One big problem after a stroke or brain injury is the inability to dissociate body movement. Movement dissociation is the ability for segments of the body to move independent of other segments. In other words, body parts (and their movement) want to “couple together” . For example, the right side of the body to move independent of the left side and the upper body to move independent of the lower body.  If you have suffered a stroke, you may find that dissociation is challenging. For instance, when you go to lift your leg, your arm also wants to raise up.  This can be referred to as movement coupling. Meaning that arm and leg movements have coupled together.

image of abnormal movement coupling

Another sign you might have movements coupling together is when you want to bend your “involved” leg (in standing), your uninvolved leg also wants to bend.  In this second instance, that would mean your strong leg will buckle when you attempt to step your involved leg (stroke effected leg) forward. No bueno.  These would be signs that movements have coupled together and that you have lost the ability to dissociate body segments.

What are the best exercises to dissociate body movements after a stroke or brain injury?

The good news is, with many of rehab HQ teachings, the brain has more potential to learn than we sometimes give it credit for. And that being said, repetitive practice of isolated movements is the best way to “unlearn” this abnormal movement.

Step one – Block non working body segments

The first step in relearning how to isolated body segments is to block all “non working” segments. For instance, you would want to block the arms while performing leg movement retraining. You can use a variety of tools to accomplish this. For example to prevent the arm from flexing up, you can try an elbow immobilizer, a sandbag, or both to block the arm while performing leg movement.

bridging exercise with arm blockedbridging exercise with arm blocked in extensionbridging exercise with alternative position for arm blocking

Squatting is a good position to block the legs while performing arm movement. This, more or less, blocks all lower body movement. In a low squat position you can work on extending the arm by using a gym ball as shown below.

squatting reach exercise part 2squatting reach exercise

Additionally, squatting is a great position to block the lower body and work on reaching.

squatting arm raisesquatting arm raise part 2

Tall Kneeling is another way to block leg movement while performing arm movement. This tall kneeling position is great for those of you who have a “rogue” leg that likes to lock out straight.

kneeling arm extension

What are the benefits of half kneeling to prevent movement coupling and relearn movement dissociation?

Half kneeling is when you kneel on one knee. The benefit of this position is that you are dissociating the right and left side of the body (by having thee legs in alternate/opposite positions). Once you can maintain this position, you can try adding arm movement. Now your are dissociating the right side of the left side and the upper body from the lower body.

NOTE: make sure the the hip stays straight and it does not drop backward as shown here.

half kneeling if you can't diissociate

Once you can hold the position without the hip dropping backward, try adding some arm movement. You may want to try using a cane to start. We call this an active assisted exercise (you are assisting the movement with your uninvolved arm).

half kneeling arm extension

You can also choose to do more active movement. A great exercise that will challenge active arm movement is to use a gym ball. 

kneeling arm extension with a gym ball

Step Two – Dissociate Body Movement in Standing

In many cases, abnormal movement coupling and spasticity go hand in hand.  Spasticity in the arm (often times) will worsen in standing. That being said, to “isolate” movement in standing, repeat step one. For example, block all non working body parts. In most cases this will mean if you are working on stepping (in this case the working body part is the leg), you will want to block the  arm from flexing up. Using an elbow immobilizer is a great way to keep the arm straight. If possible, weightbearing on the arm will also help to quite down the arm flexor muscles.  You can achieve this by using the set up show below.

standing and weightbearing with the arm blocked in extension

However, in come cases, getting the arm completely straight with the hand in a weight-bearing position as show above is not possible. In that case, try working with something round so the hand can stay slightly flexed and just work on getting the arm as straight as possible (by using your uninvolved arm). – Shown in the below images. Start with the arms bent and try and straight them out. Once they are straight, try and keep them straight and practice stepping forward and backward.

standing dissociation exercisestanding dissociation exercise part 2

To learn more, here is a video that goes into more detail of how to dissociate body movement:

Dissociate Body Movement Part One:

Dissociate Body Movement Part Two:

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