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| People living with hemiplegia usually undergo a combination of rehabilitation therapy, which typically involves physical therapists, mental health professionals, and rehabilitation therapists.<ref name=":0" /> | | People living with hemiplegia usually undergo a combination of rehabilitation therapy, which typically involves physical therapists, mental health professionals, and rehabilitation therapists.<ref name=":0" /> |
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| == Physiotherapy Approaches == | | == Physiotherapy == |
| a''. '''Conventional therapies''''' (Therapeutic Exercises,Traditional Functional Retraining)
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| * Range Of Motion (ROM) Exercises
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| * Muscle Strengthening Exercises | | * [[Stroke: Physiotherapy Treatment Approaches]] |
| | | * [[Physiotherapy Treatment Approaches for Individuals with Cerebral Palsy]] |
| * Mobilization activities
| | * [[Physiotherapy Management of Traumatic Brain Injury]] |
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| * Fitness training
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| * Compensatory Techniques
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| b. '''''Neurophysiological Approaches:'''''
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| 1. Muscle Re-education Approach.
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| 2. Neurodevelopmental Approaches :[[Neurology Treatment Techniques]]
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| * Sensorimotor Approach (Rood, 1940S) | |
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| * Movement Therapy Approach ([[Brunnstrom Movement Therapy|Brunnstrom]], 1950S)
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| * NDT Approach ([[Bobath Approach|Bobath]], 1960-70S)
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| * PNF Approach (Knot and Voss,1960-70S)
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| 3. Motor Relearning Program for Stroke (1980S)
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| 4. Contemporary Task Oriented Approach (1990S)
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| ==== Posture : Primary focus, Potential Treatment, Benefits , Activities<ref>O'Sullivan SB, Schmitz TJ. Improving functional outcomes in physical rehabilitation. FA Davis; 2016 Feb 17.</ref> ====
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| {| class="wikitable"
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| !Posture/description
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| !Primary focus/benefits/activities
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| |-
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| |Prone on elbow
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| Prone ,weight bearing on elbows
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| Stable posture
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| Wide BOS
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| Low COM
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| |Focus on improving upper trunk, UE and neck/head control
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| Improve ROM in hip extension
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| Improve shoulder stabilizers
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| Activities in posture : holding , weight shifting , UE reaching , assumption of posture
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| Modified prone on elbows can be achieved in sitting and plantigrade positions
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| |-
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| |Quadruped
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| All four positions (hands and knees)
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| Weight bearing at knees through extended elbows and hands
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| Stable posture
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| Wide BOS
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| Low COM
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| |Focus on improving trunk , LE , UE and neck/head control
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| Improve trunk , hip , shoulder and elbow stabilizers
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| Decrease extensor tone at knees by prolonged weight bearing
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| Decrease flexor tone at wrist , elbows and hands by prolonged weightbearing
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| Promote extensor ROM at elbows, wrist and fingers
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| Lead up for I plantigrade activities , floor to standing transfers , antigravity balance control
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| Activities in posture : holding , weight shifting , UE reaching , LE lifts , assumption of posture , locomotion on all fours.
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| |-
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| |Bridging
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| Weight bearing at feet and ankles , upper trunk
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| Stable posture
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| Wide BOS
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| Low COM
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| |Focus on improving lower trunk and LE control
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| Improve hip and ankle stratergies
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| Weight bearing at feet and ankles
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| Lead up for bed mobility , sit to stand transfers , standing and stair climbing
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| Activities in posture : holding weight shifting , assumption of postures , LE lifts
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| |-
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| |Sitting
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| Weight bearing through trunk and at buttocks , feet
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| Can include weightbearing through extended elbows and on hands
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| Intermediate BOS
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| Intermediate height COM
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| |Focus on improving upper trunk , lower trunk , LE and head/neck control
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| Important for upright balance control
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| Lead up for UE ADL skills ; wheelchair locomotion
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| Activities in posture : holding , weight shifting , UE reaching , assumption of posture
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| |-
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| |Kneeling and half kneeling
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| |Focus on improving upper trunk , lower trunk , LE and head/neck control
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| Weightbearing through hips and at knees ; upright antigrade postion
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| Decrease extensor tone at knee by prolonged weightbearing
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| Improve hip and trunk stabilizers
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| Weightbearing through ankle in half kneeling
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| Lead up for upright balance control , standing and stepping , floor to standing transfers
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| Activities in posture ; holding , weight shifting , UE reaching ,assumption of posture , knee walking
