Week 4 Flashcards
Stroke recommendations for amount of rehabilitation
Strong recommendation:
- For stroke survivors, rehabilitation should be structured to provide as much scheduled therapy (OT and PT) as possible
- For stroke survivors, group circuit class therapy should be used to increase scheduled therapy time
Weak recommendation:
-A minimum of 3 hr/day of scheduled therapy (OT and PT) is recommended, ensuring at least 2hr of active task practice occurs during this time
What can we do to increase intensity of practice
- Better rehab/gym environment that is motivating, inclusive and accessible
- Active participation using good communication with patient centred language, concentrating on what is important to the patient
- Therapist behaviour: one to one, semi-supervised and independent practices ensuring there is as much semi-supervised as possible to get higher amounts of reps
Common kinematic deviations after stroke in sitting balance
- Falling to affected side
- Decreased weight bearing on affected side
- Decreased ability to reach to affected side
Strong recommendation for sitting balance
- Practising reaching beyond arm’s length while sitting should be undertaken
- Reaching repetitions should be around 3000 in 2 weeks
Sitting/standing balance training ideas for very weak patients
Strengthening of LL extensors:
- Pressure cuff under knee
- Pushing on block at the end of the bed
- Gravity eliminated exercises for LL extensors
- Tilt table - pushing into LL extension
Supervised sitting practice
- Sitting/standing: wall on intact side (alignment cues)
- Sitting/standing and reaching
- Scales under affected leg
Common deviations in standing balance
- Falling to affected side
- Decreased weight bearing on affected side
- Decreased ability to reach to affected side
- Decreased hip and knee extension
- Slow/inadequate postural adjustments when moving in standing
Recommendation for standing balance
For stroke survivors who have difficulty with standing balance, standing activities that are functional and challenge balance should be provided
Has to include a decrease base of support, Going out of centre of mass and taking away any support (not holding onto anything)
Standing balance training ideas in moderately weak patients
Train patient’s specific problems…
- Falling to affected side: balancing in corner
- Decreased weight bearing on affected side: scales
- Decreased hip and knee extension: markers
- Inability to reach to affected side: supervised practise reaching to markers at 100% of arms length and progress
- Slow/inadequate postural adjustments when moving in standing: anticipatory balance training
Common kinematic deviations in sit-to-stand
- Changed muscle activation patterns
- Decreased ankle DF
- Decreased forward inclination of trunk
- Decreased weight bearing on affected leg
- Decreased hip/knee extension in standing
Sit to stand training ideas for very weak patients
Strengthening LL extensors:
- Pressure cuff under knee
- Pushing on block at the end of the bed
- Gravity eliminated exercises for LL extensors and hip abductors
- Tilt table - pushing into LL extension
Supervised STS practice
- Wall on intact side
- Assisted STS
Sit to stand training ideas for weak patient’s
-Observe patients specific problems or kinematic deviations and work on them such as ankle DF
- Placing affected foot behind unaffected foot can reduce asymmetry by half
- Placing unaffected foot on dense foam can increase muscle activity in affected leg by 50%
- Intact side very close to wall
