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nari -> Re: CVA rehab options (March 24, 2005 12:27:00 AM)
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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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