Bilateral Upper Extremity Exercise (BUEE) to Improve Motor Function in Ischemic Stroke Patients: A Case Study

Abstract

Stroke remains one of the leading causes of mortality and disability worldwide, with hemiparesis being a common complication that significantly impairs upper extremity function. BUEE is an evidence-based nursing intervention aimed at stimulating neuroplasticity and enhancing motor recovery through the simultaneous movement of both arms. The purpose of this case study was to describe and analyze the implementation of BUEE as an evidence-based nursing intervention to improve upper extremity motor function in ischemic stroke patients with hemiparesis. This study also aimed to evaluate changes in muscle strength, movement coordination, and Fugl-Meyer Assessment for Upper Extremity (FMA-UE) scores following the implementation of BUEE in two patients with different hemiparetic sides. In addition, this case study sought to demonstrate that BUEE can be effectively applied in patients with either right- or left-sided hemiparesis, thereby supporting neuroplasticity, enhancing motor recovery, and improving patients’ independence in performing activities of daily living.This case study aimed to describe the application of BUEE in two ischemic stroke patients with hemiparesis who were hospitalized in a stroke ward in Jakarta. The intervention was conducted twice daily for three consecutive days. Each 15-minute session consisted of bilateral movements of the shoulders, elbows, wrists, and fingers, performed actively or with assistance FMA-UE was used to evaluate motor function assesses active or assisted bilateral movements of the shoulders, elbows, wrists, and fingers before and after the intervention. Both patients demonstrated marked improvement in upper extremity motor performance. Mrs. S’s FMA-UE score increased from 34 to 46 (from moderate to mild impairment), while Mrs. H’s score improved from 43 to 57 (maintaining mild impairment with functional gains). Enhancements were also observed in muscle strength, coordination, and hemodynamic stability. Both patients tolerated the exercises well without any adverse effects. The results indicate that BUEE is an effective, safe, and economical intervention to improve upper extremity motor function and promote neuroplasticity in ischemic stroke patients with hemiparesis. This intervention can be integrated into routine hospital rehabilitation programs. Nurses are encouraged to apply BUEE as a non-pharmacological strategy to enhance motor recovery, prevent immobilization-related complications, and improve patient independence.