Guide To Recovering Hand Function After A Stroke

Henry Hoffman
Saturday, September 30th, 2017
Last modified on November 8th, 2022

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Stroke rehabilitation is often a slow, gradual journey, and it is not uncommon to feel that a physically, mentally, and financially challenging road lies ahead. But with ever-expanding modern therapies to recover hand function, there are many ways to approach the rehabilitation process without extravagant costs or discomfort.

Recuperation from the effects of stroke should be taken one day and one issue at a time, each increment of progress building into the next. Small repetitive actions are easier to take on in the months just after a stroke, when balance and strength have yet to be restored and the rate at which neuroplasticity takes place is at its highest.  

Basic hand exercises are encouraged as soon as the recuperative process begins, giving hope and direction at the start of the road to recovery. Whether a portion of dexterity has already returned to the hands or the journey is just beginning, hand rehabilitation exercises aim to reinforce strength and motor skills often weakened during a stroke.

The following are common reactions survivors have after a stroke:

Muscle Spasticity

When a stroke occurs, the hands may experience increased tone or stiffness due to disrupted connections between the brain and the hand muscles, this is called spasticity. Without this strong neural connection, it may become more difficult to fully straighten the fingers or grasp an item.

As hands recover, strong signs of improvement include complete extension of the fingers without assistance. Simple, repetitive rehabilitation exercises strengthen the missed connections between the mind and muscles, adjusting the pathways and preventing the spasms. A series of treatments are often prescribed to relax, stretch, and strengthen the hand muscles.

Hand Strength and Function

The grip, strength, and overall function of the hands is often additionally impaired, making it difficult to completely lift, grasp, or release items. This complicates everyday tasks and possibly the ability to be independent with functional activities. Additional issues include loss of sensation—sometimes causing a pins-and-needles feeling—or periods of swelling. Intensity of pain and loss of sensations caused by the stroke are often dependent on whether the neurological damage occurred on the dominant or non-dominant side of the brain.

Are you at risk for poor hand recovery? Take our Hand Recovery Quiz to find out now!

Stroke recovery succeeds when a supportive and knowledgeable team aids in both the specific and overarching goals of rehabilitation. A team of therapists, caretakers, and family members are key in regaining or surpassing the pre-stroke level of health. As mentioned above, decreasing hand spasticity and increasing strength and motor function are often two of the main focus points in initial stroke rehab when it comes to regaining upper extremity function.

The most important aspect of a stroke treatment regimen is consistent participation. Overall, repetition and regularity are the best ways forward with any treatment program. This promotes neuroplasticity—the capability for the mind to form or repair connections—which grow out of consistency. Much like learning an instrument or practicing a new language, you must activate the same part of the brain with repeated information to fortify the connections.

Exercises are one approach to reconnect the lost or damaged neurological pathways in need of repair that the stroke has caused. Simple and repetitive actions such as picking up small objects, stringing beads, or assembling puzzles may be combined in a treatment program to address the recuperation of fine motor skills. Each exercise is modified depending on the limitations of the person’s hands. Gross motor exercises for those with little to no hand function are also encouraged, such as steadying a rolling ball on a table’s surface or various stretching exercises to decrease spasticity.

Though stretching can feel less active, it is incredibly beneficial post-stroke. The greater the range of motion achieved, the more improvements have been found in tendon recovery, overall sensation, and mobility in the hands and fingers.

While implementing the stretching workouts that your therapist has recommended, slight discomfort may occur, but this should never extend to extreme pain or numbness. Just like with any exercise, stretching should move slowly and gradually, only increasing as flexibility and comfort improve. Lengthen the duration of a stretch as you progress, only increasing the practice further when it is safe and comfortable to do so.

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Mirror Therapy

A simple yet effective way to enhance the neuroplasticity in the brain, mirror therapy involves opening one side of a medium-sized box and securing a mirror to the outside wall that faces the affected side. The affected hand lies inside the box out of sight as the healthy one sits outside, catching the reflection. Ordinary, “mirror symmetric” actions are explored by the healthy hand, and the reflection aids the mind in visualizing the hands on both sides of the body responding accordingly.

