A Basic Primer of the Effect of Stroke on Fine Motor Control

Every forty seconds, someone in the world is suffering from a stroke. Two thirds of the victims survive, mostly from an Ischemic stroke which accounts for 87% of all strokes.

What is an Ischemic Stroke?

An ischemic stroke occurs when there is an obstruction (blood clot) in the blood vessel supplying blood to the brain. Ischemic strokes are not to be confused with Transient Ischemic Attack (TIA) where the obstruction is temporary (an average of a minute) and cause no permanent brain injury.

An ischemic stroke limits blood flow to the brain damaging it. Aside from paralysis, speech defects, and vision problems, ischemic strokes can also impair the body’s fine motor control. Among all impairments stroke victims suffer from, fine motor control is one of the hardest to rehabilitate.

Without proper supervisions, stroke patients find the rehabilitation exercises for fine motor skills to be too demanding and repetitive with frustrating results that they quit halfway.

Fine Motor Control

Fine motor control is the coordinated movement of our skeletal, muscular, and neurological body functions. An example of a fine motor skill is picking up a coin, tying a shoelace, or typing on a keyboard. Stroke patients who have difficulty in performing these kinds of activity suffer a condition called hemiparesis.

There are two common kinds of hemiparesis; Pure Motor Hemiparesis and Ataxic Hemiparesis Syndrome. Pure motor hemiparesis is the most frequent type where stroke victims have face, arm, and leg weakness. Ataxic Hemiparesis Syndrome is the weakness or clumsiness of the body on one side.

Medical Professionals Involved in Fine Motor Skill Rehabilitation

The combined specialization of the following are needed to help a stroke patient rehabilitate his fine motor skills:

• Medical Physician – manages and coordinates the long term care of stroke patients. The medical physician also recommends which rehabilitation program the stroke victim needs the most.
• Rehabilitation Nurse – educates and helps stroke patients in the basic activities of daily living. They also work with the patient reduce risk factors that may lead to another stroke.
• Physical Therapists – specializes in treating motor and sensory impairments. They design programs specifically geared for the stroke patient in regaining control over their motor functions.
• Occupational Therapists – works in conjunction with the physical therapist in improving motor and sensory movements. An occupational therapist focuses on  helping stroke victims relearn skills needed for performing self directed activities, called occupations,  such as brushing teeth,  preparing for dinner, or washing the dishes.

The most important person in the rehab program is the patient himself. He must be totally focused and determined to reach the end and achieve the program’s goal.

When Should Stroke Rehabilitation Start?

Depending on the circumstance of the stroke, rehabilitation should start when the stroke victim is stable. This is usually is around 24 to 48 hours after suffering a stroke.

The common convention when it comes to post-stroke rehabilitation is that the most recovery a patient can achieve is within the first six (6) months after the attack. Recent research has found that additional functional improvements can be achieved as late as one (1) year.

With these findings, post-stroke patients can still look forward to a more functional and independent lifestyle even out of the six month rehabilitation period.

Rehabilitation after Discharge

After being discharged from the hospital, stroke victims have several options to look for stroke rehabilitation clinics and programs. These vary from country to country, these include:

• In-Patient Rehabilitation Facilities – these are usually integrated or separate from large hospitals. The duration of stay in these facilities range from two to three weeks. Daily rehab programs last around 3 hours a day, five days a week.
• Out-Patient Facilities – Almost the same program and program length as an in-patient facility but the patient returns home at night. Frequency of visit is three days a week.
• Nursing Facilities – Unlike traditional nursing homes, these facilities focus more on rehabilitation than residential care.

There are also home based rehabilitation programs to tailor suit the activities to the stroke victim’s requirement. Specialized equipment is usually not available but being surrounded by family can be more encouraging for some. This can be compensated by consulting specialists on how to go about this.

Sample Exercises to Rehabilitate Fine Motor Skills

• Forced Use – The patient’s functioning limbs are restrained so that the stroke patient is forced to use the impaired limb (i.e. Tying down the left hand so the patient has to use his right).  This is also called Constraint Induced Movement Therapy.
• Range of Motion Finger Exercises – The stroke patient plays with a rubber band with his fingers, twirling it, stretching it with his fingers, etc.  He also makes a fist with his hand, stretches out his fingers, etc. etc.
• Hand eye coordinated exercises – Placing a peg in a hole, shooting marbles, or picking up a coin with fingers.

There are other advanced methods of treatment such as the use of Botulinum toxin better known as Botox on the affected areas (to relieve spasticity), stimulating muscles with electricity, and even direct electrical stimulation of the brain (Cortical Stimulation). These treatments are usually upon the discretion of the advising physician and are not available to everybody.

After experiencing a massive stroke, a stroke victim does not have to give in and accept his condition. With determination, patience, and proper guidance, the stroke victim can rehabilitate his fine motor skills and lead a quiet, independent and happy life.

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