Physiotherapy for moderate stroke patient

Top 10 Rehabilitation Exercises for Moderate Stroke Patient 

Are you or any of your loved ones suffering from a stroke? Do you feel depressed or frustrated, due to lack of independence? Do you miss doing the activities and hobbies you used to love? If yes, then Physical therapy has a solution for you. It can help you regain your strength and mobility. This Blog is to provide an exercise program for a moderate stroke patient in order to promote flexibility, range of motion, balance and coordination, and also decrease pain and stiffness in your body. These exercises can be done by the patient without the assistance of a physiotherapist or an assistant.

1: To enhance shoulder motion and possibly prevent shoulder pain

Lie on your back on a firm bed. Interlace your fingers with your hands resting on your stomach

Slowly raise your arms to shoulder level, keeping your elbows straight. Return your hands to the resting position on your stomach.

2: To maintain shoulder motion

Lie on your back on a firm bed. Interlace your fingers, with your hands resting on your stomach. Slowly raise your hands directly over your chest, straightening your elbows. Slowly move your hands to one side and then the other. Then bend your elbows and return your hands to a resting position on your stomach.

3: To promote motion in the pelvis, hip and knee

Lie on your back on a firm bed. Keep your interlaced fingers resting on your stomach. Bend your knees tightly together; slowly move them as far to the right as possible. Return to center. Slowly move your knees as far as possible to the left, still keeping them together. Return to center.

4: To improve motion at the hip and knee, stimulating the movements needed for walking.

Lie on your unaffected side, with your legs together. Bend and move your affected knee as far as possible towards the chest. You may need your helper’s assistance to support the leg you’re exercising. Return to starting position

5: To strengthen the muscles that straighten the elbow.

Sitting on a firm mattress or sofa, put your affected forearm flat on the surface with your palm facing down if possible. You may want to place a firm pillow under your elbow. Slowly lean your weight onto your bent elbow. Push your hand down against the support surface, straightening your elbow and sitting more upright. Slowly allow your elbow to bend, returning your forearm to the support surface. Work back and forth between the two extremities.

6: To strengthen the muscles of the wrist.

Place your forearm on a table facing upwards. Hold a lightweight water bottle or a can in your hand. Flex your wrist by bringing your palm towards your forearm. You can also do wrist extension by turning your forearm face down and bringing the back of your hand towards the forearm.

7: To reduce stiffness in the trunk and promote the body rotation needed for walking.

Sit on a firm straight chair with both feet on the floor. If necessary, a firm mattress, sofa, or wheelchair may be used. Interlace your fingers. Bend forward and reach with your hands towards the outside of your foot, rotating your trunk. Move your hands upward in a diagonal direction toward your left shoulder, keeping your elbow as straight as possible. Repeat the motions, moving your hands from your left foot to your right shoulder.

8: Movements needed to rise from a sitting position

Sit on a firm chair that has been placed against the wall to prevent slipping. Interlace your fingers. Reach forward with your hands. With your feet slightly apart and your hips at the edge of the seat, lean forward, lifting your hips slightly from the seat. Slowly return to sitting.

9: Supine bridge

Lie on your back with feet flat on the ground and arms relaxed by the side. Straighten your legs and place a bolster under your knees, then lift your hips by pressing against the bolster. Then lift and lower one foot, then the other, while holding the top of the bridge.

10: To maintain the ankle motion needed for walking

Stand at arm’s length from the wall, Knees straight. Feet planted slightly apart and flat on the floor with equal weight on both feet. With your unaffected hand, hold your affected hand in place against the wall at the chest level. Slowly bend your elbows, leaning into the wall. This places a stretch on the back of your lower legs. Keep your heels on the floor. Straighten your elbows, pushing your body away from the wall.

Rehabilitation is a slow process. It can take months or years for the condition to improve.

 

TOP 10 EXERCISES FOR MILD STROKE

Depending upon the severity of this condition, stroke can be classified as mild, moderate, and severe. Patients suffering from mild stroke have mild deficiencies in the level of consciousness, impairments in sensory and motor functioning. The purpose of this blog is to provide an exercise program for a mildly affected stroke patient, which can help him to promote strength, balance, and coordination on his own. These exercises may not need assistance but it is necessary to keep a caretaker nearby during the exercise session.

