Updated May 23, 2014.

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

 

Use it or lose it-muscle atrophy after a stroke is a real concern.

 

If you have had a stroke, you may have suffered from muscle weakness of the face, arms or legs. Usually, one side of the body is affected. A stroke that affects coordination can make it difficult to move even when weakness is not the major problem. 

Additionally, after a stroke, many stroke survivors suffer from problems such as confusion, trouble communicating, trouble swallowing, head pain, mood changes, and a variety of other problems that can make it difficult to get up and safely move around.

Patients who suffer from large strokes and life threatening complications may be monitored in intensive care units while the severe health dangers are stabilized. Sometimes, patients who are physically unstable are required to stay in bed for safety. 

Rehabilitation is an important part of stroke recovery and some patients are fortunate enough to be able to safely get started with physical therapy or occupational therapy shortly after a stroke. 

When muscles are not used, a condition called atrophy often develops. Atrophy is the shrinking of muscle tissue. In some ways, it is the opposite of the type of physical exercise that ‘works out’ muscles, triggering muscles to grow, bulk up and become stronger. In contrast, atrophy is the result of unusual inactivity of muscles. The lack of activity generally causes muscles to shrink and become weaker. Once a stroke survivor reaches a point of being ready to become active again, the muscle weakness of atrophy combined with the weakness from the stroke can make exercise a huge uphill challenge.

 

One of the methods used to get physical activity started before a patient is ready to participate in therapy includes passively moving the patient’s arms and legs gently. This is often done for hospitalized stroke patients who are not able to start activity. There are several objectives for the use of this type of passive muscle movement. It can help to avoid bedsores that result from pressure of one part of the body on the bed or chair for a long period of time. It can help to prevent blood clots that can develop in the arms or legs due to lack of movement, although passive movement has been somewhat controversial as a method to prevent blood clots. It can help to minimize some of the nerve damage and muscle stiffness that usually occur during long periods of inactivity. 

While atrophy is not good for the long term, it is a situation that can be reversed. Many stroke patients become depressed when they observe their own skinny bodies that appear weak and malnourished after a stroke. After a stroke, swallowing difficulties and tiredness interfere with eating, and it is common for stroke survivors to lose some weight shorty after a stroke. Even with the best attempts at providing nourishment in the hospital, people who have trouble swallowing, as many stroke patients do, tend to lose weight. Families often become very concerned about the appearance of a loved one’s thin muscles after a stroke.

But, slowly resuming nutrition and physical activity can help improve atrophy, allowing muscles to resume their size and shape. Atrophy takes some time to develop and rebuilding muscles takes time too.  Once a stroke survivor begins to resume physical activities with physical therapy and safe at home exercises, the appetite begins to improve. Often, it takes some planning and attention to maintain a good protein intake and adequate calories. Mild or moderate activities, such as walking a few steps with assistance or even bathing may seem exhausting at first. Reasonable expectations and gradual improvement can help prevent discouragement. Muscles that are severely impaired due to the stroke can still benefit from passive movements for the long term. This helps overall coordination and health.

Atrophy is a common consequence of lack of the use of muscles. With time, exercise, and good nutrition stroke survivors can recover from atrophy. 

 

Sources

Martin Samuels and David Feske, Office Practice of Neurology,  2^nd Edition, Churchill Livingston, 2003