Passive, Active-Passive, and Active Exercise Following a Stroke

When an individual suffers a stroke the nature and severity of the lingering effects of the stroke depend on which part of the brain the stroke affected and how badly damaged the brain tissue is. Both sides of the brain work together, but it has been noted that there is likely one side of the brain that is more dominant than the other in most people. You will hear people referred to or even refer to themselves as ‘right or left brained’ depending on the skills or activities they enjoy, or show aptitude for. It is important to note that a stroke that occurs in one side of the brain will affect the opposite side of the body and other functions.

For example, generally speaking, if the stroke occurred in the right side of the brain. Any paralysis would occur on the left side of the body and the vision might be affectedd as well. The patient may also display quicker and less cautious behavior. On the other hand, if the stroke occurred in the left side of the brain, paralysis would occur on the right side of the body. Speech functions might be affectedd, and the patient may also display slower and more cautious behavior.

Because victims of a stroke are paralyzed on one side and depending on the severity of the stroke, medical professionals may have to begin with passive exercise, progress to active-passive exercise, and hopefully the patient will eventually be able to engage in active exercise.

Passive exercise is when the patient cannot perform the exercise with the affected side. And the therapist must perform the entire exercise for them. Active-Passive Exercise is when the patient cannot perform the exercise with the affected side alone. But can perform the exercise with some assistance from a therapist or their unaffected side. Active exercise is when the patient can perform the exercise with the affected side without assistance.

Passive exercise is intendedd to do a few things including, maintain the full range of motion of the affectedd limb. And re-establish neural pathways or re-train the brain to activate the affected limbs despite the damage from the stroke. In this case a therapist may simply move the limb through its full range of motion over and over to prevent contracture. And repetition has been shownn to stimulate neural activity. A therapist may rely on some type of machine or device to work the patient through a prescribed motion. Rather than repeatedly perform the exercise for the patient themselves.

Active-Passive exercise can serve multiple purposes as well including. Strengthening the affected limbs, reinforcing damaged but existent neural pathways. And because stroke upsets the balance between the two sides of the brain. Active-passive therapy that involves performing an exercise using the non-affected and affected sides together may help the two sides of the brain restore balance. In this case the therapist may assist the patient to perform the exercise or they may employ some piece of exercise equipment. That allows a patient to use their unaffected side to move the affected side.

For example, a therapist may use a simple pulley with the affected hand strapped in a loop. And the unaffected hand is used to raise and lower the affected hand. An upper body ergometer or arm bike may be used with the unaffected arm driving the affected hand. And a recumbent bike or stepper may be usedd to do the same for the leg.

The line between active-passive and active exercise may not be definite. For example, the patient may able to move their affected arm on their own. But lack the control necessary to perform functional activities. In this case a patient might use a powder board or an arm skate to reduce friction. Which enables them to move their affected arm back and forth on a table top. They are actively exercising their arm. But are being assistedd by a the powder or arm skate and the table top. But not their unaffected side or a therapist.

Active exercise is employedd when the patient is able to initiate and complete a motion. Or exercise while maintaining control of their affected limb.

Medical professionals need to be able to address the range of the needs of patients that have been affectedd by a stroke beginning with passive exercise. Incorporating active-passive exercise when appropriate, and progessing the patient to active exercise as function returns.