Limb paralysis – how you can improve it

Characteristics of limb paralysis

Paralysis can be central or peripheral.

Central paralysis is caused by a lesion affecting the central nervous system (the brain and spinal cord), most commonly a consequence of stroke.

Peripheral paralysis affects the nerve plexuses or nerves emerging from the spinal cord, or the nerve–muscle connection. It usually develops on the trunk or limbs and causes paralysis. For example, on the arm the median, ulnar and radial nerves, on the trunk the intercostal nerve, on the face branches of the trigeminal nerve, and on the outer side of the lower leg the peroneal nerve can be involved.

In mild degrees of limb paralysis the problems are caused by loss of balance, lack of coordination, decreased movement accuracy, and muscles fatiguing more quickly. Walking, performing fine movements, and grasping objects can be difficult or impossible. In severe paralysis the ability to move is completely lost and the limb becomes "motionless."

The importance of rehabilitation

Several factors determine how severe the permanent limb paralysis will be.

In the case of stroke, the larger the damaged area of the brain, the more pronounced your residual symptoms may be. The sooner you reach a stroke center and treatment begins, the more likely it is that the largest possible brain area can be salvaged and your symptoms will remain milder.

In peripheral injury, the level of the lesion (at which vertebral level) and its severity (compression, transection, rupture, etc.) influence the symptoms. An accidental compression during surgery will, of course, cause less harm than if the nerve is severed in an accident.

Once the immediate life‑threat is over, rehabilitation must begin and you must perform the exercises persistently—for months, usually years. If you are not motivated and do not practice, success will be limited or absent. In other words, don’t give up, because practice is the only effective method—and only you can do it!

"Save what can be saved!"

When the doctors have finished acute stroke care or have relieved pressure on an entrapped nerve fiber, your treatment is far from over. It has rather only begun. From this point the outcome depends partly on your physiotherapist and nursing helpers, but above all on you: how severe a residual limb paralysis remains. If you wait passively for others to help and do nothing yourself, no improvement will occur. You have a chance only if you practice persistently and repeatedly attempt the lost movement or function.

The physiotherapist plays a major role in helping you succeed. They teach the exercises with which you can develop and relearn sensation and movement. Restoring these allows you to manage daily life and regain self‑care ability. I must emphasize again: the physiotherapist recommends and guides, but does not perform the exercises for you. If you do not practise with maximal intensity and perseverance, even the best physiotherapist cannot help enough.

Nerve fiber regeneration is very slow! It is generally accepted that nerve regrowth proceeds at 0.1–0.2 mm per day, and even in the most favorable case at most about 1 millimeter per day. The peroneal nerve, for example, runs from your lower back to the foot—a distance of around 60 cm or more depending on your height. Even in optimal conditions, regenerating 60 cm of nerve requires at least about 600 days! That's nearly two years.

In theory the nerve can regenerate on its own, but electrotherapy and training of voluntary movements (even if no movement is visible) can accelerate it. You must practise persistently, because until the nerve reaches the muscle again you will not notice any change. A muscle without motor nerve will only contract in response to an artificial impulse (electrical stimulation).

Even if you only see that, you must not give up. Because if you do not treat the muscle daily and do not ensure regular contractions with a stimulator, muscle tissue will gradually be replaced by connective tissue. If the muscle is destroyed, then even if the nerve "grows back" in 2–3 years, it will not find functioning muscle tissue and the paralysis will remain permanent.

Some applicable methods

Various methods may be used during rehabilitation in hospital; here we review those you can do yourself at home.

Imagining movement of the affected body part activates the corresponding area of the brain as if you were performing the real movement. In the brain nerves overlap, so with practice another brain area can take over the lost function. You can learn how to do this from a psychotherapist.

Rehabilitation ergometer

Home rehabilitation ergometers can already be used a few days after stroke to improve movement.

Constraint‑induced therapy

By restricting the non‑paralyzed limb, force yourself to try to use the affected side. For example, if your left hand is clumsy and you let it "hang" by your side, it cannot improve. If, despite the clumsiness, you try to use it, there is a chance for improvement.

Biofeedback device

Think of it like an ECG that senses the electrical activity of the heart. Biofeedback monitors the electrical activity of your muscles. When you perform a movement, your brain sends an "electrical signal" to the muscles and they contract. Placing the biofeedback sensor on the paralyzed muscle detects the signal sent by the brain even if it is so weak that it does not produce a visible muscle contraction, and provides feedback to you. This feedback, and its intensity, shows whether you performed the exercise correctly, thereby aiding practice.

Electrical muscle stimulation (EMS)

These treatments are used to increase sensory awareness, strengthen weakened limb muscles, and improve range of motion. Central and peripheral paralysis require different electrical treatments. You must choose a device according to the type of paralysis!

Central paralysis

In central paralysis the peripheral nerves themselves are not damaged, so treatments can be performed with a biphasic square wave—any good quality device is suitable for this. Mild electrical impulses delivered through skin‑adhesive electrodes elicit muscle contractions. This strengthens the muscle and retrains the connection between the motor nerve and the muscle. Be aware that even with a stimulator, improvement takes a long time. The necessary treatment time can exceed a year.

Peripheral paralysis

In peripheral paralysis the muscle loses its neural connection to the brain (because the nerve fiber itself is injured). This is called a denervated muscle, and it does not respond to treatments using the "normal" muscle stimulators applied for central paralysis.

Peripheral nerve injury requires a device capable of emitting triangular or trapezoidal waveforms, or long‑duration square waves.

The therapist determines the waveform and pulse duration optimal for the condition. For this, determining the intensity/time (i/t) curve is necessary. Devices such as the PeroBravo provide such testing.

If no such test has been performed, there is no choice but to try the different waveforms (this is completely harmless!). Use the one that produces the best muscle contraction. The tests should be repeated every few weeks and the treatment adjusted accordingly.

A range of assistive devices—such as a grip aid, long‑handled brush, handles, grab rails, ramp, electric toothbrush and razor, ankle brace and many others—can help. Your physiotherapist can recommend suitable options and, of course, help you learn to use them.

Clearly the greatest difficulty is discouragement and resignation. There is a way out even from very severe situations, so stay motivated and do not give up. Try to use your affected side as well. Home practice and repetition increase control over the muscles and restore the nervous system. If you can, use a muscle stimulator, biofeedback or electrotherapy device for your rehabilitation (depending on the origin of the paralysis).