The document outlines strategies for physical therapy management in the acute stage after a stroke. It discusses positioning strategies, improving respiratory and circulatory function, preventing pressure sores and deconditioning. It then outlines various physical therapy interventions to improve sensory function, flexibility, strength, movement control, functional mobility, upper and lower limb function, balance, locomotion, aerobic function, swallowing, motor learning, and provides education to patients and families.
4. IMPROVE RESPIRATORY AND
CIRCULATORY FUNCTION
Breathing exercise
Chest expansion exercise
Postural drainage
Huffing and coughing techniques
Passive and active ankle & toe exercise ( after careful assessment)
5. PREVENT PRESSURE SORES
Proper positioning
Relieve pressure points by padding and cushion
Frequent turning and changing position
Prevent from moisture
Use cotton clothing
Tight fitting cloth is prevented
Use of water bed, air bed & foam mattress
6. PREVENT FROM DECONDITIONING
Early mobilization in the bed (active turning, supine to sit, sit to supine, sitting, sit to stand)
Pelvic bridging exercise
Early propped up positioning, sitting & then later to standing
Moving around the bed
Facilitate movement of functioning limbs
8. Improve sensory function
Positioning hemiplegic side towards door or main part of room
Presentation of repeated sensory stimuli
Stretching, stroking, superficial & deep pressure, icing, vibration
Wt. bearing ex & Join approximation technique
Stoking with different texture fabrics
Pressure application
Improve other senses like use of visual & auditory
PNF technique, use of bilateral UE
9. Flexibility & Joint Integrity
Soft tissue, Joint mobilization & ROM exercise
AROM & PROM with end range stretch
Effective positioning & edema reduction
Streching program & splinting
Suggested activities
Arm cradling
Table top polishing
Self overhead activities in supine & sitting & reaching to the floor
10. Improve strength
Strengthening of agonist & antagonistic muscle
Graded exercise program using free weights, Thera bands, sand bags & isokinetic devices
For weak patients (<3/5), gravity eliminated exercise using power boards, sling suspension or aquatic
exercise is indicated
Gravity-resisted active movements are indicated (>3/5 strength)
11. Manage spasticity
Sustained stretch and slow icing of spastic muscle
Rhythmic rotations
Weight bearing exercise
Prolonged & firm pressure application
Slow rocking movement
Positioning in anti synergistic pattern
Rhythmic initiation
Air splints
Neural warmth
Electrical stimulation
12. Improve Movement control
Dissociation & selection of desired movement
Select postures that assist desired movements through optimal biomechanical stabilization & use of
optimal point in range
Start with assisted movement, followed by active & resisted movement
Task oriented exercise
13. Postural control & functional mobility
Suggested exercise
Rolling
Supine to sit and sit to supine
Sitting
Bridging
Sit to stand & sit down
Modified plantigrade
Standing
Transfer
14. In pusher syndrome
Passive correction often fails
Use visual stimuli to correct
Sit on the normal side & ask patient to lean on you
Sitting on Swiss ball
Environmental boundary can be used e.g. corner or doorway
15. Improve UE function
Early mobilization, ROM & positioning strategies
Relearning of movement pattern & retraining of missing component
UL weight bearing exercises
Dynamic stabilization exercise
Picking up objects, Reaching activities
Lifting activities
Manipulation of common objects
Push up ex. In various position
Kitchen sink exercise
Functional movement like hand to mouth & hand to opposite shoulder
Advance training-CIMT, biofeedback , NMES ,FES
16. Managing shoulder pain
Proper handling & positioning of shoulder joint
Reducing subluxation, NMES, gentle mobilization( grade 1& 2)
Use of supportive devices & slings
Use of overhead pulley is contraindicated
TENS & Heat therapy
17. Improving LL function
Strengthening muscles in appropriate manner
Suggested activities –PNF pattern of LL
-Holding against elastic band resistance around upper thighs in supine
or standing positions
-Standing, lateral side steps
-Exercise to improve pelvic control
Facilitation of DF
Cycling or treadmill training
18. Improve balance
Facilitate symmetrical weight bearing on both side
Postural perturbations can be induced in different positions
Sit or stand on movable surface to increase challenge
Reaching activities
Dual task training e.g. Carrying object while walking
Divert attention
Single limb stance
Exercise on trampoline
19. Improve locomotion
Initial gait training between parallel bars
Proceed outside bars with aids and then walking without aids
Walking forward, backward, sideways & in cross patterns
PBWSTT with higher speed improve overall locomotor activity & overground speed
Proper use of orthotics & wheelchair
20. Improve aerobic function
Early mobilization & functional activity
Treadmill training & cycling ergometer
Symptom limited graded exercise training
Exercise at 40-70% of VO2max, 3 times a week for 20-60 minutes
Proper rest should be given
Gradually progressed to 30 minutes continuous program
Regular exercise reduces risk of recurrent stroke
21. Improve feeding & swallowing
Proper head position in chin down position
Movements of lips, tongue, cheeks & jaw
Firm pressure to anterior 3rd of tongue with tongue depressor to stimulate posterior elevation of tongue
Puffing, blowing bubbles & drinking thick liquids through straw
Food presentation in proper position
Texture of food should be smooth
Tasty food should be given to facilitate swallowing reflex
Stroking the neck during swallowing
22. Improve motor learning
Strategy development- patient as an active explorer of activity
- Modify strategy of activity in correct posture
Feedback- Intrinsic and extrinsic feedback, Positive and negative feedback
Practice- Repeated practice of functional activity, Practice in different environment
23. Patient & family education
Give information, counsel family members about patient’s capabilities & limitations
Give information as much as Patient or family can assimilate
Provide open discussion & communication
Be supportive, sensitive & maintain a positive supporting nature
Give psychological support
Refer to help groups