Movement rehabilitation is essential for returning stroke survivors to their daily life after the impairment. This type of therapy plays a significant role in the rehabilitation of stroke patients, and the primary goals -amongst others- are to promote neuroplasticity and improve joint range of motion (ROM). Improving the ROM is vital for maintaining upper extremity functionality. Joints that are not moved can become stiff, leading to permanent deformities and pain. If this occurs, the patient may not be able to perform activities of daily living and can become dependent. ROM exercises can protect muscles and functionality by reducing joint contractures. ROM exercises are inexpensive methods that cover all muscle-joint groups and can be applied in any environment, whether in a group therapy setup or individually. It is recommended to perform ROM exercises twice a day. Each exercise should be repeated three times, holding the position for 30 seconds to move the resistance point. Joints should be sufficiently stretched but not forced. During movement, joints should be isolated as well as possible. Exercises should start slowly, and joint mobility should be gradually increased after each exercise has been completed/repeated several times.
ROM exercises can be done in two ways. Active Range of Motion (ARM) exercises involve moving one’s joints through active muscle contraction without the help of a therapist, caregiver, or device. ARM are classified into three different types according to the contraction of the muscles. During isotonic exercises, the muscles contract and shorten, resulting in active movement, increasing muscle tone, strengthening muscles, and increasing joint mobility. Muscle contraction occurs without shortening in isometric exercises, and the joint does not move. Isometric exercises aim to increase muscle volume and strength and improve muscle tone. Isokinetic exercises involve muscles contracting against resistance. Passive Range of Motion (PRM) exercises involve moving the joint with the help of another person and/or device without muscle contraction.
Weakened muscles can be re-educated via stretching exercises. Stretching exercises cause the lengthening of the muscles by stimulating the nerves and increasing the ROM of the joints. In addition to its positive effects on joint ROM, stretching exercises performed four or five times in the early stage and lasting for 30 seconds can reduce muscle tension and increase muscle flexibility. It is recommended to perform stretching exercises for the main muscle-tendon groups for at least 10 minutes and for each muscle group 2-3 times a week or more. Stretching exercises include static stretching exercises, ballistic stretching exercises, dynamic stretching exercises, and the proprioceptive neuromuscular facilitation technique.
Static stretching exercises involve stretching the muscles to a certain point and holding them fixed at that point for 10-30 seconds. Static stretching exercises are divided into three types: active stretching, passive stretching, and isometric stretching.
Ballistic stretching exercises involve exercising the body’s own weight and forcing the normal limits of joint range of motion. In this type of exercise, the stretched muscle fibers are contracted in the form of springing.
Dynamic stretching exercises involve attaining a normal range of motion by performing controlled stretching exercises using the body’s weight, without forcing the normal limits of the joint range of motion, and without performing exercises in the form of springing.
Proprioceptive Neuromuscular Facilitation (PNF) techniques involve combining multiple stretching methods to apply proprioception, which is the body’s ability to respond appropriately to stimuli through muscle nerve transmission to single or group muscles. Proprioceptive exercises can include weight-bearing, balance, and walking exercises and can be performed with the eyes open or closed, on one or both legs, and various exercise surfaces with different characteristics.
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