Physical Therapy for Hemiplegia Patients

1
Physical Therapy for Hemiplegia Patients

• ?????
• ???

2
Theories for stroke rehabilitation

• Brunnstrom theory
• PNF theory
• Motor relearning theory
• Bobath theory
• NDT Neural-Developmental Theory

3
Brunnstrom Theory

• Aim
• To encourage the return of voluntary movement in
  hemiplegia patient through the use of reflex
  activity and a range of sensory stimulation.
• The choice of stimulation varies depending on
  which stage the patient has reached in the
  recovery process.

4
Brunnstrom Theory

• Basis of practice
• Recovery progresses from subcortical to cortical
  control of muscle function.
• The stages of recovery
• Flaccidity
• Presence of basis synergy on a reflex level
• Voluntary control of the movement synergies
• Ability to mix components of antagonistic
  synergies but influence of spasticity still
  observable
• More difficult movement combinations mastered
  limbs synergies lose their dominance
• Individual joint movements become possible
• Normal motor function is restored.

5
Brunnstrom Theory

• Treatment
• The choice and use of sensory stimulation depends
  on the stage of recovery.
• The process is employed until the primitive
  synergies are established, then facilitation is
  used to develop some voluntary control.
• The preparation for walking should be emphasized
  early but that extensive walking should be
  postponed in order to avoid the development of a
  poor gait pattern

6
PNF Theory

• Proprioceptive Neuromuscular Facilitation
• Primary for the patient with neuromuscular
  dysfunction
• Aim
• to promote movement and functional synergies of
  movement by maximizing peripheral input

7
PNF Theory

• Basis of practice
• People who move normally have passed through a
  developmental sequence
• Diagonal and spiral patterns of active and
  passive movements are encouraged
• Treatment
• Providing appropriate sensory stimulus
• Following activities in a developmental sequence
• Patterns and techniques

8
Motor relearning Theory

• By Carr and Shepherd
• Aim
• To enable the disabled person to learn how to
  perform or improve performance of actions
  critical to everyday life.
• Utilizing theories of learning, in particular the
  use of practice and knowledge of results to
  encourage people to learn and self monitor
• Knowledge of biomechanics for analyzing movements
  and performance of tasks

9
Motor relearning Theory

• Basis of practice
• The motor control of posture and movement are
  interrelated and that appropriate sensory input
  will help modulate the motor response to a task
• The program is based on
• Elimination of unnecessary muscle activity
• Feedback
• Practice
• The link between postural adjustment and movement
• Task analysis and measurement are viewed as
  essential elements of the framework.

10
Motor relearning Theory

• Treatment
• Movement analysis and training follow the four
  steps
• Analysis of the task
• Practice of the missing components
• Practice of the task
• Transference of training
• A series of task has been chosen because learning
  by normal subjects has been shown to be
  task-specific with minimal carry-over from one
  activity to another

11
Bobath theory NDT

• Aim
• To improve the quality of movement on the
  affected side
• Key point control is to allow patients the
  experience of normal afferent input
• Basis of practice
• The movement will be abnormal if it stems from a
  background of abnormal tone
• Performing abnormal movements will reinforce more
  abnormal movements
• Tone could be influenced by altering the position
  or movement of proximal joints of the body

12
Bobath Theory NDT

• Treatment
• Treatment centre around the facilitation of
  corrected movement by a therapist who handles the
  body at key points of control
• In recent years treatment has become more active
  , dynamic and functionally directed.
• Movement are not isolated to individual joints
  but take place in patterns

13
Bobath theory NDT

• To help the patient to gain control over the
  released patterns of spasticity by their own
  inhibition
• Auto-inhibition
• Give patient normal kinematics sensation input to
  facilitated normal posture and movement
• Muscle strengthening is not viewed as part of
  treatment
• There are no set Bobath exercise

14
Clinical practice

• Rehabilitation by compensation is to a large
  extent responsible for an increase in spasticity
  and for the inactivity of the involved side
• Patient and PT must work together.
• People learn best in different ways

15
Clinical practice

• Trunk alignment and activity are critical aspects
  of limb movement
• Appropriate preparatory postural responses
• Weight bearing is an effective tool
• Safe function ? Safe balance
• No good alignment, no normal movement
• Correct posture alignment
• Give enough sensory input( visual, auditory,
  tactile, proprioception )
• Facilitation

16
Clinical practiceNormal lying posture
17
Clinical practicenormal sitting posture
18
Clinical practicenormal pattern from lying to sit
19
??????? ????