During stroke treatment, positioning of patient in an appropriate way is essential to control the development of spasticity and to help in faster improvement in the later stages.
Preferably the patient is positioned sidelying and supine generally avoided.
- ON THE AFFECTED SIDE: The shoulder should be protracted and flexed. The elbow and the wrist should be extended. The forearm should be supinated. The pelvis should be in protracted position. The hip and knee should be in neutral position.
- ON THE SOUND SIDE: The arm should be rested on the pillow kept in front of the patient. The shoulder girdle should be kept in protraction and slight elevation. The shoulder is kept in slight abduction and flexion with the elbow and wrist in extension position. The forearm should be in supine position. The pelvis should be kept in protraction. The hip should be slightly abducted and flexed. The knee should be slightly flexed and the ankle should be in neutral position.
PHYSIOTHERAPY IN THE FIRST STAGE (FLACCID MAINLY):
Turning over from supine to sidelying
One of first activities the physiotherapist should work for in treatment is that of turning over to either side. The patient should not always remain in the supine position but should soon learn to use his trunk; i.e. his shoulder girdle and pelvis to turn over and lie on his side for some part of the day.
If patient rolls over and lies on the sound side, with the affected arm uppermost, the shoulder and arm should be moved well forward, the elbow should be extended, and the affected leg lie in a natural position of semi-flexion.
If patient rolls over and lies on the affected side, the shoulder of that side should again, be placed forward with the elbow extended and in supination. This position helps to prevent shoulder retraction and the development of flexor spasticity with pronation of the affected arm.
Patients clasps hands, he then raises arms.
In this shoulder girdle is moved forward and upwards. Patient’s arms are then moved, with clasped hands to chest. With clasped hands, patient turns towards sound side keeping shoulder well forward.
Lying down from sitting
The physiotherapist holds affected hand of the patient, his arm externally rotated and extended diagonally forward at shoulder height, while the patient slowly lies down, using his sound arm for support. In this way, physiotherapist will prevent retraction of the shoulder and flexion of the affected arm. The patient then lifts the sound leg on the bed. If at all possible, he should then bend the affected leg at the knee and move it into the bed, the nurse giving a little help by lifting from under the knee.
Sitting and standing up
A foam rubber mat should be placed in front of the bed for standing. The therapist never be on patient’s sound side when he sits, stands or walks, since he can use his sound side. If he takes weight on his affected side, the patient will gradually overcome his fear of falling.