Professional Documents
Culture Documents
Turning over to the sound side should be started with his arms
and trunk, his hands clasped.
The therapist can give minimal help by turning the pt. pelvis
and move the affected leg to the sound side
When he is lying on the sound side, the shoulder of the
affected side should be brought well forward, the are
supported on a pillow and extended at the elbow.
The pillow can thus be embraced by both arms.
NOTE:
Movement started with shoulder forward; knee kept in slight
flexion with small pillow.
Bend the affected leg and place his foot flat on the bed.
The pt. will then bend the sound leg and place that foot
parallel with and close to the affected foot.
The therapist must fix both feet with one hand and ask the
patient to lift his pelvis.
The therapist will then place the bedpan under the pelvis. The
patient should keep his legs bent.
Pt.s hands are clasped, she/he will start to turn the trunk
and then the pelvis. Feet are on the bed and both knees
are kept together when turning over.
TREAMENT
-pt sits on the bed c therapist on his affected side.
-Pt raises his shouldergirdle supporting it from the
under the axilla, holding his arm abducted in lateral
rotation,extended at the elbow, hand extended at
the wrist c fingers extended if possible c the normal
hand on knee.
-Then pt leans torwards therapist, and straighten
himself up again to mid posn. He should start this
by side flexing his head lateral to the normal side
and not just turn his head
Procedure:
o The pt. hold and keep the unaffected knee in midposition
o The pt. should not move the unaffected when the affected
limb perform small movement of adduction and abduction
alternately
o At first, he may have difficulty in reversing the movement
especially if the leg fall outwards into abduction
o When he can control the movement, the affected leg will
be keep to midline while moving the unaffected into
adduction and abduction
Physical Therapist
o Standing on the affected side of the pt.
o PT will raise the pt. shoulder girdle
supporting it under the axilla
Physical therapist
o Holding the hand firmly while the other
hand lifting the shoulder girdle up
Weightbearing can
be pratice in the ff.
ways:
position of pt.: SITTING with AFFECTED limb on the
side. (important reminder: to avoid IR of the arm, pt's
hand should be sideward or even diagonal backwards
with fingers extended)
TRAINING A: pt hand is placed on the support, some
distance away from his body
> pt SH girdle is lifted & supported under the PT's
axilla
> pt moves his trunk over his supporting arm
(*transferring most of his weight on affected hip)
when pt can maintain elbow extension without help,
PT can put a downward pressure on the shoulder to
extension activity & stability.
TRAINING B: If flexor
spasticity is very strong
and pt cant keep his arm
extended by his side
PT stands behind the
patient > move the pts
arm backward in
extension & full ER >
move the arm backward,
lift them off the support
while the pt slowly moves
his hips forward > PT will
gently push & pull the
arm to stimulate pt's
active extension.
Presented by :
Arnaiz, Pauline
Villas, Karl
Stage of Spasticity
Flaccid Stage
(+) SUBLUXATION
When pt. does not need to use the sound limb for
any task, he should sit with his fingers clasped.
The pt. then sees both his arms and hands in
front of him and get the feeling of bilaterality.
The affected arm then looks, and perhaps feels,
more like the sound one and, therefore, becomes
more acceptable as part of his body percept
again.
If possible, pt. should sit at a table or in
wheelchair, with tray in front of him. So that his
upper arm is supported and raised forward.
WEIGHT SHIFTING
EXERCISE USING 3 CHAIRS
CONTROL OF ADDUCTION
AND ABDUCTION IN
SITTING
Stance Phase
Swing Phase
Walking Sideways
It is usually easier for a patient to walk
sideways on a line if PT wants him to move his
knee, than to walk forwards or backwards,
especially if he walks sideways towards the
sound side
The advantage when walking sideways towards
the affected side is that he has to take full
weight on to that leg
However, PT should make sure that the patient
does not place the affected foot in front of the
line
I. STEPPING POSITION
Four-foot kneeling
1. From prone-lying, pt. will first bend the affected
the leg then the sound leg.
2. Pt. will extend the affected elbow and hand
placed flat on the ground with the fingers
extended and thumb abducted then the sound
arm.
Half-kneeling
1. Pt. stands by the side of a chair or stool with the
affected knee resting on the seat.
2. pt. is asked to make small steps forward and
backward with the sound leg.
Note: prevent flexor spasticity of the arm by
controlling elbow and wrist extension at the side or
above the head
C. Pull-push training
Another way of stimulating active extension of the flaccid arm is
a technique called 'pull push'.
This inhibits flexor spasticity
Procedure:
1. Place patient's hand in wrist and fingers extension
2. Patients arm is also raised sideways to the horizontal, or
above
3. A quick pull followed by a push against his extended arm is
given through his hand.
4. This should be done with the patient's arms in any direction,
sideways, forward and diagonally, and also gradually downwards.
5.When sufficient activation has been obtained at shoulder and
elbow, the therapist lets go of the patient's hand and should hold
his arm up unaided.
D. Functional movements of the elbow
joint by touching various body parts in
different direction
Position:
In supine, or sitting
Procedure:
1. Patient is asked to bend his elbow to touch the top of his
head with his palm.
2. Followed by moving his hand to the opposite shoulder, then
back again to his head.
3. He can also be instructed to touch the opposite ear and
then move his hand to the shoulder and down the arm, as if
washing himself.
4. Whenever the patient moves his hand downwards, he
should be able to raise it again.
Position
Lying on the affected side.
Procedure:
1. Pts. arm is extended and in full external rotation.
2. Shoulder should be placed well forward.
3. Ask patient to bend his elbow to bring his hand to
his mouth, and then back to extend it again.
4. This movement of the elbow should be slow and
controlled at every stage
5. The same movements can be practiced in supine
6. Pts. arm lying in horizontal abduction, or lower
down by his side.
7. Ask pt. to touch his shoulder with his supinated
hand.
Position:
Sitting (Forearm resting on a table)
Procedure:
1. Flexion of the elbow with supination
brings his hand to his mouth and to
the opposite shoulder or ear.
On Affected Side
To improve balance reactions on the affected leg,
the therapist transfers the patient's weight well
over to that leg.
Therapist stands by this side and holds his hand
with his arm abducted and extended.
Pt.'s shoulder girdle should be prevented from
pulling downward.
On Affected Side
Pt. should be encouraged to flex his head laterally
towards the sound side and his arm and leg on
that side should lift and abduct.
When pt can do this well, he should be asked to
perform small alternate movements of flexion and
extension of the knee of the affected leg.
Crossed Standing
When pt is standing with his legs crossed, they
should be externally rotated so that the toes of his
feet point towards each other.
When the affected leg is in front, his hip is
extended and brought well forward.
Small movements of his hips from side to side, or
with rotation, can be done when he is safe enough
to stand still and balance.
Crossed Standing
Pt. is then asked to bring the sound foot forward
and across the affected one.
Pt. should do this slowly so that he carries his full
weight for as long as possible on the affected leg.
The therapist must guard against hyperxtension of
the knee at the back, which can be done by
bending it a little to touch the back of the sound
knee.
Crossed Standing
The pt. should then bring the affected leg forward
again and across the sound one, but he should not
abduct it more than absolutely necessary.
This movement is very useful, as the pt. has to
bend his knee to get the affected leg in front of the
sound one without circumducting the hip.
affected side.
His arm is held in external rotation and extended
by his side, slightly diagonally backwards.
His wrist and fingers should be extended and his
thumb abducted.
Walking can also be practised with the therapist
behind the patient, holding both arms backward as
described when sitting on a stool.
TRUNK ROTATION
TRAINING
Reyes, Jessie Marie D.