Moving From the Basics to Living Life After a Neurological

InsultBy Robin King, PT, C/NDT, CCCE

This 2 hour seminar will focus on treatment for individuals following neurological or other life-changing diagnoses. We will look at a patient’s long term goal and break it down into specific tasks. We will analyze movement needed for other functional/recreational activities. Treatment ideas and handling techniques will be presented to assist the individual’s return to his/her desired functional activities.

Course Description

1. Be able to define quality of life 2. Identify several tasks that lead up to the

desired functional activity that promote independent living

3. Analyze movements required to complete the functional activity

4. Create treatment activities to simulate the various tasks for the activity

5. Recognize ways to facilitate the desired movements during the tasks

Course Objectives

I or my family do not have any financial relationship with a commercial interest whose products may be discussed in my presentation

No dogs, fish, horses or staff were injured in the making of this presentation

Thank you to those who participated in activities for media purposes for this presentation

Disclaimers

Write down one of your favorite leisure activities that you would miss most if you had a tragic neurological insult occur.

Is this an activity that you use to cope with the stresses of life?

Taking it easy

Definition: The general well-being of a person or society,

defined in terms of health and happiness, rather than wealth (CollinsDictionary.com)

It may be used as a measure of energy and power a person is endowed with to enable him or her to enjoy life and prevail over life’s challenges irrespective of the handicaps he or she may have (BusinessDictionary.com)

Quality of Life

One study consisted of a participant questionnaire + interview The conclusion was that the disability did not necessarily

decrease the individual’s quality of life and that the individual’s capacity to cope with everyday life was of great importance. Occupation or meaningful occupational activities as well as social integration at different stages of life should be taken into account when planning intervention programs in the future

Quality of life in individuals with physical disabilities, Viermero V, Krause C. Psychother Psychosom 1998; 67(6):317-22

Studies

This study included 72 stroke patients who were attending rehabilitation.

The conclusion was that more than half the patients had a moderate degree of depression. There was a significant correlation between the depressive symptoms and the patients’ functional status.

The post-stroke depression and its impact on functioning in young and adult stroke patients of a rehabilitation unit. Amaricai E1, Poenaru DV2. J Ment Health. 2015 Sep 11:1-5

Studies

This study was a review of 54 studies regarding the effectiveness of community based rehabilitation interventions to reduce depression, increase participation and improve quality of life.

The conclusion was there is limited to moderate evidence supporting some rehabilitation interventions in affecting the outcomes of depression, participation and strong evidence that comprehensive rehabilitation improved health related quality of life post-stroke.

Are rehabilitation and/or care co-ordination interventions delivered in the community effective in reducing depression, facilitating participation and improving quality of life after stroke? Grave C, Brock K, Hill K, Joubert L. Disabil Rehabil. 2011;33(17-18):1501-20. doi: 10.3109/09638288.2010.542874. Epub 2011 Jan 5.

Studies

http://www.cbs.com/shows/cbs_this_morning/video/U6uef7cAU2vNd_KxnmDBi7b83ZNVowkR/boston-bombing-victim-s-miraculous-recovery-and-the-doctor-who-saved-him/

http://www.cbs.com/shows/cbs_this_morning/video/XPkXml6Yx7GQ4FavSVOCRA2WG_n8jgz6/back-on-stage-boston-bombing-survivor-dances-again/

Personal testimony

Meaningful functional activities have the potential to enhance the client’s quality of life

We need to be searching out what a patient’s long term goal is and what leisure activities they used prior to the injury or insult to cope with life

This may involve us asking more questions Then we need to see what possibilities there are to

either return to that activity, to modify the activity or to help them with finding new activities to be able to cope

How does this apply to us?

We may not be able to cure a patient, but we can assist them in managing themselves better in the activities that are meaningful to them so that they can “live life”.

So, what can we do to help?

Definitions: Conforming to a standard; usual, typical, expected The usual, average or typical state or condition Regular Natural Anything that is normal

References: WordReference.com Google.com

What is “normal”?

Normal includes finding out how the patient did the activity before i.e. putting on shoes

Normal means I have options

So then, what is normal?

You may find yourself learning a new activity We need to experience and analyze the

movement to know how to set up activities and facilitate the muscle activity needed vs modifying so the client is able to return to their interests and improve their quality of life

Something old, something new

Sometimes the activity needs to be new and novel

This will help to activate the reticular system to “put the brain on alert” so to speak

Sometimes the activity needs to also be familiar

This will help to activate the automatic or procedural memory

You have to walk before you can run (or do you?)

