My Life as A Physical Therapist – Part 8

Written by: Yaffa Liebermann PT, GCS,CEO

1985 Tel Hashomer Hospital, Israel

While working as a rotating therapist amongst the departments in a hospital in Israel, I realized that therapists and nurses utilized the same technique to guide the movement of patients who suffered a stroke.  This technique was used throughout the full rehab process from the acute stage, the subacute as well as outpatient. That observation led me to understand the power of repetition of the same movement by all disciplines. It taught the patient the correct new movement, how to transfer from bed to sit to stand. The Bobath method used by the staff was not only for patients who suffered a stroke, but to all patients who suffered from weakness; it helps to understand body movement and weight bearing changes when evaluating every patient.

Rivka 49 years old, suffered from a massive stroke that left her flaccid in her left hand and leg. Although she had been surrounded by her daughters, they were afraid to touch her. I saw their confusion and organized a meeting with the family one day at 9:00 am and requested they bring clothes and shoes.

I taught them correct hand placement to a flaccid arm as well as how to provide trunk support during transfers. With that collaborative training, each daughter felt comfortable and safe with their mother, and were able to safely and confidently care for her both in the hospital and then at home.

Working in Tel Hashomer inspired me to practice and teach therapists about the provision of treatment to a person who suffered from a stroke.  The goal was that more of us will use the same technique  to treat the patients. After years I wrote the book: Stroke Restoration- Functional Movement for the Patients and Caregivers.; a guide book with color illustrations to help rehabilitate the stroke patient from the incident to back home. It can be purchased on Amazon.

A quote from the book: “A stroke may be frightening to both patient and family, since they all find themselves in unfamiliar territory. A patient may do well with one activity but have trouble with another seemingly easier task. Those who have had a stroke often demonstrate weakness on one side of the body or difficulty moving, swallowing, talking, or thinking. It is comforting to know that stroke patients usually have at least some natural healing, continue to restore their movement in rehabilitation, and then continue to improve through practicing at home. Stroke survivors should realize that some function may never return, therefore hope and realization should intertwine with each other.”

I am a physical therapist, geriatric clinical specialist, and chief executive officer of Prime Rehabilitation Services, Inc. The purpose of writing this book is to help caregivers teach stroke patients how to regain strength and restore functional movement so that they will be able to take care of their own daily needs—such as dressing, bathing, eating, and walking. The information in this book can be applied to anyone who has suffered from a disease or event that has weakened the body, leaving them unable to perform as they did before. The illustrations demonstrate several techniques of care; they show patients how to move and show caregivers how to support patients, providing ideas for progressive functional treatments for professionals (physical, occupational, and speech therapists).”

Brain Plasticity and Re-Mapping of the Brain: If one little segment was destroyed, there are remaining cells in the brain to take over the action and to produce a good motion with the right training.  The role of early and late rehabilitation, with attention to psychosocial and environmental factors, appears to be critical for recovery.

Forced Use:  In the past, we use to adjust to the disability and to work around it, maybe to use the hand as a paperweight to hold the potato down to the counter when peeling with the good hand.  This time we would train the hand to take an active role in the peeling process.  The leg can take an active part in the walking movement, not only by dragging behind the good leg, but taking forceful weight bearing even at the flaccid stage or at a later recovery period.

Goals of Treatment : Inhibit abnormal movement and provide experience of normal movement by: Understanding and analyzing how patients deviate from normal movement. Why patients deviate from normal movement Ability to bear weight

Treatment goals must be related to the prior level of function and to functional end.

• Ask the patient for his goals to be achieved in the treatment.
• Pick up four to five goals and direct your treatment toward achieving them.
• Be specific and relate each goal to relevance in each discipline.
• Differentiate short-term goals from long-term goals.
• Consider how to begin, continue, and end treatment.

Keep in mind the functional task that you would like to accomplish in the treatment and direct each movement to get you closer toward this target.

 

Analyzing Movement :

1. What initiates the movement

1. What is the direction of the movement
2. Identify the antigravity control
3. Look at the head, trunk, and limbs

 

 

 

10 Tips to Help You Recover After A Stroke

1. Keep on Moving: There is a myth which would have one believe that all progress occurs within the first 6 months post brain attack.  Research and clinical evidence suggest there is a re-mapping and reorganization of the brain and new synapse connections continue to occur if rehabilitation is continued.
2. 

   Assists up from bed, clasping hands and moving forward

   The Importance of Equal Weight Bearing: The stroke survivor tends to stand on the strong leg and use the strong arm which pampers the weakened side. Use no discrimination policy; left = right.  **Sit in a chair with equal arm support, bearing equal weight on both buttocks.  Stand with equal weight bearing on both legs.  Sleep on both sides. If possible, go back to old activities that kept your muscle strong.

3. Stretching and moving the arm:  If the arm is flaccid, keep each joint in full range to provide the opportunity for return of muscle action.
4. Clasped Hands:  Clasped hands promote good sensation of the weak arm and keep mobility of the arm joints.  Lifting your clasped hands up over your head a few times a day can also build trunk control.
5. Wheelchair Propulsion: Use your strong hand to turn the wheel on the strong side, as the strong leg pushes and pulls the chair along the floor in the desired direction.
6. Dysphagia:  The Speech Language Pathologist may give other instructions such as these:
   • For safety reasons, you should chew food on the strong side of your mouth. You should not try to chew on your weak side until both you and the caregiver are trained by the speech language pathologist.
   • Caregivers can sit by your weak side for awareness.
   • For safe swallowing, you should sit with the hips at a 90-degree angle.  You should take small bites of food at each meal and keep the chin tucked in to prevent aspiration.  You should use extra swallows for safety and alternate solids and liquids.
   • You should stay seated for thirty minutes after eating or drinking.
7. Use of Splints: might be utilized when a joint is flaccid, swollen, or contracted, for either short term or permanent use with a wearing schedule as prescribed by your therapist and physician.
   

   Standing by the weak side

8. Caregiver: should approach from the middle to the weak side.  Remind the patient to use the weak side.  When walking, stand and support from the weak side.
9. Sensation Impairments:  Can be light touch, pain or  proprioception: it is the  deep feeling of the joint position.  The return of the deep feeling sensation goes from proximal to distal or shoulder to the fingers.
10. You should be checked regularly by the doctor: It is very beneficial to seek help from a skilled therapist to see if there is a new approach or new exercises to stimulate different muscles.

Our story continues.  We moved to New Jersey. This time it was easy to renew my PT  license since I was licensed in Virginia. My clinical experience inspired me to focus and research a few subjects that I will share with you in the next blogs.