Joan’s therapy

Go through the slides below for more information on Joan’s therapy.

Transfers – This describes the ability to move from one surface to another such as: bed-chair; chair-toilet and car transfers. These actions require education and practice of safe techniques and can improve balance, strength, postural and motor control. Initially these may be achieved with the help of a mechanical aid such as a weight-bearing hoist.

Facilitation of movement and physical function – These are therapeutic approaches used to enhance muscle activity during tasks which may include assisted or independent movements. This also includes activities performed by an individual to realise the needs of daily living in many aspects of life including physical, psychological, social, spiritual and intellectual roles. Initially in Joan’s case this involves “hands on” approaches to guide movement and function, but as she progresses she will be encouraged to perform more independently.

Strengthening – A stroke may cause a degree of muscle weakness. Strength training is used to improve muscle strength and functional motor performance. Techniques may include the use of body weight resistance, elastic bands, free weights and gym equipment. Encouraging Joan to sit up out of bed and to move from a sitting to a standing position will help to achieve this.

Self practice – This is used to increase the amount of repetition and practising of tasks/activities which may improve motor recovery and as a result, functional ability. It encourages patients to have an active role in their recovery through the unsupervised practice of exercises and functional tasks out-with therapy.

Positioning – All positions have different influences on muscle activation (tone) and joint range of motion. Good positioning assists with maintaining the flexibility of joints and can provide optimum alignment for carrying out functional tasks. The affected arm should always be well-supported so as to minimise the risk of damage and pain in the hemiplegic shoulder.

Base of support – The base of support, which is the area of the body that is in contact with the ground or another surface such as a bed or chair, is central to therapeutic physical management. Varying the base of support will place differing demands on balance and muscular activity and can be influenced by correct bed, mattress and chair choices. Varying base of support can be used to correct abnormalities in muscle tone.

Balance – Balance requires the interaction of multiple systems (e.g. motor, sensory and vestibular) to maintain the centre of gravity within a base of support in static and dynamic postures. This can allow improved functional activity and interaction within the environment. Improving balance also reduces the risk of falling and increases the safety of walking. Joan is currently working on improving her sitting balance during self-care activities such as dressing and developing early control of her standing.

Treadmill training – Treadmill training has been shown to improve walking in ambulant patients and there is increasing evidence to suggest that there may be benefits for those who cannot yet walk. Joan is using the treadmill with a harness to support her body weight and allow the early practice of walking with the help of two physiotherapists. This is task-specific and may improve aerobic fitness, speed and endurance.