Sensory Stimulation Therapy

Sensory Stimulation Therapy provides low-level stimulation (i.e., without producing a muscle contraction) to the hand and arm, increasing signals delivered to the brain. This form of treatment primes the cortex so that more activation appears during therapy or when performing a functional task. This new increase in activation can lead to improved sensory/motor recovery, function and cortical reorganization. The SaeboStim Micro provides sensory electrical stimulation (SES) to the arm and hand using a specialized Electro-Mesh Garment. This is worn like a glove and is intended to be worn for everyday tasks and rehabilitation exercises. The glove is lightweight and comfortable to wear and use. The SaeboStim Micro consists of an elbow sleeve for arm stimulation. and a glove for hand stimulation.

TENS Therapy

TENS Therapy, or Transcutaneous Electrical Nerve Stimulation sends small, pain-free electrical pulses into the sensory nerves of the affected region and is said to ease pain and numbness for stroke patients and other sufferers of chronic pain. TENS devices work by sending stimulating pulses across the surface of the skin and along the nerve strands in a glove word. The stimulating pulses help prevent pain signals from reaching the brain. It also helps stimulate the body to release endorphins.


Constraint-Induced Movement Therapy (CIMT) centers around the concept that by restraining the functional limb during waking hours, stroke survivors are forced to depend more on the damaged side, strengthening it in the process. Stroke survivors in the early stages of stroke recovery and learned non-use are the best candidates for this method of therapy. This therapy discourages learned non use which is the reliance on the healthy limb for everything.

Active-Passive Bilateral Therapy

Similar to the concept of mirror therapy, active-passive bilateral arm therapy uses repetitive motions between two sides of the mind to rebuild the half that was affected by the stroke. Switching between the right and left hand, simple movements are mimicked repetitively back and forth, the damaged side imitating the stronger one. This activates similar neural patterns in alternating sides of the brain, assisting the neuroplasticity on the damaged side.

Read more  Acute Secondary Prevention of Ischemic Stroke: Overlooked No Longer


FES (Functional Electrical Stimulation) is a technique that uses low energy electrical pulses to generate movement similar to TENS therapy but focuses more specifically on the motor neurons to increase muscle growth and re-stimulation. Small electrodes are placed on the affected muscles, sending out a light pulse to direct the muscles to contract. The goal when using this method of therapy is to restore voluntary function in the short-term. The Saebo MyoTrac Infiniti is a comprehensive, portable biofeedback electrical stimulation system designed for orthopedic and neurological patients. The device delivers stimulation to the targeted muscles based on the client’s very own EMG signal.  


Recognized for benefitting a wide range of ailments—including migraines, anxiety, and physical therapy—biofeedback provides physical reinforcement cues when patients complete particular exercises. Electrodes are placed on affected areas of those healing from a stroke, and visual feedback is generated when a simple movement is completed correctly. This trains the mind to seek out these actions, rewiring its original pathways to favor the desired outcome.

Robot-Based Hand Motor Therapy

One of the primary goals of robot-based hand motor therapy is consistent improved steadiness and hand function, traits often challenging to attain when the muscles have yet to heal. This is especially difficult to maintain as you become more tired toward the end of the therapy session. Robotic devices gently support and guide movements of the hand to increase exercise consistency.

Rehabilitation aids available at Saebo can both advance recovery and provide essential support throughout the course of recuperation. There are several options depending on the needs of the patient. At Saebo, we have three core product lines for hand rehabilitation: The SaeboFlex, SaeboGlove, and SaeboStretch. These three products have aided in the re-establishment of limited motor function after suffering a stroke or other neurological or orthopedic condition.


Saebo’s functional dynamic orthoses are specifically designed for people suffering from a neurological injury such as a stroke, head injury, and incomplete spinal cord injury. The SaeboFlex gives people the ability to perform grasp-and-release activities, which allows them to participate in task-oriented hand training. Evidence-based research supports this training as critical to recovery. The SaeboFlex is appropriate for individuals with minimal to severe tone/spasticity.

