Is it hard to recover the arm after the stroke?

More than 15 million people worldwide affect a stroke each year (Amanda G. Global stroke statistics 2014) and 5-6 % of people die from it, moreover majority suffers the disability. More than 70 % stroke survivor’s experiences limited functional recovery (Raffin E .2017). Even in the recovery population (ambulatory population), limited recovery has reported in the upper limb. Restoring the arm function after the stroke is one of the major concerns among physiotherapists and other health professionals.

Upper extremity deficiencies after stroke include muscle weakness, changes in muscle tone (spasticity), joint contraction, and laxity or impaired motor control. These impairments affect almost all day to day activities like picking up holding something and reach out activities.
Studies show that significant benefit of physiotherapy on stroke patients compared with non-treatment cases depending on time since stroke (Pollock and others 2014). It is important to start physiotherapy soon after the cerebral perfusion treatment in stroke patients to achieve the maximum potential recovery (Stinear and Byblow 2014; Veerbeek and others 2011).

Majority of the stroke population getting recovery on the lower limb rather than the upper limb (Pamela w.2018).Generally believed that the arm movement is to be less than the recovery of leg movement. This concept has widely spread over the stroke rehabilitation professionals. These concepts developed based on the measures of disability rather than the specific motor control. In general view, many are considering that the recovery of the leg is a movement initiation or stereotypic locomotion, but we know that simple movements are not worth in the arm function. But many looks for the movement rather than the fine coordinated movement. The fact is that the upper limb activity required a fine motor control and accuracy rather than legs.

Soon after the stroke, the rehabilitation experts are looking for the normal well-coordinated movement from the arm. When we speak about the normal well-coordinated movement we have to understand how it develops. The normal well-coordinated movements develop based on the many factors like motor- postural and task-related activity, Sensory- selective attention by the nervous system to relevant stimuli, Cognitive- motivation, judgment, planning and problem-solving, Perceptual- spatial and visual, Biomechanical- complementary neural and biomechanical aspects of control.After the stroke, these factors are disturbed. A good strategy is required to restore these things to develop well-coordinated movement in the arm.

What is the barrier to the upper limb rehabilitation?. The easy method to blame is on the neurological impairment.The severity of motor Impairments and the patterns of motor recovery from impairments are similar for the upper and lower extremities. (Pamela and others 2018).Moreover, the recovery of motor functions in both the upper extremities and lower extremities are similar and rapid in first 30 days.(Pamela and other 2018). Then when the imbalance of recovery is happening between the lower and upper extremities ?. The truth is lack of good strategic approach towards the upper limb rehabilitation.

Along with conventional methods, the advanced technology in rehabilitation is indeed to use in upper limb rehabilitation.Even in the conventional strategy, many things are not practising well.A lot of things are omitting unknowingly during the physiotherapy treatment. One of the major neglecting factors is the anticipatory postural adjustment. EMG studies have shown that before the initiation of the prime movement there is excitatory or inhibitory action in postural muscles. It is necessary to produce quality movement. This adjusts to minimize the disturbance of equilibrium associated with the subsequent movement (Belenkiy, Gurfinkel & Paltsev, 1967).This finding and the very known fact is that proper fixation or the stability is required in proximal part to perform an action in the distal part of the arm. Stabilization of the trunk and aligning the trunk is important to rehabilitate the hand. Addressing the problems in the trunk and scapula is necessary to make real meaning of hand rehabilitation.

To conclude, if we address the whole problems related to the stroke, it is not hard to recover the upper limb after the stroke

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