How to Make Amazing Progress in Walking After Stroke
How to Make Amazing Progress in Walking After Stroke
“Famous” Physical Therapists Bob Schrupp and Brad Heineck demonstrate techniques to help you make amazing progress in your walking after having a stroke. Gait Training Tips.
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Content
0 -> and Brad the to motivate this physical
4.92 -> there is only is today
8.45 -> all right folks I'm Bob short physical
10.83 -> therapist
11.309 -> Brad heinie physical together real the
12.69 -> most famous physical therapist on
13.889 -> internet you know opinion of course by
15.42 -> hey Brad you wanted to show some amazing
17.52 -> how you can make some amazing progress
19.289 -> somebody who has had a stroke and
20.939 -> they're walking how he can progress that
23.58 -> along right let you know the person's
25.47 -> had a stroke in this situation it's
27.24 -> going to be the left side of the brain
28.89 -> the right side is going to be affected
31.41 -> you can see Bob and I both have tape on
34.41 -> our right leg that's a reminder for you
36.48 -> and as well as for us that debts are
38.55 -> involved side in this situation the
41.969 -> person's going to be lucky enough to
43.53 -> have fairly good use of the arm although
45.87 -> it's not real critical it is with the
48.03 -> Walker but the biggest thing we're going
49.71 -> to focus on is balance walking and how
52.829 -> can that person advance that involve leg
55.5 -> so it swings through and they can put
57.21 -> weight on in balance and walk
59.219 -> functionally without falling so Brad's
60.989 -> got some neat little hints and
62.43 -> techniques that you can use both as a
64.97 -> therapist or if you're a family member
67.59 -> working with somebody lays the things
69.24 -> you can try on your own we do get quite
71.76 -> a few comments of people that aren't
73.2 -> they don't have therapeutic system right
75.84 -> and they're looking for things they can
77.31 -> do with their friends or family members
78.509 -> at home and believe me there's going to
80.939 -> be a number of things here that I think
82.2 -> will help by the way I do see a couple
84 -> people that are just coming into that if
86.46 -> you are new to our channel please take a
87.869 -> second to subscribe to us we provide
89.759 -> videos how to stay healthy fit pain-free
91.439 -> and we upload every day and please Like
94.409 -> us on Facebook Brad and I have this
96.36 -> thing that we want to be like yeah so
98.28 -> alright Kerri I going okay so once you
102.18 -> know someone has had a stroke they're at
103.68 -> home or in the clinic one of the first
107.399 -> things I do is you know get them up on
108.93 -> their feet and see if that leg here we
111.03 -> got the tape is that leg and except wait
113.25 -> or is it going to buckle obvious it's
115.56 -> going to buckle we're going to work on
116.64 -> strengthening exercises in this
118.59 -> situation the person can bear weight and
121.56 -> fairly stable on it so if they you know
125.25 -> get them have a walker I think we can
127.229 -> see that leg in there and I'll have the
129.239 -> person stand
130.11 -> check without handhold make sure they're
132.51 -> safe
133.47 -> hands back on and then Algol weight
136.17 -> shifts so can they put all the way to
138.51 -> the right leg without having this happy
142.5 -> okay so and if that looks good well then
145.92 -> we'll progress to the next step we can
148.02 -> go to some marching and can a person go
150.81 -> up like this and like this and not only
153.2 -> looking to see if the knee flexes but
156.57 -> does the knee hyperextend because that's
160.47 -> a real common quadricep weakness that
162.75 -> happens with a stroke leg okay so we're
166.14 -> going to look at that and says that if
168.93 -> they have good enough stability with the
171.03 -> marching then we're going to go right
174.06 -> into walking okay and what I'm going to
176.91 -> do is I'm going to show you some gait
181.23 -> problems that are pretty common the
183.3 -> model problem you got a common so here
186.09 -> we got the tape that's the weak weight a
187.68 -> lot of times the total drag we have foot
190.68 -> drop so the toll is unable to lift up in
193.35 -> dorsiflex so you have clearance in that
195.3 -> toe drags which is obvious a big problem
197.489 -> because it can cause you to fall down
199.4 -> okay.we weakness in the hip or in the
203.01 -> foot itself exact anywhere along a chain
204.989 -> there might be causing you difficulty
206.67 -> it's a good point and that's what
208.17 -> therapists are thinking and if you're
209.73 -> not a therapist you might see the foot
211.29 -> drop and you might just think all the
212.88 -> problems down there and the exact it may