The SaeboFlex is a high-profile orthosis with an outrigger system that covers the back of the hand, fingertips, and forearm. This orthosis positions the wrist and fingers into extension to prepare them for grasp and release exercises. With the assistance of the SaeboFlex, the user is able to grasp objects by voluntarily flexing his or her fingers. Once the fingers relax (stop gripping), the extension spring system assists in re-opening the hand to release the object.


The SaeboGlove is a low-profile, lightweight glove that helps clients suffering from neurological and orthopedic injuries incorporate their hand functionally in therapy and at home which may lead to improved motor recovery and functional independence. The proprietary tension system has elastic bands that offer various tensions for individual finger joints. The tension system extends the client’s fingers and thumb following grasping and assists with hand opening.

The SaeboGlove is appropriate for individuals with minimal to little spasticity or contractures People with moderate to severe soft-tissue shortening would need an orthosis like the SaeboFlex. The SaeboGlove can be worn to assist with day-to-day functional tasks and during grasp-and-release exercises/activities. Saebo Glove’s technology stems from the research surrounding neuroplasticity, and the brain’s ability to recalibrate and reconnect otherwise lost neural connections necessary for strength and extension.


The SaeboStretch is a soft and adjustable dynamic resting hand splint recognizable for its unique strapping and energy-storing technology and energy-storing technology. This splint is worn to stretch and prevent soft-tissue shortening and helps neurologically impaired clients maintain or improve motion. Saebo’s energy-storing technology allows the fingers to gradually return to the optimal stretched position if tone has occurred, resulting in increased comfort. and compliance.

SaeboStretch is appropriate for people suffering from minimal to moderate spasticity. The orthosis includes the choice of three tension plates that offer various levels of resistance depending on the amount of tone and spasticity the individual has. The flexible hand plates also prevent or minimize joint pain and deformities. The SaeboStretch can be worn during the day or when sleeping.

Hand-focused therapies have more extensive benefits than simply progressing the recovery of stroke. According to the American Heart Association, medical professionals also notice improvements in psychological well being, overall endurance, and a lowered risk of future stroke. As with all exercise, a consistent regimen for rehabilitation aids all parts of the mind and body, sustaining healthy circulation, coordination and strength. And as more of these factors are improved, the lower the risk for cardiovascular-related problems or accidents is, such as trips or falls.

Stroke rehabilitation can feel slow or frustrating at times, but reconnecting lost neural connections is a steady and gradual process, and is supported by strong research.

Benefits of Rehabilitation Gloves and Hand Splints for Stroke Recovery

How to Get the Most From Your Hand Strengthening Program Following A Stroke

Recover Hand Weakness After a Stroke 

How to Combat Fine Motor Loss in Hands

25 Hand Exercises for Stroke Recovery

All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Saebo website is solely at your own risk.

— Update: 01-01-2023 — found an additional article Important Facts About Stage 4 of Stroke Recovery from the website for the keyword https the-stages-of-stroke-recovery.

Henry Hoffman
Friday, January 5th, 2018
Last modified on September 9th, 2022

Evidence-Based Treatment

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In the 1970s, a Swedish occupational and physical therapist named Signe Brunnstrom developed a seven-stage approach to stroke recovery. The focus of the Brunnstrom Approach is the restoration of motor control following a stroke. Therapists and doctors use this approach to evaluate the progress of stroke recovery and guide their interventions. Engineers and technologists also use this process to help them build tools that will effectively support stroke recovery.

When a stroke patient reaches stage 4, they have already regained some motor control. Throughout this stage, voluntary movement will go from difficult to easy. Although there is still some involuntary movement and spasticity (tightness of the muscles), they have greatly diminished since the beginning of the recovery. Both will continue to decline as patients move through this stage and into the next one.

Patients will regain control mostly in the extremities, and they will have a limited ability to move normally. The movements may still be out of sync with muscle synergies, but this will improve quickly over the length of this stage.

The focus during this stage is to strengthen and improve muscle control.

This process of movement is controlled by the brain, which uses feedback from the senses to plan, adjust, and complete the movement.

