A Stroke or CVA is when the blood flow to the brain is cut off. You can have an ischemic stroke caused by a blood clot or a hemorrhagic stroke caused by bleeding in the brain. There are nearly 7 million stroke survivors in the US and stroke is the 5th leading cause of death in the US. Stroke survivors often have a long road ahead of them, months of physical, occupational and speech therapy, changes in lifestyle and activity level. What once came easily such as walking, dressing, cooking or even forming a sentence can become difficult or even impossible. More and more physical therapy is having to discharge when people still have so much potential to make progress. Personal training can pick up at that point and help continue recovery.
Recovering from a stroke is hard work. Stroke survivors will most likely receive months of physical therapy, occupational therapy and possibly speech therapy to address deficits in walking, balance, strength, ability to perform activities of daily living, language and swallowing issues, and cognitive challenges. And the individual must also put in hours of practice outside of therapy for the best outcomes. The good news is that stroke recovery is a life long process. When I first graduated from PTA school 21 years ago (yikes! That long?) the thought was, the majority of the recovery from stroke happened in the first 6 to 12 months, after that you were a lost cause. That way of thinking has changed, especially with all the recent research in neuroplasticity. Neuroplasticity is absolutely my favorite thing ever. Medicinenet has my favorite definition:“Neuroplasticity: The brain’s ability to reorganize itself by forming new neural connections throughout life. Neuroplasticity allows the neurons (nerve cells) in the brain to compensate for injury and disease and to adjust their activities in response to new situations or to changes in their environment. ” Please pay special attention to the part that says throughout life! This is exciting stuff! And this is exactly why, in my physical therapy life, neurological conditions are my absolute favorite diagnosis to work with. By definition of neuroplasticity, there is almost no limit to the return you can possibly get after a brain injury….that is exciting stuff!!
The bad news is that insurance only pays for so much therapy. Many stroke survivors are discharged from therapy because insurance benefits run out or progress is too slow to justify continued “skilled intervention”. But this is not the end of recovery. What ever it is you want to improve on, practice it. Let me tell you a story about a former physical therapy patient of mine. He was 5 years out from his stroke, and we were seeing him for a tune up for gait and balance. In my time with him, he became very excited one day because after 5 years of practicing on his own, he was able to lift his affected arm up high enough to wash under his other arm!! FIVE YEARS, this man worked on this…WITHOUT A THERAPIST!! It was a great day, a great achievement and a great example of neuroplasticity and hard work.
How can a personal trainer help?
Ok, I digress this post is about personal training, I totally nerd out about neurological potential. This brings me to, what options do stroke survivors have after discharge from physical and occupational therapy? Personal Training can be of great benefit. Personal trainers can work on stretching, strengthening, endurance and balance. One of the great things about personal training is that the trainer will work with your entire body! They will focus on making all of you stronger, where as in therapy we tend to focus on the impaired side, looking only to improve that side. Personal Trainers can harness the power of neuroplasticity and continue to help the body recover, even, in the process, possibly reducing your risk of another stroke through improved overall fitness.
Strength training can help improve strength on both sides of the body. Spasticity, or increased muscle tone on the affected side, is a common complaint of stroke survivors, and can affect how to progress a strengthening program. Load should be increased slowly to avoid injury and care should be taken to not make spasticity worse with over working a muscle. Personally I like closed chain and multi joint exercises for strength training a stroke survivor.
Personal Trainers should take care to address the entire body and especially posture and core muscles. After all it’s not just your arm and leg that were affected by the stroke, your trunk muscles are also affected and need a lot of attention as well. You need a strong foundation for your limbs to work.
Flexibility is an important part of any fitness program but is especially important for stroke survivors. Muscle weakness, spasticity and lack of use can lead to decreased range of motion. Active stretching is the best option but for nonfunctional muscles gentle passive stretching may be your only option.
Muscle weakness, spasticity, changes in proprioception, decreased reaction time can all be factors that can affect balance and increase risk to fall. Studies show stroke survivors are twice as likely to fall than the general population. Personal trainers can work on balance and strength to reduce risk to fall.
Cardio respiratory Training
Cardio respiratory training can improve mobility and ability to walk in stroke survivors. Options for cardio training can be a stationary bike, NuStep, elliptical, or treadmill. Not every piece of equipment is appropriate for every person, but some sort of cardio training would be beneficial.
Regular exercise has other benefits as well, such as improved mood, improved self-confidence and general improved feeling of well-being.
Where do I start?
First talk to your doctor. Discuss starting an exercise program with your primary care doctor. Many stroke survivors have other medical issues that may influence what type of exercise program is safe for them. Find out if you have any restrictions on the type or intensity of exercise program appropriate for you.
Next find a personal trainer with experience and education to work with a stroke survivor. Just like in many professions, Personal trainers can have specialties. For me I have experience working with older adults, stroke, Parkinson’s, and the frail elderly. If someone came to me and wanted me to train their athlete for sports, I would send them somewhere else, it’s just not my area of expertise. I would be doing them a disservice by taking them on. If you can’t find a trainer with experience with working with stroke survivors (they aren’t easy to find) look for a trainer with a degree in exercise science or another allied heath profession, and a solid education in anatomy, physiology and neurology who is will to reach out to your doctor or even better your physical therapist to develop a fitness program to address your needs.
Living through a stroke is a life changing experience. Often the life you once had is forever affected. However, a growing body of research is supporting that recovery can continue throughout a life time. Unfortunately, the course of therapy is usually limited. Personally, in the future, I see the fitness industry filling the gap by educating themselves in working with special populations such as stroke survivors. If you are a stroke survivor, don’t stop working toward recovery….ever. The process may be slow but it’s worth it.