 1: Exercise to strengthen the muscles that stabilize the shoulder.

Lie on the back with your arms resting at your sides. Keep your elbow straight, lift your affected arm to shoulder level with your hand pointing to the ceiling. Raise your hand towards the ceiling, lifting your shoulder blade from the floor. Hold for 3 to 5 seconds, and then relax, allowing your shoulder blade to return to the floor. Slowly repeat the reaching motion several times. Lower your arm to rest by your side.

2. Exercise to strengthen the shoulder muscles as well as those which straighten the elbow.

Lie on your back grasp one end of an elasticized band in each hand with enough tension to provide light resistance to the exercise, but without causing undue strain. Place both hands alongside the unaffected hip, keeping your elbows as straight as possible. Move your affected arm upward in a diagonal direction, reaching out to the side, above your head, keeping your elbow straight. Your unaffected arm should remain at your side throughout the exercise. During the exercise, stretch the band so that it provides resistance. 

3. Exercise to strengthen the muscles which straighten the elbow.

Lie on your back with your arms resting at your sides and a rolled towel under the affected elbow. Bend the affected elbow and move your hand up toward your shoulder. Keep your hand up toward your shoulder. Keep your elbows resting on the towel. Hold for a few seconds. Straighten your elbow and hold. Slowly repeat several times.

4. Exercise to improve hip control preparation for walking activities.

Lie on your back, start with your unaffected leg flat on the floor and your affected leg bent. Lift your affected foot and cross your affected leg over the other leg. Lift your affected foot and un-cross, resuming the position of the previous step. Repeat the crossing and un-crossing motion several times.

5. Exercise to enhance hip and knee control.

Lie on your back, start with your knees bent, feet resting on the floor. Slowly slide the heel of your affected leg down so that the leg straightens. Slowly bring the heel of your affected leg along the floor, returning to the starting position. Keep your heel in contact with the floor throughout the exercise.

6. Exercise to improve control of knee motions for walking.

Lie on your unaffected side with the bottom knee bent for stability and your affected arm placed in front for support. Concentrate on bending and straightening your knee while keeping your hip straight

7. Exercise to improve weight shift and control for proper walking technique.

Lie on your back, start with your knees bent, feet flat on the floor, and knees close together. Lift your hips from the floor and keep them raised in the air. Slowly twist your hips from side to side. Return to center and lower your hips to the floor. Rest, repeat the motion

8. Exercise to improve balance weight shift and control to prepare for walking activities.

The starting position is on your hands and knees. Weight should be evenly distributed on arms and both legs. Rock in the diagonal direction back toward your right heel as far forward towards your left hand as possible. Repeat motion several times, slowly rocking as far as possible in each direction. Return to center. Rock in a diagonal direction to and your right hand. Move as far back as possible in each direction slowly.

9. Exercise to stimulate proper weight shift and knee control necessary for walking.

Stand with your unaffected side next to a waist-height tabletop or other firm surface. Rest your unaffected arm on the surface for support. Lift your unaffected foot from the floor so that you are standing on your affected leg. Slowly bend and straighten the leg on which you are standing through a small range of motion. Try to move smoothly, not allowing your knee to buckle when you bend, or to snap back when you straighten. Repeat the knee bending and straightening several times, slowly.

10. Exercise to stimulate proper weight shift while strengthening the hip and pelvis muscles.

Stand facing a waist-height tabletop or other firm surface for support. Shift your weight onto your right leg and lift your knee straight. Return to center with both feet on the floor. Shift your weight onto your left leg and lift your right leg out to the side keeping your back and knee straight. Repeat several times, alternating lifts.

All these exercises will also help the patient to move more steadily while walking and also improves the motor skills like fastening buttons or tying shoelaces.

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What is Tailbone Pain and How Physiotherapy can help!

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People often experience a dull ache, which changes to sharp or throbbing pain with activities such as getting up from a sitting position or prolonged sitting. While most of people don’t know the actual cause of these symptoms, a condition called Coccydynia has often been linked to such chronic pains in the lower back. Identifying coccydynia and separating it from other types of lower back pain by Physiotherapists and Chiropractors is important for its pain management.