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| |-
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| |Modified plantigrade
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| Standing with weightbearing on hands through
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| extended elbows (on support surface) and through
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| trunk, LEs
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| Modified upright antigravity position
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| Stable posture
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| Wide BOS
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| High COM
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| • Focus on improving head/neck, trunk, and UE/LE
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| control in supported, modified upright posture
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| • Decrease tone in elbow, wrist, and finger flexors by
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| prolonged weightbearing
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| • Increase extensor ROM at elbows, wrists, and fingers
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| • Hips flexed, COM forward of weight bearing line
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| creating an extension moment at the knee
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| • Increased safety for early standing (four-limb posture)
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| • Lead-up for upright balance control, standing and
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| stepping; standing UE ADL tasks
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| • Activities in posture: holding, weight shifting, UE
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| reaching, LE stepping, assumption of posture
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| |-
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| |Standing
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| Weightbearing through trunk and LEs
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| Full upright, antigravity position
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| Narrow BOS
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| High COM
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| |• Focus on improving head/neck, trunk, and LE control in
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| fully upright posture
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| • Hips and knees fully extended
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| • Lead-up for upright balance control, stepping,
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| locomotion, stair climbing; standing UE ADL skills
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| • Activities in posture: holding, weight shifting, UE
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| reaching, LE stepping, assumption of posture
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| |}
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| ==== Programming variables ====
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| * '''Duration:''' The overall duration of the session will be one hour. The total duration of the aerobic/cardiac exercise training should increase from 15 minutes (week one) to 40 minutes by week 12.
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| * '''Intensity:''' The intensity of exercise should aim to be moderate as opposed to low. This effort level is required for all components but will be adjusted for each individual according to health status on a session-by-session basis.
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| * '''Frequency:''' The frequency of the session should be three times per week wherever possible<ref>Best C, van Wijck F, Dinan-Young S, Dennis J, Smith M, Fraser H, Donaghy M, Mead G. Exercise after Stroke Services.(accessed 29 June 2018)</ref>.
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| === Functional electrical stimulation (FES) ===
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| * FES is a modality that applied a short burst of electrical current to the hemiplegic muscle or nerve.
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| * In Hemiplegia Physical Therapy, FES has been demonstrated to be beneficial to restore motor control, spasticity, and reduction of hemiplegic shoulder pain and subluxation. It is concluded that FES can enhance the upper extremity motor recovery of acute stroke patient.
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| * FES could reduce spasticity in stroke patient. A recent meta- analysis of randomized controlled trial study showed that FES improves motor strength.
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| * FES can significantly improve arm function, electromygraphic activity of posterior deltoid, range of motion and reduction of severity of subluxation and pain of hemiplegic shoulder.
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| === Biofeedback ===
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| * [[Biofeedback]] is a modality that facilitates the cognizant of electromyographic activity in selected muscle or awareness of joint position sense via visual or auditory cues. In Hemiplegia Physical Therapy the result of studies in biofeedback is controversial.
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| * A meta-analysis of 8 randomized controlled trials of biofeedback therapy demonstrated that electromyographic biofeedback could improve motor function in hemiplegic patient. | |
| * Another meta-analysis study on EMG has showed that EMG biofeedbcak is superior to conventional therapy alone for improving ankle dorsiflexion muscle strengthbshowed that biofeedback could improve earlier postural control to improve impaired sitting balance.
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| === Conventional gait training ===
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| Conventional [[Gait Training in Stroke|gait]] training has focused on part-practice of components of gait in preparation for walking. It includes
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| * Symetrical Weight bearing training
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| * Weight shifting
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| * Stepping training (swinging / clearance )
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| * Heel strike
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| * Single leg standing
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| * Push off / Calf rise. Followed by,
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| Circuit training (reaching in sitting and standing, sit-to-stand, step-ups, heel lifts, isokinetic strengthening, walking over obstacles, up and down slopes).
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| Traditional approaches to stroke recovery have a focus on neuro facilitation or neuro developmental techniques (NDT) to inhibit excessive tone, stimulate muscle activity if hypotonia is present and to facilitate normal movement patterns through hands-on techniques. Practice based on the framework advocated by Berta Bobath remains the predominant physical therapy approach to stroke patients in the UK and is also common in many other parts of the world, including Canada, United States, Europe, Australia, Hong Kong and Taiwan. The Bobath framework has evolved from its original foundations, however, therapists surveyed on the core Bobath elements still emphasize normal tone and the necessity of normal movement patterns to perform functional tasks. Strength training to improve walking ability Task-specific training to improve walking ability.
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| == References == | | == References == |