Stroke is a leading cause of disability worldwide, often leaving patients with impaired motor and sensory functions, reduced mobility, and diminished quality of life. Physiotherapy plays a crucial role in aiding stroke survivors on their path to recovery by addressing these challenges systematically and holistically. Here’s a detailed overview of physiotherapy management for stroke, covering goals, positioning strategies, motor learning, gait training, balance improvement, and more.
Goals of Physiotherapy Management
- Regain motor function.
- Regain sensory function.
- Improve muscle strength and performance.
- Enhance gait.
- Boost balance and coordination.
- Improve joint flexibility and mobility.
- Enhance activities of daily living (ADL).
- Prevent further complications.
Management Techniques
1. Positioning
Proper positioning is vital for support, comfort, and preventing complications such as abnormal muscle tone and pressure sores. It also improves awareness of the affected side.
Supine Position:
- Keep the head in midline on a pillow.
- Place a towel under the affected scapula.
- Extend the affected elbow and support the forearm with a pillow.
- Use a rolled pillow under the affected pelvis.
Side-Lying on the Unaffected Side:
- Support the head on a pillow and bring the affected shoulder forward.
- Place a pillow below the affected arm and flex the affected hip and knee, supported with a pillow.
- Ensure the spine remains straight.
Side-Lying on the Affected Side:
- Support the head and shoulder with pillows.
- Position the unaffected leg forward with hip and knee flexed, while keeping the affected leg straight.
- Place pillows in front and behind for support.
Sitting:
- Maintain an upright posture with the head in midline.
- Use a chair with armrests for support.
- Symmetrical weight-bearing on both buttocks.
- Flex hips and knees to 90 degrees, with the ankle in a neutral position.
2. Motor Learning Strategies
Motor learning promotes recovery through passive and active exercises tailored to the patient’s recovery stage.
- Scapular mobilization and passive-to-active joint movements.
- Functional tasks such as:
- Touching the opposite shoulder.
- Bridging activities (full and half bridging).
- Trunk rotation exercises.
- Activities in sitting:
- Weight-bearing on the affected limb.
- Shoulder shrugs and forearm movements.
- Sit-to-stand transfers with therapist support.
- Physio ball exercises.
- Activities in standing:
- Forward and lateral leg movements.
- Unilateral stance on the affected leg.
- Pivot turning.
3. Gait Training
Once the patient can actively stand and perform transfers, gait training begins.
- Start with parallel bars for support and progress to walking without aids.
- Introduce side stepping, backward stepping, and pivot turning.
- Incorporate treadmill walking to enhance endurance and confidence.
4. Balance Training
Balance training is essential to reduce the risk of falls and promote independence.
- Exercises in quadruped and Superman positions.
- Transitioning from kneeling to knee standing.
- Reaching activities in various positions.
- Use of balancing boards, single-limb standing, and Swiss ball exercises.
5. Joint Flexibility, Mobility, and Strength
Regaining joint flexibility and strength requires a combination of passive and active approaches.
- Start with soft tissue manipulation and peripheral joint mobilization.
- Gradually introduce:
- Passive to active movements.
- Stretching and resisted movements (e.g., wall squats, weight-bearing exercises).
- Splinting and slings for support.
- Progressive resistance exercises (PRE) and PNF patterns with resistance.
6. Advanced Techniques and Approaches
- Neurodevelopmental Technique (NDT): Focuses on facilitating normal movement patterns.
- Rood’s Approach: Uses sensory stimulation to improve motor control.
- PNF Technique: Enhances movement through resistance.
- Constraint-Induced Movement Therapy (CIMT): Promotes the use of the affected limb.
Conclusion
Stroke rehabilitation requires a well-structured physiotherapy program tailored to the patient's individual needs. By focusing on positioning, motor learning, balance, gait training, and advanced techniques, physiotherapists can significantly enhance recovery and improve quality of life for stroke survivors.
This systematic approach ensures that the patient regains independence and minimizes the risk of complications, making physiotherapy an indispensable part of stroke management.