Coccydynia, or inflammation of the tail bone, is a unique type of lumbar pain that can cause patients a severe amount of discomfort and agony. Coccydynia/ Tailbone pain is a pain that occurs in or around the bony structure at the bottom of the spine (coccyx). The coccyx is much smaller than the sacrum, has an important weight-bearing role, and supports the body weight while sitting.

 

Physiotherapy has proven to be beneficial in teaching pelvic floor relaxation techniques (reverse Kegels) which help to get coccyx into better alignment and can relieve the pain experienced when urinating or defecating. For women, tailbone pain can make menstruation uncomfortable as well. As women may suffer injury to the coccyx or direct trauma to the coccyx during childbirth, these conditions have been more commonly reported with females.

 

Common causes of Coccydynia:

 

Coccydynia/ Tailbone pain can be caused by trauma to the coccyx during a fall, prolonged sitting on a hard or narrow surface, degenerative joint changes, or vaginal childbirth. Tailbone pain ranges from a dull ache to a fierce stab. It can last for weeks, months, or sometimes longer. A diagnosis of coccydynia will usually identify one of the following underlying causes of pain:

 

• Local trauma. A direct injury to the coccyx is the most common cause of coccydynia. A fall on the tailbone can inflame the ligaments and injure the coccyx or the coccygeal attachment to the sacrum. 
• Repetitive Strain Injury (RSI). Sports and activities that put prolonged pressure on the tailbone, such as horseback riding and sitting on hard surfaces for long periods of time or bicycling may cause the onset of coccyx pain.
• Childbirth/ Pregnancy. During delivery the pressure against the coccyx can sometimes result in injury to the coccygeal structures (the disc, ligaments, and bones. Some hormonal secretions during pregnancy may also soften the area between the sacrum and coccyx.
• Referred coccyx pain. In rare cases, the pain will be referred to the coccyx from elsewhere in the spine or pelvis, such as a lumbar herniated disc or degenerative lumbar disc

Physio-therapeutic Approach

 

The initial goal of physiotherapy treatment is focused on providing postural education. A proper sitting posture ensures weight is taken off the coccyx and is instead loaded onto the ischial tuberosities and the thighs. Physiotherapists may also recommend the use of cushions. Modified wedge-shaped cushions (coccygeal cushions), help to relieve the pressure placed on the coccyx during sitting. Other treatment modalities include:

 

• Mobilizations: This can help realign the posture of the coccyx. Mobilization techniques may be the preferred technique when the goal of treatment is to increase coccygeal mobility.
• Manipulation: Patients also find pain relief through manual manipulation of the coccyx. Through manual manipulation, the joint between the sacrum and the coccyx can be adjusted, potentially reducing pain caused by inadequate coccyx mobility.
• Massage:  Coccydynia may be reduced or alleviated by massaging tense pelvic floor muscles that attach to the coccyx. Tense muscles in this region can place added strain on the ligaments and sacrococcygeal joint, limiting its mobility or pulling on the coccyx.
• TENS unit. Transcutaneous Electrical Nerve Stimulator (TENS) units apply electric stimulation that interferes with the transmission of pain signals from the coccyx to the brain. These devices can be a good option for patients who wish to keep their intake of medications to a minimum. 
• Dry needling. It is surprisingly comfortable and very effective for specific conditions such as pelvic pain, incontinence, coccyx pain (tailbone), and other diagnoses. It helps in reducing muscle spasms and assesses the mobility and position of the sacrococcygeal joint.

 

Although the vast majority of patients who seek medical attention respond to conservative treatments, some patients require more aggressive treatments. A multidisciplinary approach employing physical therapy, ergonomic adaptations, medications (NSAIDs), injections, and, possibly, psychotherapy leads to the greatest chance of success in the patients.

