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"water skiing" patient
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"water skiing" patient - May 6, 2000 1:18:00 PM
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hamplifier
Posts: 8
Joined: January 12, 2000
From: jackson, ms
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I have a stroke patient that wants to plantarflex big time when standing, but does fine with ambulation (with two others assisting). Looks like he is waterskiing. Patient basically has no use of UE yet, but has strength in LE wfl. Any ideas why this is happening and what I might could do about it treatment wise? note: this is in home health setting.
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Re: "water skiing" patient - May 6, 2000 3:17:00 PM
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Dana D
Posts: 142
Joined: September 18, 1999
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What do you mean by looking like he's water skiing? I can't picture it?? [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG]
Maybe the weight bearing that is going on during ambulating is breaking up his tone. And then in static stance he has the ability to just weight bear on one leg, rather than both? Try promoting WB and lateral weight shifting by giving proprioceptive input through his pelvis on that side.....
You could try having him wear a cuff weight on his ankle. This may give him some proprioceptive input and encourage more weightbearing on that side.
You could also pursue an orthotic... even if it is a temporary off the shelf AFO, to see how that impacts his plantar flexion and functional abilities. This may be needed temporarily because some of his increased tone may resolve.
Just some suggestions... good luck and keep us posted.
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Re: "water skiing" patient - May 6, 2000 3:44:00 PM
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Andrew M. Ball, MS, PT
Posts: 500
Joined: October 8, 1999
From: Chapel Hill, NC, USA
Status: offline
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I agree with Dana's suggestion about trying an off the shelf AFO after doing a full orthotic evaluation.
I'd caution against use of a cuff weight on the ankle for proprioceptive input. Although the theory is sound, the problem is what happens when you take the weight cuff off . . . a "springboard" effect is created and the patient ends up worse off than had you done nothing at all.
I've also had some good clinical experiences with orthotic intervention plus a toe comb that tends to help break up the LE tone. Caution must be taken here too though . . . if you don't find and "attack" the proximal cause of the distal tone, then the patient usually just accomodates to the toe-comb within about 8 weeks . . . and nothing functional or long term is gained.
I, like Dana, am not sure that I'm picturing this patient correctly. Could you describe further?????
Drewfus, MBA, MS, PT
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Re: "water skiing" patient - May 6, 2000 4:46:00 PM
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hamplifier
Posts: 8
Joined: January 12, 2000
From: jackson, ms
Status: offline
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Basically, in static stance, he leans backwards due to increased pf tone, but with assisted ambulation, there is no pf tone (or none that I observe), so there is no backward lean. hope this helps paint a clearer picture...its almost like with static stance the patients cog is off and he is trying to compensate with a backward lean.
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Re: "water skiing" patient - May 7, 2000 11:19:00 AM
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hamplifier
Posts: 8
Joined: January 12, 2000
From: jackson, ms
Status: offline
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Bobcat,
good point on #2, never thought of it that way!! I will work on the info and get it back on here as quickly as I can...
thanks
the hamplifier
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