Quadriplegia |top 20 Mobility Exercises To Regain Strength And Function

We know that exercise is a vital component of overall health, both physical and mental. This is just also true for individuals suffering from quadriplegia. For quadriplegic patients' active movement is limited, therefore, it is necessary to find alternative ways to incorporate movement into their daily life. Movement can be incorporated with the help of an experienced physiotherapist, who can recommend exercises according to the patient's needs. Regular exercises can benefit quadriplegic patients in a variety of ways. Exercising helps maintain the range of motion and promotes circulation, bone density, and muscle mass. And also minimizes the additional complications of quadriplegia and thus increases the ability to participate in daily activities. This blog has been written to give you some idea about exercises that can be done for quadriplegic patients.
Quadriplegic patients with less severe and incomplete injury to their cervical spine can move their upper limbs. Whereas, those patients with more severe spine damage have to deal with total loss of upper limb function. The recovery of the quadriplegic patient relies on the nature of the injury. Mostly, patients with incomplete quadriplegia have a higher chance of recovering lost functions to some degree.
Passive range of motion exercises plays a significant role in quadriplegia recovery.  Passive range of motion exercises makes a big difference in the healing and recovery journey. The physiotherapy technique consists of assisted activities that stimulate nerve healing and increase muscle strength. Quadriplegic patients can practice passive range of motion exercises. This type of exercise requires no active muscle contraction, instead, a physiotherapist or a trained caregiver can facilitate the movements for the patients to make sure that the joints move through their full range of motion.
Doing regular exercises can improve digestive function and also reduces the risk of urinary tract infections or constipation. Exercising strengthens the breathing muscles, improves blood circulation, and also helps prevent secondary complications such as swelling, pressure sores, infections like pneumonia, etc.

Exercises can be recommended for patients with both incomplete and complete paralysis.  Discussed below are some examples of passive range of motion exercises used for quadriplegia recovery:

Neck rotation stretch
Neck exercises like neck rotation, tilting the head left to right, up and down strengthen and re-activate the neck muscles, shoulders, and upper back, and also helps release tension in the muscles, easing pain in most quadriplegic patients.

Piriformis stretch

• Increased hip flexibility can improve hip movements, and eases lower back pain, which is a common problem among patients with paralyzing injuries to their upper and lower limbs. Quadriplegic patients do this exercise, with the help of a physiotherapist.
• The therapist gently pushes one leg in while the patient grasps his knee for around 8 to 10 seconds.  

Doorway chest stretch

• Stretching the chest muscles can relieve pain in the upper neck or upper back. This exercise lengthens the pectoral muscles and strengthens other muscle groups that help in facilitating upper limb movement.
• The physiotherapist bends the elbow and positions the forearm against a doorway opening.
• Lunge forward to open up the chest and stretch the muscles 

Spine twists

• Spine or trunk rotation exercises improve lower back flexibility which can increase spine mobility and rotation.
• To rotate the trunk, the therapist needs to raise and bend the legs and push them gently toward the chest.
• After completing the movement, the patient should tilt his knees from one side to the other without moving his shoulder muscles.

Shoulder Flexion

• The patient's arm is relaxed by the side so that the palm is facing inward.
• The therapist raises the arm forward slowly, keeping the elbow straight, bringing it up so that the hand reaches up and the arm is as close to the ear as possible.

Shoulder Abduction

• The patient's arm is straight with the palm facing forward.
• The therapist slowly brings the arm and hand outward to the side, away from the patient's body.
• The patient's arm should be level with the shoulders or higher.
• Then, bring the arm back to the starting position.

Elbow Flexion and Extension

• The therapist bends the elbow so that the hand can touch the shoulder.
• Then extends it so that the arm is fully straight.

Forearm Rotation

• The therapist bends the elbows at 90° at the patient's sides with the back of the hands facing up.
• With one hand, hold just above the elbow, and with the other, flips the hand over so that the palm faces up.
• Forearm rotation can also be completed with the arms straight and positioned at the patient's sides.

Wrist Flexion and Extension

• The therapist bends the patient's wrist so that the palm moves toward the inner arm and makes a 90° angle.
• Then, extends the wrist in the opposite direction.

Finger Flexion and Extension

• The therapist curls the patient's fingers inward towards the palm, creating a fist.
• Then extends them back so that they are straight.
• Keep the wrists neutral (straight) while doing this.

Finger O's

• The therapist touches the tip of the patient's each finger to the tip of the thumb.

Finger Abduction (Splits)

• The therapist separates the patient's two adjacent fingers by moving them away from each other.
• Then brings them back together.

Finger splits

• The therapist splits the fingers through the passive exercise that helps loosen up stiff joints and activate the hand and finger muscles. The physiotherapist does this movement by separating two adjacent fingers and putting them back in their resting position. 

Hip Rotation

• The therapist bends the patient's knee so that the thigh is perpendicular to the bed and there's a 90° angle at the knee.
• Then he rotates the patient's hip in the socket by holding the thigh just above the knee and moves the foot inward towards the opposite leg. Further, reverse the direction of rotation and move the foot outward, keeping the thigh perpendicular to the mat the whole time 

Hip Abduction

• The patient's legs should be straight. The therapist pulls one leg to the side away from the midline of the body and creates a separation between the feet until there's slight muscle resistance. Then, brings the feet back together.

Ankle Rotations

• The therapist puts one hand just above the patient's ankle to stabilize the leg and the other hand on the foot.
• Then moves the foot in a circular motion to stretch the ankle and calf.

Toe Flexion and Extension

• The therapist bends the toes of the patient towards the sole and brings them back out to neutral.
• Then extends them upward toward the shin to stretch the bottom of the foot.

Breathing Exercises

• The muscles of the abdomen and diaphragm are vital to performing breathing exercises depending on the level of injury, these muscles may be affected. Breathing function and overall respiratory health are also important for quadriplegic patients. Breathing exercises help maximize respiratory function.
• The patient takes a deep breath through the nose, trying to expand the chest and lungs. The patient holds this breath for 2-3 seconds and releases slowly through pursed lips.

Air stacking

• The patient sits upright or reclines slightly with the support behind his back. Then takes a deep breath in and holds, then breathes in more air and holds again. The patient then continues this exercise 4-5 times without exhaling and holds for 2-3 seconds, then exhales slowly to finish one cycle of the exercise.

Number Counting

• The patient takes a deep breath in, then releases the breath slowly while counting out loud. Then tries to gradually increase the number to reach to improve his breath control.

The above-mentioned exercises are designed in such a way that they are to be performed for the patient by the therapist or caretaker. As the patient continues practicing these exercises, he might find that he can actively do some of the movements. Then this is a sign of recovery and progress.

Stroke and Cold Weather: How decrease in Temperature increases the risk of Ischemic Stroke?

Incidences of stroke have been found to have possible associations with certain weather conditions. Daily temperature variations and higher humidity were associated with increased stroke rates. Colder average annual temperatures are associated with stroke. An average daily temperature change of 5 degrees Fahrenheit is associated with about a 6 percent increase in stroke risk. In this blog, we will discuss how stroke is associated with cold weather and how we can prevent it.

 

Winter season is a cause for various health ailments, as we head towards winter it has been seen that the drop in temperature is responsible for a rise in several health-related problems, among which stroke is one of the critical challenges.  During the winter months the chances of getting a stroke increase.

Stroke is a unique health condition that can occur because of blockage, causing paralysis, or can even burst which leads to bleeding. If a stroke occurs in the right side of the brain, the left side of the body will be affected, causing paralysis on the left side of the body, speech or language problems, slow, cautious behavior, memory loss, etc.

Studies have proved that there are more stroke cases during extremely cold conditions. The risk of getting a stroke attack increases by 80% particularly when the temperature dips below 15 degrees Celsius. One of the main reasons that can attribute to this is, that during the cold seasons the blood vessels constrict, which leads to an increase in blood pressure, which means that the blood has to be pumped harder to travel around the body, making it one of the major factors for the onset of stroke.

Another reason may be due to the various changes in the chemical balance that occur in the body during the winter season. These include cholesterol levels and some other factors that increase the chances of clotting. Also, changes in physical activity which usually decreases during winter as well as weight gain can play a role. These are probably the reasons why the number of stroke cases goes up during winter.

Winter can lead some people to develop depression, which has been linked to an increased risk of stroke.

The incidence of stroke is significantly increased in winter, especially when the temperature drops sharply in a cold period. Though the pathogenesis of ischemic stroke remains unclear, one of the causes may involve a cold-induced increase in blood pressure, hypercoagulation, and fibrinolysis.

 

Ways to Control the risk of Stroke in Winter:

To prevent the chances of stroke and other cardiovascular events, it is strongly recommended:

• To regularly monitor blood pressure during the changing weather. And even with mild changes or a rise in blood pressure, one needs to immediately consult the doctor who can prescribe an adjustment in the medications.
• Avoid sudden exposure to harsh cold weather.
• Maintain the recommended levels of regular physical activity.
• Avoid sudden changes in diet.
• Avoid stress.
• Avoid unhealthy drinking and eating too much.
• Avoid being less active in winter,
• Avoid developing depression,
• Wear warm clothing when going outside.
• Quit smoking.
• Do more exercise if overweight.
• Simply staying indoors or ensuring ample heating when it's especially cold outside.

During the average winter temperature of <13°C, the risk factors, etiology, coagulation factors, and degree of neurological impairment of patients with ischemic stroke are found to be significantly different from patients with ischemic stroke during warmer temperatures thus it is advised to keep warm and avoid sudden exposure to severe cold temperatures as the risk of stroke remains for many days after the exposure.

 

Post-Stroke Rehabilitation

Post-Stroke Rehabilitation: How to regain Strength and Mobility

Stroke is a life-changing condition, which leads to physical disability and mental setback. After returning from the hospital, a patient suffering from a severe stroke may feel depressed and helpless as a result he might refrain from doing the prescribed exercises. Through this blog, we will provide you with exercises, which will not only improve patients function but also will boost their confidence for doing the tasks independently.

These exercises are based on Active-Passive Bilateral Therapy, a therapy in which a patient is asked to use the unaffected and the affected arms and legs together. This helps the two sides of the brain to work better together, as severe stroke is a condition that affects the balance between the two sides of the brain therefore these exercises help to restore the balance and improves hand and leg function.

 

1: ARM STRETCHING EXERCISES

Sit on a chair with a table in the front, place 2 boxes on the table, now place your hand on the box and extend your elbow and stay in this position.

Lie down and hold your wrist with your healthy hand lift your arms backward lift as far as you can and stay in this position.

Place your elbow over a towel on the table. Hold your wrist with your unaffected hand, Extend your elbow with the help of your unaffected hand stay in this position.

Hold the hemiplegic wrist with the unaffected hand extend your hemiplegic arm behind your back with the help of your unaffected hand, stay in this position.

Place your elbow on the towel over the table. Hold your wrist with your unaffected hand turn the forearm with the palm of your hand facing you extend the elbow with the palm of your hand towards the ceiling, and then stay in this position.

Place your hemiplegic hand on the table open your hand and extend your fingers with the help of your unaffected hand stay in this position keeping your hand on the table.

Place your hand on the table with the help of your other hand extend your thumb.

 

2: LEG STRETCHING EXERCISES

Sit on the bed by your side supporting yourself on your healthy hand with legs bent kneel to sit on your heels put a cushion under your buttocks, sit down on it. Straighten your back and stay in this position.

Place two chairs opposite one another and extend your hemiplegic leg on the chair, press down on your knee with your unaffected hand lean forward without bending your knee and maintain this position.

Stand on the stairs holding onto the handrail let your heel hang off the edge of the step while moving your heel downwards then extend your knee. Maintain in this position.

·   Place your hemiplegic foot on a low height stool against the wall with your heel hanging off the edge move your heel downwards while extending your knee move your pelvis forward without lifting your heel. Maintain in this position.

 

 3: ARM MUSCULAR STRENGTHENING

 

·    Lifting an object

Sit on a chair and hold a bottle full of water with both hands lift the bottle as high as you can put the bottle back on the table

·    Extending the elbow

Place your elbow over a towel on the table hold bottle full of water in the hand lift the elbow as much as possible and bring down, take the help of the healthy hand.

·    Extending the wrist

Place your forearm on the pillow or a box with your hand hanging then extend your hand as high as you can try to take the help of your unaffected hand.

·    Hand-Opening

Place your forearm on a box with your hand hanging then  open your hand as much as you can with your wrist extended  try to take the help of your unaffected hand

 

4: LEG MUSCULAR STRENGTHENING

 

·    Extending your leg outwards

Stand opposite to the wall and hold the wall with both your hands, extend your hemiplegic leg outwards without extending the pelvis without putting your foot on the floor and start again.

·     Extending your leg outwards

Stand opposite to the wall and hold the wall with both your hands, move your hemiplegic leg backward without putting your foot on the floor and start again.

·     Extending  your knee

Sit comfortably on a chair with your back straight then extend your knee as much as you can.

·     Extending your knee

Sit on a chair with your back straight then extend your knee and lift your foot as high as you can.

·     Bending your knee

Lie down in bed on your stomach, bend your knee, bring your foot towards your buttock, gently bend it back.

·     Standing on tiptoe

Stand opposite to the wall with both your hands on the wall and your feet apart stand on tip-toe and move back down again.

·     Extending your toes

Sit in a chair place a towel under your knee with your foot hanging loose extend your toes as much as you can.

 

5: GETTING UP FROM A FALL

 

Hemiplegic patients have a greater risk of fall, therefore if a stroke patient had a fall he should follow the following steps to stand or get up:

Assume a side-sitting position with the unaffected side close to a heavy chair or other objects that will not move.

·   Place the affected forearm on the seat of the chair and lean on the elbow or hand. Shift weight forward onto your knees and lift your hips until you are in a kneeling position.

·    Supporting yourself with your affected arm, bring your unaffected foot forward and place it flat on the floor. Keep the affected limb in the kneeling position while placing the unaffected one in the kneeling position.

·    Lift yourself by pushing with your unaffected arm and leg. Twist your hips toward the chair and sit on the seat.

 The forces needed to move the disabled arm or leg with the help of your healthy arm or leg while doing stretching and strengthening exercises reduces spasticity, helps to prevent muscle shortening and joint stiffness. Repeatedly using the hemiplegic arm and leg arm to do tasks is effective for recovery after a stroke. And this repetitive practice is now considered key to stroke rehab.