Howdy Folks
One thing that being on a neuro ward has taught me is that strength and stability of the trunk are key factors in determining the degree of balance and mobility a person has, or could possibly achieve. I have seen patients with a number of different diagnoses and one thing in common with them all is that their balance is affected, usually both sitting and standing, static and dynamic. And the trunk is one area of the body that all of these patients have required rehabilatation on in order for them to improve their balance. While the specifics of their impairments have differed, being either alteration in tone, a decrease in voluntary movement or ataxia, my treatments for these patients have centred on exercises for the trunk, and then translating these into relevant functional tasks. As you know, without a stable trunk, it is considerbaly more difficult for us to move our limbs or our head, and as such we are severely limited in how much of our environment we can independently explore.
What I have been having trouble with is coming up with new and exciting ways to treat the trunk, and progressions for these exercises. To treat altered verticality I have been using techniques we covered in class such as having the patient SOEB and leaning down on their elbow on their unaffected side (for stroke patients) then coming back to the midline. To improve fractionated movement, pelvic tilting exercises in crook lying, SOEB, modified plantar-grade and standing, as well as isolated pelvic then shoulder rotations in side lying. For ataxia, AI's and RS's while the patient is SOEB, in 2pt or 4pt kneeling. To increase strength, moving the knees from side to side while in crook lying, or laterally side flexing while in supine. I have also been shown some low level abdominal exercises for early stroke patients which I have added to my arsenal.
I am slowly coming to understand that if we keep in mind priniciples of rehab, and what our specific aims of treatment are, our background knowledge is sufficient to enabe us to adapt whatever exercises we have to any particular patients. But until then I would love to hear suggestions of other exercises for the trunk that you guys have come across in your travels, or any specific techniques that address trunk-related impairments.
Thanks and enjoy your long weekends!!
Bini
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3 comments:
Hey Bini,
I agree with what you were saying in your blog- I didn't realise how important trunk exercises were for patients until I started my Neurology placement as well.
In terms of different exercises to use the ones you are doing seem very similar to the ones that I adopted with my patients. There is however a few more which you could add to you list:
-Central Key Point exercises which focus on the trying to draw the thorax upwards in order to position the pelvis in a better position. Have the pt in SOEB and have hands in front of back of thorax at about breast height and then slowy try to draw them upwards to reduce any kyphosis.
-In addition to positioning the patient in crook lying and having them role their legs side to side you can practice the entire rolling movement or practice the movement of sidelying to lowering the legs down to the floor and back up again to work on core stability.
Good work with all your ideas!!
Debs
Hi, Bini and Debs!
I totally agree with you two..I've seen patients with different conditions and they all have poor postural trunk control and realised how important it is to improve core stability in order to progress them to the next level.
I think strengthening exercises in bed are important though we should make it functional. I have been using sidelying to sitting task to strengthen oblique abdominal muscles and trunk side flexors by asking them to bring the legs up and down as well as lifting the upper body up to sitting with less use of arms. Also, we need to get them to practice in different angles like quarter to supine and prone as we do in reality.
Enjoy your placement!
In Sun
Hi Bini,
I have an "ataxic patient" and even I was doing AI's and RS's and all different sort of balance exercises I've noticed improvement in balance skills but not significant improvment in his gait. My treatment now includes:abdominal exercises fisrt in supine with diffrent LL position/different angle and moving upper part of a body and alternatively upper body still and moving LL (for example on a fit ball), finally combination of two.I've noticed that many patients overuse their back muscles so before they starts exercise abdominal muscles I teach to "press a spine toward a plinth". I find useful to teach a patient palpates muscles which should work.This is beginning then as In Sun mentioned during walking/ steping I will encourage a patient to think and activate core muscle.
All the best,
Daria
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