 

World Stroke Day: Managing Post Stroke Rehab by physiotherapy

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October 29 celebrated as World Stroke Day, seeks to emphasize the serious nature and high rates of stroke. This day is also observed to raise awareness about the disease prevention and therapy, ensure better survivor support and treatment. Organizations around the world have facilitated activities on this day, emphasizing education, research, and programme globally to prevent the adverse effects of stroke. The annual event was started in 2006 by the World Stroke Organization (WSO) and WSO declared stroke a public health emergency in 2010. The WSO now has an on-going campaign that serves as a year-round interface for advocacy, policy, and outreach to support strides and continue the progress made on World Stroke Day. Over 6 million people die as a result of a stroke. Stroke is the second leading cause of death throughout the world. Medical experts and health advocates across the globe share similar messages on World Stroke Day. The messages range from stressing the importance of quick action during a suspected stroke to simple tips for preventing stroke. Most stroke survivors opt for a rehabilitation program. Physiotherapists recommend the most rigorous therapy program based on age, overall health and degree of disability from stroke.

 

Why Stroke matters, Factors responsible?

A stroke occurs when the blood supply to part of your brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients. A stroke is a medical emergency, and prompt treatment is crucial. Early action can reduce brain damage and other complications. Stroke has two types i.e. ischemic strokes and Hemorrhagic stroke. Ischemic strokes are usually caused by a piece of plaque or a blood clot that blocks blood flow to the brain while sudden bleeding can cause a hemorrhagic stroke. This happens when an artery in or on top of the brain breaks open. The leaked blood causes the brain to swell, putting pressure on it that can damage brain cells. A stroke can cause lasting brain damage, long-term disability, or even death.

FAST is an acronym used as a mnemonic to help detect and enhance responsiveness to the needs of a person having stroke. The acronym stands for:

·   Facial drooping: Facial weakness can indicate a stroke. A person having a stroke, one side of their face may appear droopy.

·   Arm weakness: A stroke can cause muscle weakness, numbness and paralysis on one or both sides of body. A person may be unable to lift one arm or one are may be drifted.

·   Speech difficulties: Strokes can also affect speech and understanding. Difficult speaking or slurred speech indicates a stroke.

·   Time to call emergency services: Seeking immediate  medical help is important if a person experiences any of the above symptoms

Chances of having a stroke increase with certain risk factors associated with it. High blood pressures, Heart diseases, Diabetes, smoking, and cholesterol often increase the chances of having stroke. However adopting a healthy lifestyle, changing in eating habits, and regular exercises are the best steps that can reduce the likelihood of having a stroke.

Physiotherapy For Post Stroke Rehabilitation:

Physical Therapy plays an important role in the process of rehabilitation after stroke. As a part of the interdisciplinary team, physiotherapists work in concert with the managing doctor and other rehabilitation specialists to provide stroke patients with a comprehensive rehabilitation program. The stroke physical therapy rehabilitation program involves a dynamic process of assessment, goal-setting, treatment and evaluation; its coverage spans from the acute stage, through the rehabilitation stage, to the community stage. The whole rehabilitation program is predicated on two general components. The first includes preventive measures targeted at maintaining physical integrity and minimizing complications that will prevent or prolong functional return.

Physiotherapy is an integral component of the road to recovery from a stroke as rehabilitation continues as long as the person is showing measurable benefit from treatment and has achieved their agreed goals. Rehabilitation improves recovery of function and mobility after stroke. Post-stroke, physiotherapists begin rehabilitation in short frequent spells, focused on getting out of bed, standing and walking. This repetitive task training helps people regain movement and relearn everyday activities. Physiotherapists often work with other professionals to help you with the range of problems that stroke can cause. Physiotherapy applied early in the patient journey will improve, function, health, and independence.

Physical therapy enables people to relearn lost abilities, regain independence and reduce the risk of further strokes. Physiotherapists use assistive equipment to enhance stroke rehabilitation. Robot-assisted devices support people to walk independently while treadmill training improves walking speed and endurance. Physiotherapy helps stroke survivors incorporate the physical activity recommendations into their daily routine to reduce the risk of another stroke by up to 35%. Physiotherapists can provide circuit training, involving intensive repetition of everyday activities, to help people walk further, faster, with more independence and confidence. Integrating endurance and strength training into rehabilitation reduces disability. Core stability and exercises incorporating balance, weight-shifting and gaits improve balance after stroke.

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