215.34 -> be up here part of is out here
217.17 -> another thing with foot drop is you
219.209 -> might hear this foot a slab foot slat up
223.35 -> it's the same problem I've got a patient
225.66 -> that I've been working with recently and
228.959 -> he has this his code goes out to the
231.75 -> side and he's dragging it that's very
234.36 -> common - right exactly so we're going to
236.4 -> show you a couple of really neat tricks
237.84 -> on how to do that in just a little bit
239.72 -> okay if things are going okay with a
243.87 -> walker and you can go 100 feet couple
248.7 -> hundred feet on the flat and take well
250.23 -> maybe we should progress to the cane
252.03 -> sure so Bob why don't you show some
254.82 -> examples where they came so I move the
257.459 -> came forward in my foot
260.25 -> I might have trouble moving that foot
263.28 -> forward okay so and this is very typical
266.24 -> you're going to use the cane on the
268.23 -> opposite side this legs good you have
270.24 -> pretty good balance between the cane in
271.74 -> here but that that stroke leg is really
274.5 -> having a hard time coming forward okay
276.96 -> this is a technique that I've used over
279.39 -> the years and it works really well the
281.52 -> whole face this way straight towards so
283.86 -> what you're going to do bob has a gait
285.99 -> belt on so I'm going to use that to grab
287.55 -> always have a gait belt that there's a
289.11 -> risk or fall and I'm going to come on
291.24 -> and called a hip hugger technique around
293.49 -> here and my hip is going to Bob's hip
296.01 -> and I got pretty good control I'm not
297.78 -> being shy here I need to know where his
300.27 -> hip is I need to help guide it so Bob
302.58 -> having a hard time bringing that right
303.96 -> foot forward and I'm not going to drag
306.09 -> it forward by reaching down and grabbing
307.5 -> it I'm gonna throw his right hip forward
310.669 -> and they're going and I didn't do
313.02 -> anything there he lifted it for me yeah
315.18 -> he's really pulling on my pelvis here
317.4 -> right what you're doing right and you're
319.29 -> pulling it up and around like that and
321.21 -> you know after time you can maybe help a
324.72 -> little bit less and you're hoping
326.01 -> exactly are you hoping I do more and
327.75 -> more time but one thing I'll do is I'll
330.12 -> give out of verbal cues okay by bringing
332.97 -> that right foot forward bring it forward
334.38 -> just like that bring it forward there
335.76 -> you go up too far bring it back where
337.56 -> belongs back there you go okay take the
339.9 -> next step bring the cane forward now
342.36 -> bring that right foot forward I'm going
343.89 -> to help you and there we go and actually
346.229 -> these muscles over here in the hip I'll
347.88 -> kind of bump a little bit of kind of
349.35 -> wake them up anything to get his brain
352.229 -> to communicate with that right side I
354.63 -> could get more visual feedback right
358.41 -> weather is double and you can use visual
361.11 -> and the way you do that is you put a
362.669 -> mirror a full-length mirror in front of
364.919 -> the patient and then you do that
366.36 -> together and once the person can see
368.46 -> that leg sometimes they get the
370.5 -> connection right there's a lot of little
372.8 -> tricks yeah a therapist use with strokes
375.81 -> and these are just yeah you want to give
377.7 -> them as many senses you're going to
379.11 -> bring in as as possible yeah you know
380.97 -> you got auditory it's in visual and then
384.57 -> you can also feel right it's a high
386.28 -> school so I got three things going all
388.11 -> at once
388.74 -> it's very taxing for the person with
391.289 -> stroke because I'm very working very
393.21 -> hard and the mind isn't ready for it yet
395.58 -> yeah I'd have to push it yeah you have
397.5 -> to get start hoping some of the other
399.06 -> parts of the brain are going to help out
400.349 -> okay now let's go to the technique if
404.789 -> the person has foot drop in that tolls
407.46 -> dragon and you're trying to get that toe
409.289 -> up so that will swing through and this
411.78 -> is where if you're at home and you're
414.539 -> going to need some thinner band or some
417.63 -> stretch band where I'm going to actually
420.03 -> recommend the branding thera-band
422.4 -> because if you go online if you look
424.32 -> they sell it in five yards or six yards
427.26 -> lengths otherwise you got to buy a big
429.3 -> role like to do it the therapy
430.56 -> department yeah and those are expensive
432.33 -> for 150 200 dollars you don't need the
434.43 -> high ash and then they sell other ones
436.229 -> they're only five feet long well that's
437.94 -> not long enough you need something
439.32 -> that's going to be about 2 to 3 yards
