In this post I will attempt to blend 2 of my favorite areas of Rehab - helping patients recover from strokes (CVAs) and developing equipment/exercises to help to this end. Strokes can leave patients with a wide range of physical and cognitive limitations. One of the most meaningful aspects of being a Therapist is helping patients overcome these problems. The following 5 treatment areas will highlight, in increasing order of difficulty, ways to improve physical and/or cognitive abilities. Each area will also highlight equipment, primarily for IPR and SNF settings, to aide in the rehab process.
- Sitting balance: For patients with limited sitting balance, wheel patient into ADL Balance Trainer, scoot them forward in the wheelchair (WC) and remove the foot rests and arm rests (reduces support). This also helps give space to use your handling skills to spot and facilitate sitting posture without hitting the WC. With the Trainer on each side and you in front, the patient naturally feels safe and secure. In this setup, you are ready to work on improving sitting stability. Unlike working at the edge of a mat table, it is easier to work on sitting balance in the Trainer without the need of a second helper. It is also easy to add cognitive challenges using the colored items on the Trainer (see ADL Balance Games for examples). For patients with visual neglect, move all of the colored platforms to that side to focus attention and movement toward these areas (see attached photo). Additionally, for patients with poor hand function, use rings and rods (instead of cones). Rings are easier to manipulate and the rods provide increased stability at release point, which helps reduce dropping items.
- Standing balance: Similar to sitting balance, sit on a rolling stool in front of patient, and use your manual skills to spot, block, and facilitate standing posture. The Trainer is wide enough to let you get your hands and arms around the side of patient without hitting against any bars. Also, unlike parallel bars, the design of the Trainer has options for reduced arm/hand support. This helps promote a more upright standing posture and increases use of the trunk and legs for balance. As an alternative, for patients able to stand with minimal assistance or better, the ADL Reach Trainer is a great product for improving balance while standing and reaching. Similar to sitting balance, cognitive challenges can be easily added using the ADL Balance Games.
- Reaching tasks: Being able to safely and confidently stand and reach is essential to preparing patients for going home (see blog "2 Basic Balance Needs for Patients in IPR & SNF" for more information). When a patient reaches, to place a cone, ring, or other items on a platform, they're also moving their head, trunk and arms. Such movements challenge balance, as the patient tries to steady their center of mass (COM) while they reach. Proportionally, the further the reach is away from neutral, the greater the disruption is to the COM and the greater the balance challenge. The ability to easily control and change reach distances is a key feature of the ADL Balance Trainer and Reach Trainer. The value of this feature is how effectively it lets you grade balance challenges (not too easy and not too hard) to achieve better outcomes.
- Weight shifting. Weight shifting exercises (moving the body’s center of mass without moving the feet) help improve stability for ADLs. For example, when reaching to retrieve an item at the back of fridge, you weight shift forward and extend the arm to reach far into the fridge. Other examples of weight shifts include backward (opening a door), side-to-side (walking), and rotational (looking over shoulder). It is not uncommon for losses of balance or asymmetries to occur in weight shifting following a stroke. The ADL Balance Mat or ADL Quadrant Hurdle (in combination with the ADL Balance Trainer or parallel bars if hand support is needed) are helpful for improving weight shifting movements. Direct the patient to stand on colored squares (or quadrants) to help set their feet for the weight shifting movements. For example, have patient place their right foot on blue and left foot on yellow to get into a split stance for practicing weight shifting forward and back.
- Stepping. Stepping is a high-level balance exercise. However, when the patient is physically ready, adding stepping movements will help guard against future falls. The ability to quickly adjust and reset one's base of support, e.g. stepping strategies, is important practice for when the unexpected happens, i.e., bumps, slips, trips, etc. The ADL Quadrant Hurdle or ADL Balance Mat (in combination the popular Clock Yourself app) are great products for stepping exercises.