First, the brain needs visual information to locate the target (a mug, for example). Then, the frontal lobe calculates the reach needed and sends a command to the muscles. The nerves of the spinal cord transmit the information to the hand, and smaller motor neurons distribute the message to the correct muscles. When the hand touches the mug, the sensory receptors send a message back to the brain saying “we’ve made contact.” This information goes up through the spinal cord, and parts of the brain called the basal ganglia and the cerebellum make adjustments and finally confirm to the brain that the mug is securely in the hand.

Read more  The Effect of Sneezing on the Reduction of Infarct Volume and the Improvement of Neurological Deficits in Male Rats

During the second it takes to reach for a mug and grasp it, the brain does the following:

  • It plans a strategy for grasping the mug by calculating the order of movements, their direction, strength, and timing. It needs to predict the movements relative to one another, the duration of each movement, and whether they are phasic (transient movements) or static (stabilizing joints).
  • It initiates the movement.
  • With feedback from the environment, the brain makes adjustments in the posture and limb positions required to complete the task.
  • Once the task is completed, the brain stops the movement.

Muscle control is essential for performing even the most ordinary tasks. Without the ability to initiate, adjust, or stop a movement, we couldn’t walk or feed ourselves.

Now that you are regaining motor control and can start to make normal, controlled movements on a limited basis, you can start to build strength back in your limbs and continue work on your range of motion. Continuing to stretch out your muscles is still important in this stage.

All exercises should be performed in moderation. Fatigue will only increase your weakness and rob you of energy needed for your daily routines and the activities you enjoy.

Active-Assisted Range of Motion Exercises (AAROM)

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Therapists use active-assisted range of motion (AAROM) exercises when a stroke patient has some ability to move but still needs help to practice the exercises or complete the movement. A therapist may help guide the movement with their own body (hold the limb, for example) or use bands and other exercise equipment to support the patient. Gravity-assisted devices such as the SaeboMAS, are beneficial in helping the patient perform the movements.

Active Range-of-Motion Exercises (AROM)

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You can begin active range-of-motion (AROM) exercises once you have regained some muscle control and can perform some exercises without assistance. They often involve moving a limb along its full range of motion, like bending an elbow or rotating a wrist. AROM exercises increase flexibility, muscle strength, and endurance. Range-of-motion exercises should be practiced equally on both the affected and unaffected sides of the body.

AROM and other active exercises help rebuild the neural pathways that control movement. The more you do them, the stronger and better you will get.

Stroke Recovery Gloves

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Stroke recovery gloves work a little bit like splints and can help improve muscle control as practice-active exercises. Rehabilitative supports like the SaeboFlex and the SaeboGlove imitate the natural movement of limbs, thus making it possible to grasp and release objects, even if you have spasticity.

Devices like stroke recovery gloves help build your muscle synergy and increase your muscle control, which will contribute to your ability to perform daily tasks with more and more control and accuracy.

Stretching Exercises

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Regular stretching of muscles is essential to regain muscle control and range of motion. A stroke can cause muscle tightening and shortening and joint contractures. Stretching helps with all of these issues. Sometimes, stretching requires a splint or other rehabilitative tool for extra support.

Light Resistive Exercises

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Once you have regained some muscle control, it will be important to strengthen your muscles with light resistive exercises. Weight exercises will also help to prevent bone loss. A decrease in bone density happens when muscles are not used or are underused; it can cause brittle bones, which puts you at a higher risk of bone fracture. You should do these weight-bearing exercises for both your arms and your legs.

Strengthening and Resistance Training

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These exercises are similar to resistive exercises, but resistance training can also be done with bands, tubing, exercise machines, and putty, for example. The basic principle is to move the muscles against a resistance so that they get stronger over time. The exercises should only be done once you’ve regained enough control over your muscles to manage normal movement for a short period of time.

Of course, when it comes to building a stage 4 stroke recovery exercise program, you should always consult a professional physical or rehabilitation therapist. They can help you with exercise specifics, finding the right tools and equipment, and, of course, to provide assistance, especially in the beginning.

Remember: the goal of stage 4 is to regain enough muscle control to perform daily tasks normally at least some of the time. The following stages will help you regain more muscle control, range of motion, and endurance so that these daily tasks become easier and easier.

