Pelvis as a Base of Support

This past week ended with an exciting outcome as one of my patients on my neurology placement achieved an important goal that he had set for himself. This patient was diagnosed with Guillain-Barre Syndrome three weeks ago and after deteriorating for approximately one week, has started to experience gradual recovery of his upper and lower muscle groups over the past two weeks. It has been a privilege to work with this patient from the beginning and watch his progression of recovery. The patient had the goal of taking his first steps by the end of last week, however at the beginning of the week the patient was still quite wobbly in standing. This was partly due to the weakness in his lower limbs but, as my supervisor pointed out to me, he still didn’t have the stability around the pelvis to stand, let alone take a few steps.

So we focused our sessions around improving the activation of his lower abdominal wall and thus improving lumbopelvic stability. The exercises progressed from crooklying, 4pt and then 2pt kneeling. We worked on contraction of the lower abdominal wall with lower and upper limb movement, then dissociation of the lumbar and pelvis in both the 4pt and 2 pt positions. The improvement was quite noticeable as his ability to perform ¼ squats in 2pt and standing progressed even though his muscle strength in the hip and knee extensors remained constant.

The importance of having good activation of the trunk and pelvic muscles as well as good stability around the hips and pelvis was a frequent theme in our labs and was highlighted to me in this experience. And as was pointed out to me, with ambulation the pelvis is the base of support of importance. So as a result of his hard work this week, the patient was able to walk two laps in the parallel bars independently. It was great to able to share in his excitement for being able to achieve such an important goal for the patient.

Gareth