to shoulder level, keeping your elbows straight.
c. Return your hands to resting position on your stomach.
Note: If pain occurs, it may be reduced by working within the range of motion that is relatively pain-free, then going up to the point where pain is felt. The arm should not be forced if pain is excessive, but effort should be made to daily increase the range of pain-free motion.

Exercise 2

To maintain shoulder motion
(may be useful for someone who has difficulty rolling over in bed)
a. Lie on your back on a firm bed. Interlace your fingers, with your hands resting on your stomach.
b. Slowly raise your hands directly over your chest, straightening your elbows.
c. Slowly move your hands to one side and then the other.
d. When all repetitions have been completed, bend your elbows and return your hands to resting position on your stomach.
Note: If shoulder pain occurs, move only to the point where it begins to hurt. If the pain continues, don’t do this exercise.

HOPE: THE STROKE RECOVERY GUIDE

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Exercise 3
To promote motion in the pelvis, hip and knee
(Can help to reduce stiffness and is also useful for rolling over and moving in bed)

1. Lie on your back on a firm bed. Keep your interlaced fingers resting on your stomach.
   
2. Bend your knees and put your feet flat on the bed.
   

c. Holding your knees tightly together, slowly move them as far to the right as possible. Return to center.
d. Slowly move your knees as far as possible to the left, still keeping them together. Return to center.
Note: The helper may provide assistance or verbal cues to help you keep your knees together during this exercise.
Exercise 4
To improve motion at the hip and knee, simulating the movements needed for walking
(Can be useful when moving toward the edge of the bed before coming to a sitting position)