All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Saebo website is solely at your own risk.

— Update: 01-01-2023 — found an additional article Important Facts Of The First Stage Of Stroke Recovery from the website for the keyword https the-stages-of-stroke-recovery.

Henry Hoffman
Monday, April 16th, 2018
Last modified on July 27th, 2022

Electrical StimulationEvidence-Based TreatmentMental ImageryMirror TherapyNeuroplasticitySaeboStim MicrostrengtheningWeakness

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Every stroke is different, and every patient’s stroke recovery experience is, too. Just as your symptoms depend on the severity of the stroke and treatment you received, your ability to regain certain functions and work toward recovery will also depend on a variety of different physical factors. However, it helps to know a little more about what to expect in the days and weeks ahead.

You’ve learned about the different stages of stroke recovery, but in order to simplify this experience and improve recovery odds, it’s important to understand more about each stage. If a patient or loved one has recently experienced a stroke and lost motor control on one side of their body, they’re probably in Stage 1 of their recovery process.

But what exactly does “Stage 1” mean, and how can patients and their caregivers navigate this first chapter of the journey toward recovery? Let’s start by breaking down the nature of this first stage. After you understand the basics of your Stage 1 progress, start applying some of the most helpful recovery techniques to reach the second stage.

What is Stage 1 of Stroke Recovery?

Stroke involves the deprivation of oxygen to the brain. This damage usually occurs in a specific region of the brain, and if oxygen is not restored quickly enough, it may permanently kill or damage brain cells, resulting in varying levels of paralysis. Because of the way the brain interacts with nerves and muscles, damage on the left side of the brain can result in paralysis on the right side of the body, and vice versa.

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After stroke, your brain isn’t simply damaged; it’s actively responding to this damage and attempting to protect itself from further trauma. This response may evolve throughout the stages of stroke, but it usually starts with flaccid paralysis.

Flaccid Paralysis

Stage 1 actually represents this initial period of shock immediately after stroke. Flaccid paralysis, a medical term for complete lack of voluntary movement, often sets in during Stage 1. This paralysis is caused by nerve damage that prevents the muscles from receiving appropriate signals from the brain, whether or not the brain is still capable of moving those muscles.

Read more  The sensory side of post-stroke motor rehabilitation

When a stroke survivor is in this early state of flaccid paralysis, they cannot initiate any muscle movements on the affected side of their body. If this continues for long enough without intervention or physical therapy, the unused muscles become much weaker, and begin to atrophy. Simply put, muscles need to be used in order to retain their tone and definition, and flaccid paralysis prevents muscles from doing this important work.

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Hypotonia is the medical term for this low muscle definition, which causes weakness and numbness that seriously interferes with a patient’s quality of life. In addition to therapy exercises and treatments that reduce the severity of hypotonia, this Stage 1 condition also requires lifestyle modifications to protect the affected limbs from injury.

Hypotonia increases a patient’s risk of injury and deterioration as they recover because they are not able to sense trauma or reposition their limbs themselves. Fortunately, their unaffected body parts can play a big role in recovery. Limbs affected by hypotonia may be moved and supported by the unaffected limbs or assistance devices, which may range from an arm support for your arm to a footrest for your wheelchair. This prevents limbs with hypotonia from getting injured.

Caregivers also serve an important role in helping patients to minimize injury risks and speed up the pace of healing during hypotonia. It’s caused by serious sensory loss, so it can be severely debilitating for patients who are also dealing with the psychological trauma of stroke.

Stimulation of the affected muscles is one way to kick-start the body’s healing process. For example, brushing the flaccid biceps or triceps gives sensory input that prompts natural responses from your body. It’s important to understand all the exercises designed for minimizing complications and keeping patients comfortable after stroke.

What are the Best Treatments for Hypotonia and Flaccid Paralysis?

Though stroke does serious neurological damage, other healthy brain cells and muscles can help make up for some of this damage. In fact, the patient’s own body is full of tools that reduce complications and increase their likelihood of entering new stages of recovery. It’s never too early to start retraining the body and brain after stroke, even if patients are still experiencing flaccid paralysis and hypotonia.

