T2

STROKE PATIENTS, SCENARIO 2

Stage 1:
Before beginning the task should know- if the exercise is neccessary for the patient
How the patient is to be moved
What equipment is needed

Examine surrounding enviorment,checking for any obstacles that may provide problems during the exercise

Check that bed is at the correct height and the positioning of the wheelchair allows for easy transfer of patient to the bed


Patient initially sitting in wheelchair

Introduce yourself as the physio

Explain to the patient the objectives and benifits of the excercise.

Ask for consent before beginning the exercise

Test patient so that they are capable of the transfer

Right side is affected

Check patients dermatomes and then myotomes(comparing both sides to each other)

Now check arm and shoulder mvts

Ask them to their good/left arm up and down indepentely

Support affected arm up in flexion and see if patient can bring hand towards head (arm at 90 degrees)

Using left hand, have patient touch their nose and then back of neck in one motion

Then with right hand assist in touching their nose and then back of neck in one motion

Get patient to lift left thigh

Then while keeping heel of feet on the plate, get patient to lift their toes

Ask can they feel your hand on their left and right leg, does it feel the same on both sides

Assist patient in slighty lifting their right leg and get them to lower it slowly down

See if patient can extend knee while physio holds onto leg and foot

Get patient to bring legs in closer together and back out



See if they can slowly lower downwards knee

Can the patient bring there shoulder and back of the chair (hands on knees)

Physio in front and assistant behind

Physio places hand down along side and holds onto hip

See if patient can shuffle on left and then right keeping their spine in slight forward flexion


Stage 2:

Bring wheelchair up to side of bed at an angle

Paper towel should be placed on bed for infection control

Physio should make sure that patient should turn no more than 90 degrees on the rotator

Take the foot plates off completely and hold onto patients foot as you do so

Rotar turner shoul be pushed in right to wheel chair

Get patient to lean forward once more and to reach rotar turner with good arm

Then stop and explain the movement needed to stand up

Tell patient to look straight ahead while in the process of sit to stand

Patient holds onto turner with good arm and physio holds onto hips, offering stability to trunk, and helps patient stand up against rotar

Physio assistant stands on other side of rotar making certain it is stable

Spin rotar around so that patients bum is facing the bed

Physio continueosly holds onto patient at weak side

Explain that you will be sitting back onto the bed and you will be sitting back with them

Allow patient to feel for position of bed before sitting, physio offering guidance and reassurance

Slowly sit back with patient,arms still in support of back

Physio and assistant helps patient to shuffle back

Assistant lowers the bed while physio is still sitting with patient

Physio assistant moves to behind patient, kneeling on bed and supporting trunk and shoulders

Physio places approx 3 pillows on affected side of patient, gives slight support

Physion kneels on floor in front of patient ready to remove shoe




Stage 3:
Take the affected/right arm and put it under the medial aspect of the patients left knee and the other hand under the later aspect of the knee.

Physio places hands around ankle for support and the patient lifts that leg ( left) up and across over the right leg

After each leg cross tell patient to bring good hand down to shoe and slide it off and then back up to knee and into normal sitting position

Physio holds onto weak arm while patient removes shoe

Then do the same with the opposite leg


Tell them to practice with relatives and to wear appropriate shoes for easy shoe removal
















Analyse the activity occuring at the lumbar spineand the hip joint as the patient removes the shoe from the unaffected leg.

Starting Position – hip flexed to 90, slight abduction, lumbar spine-lumbar lordosis.
Muscle work isometric to maintain an upright sitting position.
BOS quite large as it includes the chair and the floor spaces in-between.
COG at pelvic level,just anterior to ischial tuberosities when sitting.

Movement in saggital plane

Hip joint

As the model flexes forward, the hip moves into further flexion, as the leg is raised from the floor. Flexion is occuring in the sagittal plane around the coronal axis,muscles achieving hip flexion are rectus femoris and ilioposoas working concentrically.
As the model facilitates raising the leg off the ground their is further flexion using the same muscles.
The hip is raised higher than neccessary so that the opposite leg can be cleared,therefore the hip must extend by eccentric contraction of the above muscles (rectus femoris and ilioposoas) to the lower leg, so it comes to rest across the opposite leg.
There is the some further flexion as the model flexes forward to reach the shoe, again this is in the sagittal plane, the muscles initiating the movement are rectus femoris and the ilioposoas, working concentrically. However to overcome gravity pulling you further forward the hip extensors: gluteus maximus and the 3 hamstring muscles will work eccentrically to stop the movement.
Following the removal of the shoe, the hip flexors contract concentrically to raise the leg off the opposite one so that the leg is cleared when placing it back on the floor.
As the leg is lowered to the ground it extends by eccentric contraction of the hip flexors rectus femoris and iliopsoas, they lower the leg gently down to a 90degree of hip flexion, as start position.

Lumbar spine

From the original neutral start position, the lumbar spine goes into flexion, and this occurs in the sagittal plane around a coronal axis, it is initiated by a concentric contraction of rectus abdominus and psoas major. At a certain point gravity wil take over,therefore eccentric work of the spinal extensors bilateral erectae spinae and mutifidus must occur to slow/stop the movement.
The model then extends the lumbar spine back to the upright position, occuring in the sagittal plane by concentric contraction of bilateral erectae spinae and multifidus.

Then do the same with the opposite leg