EXERCISES IN STANDING
In standing the patient is trained to achieve static balance by giving perturbation or by making the person stand on a wobble board or tilt board. Balance should also be trained in step stance. The patient is trained to shift weight alternately on both the lower limbs. Standing should be encouraged by keeping the affected leg slightly behind the normal leg to facilitate more weight-bearing on that side.
Dynamic balance can be trained in standing by teaching various reaching out activities and also by teaching the patient rotation of the trunk and forward bending exercises. These exercises also help in development of automatic adaptation of the muscles which is important for performance of many activities.
The patient balance should be trained for anticipatory response.The following exercises may be given in standing:The therapist stands behind the patient and hold the pelvis such that the affected pelvis is kept in protraction. The patient is then encouraged to place the affected leg forward and then take it back. This is repeated for 10 times. Similarly the patient is encouraged to place the affected leg to the sides (abduction) and then come to the neutral position for ten times. These activities help the patient during swing phase of the gait cycle.
In the same position, the therapist trains the patient to take weight on the affected leg and place the normal leg forward and then back. This is repeated ten times. Similarly abduction movement can also be trained for 10 times. This activity encourages proper weight bearing of the affected limb.
Symmetrical throwing activities should be encouraged to increase the balance reaction and also to increase the stability limit which will help the patient in proper postural control.
Unilateral stance on the affected leg should be given to the patient which will facilitate isometric work of the abductors to prevent Trendeleburg’s sign.Once the patient is comfortably doing the above exercises then he may be trained to walk in between the parallel bars in a near normal gait pattern. Side walking and backward walking should also be given.Then progressed to walking unaided on the level ground.Treadmill training or using a static cycle to train the gait in hemi plegic patient, especially in the early stages, has been found to improve the gait pattern to a remarkable extent.
Treadmill walking with partial weight supporting harness has been useful in rehabilitating gait in hemiplegics.
The patient should be trained to walk in the environment which he will come across in his day to day life like walking on uneven surface, staircase climbing, walking in the market place, etc.Once the patient develops various components of movement available to perform his activities of daily living the basic functional activities should be directly practiced to gain independency and accuracy.
Repeating each functional task again and again over a period of time helps in faster learning of those task by formation of the engrams in the brain.