4 evidence-based strategies to help you on your journey towards stroke recovery

The Bottom Line

  • Globally, stroke has been identified as a top cause of death and disability.
  • Mirror therapy may improve movement in arms and legs affected by paralysis due to stroke and increase the ability to conduct activities of daily living.
  • Walking training can improve walking speed, walking distance, and self-care post-stroke. Results may vary depending on the type of walking training and number of months post-stroke.
  • Speech language therapy improves language and communication skills following a stroke.
  • Consult with your health care team about if and how to incorporate one or more of these strategies into your rehabilitation plan. 

Stroke is one of the leading causes of death and disability worldwide (1;2). Folks who suffer and survive a stroke can face a variety of temporary or permanent disabilities that differ in severity and impact their ability to complete activities of daily living. For instance, approximately 80% of people experience limitations moving their arms or legs following a stroke, while over 30% encounter difficulties communicating (3-5). These problems can feel like insurmountable obstacles on the road to recovery. However, research has identified four strategies that can help address these issues and aid with rehabilitation efforts (3-9). Click on the links below to learn more.

1. Mirror therapy 

Mirror therapy is a technique that involves placing a mirror in between the arms or legs of the person who has had a stroke. The mirror produces a reflection of the arm or leg not experiencing paralysis. When the person moves their working limb, the mirror makes it appear as though the paralyzed limb is moving. Research shows that mirror therapy may be safe and effective in improving movement in upper and lower limbs that have been impacted by a stroke, as well as the ability to conduct daily activities. These benefits can be seen for up to 6 months or more following a stroke; however, larger, high-quality studies are needed to further support these results. Bonus points: mirror therapy has the potential to be completed at home and without supervision (3).

2. Virtual reality and video games

For adults with an acquired brain injury stemming from stroke or head trauma, play-based therapy encourages them to, well…play. Research shows that technology-based games and activities—such as video games and virtual reality—can improve independence and balance in people with acquired brain injuries, generally due to stroke. This strategy appears to be enjoyable for patients and more effective than usual therapy options (6). Additional evidence suggests that virtual reality therapy can lead to small improvements in overall arm function, the level of motor impairment, and the ability to perform activities of daily living. Virtual reality therapy that immerses people more deeply within the virtual environment is most beneficial (7).

3. Walking training

Traditionally, walking training combines walking with the use of vital walking aids or devices and verbal and manual guidance. Sometimes, additional techniques include musical feedback and treadmill training. Research shows that walking training that includes musical feedback or treadmill training can improve walking speed and walking distance in adult stroke patients one to six months post-stroke, compared to traditional walking training. For patients that are more than 6 months post-stroke, participating in any type of walking training has the potential to enhance walking ability, speed, and distance, compared to receiving no treatment, placebo, or physiotherapy. Lastly, peoples’ ability to care for themselves may also improve with walking training (8).

4. Speech language therapy

Following a stroke, some people experience aphasia, a language disorder characterized by difficulty speaking, listening, understanding, reading, and writing (9). Research shows that speech language therapy enhances language and communication skills in people with aphasia. What is more, it appears that “higher-intensity” speech language therapy can lead to quicker and greater improvements. This level of intensity can be achieved by increasing the number of sessions and/or their duration (10). However, speech language therapy may not be accessible to all; access can depend on whether it is offered in a particular location and cost.

Stroke recovery can be difficult and frustrating. But survivors are not alone; there are a variety of evidence-backed strategies that support improving or regaining limb function, independence, language skills, and the ability to complete necessary and desired activities of daily living. Folks who have suffered a stroke should speak with their health care team about the different strategies that can be incorporated into their rehabilitation plan; and how to do so safely and in a way that optimizes success.

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  1. World Health Organization. The top 10 causes of death. [Internet] 2020. [cited April 2022]. Available from https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death
  2. World Health Organization. WHO reveals leading causes of death and disability worldwide: 2000-2019. [Internet] 2020. [cited April 2022]. Available from https://www.who. https://www.who.int/news/item/09-12-2020-who-reveals-leading-causes-of-death-and-disability-worldwide-2000-2019
  3. Thieme H, Morkisch N, Mehrholz J, et al. Mirror therapy for improving motor function after stroke. Cochrane Database Syst Rev. 2018; 7:CD008449. doi: 10.1002/14651858.CD008449.pub3. 
  4. Barker WH, Mullooly JP. Stroke in a defined elderly population, 1967-1985. A less lethal and disabling but no less common disease. Stroke. 1997; 28(2):284-290. doi: 10.1161/01.str.28.2.284.
  5. Engelter ST, Gostynski M, Papa S et al. Epidemiology of aphasia attributable to first ischemic stroke: Incidence, severit, fluency, etiology, and thrombolysis. Stroke. 2006; 37(6):1379-1384. doi: 10.1161/01.STR.0000221815.64093.8c.       
  6. Saywell N, Taylor N, Rodgers E, et al. Play-based interventions improve physical function for people with adult-acquired brain injury: A systematic review and meta-analysis of randomized controlled trials. Clin Rehabil. 2017; 31(2):145-157. doi: 10.1177/0269215516631384.
  7. Jin M, Pei J, Bai Z, et al. Effects of virtual reality in improving upper extremity function after stroke: A systematic review and meta-analysis of randomized controlled trials. Clin Rehabil. 2022; 36(5):573-596. doi: 10.1177/02692155211066534.
  8. Peurala SH, Karttunen AH, Sjogren T, et al. Evidence for the effectiveness of walking training on walking and self-care after stroke: A systematic review and meta-analysis of randomized controlled trials. J Rehabil Med. 2014; 46(5):387-399. doi: 10.2340/16501977-1805. 
  9. Stroke Recovery Association of British Columbia. What is Aphasia? [Internet] 2013. [cited April 2022]. Available from https://strokerecoverybc.ca/about-aphasia/
  10. Brady MC, Kelly H, Godwin J, et al. Speech and language therapy for aphasia following stroke. Cochrane Database of Syst Rev. 2016; 6:CD000425. doi: 10.1002/14651858.CD000425.pub4.

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