A new option in stroke rehabilitation: the ARNI method
After leaving the acute stroke unit, patients' in-hospital rehabilitation ends. Since improvement is usually slow, rehabilitation must be continued at home, but the patient is rarely advised to do so.
The structure and organization of our brains are constantly changing as a result of experience and learning (neuroplasticity). Neural connections are constantly strengthening or weakening, depending on how much we use which area.
The English language also takes this into account in its activities. THEAction For Rehabilitation From Neurological Inyury (ARNI) Institute is a charity that provides rehabilitation tools, mainly for people suffering from stroke and other neurological injuries/diseases, by utilizing the neuroplasticity of the brain.
Customized, active solutions
ARNI provides support mainly through task-oriented, specific functional training and the use of individual coping strategies.
With its application, exercises that include bodyweight and resistance training must be performed below the pain threshold while performing increasingly difficult and complex tasks, but constantly pushing the limits of the patient's abilities.
After assessing your condition and determining your short, medium and long-term goals, the ARNI trainer will create a personalized rehabilitation plan.
The highest, evidence level 4, method of "retraining" the brain is training, not therapy, in which we actively involve the patient and their family members.
During the training sessions, we practice activities of daily living (ADL): e.g. sitting down on a chair, on the floor, standing up without external assistance, fall management, innovative walking on different terrains, grasping, reaching for objects, etc.
The patient needs to train a lot to improve, based on research results, 300 hours in 12 weeks, and it is important to constantly repeat what they have learned.
ARNI in practice
In ARNI, the exercises start with the hand, not the shoulder (it is observed all over the world that patients do not receive good treatment for the upper limb). The entire arm must be trained very intensively, since it has been known since 2008 that the motor pathways going up to the brain can be strengthened by rehabilitating the hand. Since the hand performs the most tasks, the most time must be spent on developing it, but few people like this, because unfortunately, there is no immediate improvement. However, diligent work usually brings the desired result.
Based on evidence research from 2012–2017, it can be said that the use of fingers should be started immediately after a stroke. Patients spend a lot of time performing tasks after creative stretching. Stretching has moderate evidence, but does not reduce spasticity in the long term, but the combination of stretching and task performance can bring good results.
The positive effects of training include, for example, improvements in balance and posture, as well as thinking, planning and execution, increased flexibility and muscle mass, and strengthening of muscles, tendons and ligaments.
In ARNI, we avoid all passive aids as much as possible, and use active orthoses due to their higher level of evidence. Our goal is for the patient to use the affected side, preferably without any assistive devices.
With up-to-date knowledge
The ARNI knowledge base is up-to-date, as there is constant research into the method and its coping strategies. Several research centres, hospitals and universities in England are conducting studies and developing aids on this topic. ARNI has been used in the UK for more than 15 years, where approx. 120 ARNI instructors, including 6 senior instructors, work with stroke survivors. In addition, 28 additional trainers work in Ireland, America, Australia, France and now also in Hungary.
The creator of ARNI, Dr. Tom Balchin, suffered a stroke in 1997 that left him paralyzed on the left side of his body. He developed this method over 15 years to heal himself. His most important book, “The Successful Stoke Survival,” and his 7-disc DVD are considered the Bible of stroke recovery.
Tom Balchin's self-rehabilitation method is an innovative combination of self-defense sports, weight training, and mental/self-management training. This triple strategy is now a clinically proven rehabilitation method for stroke survivors and neurologically injured individuals to achieve optimal development.
Domestic ARNI courses
I brought ARNI to our country. I originally worked as a biology and physical education teacher, handball coach, physiotherapist, and then as a leading physiotherapist in Mátészalka. As an energetic professional who constantly trained myself, I eventually became a Senior ARNI Instructor.
Gabriella Pasztor
Senior ARNI Associate Instructor, physiotherapist
Stroke Neuro Rehab Hungary
The full article was published on the website of the Academy of Physical Therapy.
