Hi all,
During the last placement I have come to the conclusion that hydro is great way of treating patients with neuromuscular disorders especially Guillain Barre Disease. I have been treating a couple of patients with this disease and both are able to complete tasks in the pool that seem impossible in the clinic. Hydro is especially effective when dealing with the impairments of decreased strength, decreased balance and hypotonia. My sessions usually begin with trunk exercises including seaweeding, alternate shoulder protractions keeping trunk level on the surface of water, and assisted ab curls. Then my session moves on to LL strengthening exercises utlising kicking and swimming activities, buoyancy resisted work, squatting and steps exercise. After this the session moves on to high level balance activities that can be progressed in difficulty by reducing water depth and/or adding trubulence. Finally the session ends with some running, and bounding work followed by some stretching.
The two patients have made the comment that they are often less fatigued after the sessions (which is a huge problem with GB) and recover faster for subsequent sessions. I guess the thing to remember is that they must be able to transfer the impairment improvements into every day functional activities so I think the best mix is to have one session in the pool and one in the clinic/gym. It would be interesting to hear from anyone else about their hydro experiences during their various placements. It is certainely one area where I feel there is much still to learn.
Finally I just would like to say thanks everyone for the interesting and informative blogs over the last couple of months. Good luck this week and have fantastic rural placements.
Cheers
Nico
1 comment:
So true Nico, I found that fatigue was a huge factor when working with my patient who had been diagnosed with GBS. And as you mentioned, the afternoon session was always more difficult as the patient hadn’t recovered from the morning. The difficulty in designing the rehabilitation program was trying the find the balance between making the sessions challenging but not exhausting for the patient. The fact that my patient was making progresses in his muscle strength every couple of days meant that constant changes to his program were needed. So your idea about having split sessions between the pool and gym would definitely be something to look at, especially if the patient had grades of 2/5 in the proximal muscle groups. The pool would facilitate active movement through full range, challenge the core muscle groups and protect joints made susceptible by weak stabilizing muscles.
Gareth
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