5 Activities To Increase Engagement Post-Stroke

By Meghan Fallon, PT, DPT

Physical Therapist

What can we do to better involve those who have experienced a stroke in daily life?

TODAY’S QUALITY CARE

When a stroke occurs, brain cells are destroyed due to lack of oxygen.  This event may result in both short and long-term sequelae:  Examples include impaired comprehension or production of speech, long-term muscular weakness or paralysis, decreased memory, reduced coordination resulting in unsteady walking, and increased difficulty with tasks such as standing from a chair.

If the drug Alteplase IV r-tPA, more commonly known as tPA, is administered within 3 and 4.5 hours of the initial stroke, the amount and severity of the injury are reduced.  Administration of tPA is one example of how modern healthcare is better managing those who suffer a stroke.

A societal shift toward prevention has revolutionized the outcomes of those who experience strokes, allowing for improved quality of life and for individuals to return to activities and hobbies quicker than ever before.

Utilizing the F.A.S.T. method (facial drooping, arm weakness, slurred speech, and time of occurrence), to recognize early stroke symptoms has allowed for the more timely provision of health care and thus better outcomes.  New blood pressure guidelines recommended by the American College of Cardiology and the American Heart Association allow for earlier identification of those with high blood pressure, a key diagnosis that can lead to stroke if unmanaged.

Neuroplasticity, the brain’s ability to reorganize itself and create new cells, is a crucial component of one’s recovery from a neurological incident such as a stroke.  Demain et al. were able to deflate the notion that there is a time-limit to the brain’s ability to make a positive change after stroke; in 2006, their research demonstrated that recovery was able to occur for longer than 6 months after the event.

In order for neuroplasticity to best occur, the patient needs to stress the area that has been affected by the stroke to signal the brain that it needs to change.  This is best achieved through skilled therapy services such as physical and occupational therapy and speech-language pathology.  For optimal results, these interventions need to be augmented by additional targeted activity, within the senior living community, to further enhance neuroplasticity.  The saying “practice makes perfect” may have never been truer!

For example, if a patient is experiencing weakness in their hand after a stroke, completing an activity with this hand increases the signals to the brain to create new cells, allowing for long-term retention of strength and functional improvements.  This is just one example of why it is important to physically challenge the body when the patient is re-entering their community as well as keep them engaged when they reach the chronic stages of the stroke.  The inclusion of those who have experienced a stroke in a community’s events is key to their continued long-term improvements, resulting in improved quality of life and participation in activities.

Five activities to increase resident engagement post-stroke:

GROUP EXERCISE

GENERAL EXERCISE CLASSES

Group exercise classes allow those who have experienced a stroke to challenge the musculature that has been weakened while simultaneously spending time with peers. Socializing and communicating with other residents and staff can assist in the person feeling a sense of inclusion and normalcy.

It is of the utmost importance that SLC staff understands the best way of communicating with a person who has had a stroke.  For example, oftentimes visual cues, as opposed to verbal, can make an immeasurable difference in the person’s comprehension and quality of life.

Group exercise classes often range in intensity, allowing the patient to challenge themselves and enabling neuroplasticity and prolonged functional gains.  For those with a chronic stroke, participating in exercise classes (and outpatient therapy) allows for a transition from a rehabilitation facility to the SLC while still improving the person’s functional strength.

YOGA AND TAI CHI

Multiple research studies link the completion of tai chi and yoga to improved strength, balance, and stamina.  These forms of movement are available to be modified to seated exercises, allowing for challenging physical activity that leads to increased neuroplasticity and, by extension, increased function for older adults post-stroke.

LEISURE ACTIVITIES

DEXERITY AND COORDINATION

Leisure activities commonly offered within an SLC can assist in regaining a patient’s dexterity and fine motor skills.  For example, playing bingo is a common activity available to residents which allows for increased participation in the community.  Bingo boards tend to be small, so utilizing a pen to cross off numbers is an excellent challenge for hand and upper extremity dexterity, allowing for neuroplasticity and long-term improvement.  Other activities with similar results include jewelry making, painting, and drawing due to the specific nature of the coordination necessary to complete these tasks.

SOCIAL ENGAGEMENT AND COGNITION

Puzzles, word games, and trivia are all examples of leisure activities that could prove beneficial for patients to participate in after reaching the chronic stages of a stroke.  Not only do these activities challenge the patient cognitively, but the group nature of them allows for increased communication among residents. This creates inclusion within the community as previously mentioned.

The importance of the emotional benefits of leisure and social activities cannot be overstated, as these can serve as motivating factors for the patient to continue stressing their body and minds for continued post-stroke improvements.

CAREGIVER SUPPORT GROUPS

While they do not physically challenge the patient, family support groups allow for a safe place for caregivers and family members to discuss the challenges associated with caring for a loved one who has experienced a stroke.  These meetings assist in maintaining the mental health of caregivers, reducing “burnout,” and allowing for increased positive interactions between the older adult and their caregiver.

Positive caregivers with the proper resources and adequate support can assist in facilitating neuroplasticity. They can help with home exercise programs, challenging the appropriate areas in need to help foster improvements with the older adult’s functioning.

These are just a sample of many options to increase older-adult engagement after they experience a neurological event such as a stroke.  With the aim of facilitating each individual’s goals to return to maximum function, we can assist the older adult to achieve what they once thought impossible.

While the people in this photo are a real FOX clinician and patients, they are not mentioned in this article.