The golf swing The piano player Washing the car The return of hand function The transfer that didn’t go well

Patient examples

Safety Always Comes First!!

The Core Work proximal then distal Less is more

Starting with what holds us up

Activating the core postural muscles set the tone for better success in movement

When activating extremity muscles, start and end in weight bearing

The Core

Activity – poor posture and lifting the arm

Activity – standing up with poor posture

Posture Base of support Surface area

Activity – sit to stand

Activity – lift your neighbor’s arm

Manipulating coins Carrying a bucket of water Filling the water bucket Squeezing water out of a sponge Spraying a spray hose while walking around

the car Wiping/drying off the car

Examples of tasks

Washing a Car

Walking Grip Side stepping Leaning over the car Bending over Squatting

Examples of movements

Modified plantargrade positions Standing balance activities Walking with grocery cart Walking with pole Squatting Carrying bucket of water

Examples of Treatment Activities

Planes of movement Hip instability in the transverse plane Hip instability in the frontal plane Hip instability in the sagittal plane

Where is the patient stiff How does the pelvis and shoulder girdles

move What movement does the patient lack Where is the problem coming from

Examples of dysfunctional movements to look for

Start with the core Anterior/posterior movements Lateral movements Lumbar extension Activate the abs – maintain contraction with activity

Reduce the stiffness where needed Know the timing and sequence of movements

required Ex: allow the tibia to move over the foot before

unfolding out of gravity

Facilitation techniques

Activity – facilitating the triceps

Ways to change the environment Ways to modify the environment

Creating the environment for treatment

Walking the Dog

Giving the dog a treat – opening and closing the jar

Feeding the treat Putting on the harness vs the leash Putting on your own jacket Opening the door Locking and unlocking the door The pull of the leash Going down the steps

Examples of Tasks

Stabilizing the jar Radial and ulnar deviation to turn the lid What range is needed Opening a sliding glass door – horizontal abd/add Pinch and release to hold the treat Bending down or over Squatting to put on the harness Manipulation of the clasps Standing up Pronation/supination to open and lock/unlock the door Ankle strategies if the dog pulls on the leash

Examples of Movements

Using a plastic jar vs a glass jar Using a screw on lid vs a lid you pull off Zoom ball Rebounder Locking and unlocking doors Frames with clasps for the harness

Examples of Treatment Activities

Fishing

Opening tackle box Sorting tackle Putting on life jacket Stringing rod Casting Standing or sitting in boat

Examples of Tasks

Neck flexion when looking down to clasp life jacket

Grip External rotation and extension of shoulder,

elbow flexion, radial and ulnar deviation for casting

Core control Standing balance, stabilizing when reeling in

the catch

Examples of Movements

Carry tackle box in one hand and fishing pole in the other during gait training

Sort tackle Tying a weight onto the string Sitting on swiss ball while casting Standing on rocker while casting

Examples of Treatment Activities

Horse back riding

Putting blanket and saddle on horse Cinching Putting harness on Lunging the horse Feeding a treat Brushing the horse Carrying a bucket of feed Turning on/off faucet to water the horse

Examples of Tasks

Hand needs to be flat to feed a treat Amount of range and strength needed to get

up on the horse Core stabilization while sitting on horse Bending to reach the faucet Pronation/supination to turn on/off faucet

Examples of Movements

Carry a saddle while walking Lift a saddle onto the stairs for the height of

the horse Lift a saddle on the “cylindrical tumbleform”

and cinch the belt Carry the reins Sitting on “cylindrical tumbleform” on mat Sitting on “cylindrical tumbleform” on the

“rocker boat”

Examples of Treatment Activities

List several tasks required to complete your favorite activity

Taking it easy

What kind of movements does it take to complete your favorite activity?

Think about the following: ROM Strength Sequence of movements and muscle contractions Timing of muscle contractions What type of muscle contraction occurs when:

isometric, eccentric and concentric

Taking it easy

What activities can you come up with in the therapy world to help promote the movements required for your favorite activity?

Taking it easy

What I have learned being the wife of someone who is physically challenged and the change of my philosophy to getting clients back to living life

Personal testimony