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CVA rehab options
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CVA rehab options - February 10, 2005 1:28:00 AM
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modegard
Posts: 7
Joined: August 30, 2004
From: central wisconsin
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I am working with a patient who suffered from a CVA in Sept. 2004. Does anyone have any suggestions for facilitation hamstring recruitment..I have tried electrical stim. with/without gait with 2+ muscle grade. I am having difficulty working through his extensor synergy pattern.
Thank you in advance for any suggestions.
Michelle
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Re: CVA rehab options - February 10, 2005 10:14:00 AM
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Yogi
Posts: 403
Joined: April 5, 2004
From: San Antonio, Tx., USA
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Michelle, What's happening, is this a right CVA, left hemi that goes in extensor pattern on the left, in weight bearing, and then can't break into flexion?
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Re: CVA rehab options - February 10, 2005 5:52:00 PM
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nari
Posts: 1568
Joined: November 14, 2003
From: Australia
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Michelle
This can be tricky - and slow. I have used sit-->stand--> sit as a repetitive movement to facilitate hams and break the synergy enough to initiate flexion.
What is the ipsilateral arm doing? If it is flexed at all, anywhere, it will be almost impossible to crack the knee flexion....
The next thing to consider is what the contralateral arm is doing - probably ruling the roost. Try tying it behind the hip, in extension.
Let us know a bit more..
Nari
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Re: CVA rehab options - February 13, 2005 2:19:00 AM
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modegard
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Joined: August 30, 2004
From: central wisconsin
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Thanks for the replies. This patient is a left CVA right side affected. The main barrior is the extensor pattern in NWB. We have done a lot of exercises on the mat table i.e. hip extension with the leg off the side of the table, assist into DF, knee flexion and have him try to move out of this. He has gotten a lot better controlling hip flexion to bring the leg up onto the mat maintaining the knee flexed, but not 100%. However, in standing hip flexion is minimal with dominant trunk and knee extension. The ipsilateral UE is worse yet. Patient holds it braced close to the body with the elbow and wrist flexed with extreme difficulty to break this, even passively. We have worked on sit-stand transfers and this has carried over well with safe and appropraite transfer with this, but once the leg is lifted.........
This is a very determined and motivated patient and I would like to offer him anything and everything to help but I am hitting a roadblock!
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Re: CVA rehab options - February 13, 2005 10:21:00 AM
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nari
Posts: 1568
Joined: November 14, 2003
From: Australia
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Have you thought of an airsplint for the UL?
Can you get any kind of shoulder abduction? Even enough to place the airsplint on, inflate and achieve some elbow extension??
Try an airsplint on the affected arm, and if his LL patterning improves, he may be more able to break the synergy in WB.
Don't worry about exercises TOO much, there is not much carry-over with them. Try rolling, active assisted into prone, back again, and keep away from supine if possible as neural tension increases+.
Think of treating the whole trunk (rotation, side flexion, etc) rather than sections...
Nari
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Re: CVA rehab options - March 7, 2005 4:43:00 PM
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yankeept
Posts: 44
Joined: October 29, 1999
From: Ft Lauderdale, FL
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Please explain to me how working on sit to stand & vice versa will work on facilitating knee flexion. I'm a bit confused???
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Re: CVA rehab options - March 23, 2005 10:18:00 AM
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AYAJ
Posts: 5
Joined: March 20, 2005
From: Greece
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Michelle,
you seem to be a bit trapped,thinking muscles and synergies. What you have to do is to think "goals" which means you have to teach your man to achieve results and not just to perform exercises perfectly. If you are to teach swing phase ask him to shoot a ball or push and drag a light object with his foot along the corridor. Exercise on a mat table, that you describe are helpful but are far away from providing to him the experience of achiving a simple and meaningful goal.
I hope you get the concept.
_____________________________
AyaJ 'm only a pt
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Re: CVA rehab options - March 24, 2005 12:27:00 AM
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nari
Posts: 1568
Joined: November 14, 2003
From: Australia
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...which is why teaching a functional movement such as sit/stand/sit is useful for gaining control. The opposite leg functions more or less naturally and provided the weight is evenly distributed, and not biased to the unaffected side, it is quite effective.
I agree that exercises that are orthopaedically based are not effective.
E-stim can help, but practising the required movement is more reliable.
Dealing also with the proximal and central areas such as the trunk and neck also helps to reduce the synergy pattern and establish more control.
Establishing a simple goal works in any kind of physiotherapy; and essential in Rehab, where the concept of natural movement is largely lost.
Always remember that it is never too late to teach motor control - I am seeing a 60 yo man who had a severe (R) CVA in 1997, and was discharged from the Rehab centre with a rigid gait, walking stick and wheelchair 6 months later.
His affected arm was flexed, zero movement and zero function, and affected knee locked in extension. He had extreme pain in his (L) shoulder.
He now, after 6 weeks, seen 1Xfortnight, is free of walking aid, (L) arm by the side (but no function yet) and slight knee flexion coming in after push-off. He has full potential movement in the arm but it has not translated yet into function - the LE is still blocking that goal. He has some pain but it does not bother him anymore.
Neurodynamics resolved most of the pain.
Nari
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Re: CVA rehab options - June 17, 2005 6:28:00 PM
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bigposse
Posts: 4
Joined: March 10, 2005
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One thing I have found that works sometimes, though mostly on LE hemiplegics, is to use some NDT techniques with the Swiss ball. A full kneeling position with UE's supported on the ball with various perturbations can also envoke hamstring contractions. The only difficult thing about this is enabling the pt to assume this position, and some will refuse to attempt it. Maybe worth a shot though.
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