Some of these exercises are particularly useful for patients who want to enter the next stage of recovery:

Supporting Affected Limbs with Unaffected Limbs

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Because the muscles can’t contract at all during flaccid paralysis, it can be helpful for recovery to use the working limbs to help support the flaccid ones. Doing passive exercises involving your stronger arm to produce the forces needed to move and manipulate the disabled arm will help prevent muscle shortening and joint stiffness. Having your stronger arm help your weaker arm with common activities such as pushing objects on a table or grasping a bottle, will help keep the arm moving and start the process toward retraining the arm to be back to normal.

Passive Range of Motion

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Passive range of motion exercises involve using the strong arm or a caregiver’s assistance to move the affected arm or leg through a series of movements to help prevent joint contractures and maintain joint flexibility. It’s important that patients do these exercises without pain. There are many different Flexion and Extension exercises you can do to help build arm recovery. Check out Physio Therapy Exercises for helpful how tos and pictures of passive range of motion exercises you can do.

Muscle Facilitation

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Muscle facilitation includes techniques such as  tapping, sensory electrical stimulation and quick stretches. Muscle facilitation, especially tapping, effectively stimulates the proprioceptive sense, muscle spindles, Golgi tendons, etc., and strengthens muscles in the affected parts. Specifically with Sensory Electrical Stimulation (SES), it is believed to enhance the neural plasticity and activate brain areas, helping with stroke recovery. Studies show that providing SES to an impaired nervous system can prime the cortex ultimately leading to improve neuroplasticity, motor recovery and function. Using a Sensory Electrical Stimulation tool like the SaeboStim Micro is perfect for stroke patient in stage 1 of stroke recovery suffering from flaccid paralysis in their hand and wrist.

Movement Exercises

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Repeatedly using the arm to complete tasks is effective for recovery after a stroke. Doing basic exercises such as straighten a leg, moving a leg onto a bed, having a patient manipulate a cane up and down, rolling a ball backward and forward and sliding a hand across a table can all help functional context. Repetition is key for recovery much like practice is key for performance.

Mirror Box Therapy

A mirror box can help with neuroplastic changes to help with stroke recovery. In a mirror box, the patient places a good limb outside the box with a mirror, and the flaccid one into the box. The patient then looks into the mirror on the side with the good limb and makes “mirror symmetric” movements. It has been suggested that visualizing and undertaking symmetrical, bilateral movements, like this, post-stroke enhances neuroplastic changes within the brain. Through the use of this simulated visual feedback, it becomes more possible for the patient to move the stroke-affected limb, and possibly unclench it from potentially painful positions.

Mental Visualization

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Like the mirror box, mental visualization can also help with neuroplasticity. Even as the patient experiences lack of voluntary muscle movement, they can still these movements. Mental rehearsal and visualization of movement can produce similar effects as practicing the actual movements. Imagining hand movements can stimulate restitution and redistribution of brain activity, which accompanies recovery in overall hand function.

Getting Over The Hump Of Stage 1 Of Stroke Recovery

In stage 1 of stroke recovery, a patient is in an initial period of shock and flaccid paralysis and hypotonia is very common. Movement may be very hard and painful during this stage. The best treatment you can do for are some of these treatments but take them slowly. Most stroke treatments require some basic supplies and the help of therapists or caregivers, so make sure you understand the best exercises and supplies for each stage of the stroke recovery process. With the right preparation and focus, Stage Two of the the Brunnstrom Approach will be that much easier to graduate to.


Whether you are a caregiver, occupational therapist or even a stroke survivor yourself, Saebo provides stroke survivors young and old with access to transformative, life-changing products. We pride ourselves on providing affordable, easily accessible, and cutting-edge solutions to people suffering from impaired mobility and function. We have several products to help with the stroke recovery and rehabilitation process. From the SaeboFlex, which allows clients to incorporate their hand functionally in therapy or at home, to the SaeboMAS, an unweighting device used to assist the arm during daily living tasks and exercise training, we are commitment to helping create innovative products for stroke recovery. Check out all of our product offerings or let us help you find which product is right for you.

All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Saebo website is solely at your own risk.


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