Stroke-related physical deficits are brain problems, not muscle problems. Understanding why the body moves differently after stroke helps you provide better physical assistance and apply rehabilitation principles correctly.

Section 01

Hemiplegia and Hemiparesis

  • Hemiplegia: Complete paralysis on one side — the person cannot move the affected arm or leg voluntarily.
  • Hemiparesis: Partial weakness with reduced strength, coordination, and control on one side.
  • Which side: Left brain stroke causes right-sided weakness. Right brain stroke causes left-sided weakness. The brain controls the opposite side.
  • Upper vs. lower extremity: The arm is typically more affected than the leg. Walking may return before full arm function.
Section 02

Spasticity — The Muscle Tone Problem

⚠ Understanding spasticity
Spasticity is increased involuntary muscle tone that develops in weeks after stroke. The affected arm often develops a characteristic pattern: shoulder pulled inward, elbow bent, wrist and fingers flexed. This is not voluntary — it is neurological. Forced stretching or pulling against spasticity causes pain and potential injury. Follow the positioning and range of motion program from the therapist exactly. Report increasing spasticity or pain to the nurse.
Section 03

Balance and Coordination Deficits

  • Proprioception loss: The ability to sense where a limb is without looking. A survivor may not know where their foot is in space — making walking unsafe without visual compensation.
  • Ataxia: Uncoordinated movement that overshoots or undershoots the target. The person appears unsteady even when strength is relatively intact.
  • Vertigo: Particularly with posterior stroke — a spinning sensation that dramatically increases fall risk.
Section 04

Shoulder Subluxation — A Critical Pain Risk

🚨 Protecting the flaccid shoulder
In the early weeks after stroke, a paralyzed arm may be completely flaccid (no tone). A flaccid arm is at serious risk of shoulder subluxation — partial dislocation — because the muscles that hold the joint in place are not working. Never lift, pull, or support a stroke survivor by their affected arm. Always support at the elbow and wrist. Protect the shoulder from forward pulling or downward hanging. Shoulder subluxation causes chronic pain that significantly impairs rehabilitation.
Section 05

Sensory Deficits

Many stroke survivors have reduced sensation on the affected side — they may not feel pain, temperature, or pressure normally.

✓ Sensory deficit safety checklist
  • Check water temperature carefully before bathing — the client cannot reliably detect scalding on the affected side
  • Check for pressure areas more frequently — they cannot feel a developing pressure sore
  • Watch for objects they may be sitting or lying on that they cannot feel
  • Encourage visual checking of the affected limb regularly
Knowledge Check

Lesson 1 Quiz

5 questions · Passing score: 80%
Question 1
A client had a right hemisphere stroke. Which side will be weak?
Question 2
When assisting a stroke survivor with a flaccid arm during a transfer, you should:
Question 3
A stroke survivor's affected hand is clenched in a fist they cannot voluntarily straighten. This is most likely:
Question 4
A stroke survivor cannot feel where their foot is without looking at it. This deficit is called:
Question 5
A stroke survivor has reduced sensation on their affected right side. When preparing a bath, you should: