Physiotherapy Walking Aids and their use to gain Mobility after an Injury

If you suffer from a stroke or any injury in your leg or foot, then you need to use a walking aid during the process of healing or recovery. These essential walking aids are recommended by your physiotherapist, they include crutches, a cane, a walker, etc. The walking aid helps to keep the bodyweight off the injured or weak leg and helps in balancing and enables to perform the daily activities more safely. In this blog, we'll discuss the different walking aids and how to use them safely.

 

Crutches

After injury or surgery, non-weight bearing on the leg or foot is required if you are unable to bear any weight on your leg or foot, you may have to use crutches.

 

Positioning

• While standing straight, the top of the crutches should be about 1-2 inches below the armpits.
• Handgrips of the crutches should be at the level of the top of the hip line.
• Elbows should be slightly bent while holding the handgrips.
• The weight should rest on the hands and not on the underarm supports, to avoid damage to the nerves and blood vessels in the armpits.

Walking

• Slightly lean forward and put the crutches about one foot in front.
• Begin the step as if you were going to use the injured leg or foot but, instead, shift the weight to the crutches.
• Slowly bring the body forward between the crutches.
•  And finish the step with a good leg.
• While the good leg is on the ground, move the crutches ahead to prepare for the next step.
• Always look forward, not down at the feet.

Sitting

To sit:

• To sit on a sturdy chair.
• Put the injured foot in front of you and hold both crutches in one hand.
• Use the other hand to feel for the seat of the chair behind you.
• Slowly lower yourself into the chair.
• While being seated, lean the crutches upside down as crutches tend to fall when they are leaned on their tips.

To stand up:

• Bring the body to the front of the chair.
• Both the crutches are held in the hand on the injured side.
• Bring the body up and stand on the good leg.

 

Stairs

To go up and come downstairs with crutches:

• Face the stairway, hold the handrail with one hand, and tuck both crutches under the armpit on the other side.
•  While going up, lead with the good foot, keep the injured foot raised behind you.
• While going down, hold the injured foot up in front and hop down each step on the good foot.
• Take only one step at a time.

 

Canes

•  A cane can be used in case of minor problems like pain, weakness, injury in the leg or trunk, or problems with stability or balance.
• In elderly people, a single-point cane is used to walk more comfortably and safely. For more stability, a quad cane, which has 4 points, can be useful.

 

Positioning

• While standing straight, the top of the cane should reach the crease in the wrist.
• Elbow should be slightly bent to hold the cane.
• Hold the cane in the hand opposite to the affected side. For example, if the left leg is injured, hold the cane in the right hand.

 

Walking

• To walk with the cane take about one small stride ahead and step off on the injured leg.
• Finish the step with the good leg.

 

Stairs

To climb stairs:

• Place the cane in the hand opposite to the injured leg.
• With the free hand, grasp the handrail.
• First, step up on the good leg, and then step up on the injured leg.

To come downstairs:

• Place the cane on the step first
• Then, put the injured leg on the step.
• Finally, put the good leg, which carries the body weight, on the step.

 

Walking

• Position the walker about one step ahead, making sure that all four legs of the walker are on even ground.
• With both hands, grip the walker for support and move the injured leg into the middle area of the walker, don't stop at the front.
• Push straight down on the handgrips of the walker to bring the good leg up so it is even with the injured leg. While turning take small steps and move slowly.

 

Sitting

To sit:

• Back up until the legs touch the chair.
• Use the hands to feel for the seat of the chair behind.
• Slowly lower yourself into the chair.

To stand up:

• Push yourself up using the strength of the arms and grasp the walker's handgrips.
• Do not pull on or tilt the walker to help to stand.

 

Stairs

• Never climb stairs or use an escalator with a walker.

 While using walking aid for the first time, have a family member or a friend nearby to give you support. Initially, it may seem difficult but after taking a few tips and a little practice, most people can gain confidence and learn to use a walking aid safely.

 

Hemiparesis | Training, and Re-education of Muscle Weakness by Physiotherapy

Hemiparesis is a condition, in which there is weakness on one side of the body that can occur due to the secondary effect of injury to the central nervous system. Because of this, the treatment of this condition involves engaging the central nervous system's natural ability to heal itself. For this process, the neural pathways are created, reorganized, and strengthened. This blog helps to explain how this technique works through physiotherapy. The physiotherapist helps individuals with hemiparesis to improve their movements by doing repetitive and consistent exercises on their weakened sides. We have discussed below, the effect of physiotherapy exercises on the central nervous system.

 

Hemiparesis

Hemiparesis is most commonly caused by a stroke, in which, the supply of blood in the brain becomes disrupted, which causes brain cells to die. This process can affect the areas of the brain responsible for movement, it can cause issues with motor control such as hemiparesis (weakness on one side of the body) or hemiplegia (paralysis on one side of the body).

Each hemisphere of the brain controls the movement of the body on the opposite. Therefore, hemiparesis typically affects the side of the body opposite to the side of the stroke, whereas some strokes or brain injuries can cause muscle weakness on the same side as the injury, which is called ipsilateral hemiparesis. Movement is not only controlled by the motor cortex but other areas of the brain, such as the cerebellum, that play a role in the ability to move. As a result, there is an increased risk of a stroke or brain injury affecting an area of the brain that contributes to the movement. Other conditions that can cause hemiparesis are cerebral palsy, brain injury, or other diseases that affect the nervous system or brain such as cancers or tumors. Though these causes are less common but still are prevalent.

 

Effect of Physical Therapy Exercises on Neuroplasticity

The central nervous system has the capability to heal itself through the phenomenon of neuroplasticity.

Neuroplasticity occurs based on demand ie the task that is practiced most frequently are the neural pathways that will be the strongest. This is why everyday tasks like combing, eating, tying shoes eventually become thoughtless. Because of practicing the task a thousand times, the neural pathways for that skill become very strong.

Hemiparesis involves neuroplasticity which helps the brain to create and strengthen new pathways that control movement. The stronger these pathways become, the more strengthened and coordinated movement the individual will have with their affected side.

Physiotherapy is such therapy that focuses on neuroplasticity and is crucial for helping survivors regain movement. This is important to regain independence and therefore helps to accomplish the daily activities.

 

Physiotherapy for Hemiparesis

Physiotherapy aims to rehabilitate the nervous system, though hemiparesis recovery is a long process. Neuroplasticity does not occur overnight, it requires repetitive training and a consistent rehabilitation program to keep the recovery going. Physiotherapy helps to restore optimal functioning. The physiotherapist understands how to design exercises with an optimum challenge for patients with hemiparesis to target their affected limbs.

Physiotherapy helps to retrain the affected limbs by repetitive exercises. The more the individual moves their affected side, the more neuroplasticity occurs in response.

As a result the individual gains independence for daily activities like eating, dressing, bathing, etc. Functional training is given such as lifting a spoon, holding things, and placing them back down. Compensation techniques are also taught to the individual to accomplish difficult tasks by using shortcuts and to help him/her navigate their new life. If the individual continues to exercise their affected side regularly, only then they can continue to maximize their chances of motor recovery.

 

Repetitive Practice

Neuroplasticity occurs based on frequency and consistency. For engaging neuroplasticity repeating skilled movements with the weakened side is essential.  The more the task is being practiced, the better the movement becomes. This is referred to as massed practice and it's essential for hemiparesis recovery.

 

Home Exercise Programs

Home exercise programs become important, as they can help individuals to improve by practicing exercises with massed practice at home.

Depending on the frequency of the physiotherapy sessions, physiotherapists suggest practicing home exercise programs to build upon the skills that have been learned in physiotherapy sessions. To optimize neuroplasticity and functional recovery, it is essential to continue practicing outside of therapy sessions.

 

Constraint-Induced Movement Therapy

Constraint-Induced Movement Therapy (CIMT) is a treatment that involves restraining the unaffected side while exercising the affected side for10-15 consecutive weekdays each day the exercises are done for several hours. CIMT is most commonly used for affected arms/hands and involves the affected lower extremities as well. Being more aggressive therapy in the volume, it shows great improvement.

 

Mirror Therapy

This therapy uses a mirror that is placed over the hemiparetic arm or leg. Then, the individual performs exercises with the stronger arm or leg while watching the moving image in the mirror. This image in the mirror tricks the brain into thinking both arms or legs are moving, which helps spark neuroplasticity.

 

Electrical Stimulation

Electrical stimulations are applied to the muscles through pads on the skin, this stimulates movement on the weakened muscles. For example, if an individual has a weak hand or wrist movement, the physiotherapist can apply electrical stimulation, which helps flex and extend the wrist, depending on the placement. For maximum results, these stimulations can be combined with task-related training.

 

Mental Practice

Mental practice is a cognitive treatment that requires no movement at all it helps activate neuroplasticity. It involves mentally rehearsing specific activities to improve the performance of those activities. An individual with hemiparesis is asked to spend time mentally rehearsing their exercises before actually performing them.

 

There is no specific time period for recovery, it can be challenging to predict neurological recovery time, as each person's brain is wired differently, which makes recovery after every neurological injury unique.

 

Recovering from Omicron | How Physiotherapy helps to regain Strength after COVID-19?

Omicron is a variant of global concern as it has high transmissibility, though the variant causes less damage to the lungs and less severe disease when compared to other variants. In most cases, it causes severe myalgia, body pain, and lethargy, even after recovery. This is because people exercise less and become more sedentary during the pandemic, which worsens the condition. Therefore to prevent this weakness, exercising should be continued. Your physiotherapist will recommend some kind of exercises or activities that can prevent the after-effects of omicron. In this blog, we have discussed how you can manage omicron while staying at your home.

 

What causes this Post-recovery pain?

As data on Omicron is limited and gene sequencing is costly. The reason for pain might be due to inflammatory mediators that this variant is causing after recovery. And the other reason may be that this variant is affecting the musculoskeletal system more than any other variant.

 

What's the Course of Treatment?

Once recovered from the virus, the patient should take all the precautionary measures, like wearing masks and maintaining social distancing. After recovery, your physiotherapist will recommend you to take complete rest and not to exert yourself too much in daily activities, pay heed to the recovery process, not to start with heavy workouts, take one step at a time and also increase the intake of water as the body needs a lot of water during the recovery phase. If myalgia and back pain is severe in the post-recovery period, then regular stretching exercises at home can be done.

 

 

 

Breathing Exercises:

The virus affects the brain function and mind, so the best way to relax is by taking good sleep and doing breathing exercises.

 

Correct sleeping posture:

Long periods spent on the couch or in bed can exacerbate the pain, making it worse while dealing with lower back pain associated with the Omicron variant.  While sleeping and taking rest maintains the spine's natural alignment. The spine has several curves that need to be supported. Use a suitable mattress to support these curves, avoid any mattress that adds extra pressure during sleep. Place the pillow under the knees to remove tension from your back and allow for more natural alignment during sleep. 

 

Heat and cold therapy:

Your physiotherapist will also recommend heat and ice therapy. The patient can try both and use whichever makes him/her feel better. Sometimes heat therapy can have a soothing effect on sore muscles. It should be used for 20 minutes at a time. Whereas ice therapy can be used for lower back pain as it provides great relief.

 

Simple range of motion exercises and stretching exercises:

Rest is essential when you don't feel well. But staying in the same position can cause tightness of the body. To prevent tightness, while taking rest take breaks, get up and move whenever possible during the day. While in isolation or quarantine, start doing simple exercises for 10-minutes like bending and straightening the leg,  bending and straightening the elbow, or doing ankle-toe movements. As the individual is sedentary during the recovery period or isolation or work from home, muscle tightness can develop like tight hamstrings, tight back muscles, tight neck muscles, even tightness may develop in arms and legs. Stretching the foot helps relieve pain in calves while alleviating lower back pain.

Stretching exercises to prevent tightness like raising the arms into the air, slowly twisting the back. Stretching the back bringing it backward, arching the back, bending forward, touching the toes, slowly twisting the back, etc.

 

Tools to support back health:

Your physiotherapist recommends a few tools to support your back health while dealing with back pain. The foam roller is a good example. They come in all shapes, sizes, and designs, and are easy to use and adapt to wherever you have sore muscles. The person can lean on it, lie on it, or can be used by someone to roll it over the sore muscles or knots. These foam rollers increase blood flow and reduce pain and soreness by penetrating the soft tissue. These rollers can be used in the back, legs, arms, and feet, to provide relief to strained muscles.

Back massager: Back massager can be used for dealing with sore muscles, these devices loosen the muscles and can be used in multiple directions to relieve pain.

 

Omicron can be deadly, therefore prevention is essential to keep yourself healthy. Avoid becoming infected with omicron by taking the right precautions.

 

Parkinson’s Disease | How to manage it by Physiotherapy?

Parkinson's disease is a complex neurodegenerative disorder that causes motor and non-motor symptoms, including cognitive impairments. Though there is no permanent cure for Parkinson's disease, drug treatments, surgery, and other therapies are employed to relieve these symptoms. However, for most Parkinson's patients, an additional treatment method like physiotherapy is required to aid mobility and boost independence. Exercise of all types is beneficial for patients with Parkinson's disease. The physiotherapist can guide the patient through the right moves to increase mobility, strength, and balance, and help him/her remain independent. In this blog, we have discussed the physiotherapy management of patients suffering from Parkinson's disease. Given below are the benefits and exercise techniques used by a well-trained physiotherapist to manage the symptoms of Parkinson’s disease.

 

What is Parkinson's disease?

Parkinson's disease is linked to disorders of the basal ganglia, basal ganglia are a group of neurons located deep within cerebral hemispheres. The disorders include rigidity, characterized by an increase in resistance and tremors at rest. Parkinson's disease occurs due to dopaminergic cell loss within the substantia nigra, it occurs due to genetic and environmental factors.

 

Benefits of physiotherapy

The main role of the physiotherapist is to maximize the functional ability strength, endurance, flexibility, functional practice, and balance through movement rehabilitation using support and education. Physiotherapy interventions include exercises and movement strategy training.

• Maintains a good breathing pattern,
• Increases muscle strength and joint flexibility,
• Corrects and improves abnormal movement patterns and posture,
• Maintains and improves function and independence, which helps to improve a person's quality of life.

 

Physiotherapy management

The physiotherapist conducts a comprehensive evaluation of the posture, strength, flexibility, walking, endurance, balance, coordination, and attention with movement. Based on these test results physiotherapist develops an exercise program to help stay as active and as independent as possible.

Depending on the nature and severity of the condition, the treatment program is designed that focuses on activities and patient education. It consists of exercises that help to:

 

• Improve fitness level, strength, and flexibility,
• Turnover in bed more easily,
• To get in and out of bed, chairs, and cars,
• Turnover in bed more easily,
• Stand, turn, and change directions more efficiently,
• Improve the smoothness and coordination while walking.
• Improve ability to perform hand movements,
• Improve ability to climb and descend stairs and curbs,
• Perform dual tasks at a time more efficiently,
• Participate in important activities.

Exercise has been proven to maintain health and well-being in Parkinson's patients. Neuroprotection exercises focus on endurance and use of motor learning principles approaches, such as mental imagery and dual-task training. It involves complex, powerful and intensive exercises. Neuroprotection training is effective and should be introduced in the early stages, though it helps at all stages.

 

Aerobic exercises

Physical activity like aerobic exercise helps slow down motor skill degeneration and depression. And also increases the quality of life of patients with Parkinson's. Exercises aimed to improve cardio-pulmonary functioning and improvement in biomechanics, posture, trunk and overall symmetric movement have been found of great advantage in neurodegenerative disorders.

 

Breathing exercises

Breathing exercises like inspiratory muscle training on lung functions in patients with mild-to-moderate Parkinson's are found to be effective. Respiratory complications are found to develop in many patients as their Parkinson's progresses, so attention should be given to managing the progressive weakness of respiratory muscles and rigidity of the thoracic cage. The individual is encouraged to continue being active and participate in physical exercise for as long as possible.

 

Range of motion exercises

To target both motor and non-motor symptoms, correct and proper movement is achieved by improving range of movement and physical capacity in daily activities by walking, incorporating manual activities like holding, grasping, etc.

 

Strengthening exercises

Strengthening exercises are given against an external resistance like weight machines, weight cuffs, therapeutic putty, cycle ergometer, elastic, etc. This also improves balance, overall physical performance. As muscle weakness is a major problem for patients with Parkinson's disease, depending on the stage of the disease, the physiotherapist recommends resistance exercises with light dumbbells or resistance bands. Hydrotherapy, water resistance can also be used to strengthen muscles.

 

Stretching and Flexibility

Parkinson's disease patients tend to develop tightness in the hip flexor, hamstring, calf muscles, etc. To decrease this stiffness, stretching exercises are given at frequent intervals throughout the day.

 

Executing a dual-task

Motor-Cognitive dual-Task training improves dual-task ability and can also improve gait, balance, and cognition. Dual-task like talking while walking is difficult in patients with Parkinson's.

 

Progressive resistance training (PRT)         

Progressive resistance training (PRT) is used to be effective in decreasing bradykinesia and improving functional performance in patients with mild-to-moderate Parkinson's disease.

 

Reciprocal Patterns

Reciprocal movements include left-to-right or side-to-side patterns, such as swinging the arms while taking steps while walking. Parkinson's disease may affect these patterns. The physiotherapist may help reinforce reciprocal patterns by the use of a stationary bike or an elliptical machine, also incorporate walking by keeping in mind the swinging of the arms.

 

Balance Work

Normal balance is an interplay among the visual feedback, the inner ear which helps orient, and how the feet sense the ground beneath them. Parkinson's disease can affect this balance system, making the gait unstable. Gait training can help to improve balance. Physiotherapy combines cognitive movement strategies, cueing techniques, balance exercises, and physical activities. Immediate effects of external cueing and attention can be seen on improving step length, freezing, and turning during walking tasks, and in activities of daily living.

To deliver a patient-centered treatment, it's important to provide patient education, discuss the options, and have an interactive session. Good communication and educating the patient are important as delivering an intervention.