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balance & mobilization
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balance & mobilization - August 24, 2004 9:43:00 AM
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dram
Posts: 10
Joined: January 9, 2001
From: chennai, tamilnadu, south india
Status: offline
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i have been attending a patient of 28 yrs old male, communicating obstructive hydrocephalus and shunting done thrice due to improper surgeries. Now, the patient feels unsteady in walking and balance is poor and lower limbs are stiff and muscle power is than 2.
plantar response - extensor.
cerebellar signs are normal.
How to bring balance in a more appropriate proper way?
How to strengthen him periodically?
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Re: balance & mobilization - August 26, 2004 12:33:00 AM
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PTAide
Posts: 11
Joined: August 21, 2004
From: Portland OR
Status: offline
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Dram, what have you been doing with him so far? I use therapy balls (can be found at wallmart)with my patients who need to improve ballence, strength,posture and flexibility. I assist by holding arms with the patient, helping them with different ball excerises. In your case, just sitting on the ball can help with balence. Eventually he may practice walking (while sitting)and can stretch hamstrings also.
Since he is so young motivation is important, he may be frustrated, and mistrusting.
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Re: balance & mobilization - August 28, 2004 11:04:00 PM
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Yen
Posts: 25
Joined: May 13, 2004
From: Australia
Status: offline
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How to bring balance in a more appropriate proper way?
Balance will definitely need work. He sounds paraplegic with G2 lower limb strength. Low level mobility right? Anyway, If so, try rehab on a bobath plinth, adjusting bed height/back rest as needed. Try muscle/joint stretches first and PNF exercises. Try active strenght exercises supine for the LL +/- manual support. Progress exercises with weights, inc reps/sets/holds etc. You can try some supine closed chain LL exercises.
So you mean muscle power less than 2? Upper limbs 4+? If so, gait orthosis eg rollator gutter frame thanks will be needed. Functional transfers (bed/chair mobility and transfers up-down bed, side-side, rolling, lie-sit, sit-stand) should all be part of your program and aim for independence +/- equipment (eg bed stick/overhead triangle bar) +/- assistance x1.
And utilise a PT assistant if you need the extra safety support when upright. It will take a while to get to this stage if he has muscle strenght 2/5. When u get here, try weightbearing exercises in parallel bars eg weight shift L-R, fwds-bwds,1/4 squats, hip/knee excercises. Offer manual facilitation if needed. Or attach a light weight on his ankle for limb dissociation awareness.
Um, is he of higher level mobility? If so, I have some other ideas for that kind of rehab. But for now, I'll leave it here.
Let us know how u go.
How to strengthen him periodically?
set a program for him to do. train a carer/family member/aide to help with the program. Theraband can help for auto assisted exercises (attach one end to foot/ankle and hands can help with SLR or hip Abdn, knee flexion exercises). Include stretches and joint PROM ex's.
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