🧠 Stroke & CVA Recovery 💪: Understanding the Brain, Body, and Unilateral Paresis Rehab

At Neuroplastic Rehab, we work with individuals and families navigating the complex journey of stroke recovery every day. Whether the stroke was ischemic or hemorrhagic, the road forward requires a tailored, patient-centered approach focused on both safety and possibility. This article will walk you through what a stroke is, the differences between stroke types, and evidence-based exercises we commonly use in therapy—especially when addressing unilateral paresis of the upper and lower body.

What Is a Stroke?

A stroke, or cerebrovascular accident (CVA), occurs when blood flow to the brain is disrupted—either blocked or bleeding—causing damage to brain tissue. In just a matter of minutes, neurons can begin to die without oxygen and nutrients, resulting in a wide range of functional impairments depending on the location and size of the injury (Campbell et al., 2019).

There are two main types:

1. Ischemic Stroke

This is the most common type of stroke, making up about 87% of cases (Benjamin et al., 2019). It occurs when a clot blocks a blood vessel in the brain. The blockage can stem from a thrombus (local clot) or an embolus (a clot that travels from another part of the body).

Common effects:

• Unilateral weakness or hemiparesis

• Language and speech difficulties

• Decreased balance and coordination

• Sensory changes

  
  

2. Hemorrhagic Stroke

This type occurs when a blood vessel bursts and bleeds into the brain. Though less common, it often results in more severe symptoms due to swelling and increased pressure in the brain (Feigin et al., 2014).

Common effects:

• Headache, vomiting, and altered consciousness

• More severe impairments depending on the bleed’s size and location

• Increased likelihood of surgical intervention and ICU care

  
  

Unilateral Paresis: What Happens When One Side Is Weakened

Many people experience unilateral paresis—partial paralysis or weakness on one side of the body—after a stroke. This can affect the arm, leg, hand, foot, or face, and may be accompanied by spasticity (tightness), flaccidity (limpness), or difficulty initiating movement.

At Neuroplastic Rehab, we emphasize neuroplasticity, the brain's ability to rewire and relearn through guided, repetitive, and task-specific activities (Langhorne et al., 2011). Exercises must meet the person where they are—starting in gravity-eliminated positions and progressing to movements against gravity and through functional tasks.

Rebuilding Strength: Exercises by Body Position

Here are evidence-based exercises used by therapists at Neuroplastic Rehab. These can be adapted for both upper extremity (UE) and lower extremity (LE) and modified based on strength, tone, range of motion, and overall functional level.

🛌 Supine (Lying on Your Back)

Upper Extremity

• Passive range of motion (PROM): Therapist or caregiver gently moves the affected arm.

• AAROM with Wand: Use a dowel to assist shoulder flexion and abduction.

• Theraband Chest Fly (horizontal plane): Tie band to headboard or assist from the side. Begin with low resistance.

Lower Extremity

• Heel Slides (AAROM): Use a gait belt or towel to guide the leg.

• Ankle Pumps (PROM → AROM): Promotes circulation and joint health.

• Theraband Ankle Dorsiflexion: Helps prevent foot drop and increase strength (Ada & Foongchomcheay, 2002).

Supine shoulder flexion with wand for PROM or AAROM

Supine heel slides with theraband for AAROM

🤲 Side-lying (on the stronger side)

Upper Extremity

• Scapular mobilization (PROM to AAROM): Mobilizes shoulder blade movement.

• Theraband External Rotation: Band anchored at waist level in gravity-minimized position.

• Pendulums: Gentle shoulder mobility, useful early on (Burridge et al., 2019).

Lower Extremity

• Clamshells with Theraband: Activates glute medius, helps pelvic control.

• Side-lying hip abduction (AAROM to AROM): Strengthens hip stabilizers.

🪑 Sitting

Upper Extremity

• Theraband Rows (horizontal plane): Band secured around feet or chair legs.

• Tabletop Towel Slides: Forward and side-to-side reaching for shoulder range.

• Overhead Wand Reaches: Use wand or pulley system for AAROM/AROM.

Lower Extremity

• Marching in Place: Begin with active assist and progress to independent.

• Seated Theraband Knee Extension: Strengthens quads; tie band to chair leg.

• Heel Raises/Toe Taps: Promotes ankle control and weight shifting (Pollock et al., 2014).

🧍 Standing (only when safe and cleared)

Upper Extremity

• Wall Push-ups: Improves scapular and arm stability.

• Diagonal Theraband Patterns (PNF): Targets functional reaching (D1/D2).

• Functional Reach Tasks: Placing items on shelves, light object transfers.

Lower Extremity

• Sit-to-Stand Transfers: Foundational task for mobility; may require CGA.

• Theraband Side-Stepping: Targets glutes and promotes lateral stability.

• Supported Heel Raises: Improve ankle strength and balance.

Wall push ups w/ hands pointed inwards for increased external rotation of shoulder and serratus muscle activation

Theraband side steps for strengthening hip abductors and gluteus medius

Neuroplasticity Takes Repetition, Intensity, and Hope

At Neuroplastic Rehab, we encourage individuals to start where they are, practice consistently, and remain hopeful. Brain healing doesn’t follow a fixed timeline, and every small gain builds toward larger functional improvements. Exercises involving AROM, AAROM, and PROM are a foundation for recovery—especially when integrated into daily tasks and meaningful routines. Remember, early intervention and consistency are key drivers of neuroplastic change (Kleim & Jones, 2008). With time, encouragement, and the right tools, the brain can absolutely relearn.

References

Ada, L., & Foongchomcheay, A. (2002). Efficacy of electrical stimulation in preventing or reducing subluxation of the shoulder after stroke: A meta-analysis. Australian Journal of Physiotherapy, 48(4), 257–267. https://doi.org/10.1016/S0004-9514(14)60280-6

Benjamin, E. J., Virani, S. S., Callaway, C. W., et al. (2019). Heart disease and stroke statistics—2019 update. Circulation, 139(10), e56–e528. https://doi.org/10.1161/CIR.0000000000000659

Burridge, J. H., Altmann, L. J. P., Hughes, A. M., et al. (2019). A review of upper limb recovery after stroke: Mapping recovery pathways and understanding responses to therapy. Neurorehabilitation and Neural Repair, 33(9), 773–784. https://doi.org/10.1177/1545968319868712

Campbell, B. C. V., Khatri, P., & Ntaios, G. (2019). Stroke. The Lancet, 393(10174), 1581–1592. https://doi.org/10.1016/S0140-6736(19)30050-9

Feigin, V. L., Lawes, C. M. M., Bennett, D. A., & Anderson, C. S. (2014). Stroke epidemiology: A review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. The Lancet Neurology, 2(1), 43–53. https://doi.org/10.1016/S1474-4422(03)00331-9

Kleim, J. A., & Jones, T. A. (2008). Principles of experience-dependent neural plasticity: Implications for rehabilitation after brain damage. Journal of Speech, Language, and Hearing Research, 51(1), S225–S239. https://doi.org/10.1044/1092-4388(2008/018)

Langhorne, P., Coupar, F., & Pollock, A. (2011). Motor recovery after stroke: A systematic review. The Lancet Neurology, 8(8), 741–754. https://doi.org/10.1016/S1474-4422(09)70150-4

Pollock, A., Baer, G., Langhorne, P., & Pomeroy, V. (2014). Physiotherapy treatment approaches for the recovery of postural control and lower limb function following stroke. Cochrane Database of Systematic Reviews, (4), CD001920. https://doi.org/10.1002/14651858.CD001920.pub3