Bilateral Exercises in Stroke Rehabilitation

Most of our movements are double-sided. Bilaterality in medicine is expressed by the term bilateral. While walking, our right and left legs should work together in harmony. Our arms also move mostly bilaterally. Even in most of the movements that we think we are doing with one hand, our other hand and arm do not stay idle. For example, when writing, we hold the pen with one hand and the paper with the other. Bilateral exercises are one of the physical therapy methods that have been shown to be effective in stroke rehabilitation.

The Weak Side Works Better With Two Sides

Studies in healthy people have shown that the quality of movement, accuracy and speed of the non-dominant hand increase when both hands are used while doing work. A similar situation has been found in individuals who have had a stroke. When the healthy arm and the paralyzed arm do the same movement at the same time, the paralyzed arm moves better. This applies to both equal and opposite movements. In stroke rehabilitation, bilateral exercises can be used to train the paralyzed side of the healthy side. Since walking cannot be performed with one leg, the paralyzed leg is forced to move together with the healthy leg in walking exercises. The arm and hand also benefit from this type of therapy.

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Bilateral Exercise Can Be Applied Even With Little Movement On The Paralyzed Side

Most of the methods used in the treatment of stroke after stroke require some active movement of the patient. For example, this movement can be improved by intense physical therapy ( compulsory use therapy , task-specific exercises, virtual reality, EMG biofeedback, etc.) in a person who can bend his fingers a little . However, if the person has little or no active movement, the therapy methods that can be applied are reduced. Bilateral exercises are among the methods that can be applied even in people with very little active movement. A small amount of movement from the shoulders and elbows is sufficient to work the arm and hand bilaterally. Even if there is no movement in the ankle, ankle movement can also be encouraged with the help of movement in the hip and knee.

Right and Left Sides Communicate at the Spinal Cord Level

The effectiveness of bilateral exercises is attributed to the communication of the right and left sides at the level of the spinal cord, apart from the brain. Most rhythmic movements are controlled by the so-called “central pattern generator” in the spinal cord. For example, the stepping motion observed when small babies are lifted and their feet touch the ground is the activity of the central pattern generator. Communication between the two limbs at the spinal cord level may be important in the recovery process in strokes caused by brain damage such as stroke. Bilateral work can also stimulate brain plasticity. In unilateral movements, one side of the brain hemisphere is suppressed, while in bilateral movements, both cerebral hemispheres are activated.

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Simultaneous, Same or Opposite Movements

In order to work the arm and hand bilaterally, generally the same but opposite movements are made on the right and left sides. Music can be used to maintain rhythm during exercise. The metronome can also be used for rhythm. The more similar the movement of the fortune teller side is to the healthy side, the better. If the movements seem too easy, complicating factors such as increasing the speed can be added. It is generally safe to perform the exercises in a sitting position. If it is desired to be done standing, there may be a risk of falling because factors such as balance, endurance, leg strength are added. Below are some examples of bilateral exercises for the arms and hands.

Same moves at the same time:

  • Passing the ball with both hands
  • Cloth folding symmetrically
  • Waving hands like you’re conducting an orchestra
  • Keeping tempo by striking hands at the same time
  • Placing objects close and far from the body
  • Two-handed picking of solid contents, such as beans, beads, from a container

Concurrent reciprocal movements:

  • Fisting gesture using the right and left hands alternately
  • drumming
  • Cloth folding asymmetrically
  • Rope pulling using alternate hands
  • Wiping the table with a cloth so that the hands make opposite movements at the same time
  • Hit the balloon alternately with one hand and the other

Similar exercises can be designed and performed for the legs and feet. Leg movements can be done while lying on your back or sitting.

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