After Stroke: The Critical First Step to Improve Balance.
After Stroke: The Critical First Step to Improve Balance.
Famous Physical Therapist Bob Schrupp and Brad Heineck describe the critical first step that must be done to improve balance after a person has a stroke.
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Content
0.959 -> all right today we're going to talk
3.01 -> about most critical steps that you need
5.14 -> to take right after someone has had a
7.66 -> stroke to improve their balance right
9.639 -> keep them upright stay tuned Bob and
14.139 -> Brad the two most famous physical
18.43 -> they're this on the Internet hi I'm Bob
23.86 -> shrub physical therapist
25.09 -> Brad Hynek physical therapist together
26.5 -> we have the most famous physical
27.73 -> therapist on the internet in our opinion
29.47 -> of course Bob all right as we already
31.21 -> hinted towards Brad we're going to talk
33.219 -> about balance after someone has had a
35.14 -> stroke and the most critical thing you
36.879 -> need to work on first is seated balance
39.429 -> right if you're not able to balance in
42.039 -> the seated position you're not going to
43.899 -> be able to stand in balance so this is
45.55 -> the first step that's why it's critical
47.26 -> we get this established now for we go to
48.999 -> the next step and Brad's got a bunch of
51.28 -> exercises you can do to start ok now
53.019 -> this is we don't know I don't know where
54.94 -> the person is that you're working with
57.37 -> but we're going to start from the basics
58.659 -> okay now here Bob is going to act like
61.69 -> he's had a stroke he's leaning to his
63.1 -> involved side which is his right side I
65.199 -> might put his hand down here just to get
67.24 -> that I'm working a little bit to start
68.59 -> with but this to the point where he's
70.45 -> going to fall over so I need a system
73.03 -> okay
73.689 -> now I'm actually going to get here so
75.759 -> you can see better but I do like working
77.469 -> with people from this position as well
79.539 -> if they've had a stroke and we're going
81.82 -> to hold that person up in a lot of
83.38 -> verbal cues okay Bob I need you to get
85.27 -> up tall and I'm going to help him out
86.77 -> push with this hand but there you go and
88.93 -> I'll hold it right there hold hold hold
91.42 -> and what will happen sometimes is
92.95 -> they'll continue to go over but we need
95.59 -> to continue to work on verbal cues
98.13 -> tactile rulers to have the hand push
100.719 -> down in here push into the shoulder
102.46 -> that's weak we're trying to wake up this
104.109 -> side wake up everything over here so
106.119 -> it's good to give some physical cues as
108.64 -> well as the verbal cues the other thing
110.92 -> is you want to make sure on a firm
111.939 -> surface right right we're going to start
113.5 -> on a firm surface not on a bed a few
117.039 -> other things you can do is you can put a
119.14 -> bigger mirror if you haven't on wheels
120.88 -> you may or a wall mirror that you can
123.039 -> get in front of the person so they can
124.539 -> see themselves because they may not be
126.159 -> aware that they're tipping over but
128.08 -> visually if they see it it's going to
130.06 -> help them get upright because they're
132.55 -> aware of why
133.34 -> experiences it helps right I mean and
135.62 -> you were talking about instance of which
136.97 -> a dent right I had one person she did
140.66 -> not want the mirror in front of her
141.92 -> because she saw how she looked after the
144.379 -> stroke one side was different and it
147.37 -> psychologically really was depressing
149.45 -> for her so we did not use a mirrors this
151.31 -> one of the precautions okay so but I
155.06 -> have a patient right now without a doubt
156.89 -> is help okay do she she corrects herself
159.2 -> she sees herself in the mirror and
160.94 -> you'll figure that out quickly you
162.17 -> probably know by annoying the person
163.879 -> okay once you get to the person where
166.73 -> they can sit up in this position and you
168.86 -> can let go okay and Bob soul in it there
172.22 -> and we're going to go for you know
173.39 -> twenty thirty seconds it's kind of
174.98 -> indefinitely
175.7 -> nice job Bob we're going to go to the
177.799 -> next step and that is going to be we're
179.93 -> not going to do it here but you're going
180.98 -> to imagine you're going to put the
181.94 -> person on a bed because you get out of
184.61 -> bed in the morning you have to sit up on
186.019 -> the edge of the bed sitting on the edge
188.09 -> of a bed is much harder than a firm
190.31 -> surface like that because you have a
191.69 -> soft surface and you may get this going
194.9 -> on and so on that soft edge of the bed
197.81 -> sitting up okay Bob that sit up tall
199.7 -> okay if you're going to he starts going
202.22 -> this way hand over here to hold yourself
204.44 -> up same thing if what we went through
207.019 -> the first flat except for around that
208.7 -> soft surface just like a bed or using a
211.069 -> bed except the bed that they actually
212.48 -> have is a good idea okay going to the
215.239 -> step three once they're able to sit
216.739 -> under the bed with good control then
218.84 -> we're going to start pushing in all four
221.389 -> directions in other words straight from
223.01 -> the front from the back right side and
225.23 -> left side okay okay Bob stand up tall
227.84 -> and I'm going to push you and don't let
229.459 -> me tip you over and we push right on the
231.47 -> sternum here hold hold hold and relax
234.709 -> good job Bob I'm going to push this way
236.81 -> hold I'm pushing this direction pushing
239.06 -> him forward he's doing Hulk come on Bob
241.34 -> push push push push there you go we're
243.62 -> going to hold it for five to ten seconds
245.329 -> in relax good job so if he did good
247.88 -> forward and backwards now I'm going to
249.739 -> go this direction because I know that's
251.48 -> his strong side I'm going to push this
253.069 -> way hold hold hold Bob okay well he's
257.78 -> tipping he's tipping good have come back
259.31 -> out Bob okay and I'm going to go this
261.169 -> direction and see if he can hold this
262.49 -> better and he's stronger this way okay
264.95 -> he's holding good which makes sense
266.99 -> because he normally tips this way now
269.06 -> Bob I'm going to push here again now you
270.889 -> hold me push against the side I'm going
272.479 -> to tap I'm going to give verbal cues
273.919 -> push push push come on Bob you can do it
276.289 -> I'm going to let them work into it
277.669 -> you're going to help them out again push
279.53 -> push push Bob and this might take a few
282.259 -> days a week or two whatever it takes you
284.599 -> need to get that stabilization against
287.509 -> just a static or an isometric push and
290.3 -> hold okay once you get to the point
292.4 -> where I can hold no matter what you're
294.86 -> going to stand like a sit like a statue
296.419 -> I'm sorry push push hold strong don't
300.05 -> let me move you do not let me move you
301.699 -> Bob and now look at that he's strong
303.169 -> we've worked to that face okay now the
306.02 -> next phase okay Bob just sit there
309.05 -> now don't let me move you and I'm going
311.509 -> to do some what we call perturbations or
313.61 -> pushes and forces I think without him
316.22 -> knowing it so I'm going to get a little
317.389 -> push here okay and he's holding Bob I'll
321.5 -> just be strong be strong and now he
324.199 -> knows I'm doing it so he's stronger plus
326.03 -> you may be working off everything's
328.039 -> working together and then without him
330.169 -> knowing I'm going to come from this side
332.06 -> he doesn't know what I'm going to push
333.44 -> here
333.979 -> no he held pretty good this way too so
336.02 -> that's good okay sometimes is this he
338.21 -> knows that you're going to do it so
339.409 -> you're more aware of it either way
341.06 -> you're working the mind you're working
342.5 -> the body and if you can do perturbations
344.96 -> or pushes from any direction and they
346.88 -> can maintain that okay it might be if I
349.52 -> push here and he gets that way that way
351.979 -> we're going to keep working okay Bob
353.69 -> hold strong be strong be strong hold it
356.63 -> hold it there you go he's getting better
358.759 -> getting stronger
359.93 -> and once that's established that hooks
362.449 -> it strong they can work against
364.94 -> isometric perturbations then we're going
367.94 -> to dynamic exercise that suggests to me
370.19 -> where it's fun okay what you can do now
375.08 -> this is going to depend on the involved
377.719 -> arm how good it is if that I'm is good
380.449 -> enough to hold on to a ball and throw it
383.3 -> that's really good we're going to work
385.039 -> with a ball toss okay good now this is
388.49 -> working that core balance and to be
391.19 -> honest with you if someone's had a
392.75 -> stroke their arm is probably not going
394.819 -> to be good enough to throw a ball would
396.83 -> you say that's true Bob right
398.99 -> and that's where you may want to do as
400.85 -> an alternative is maybe just some
402.259 -> reaching with the other arm sure all
404.15 -> right this is an evolve arm you might
406.13 -> have them reach up this way and then
407.84 -> reach across midline sure and then reach
410.33 -> down right and you might give them a
412.55 -> tail yeah can you reach out here bub and
415.009 -> hold it and if you can hold it let's see
417.139 -> if you can go over this way it's getting
419 -> hard to get her and here you probably
420.71 -> need two people one person holding the
422.479 -> ball another person to help the person
424.819 -> out in case they start to tip okay
426.86 -> they're going to go over this tree area
429.38 -> go in here and then you want to get four
432.53 -> corners I like to go here here now lower
435.44 -> is going to be the hardest one lap down
437.18 -> hip down there and then over here okay
441.229 -> and you get a system going one two three
444.11 -> four and then break it up different
445.88 -> things maybe five or six repetitions on
448.19 -> each corner okay now the other thing
450.889 -> about working with stroke stroke
452.84 -> patients as well as any patient is you
455.09 -> got to have a little humor with it right
456.32 -> by yeah and so if I was working with Bob
460.43 -> and he had a stroke I know he's a Viking
462.349 -> fan I'm a Packer fan so I'm not going to
465.86 -> take the Packer ball and have him reach
468.409 -> for because you know he's going to do
469.759 -> here to punch it and maybe the healthy
472.34 -> thing that a little bit therapy as well
474.789 -> and then if I'm going to use this Viking
477.71 -> ball I'm not going to hold it I'm going
479.389 -> to throw that no I'm just kidding we're
481.94 -> both weeping because we both were in the
483.86 -> playoffs we both had bad playoff losses
486.349 -> yeah they were close games game rates is
489.05 -> a very last sectional and we're still
491.3 -> crying they both had good years all
493.52 -> right take care good luck with watching
Source: https://www.youtube.com/watch?v=4sEG5lOy9Nk