442.05 -> long and it will break mine broke here
445.08 -> and I don't really know why I'd get on a
447.479 -> sharp-edged you broke this one just
448.77 -> broke I tied it not and this is a pretty
450.479 -> thick stuff isn't it so you're going to
452.16 -> want to get not too yellow that's the
453.72 -> lightest you're going to probably want
454.979 -> the orange or the red that's the colors
457.38 -> I'd recommend to the thera-band
459.03 -> ok ok so so you have a length how long
462.18 -> bread well if you double it up it should
464.849 -> come up shoulder at least because of the
467.37 -> mat just got shorter I liked up the chin
469.56 -> if you double it should go to the chin
471.45 -> I'm going to make this work it's a
473.01 -> little forgiving because it's stretchy
474.47 -> step on it at the mid length you're
477.9 -> going to cross it double cross it make
482.13 -> the cross down by the toll then you're
485.43 -> going to go behind the knee there you go
489.96 -> see how the X going across the knee and
494.76 -> they're going to the front make a cross
496.409 -> across the front and then we're going to
501.12 -> go around and you can tie it back here
503.49 -> or if you have long enough loops tails
506.099 -> you go to my middle tie in the front
507.479 -> exactly I'm not going to tie knot in
509.669 -> there because I'm going to hold it now I
511.8 -> showed my wife this and she said that's
513.45 -> that's
514.5 -> dangerous because this going to cut
515.64 -> circulation off to their leg and as a
518.01 -> good point but you're only going to
520.979 -> leave this on while you're working with
522.39 -> the person fine you're not on all day
524.25 -> right you don't put this on it and then
525.84 -> leave the person walk around with it all
527.31 -> day because it is a circulation problem
529.05 -> at that point I yeah I think it would
531.36 -> take a while before yeah sure that would
533.67 -> be a pretty conservative but sometimes
535.65 -> you need to be that way so what's
537.42 -> happening here is a thera-band is
539.36 -> literally pulling my toe up and behind
543.27 -> here keeping my knees
544.38 -> remember the hyperextension we talked
546 -> about it helps prevent that and it gives
548.16 -> the portal in the hip and it's giving
549.81 -> them maybe a little bit of hip flexion
550.89 -> or not yeah a little bit yeah cuz it's
553.38 -> falling right here right it really works
555.84 -> with the chain the way of stabilizing
557.58 -> settings without and yet you can move
560.52 -> but yet it helps right I mean unlike a
563.25 -> knee immobilizer which just you know
565.59 -> locks you in place in there not if you
567.39 -> have is it all flows with the bad eye so
569.94 -> to speak so normally I was walking like
572.04 -> this and then if you put something like
574.71 -> this on a real patient all of a sudden
576.72 -> you get it it starts to go through and
579.03 -> you don't need all that help that I was
580.77 -> given by before okay now and once that
584.43 -> happens you know the first you make the
586.62 -> connection and they can start using
587.85 -> their own you know hopefully make the
590.07 -> neural connections and start using their
592.23 -> own body to do a with repetition lines
595.86 -> start to take over and it remembers oh
597.72 -> yeah and it makes them move synapses if
599.76 -> you will there's a I don't want to get
601.83 -> into all the details that's pretty
603.3 -> complicated the other thing is that the
605.46 -> person is walking and they drag their
607.38 -> foot external rotation out they turning
610.02 -> their foot outward which is very common
612 -> after a stroke because there's a lot of
613.74 -> times that hip adductor come back first
615.96 -> yeah or the hip flexor so we do this one
617.91 -> on you Bob sure okay you can use the
620.04 -> same length hit thera-band
622.88 -> put that around the toe and this is
626.7 -> easier to do it on someone else and I'm
628.26 -> going to put two wraps downer on the toe
630.06 -> to keep it semi tighter on the toll so
632.55 -> when you crossed over twice yeah you can
636.12 -> do it once I'm doing it twice you work
638.97 -> with a little bit you'll know the little
640.32 -> tricks that's that's if you little bit
642.08 -> just to experience now the toe goes out
645.78 -> this way we're going to report the
647.339 -> opposite
648.18 -> we're going in between the legs first
650.25 -> yeah and let me come around up so
653.07 -> basically here and make a spiral right
654.54 -> round you up the opposite direction of
656.55 -> the problem I like this go right behind
658.92 -> the knee okay okay I'm going to bring it
664.08 -> there I take that I didn't mean behind
668.43 -> me it's actually behind the cab
670.709 -> yeah I'm not behind a knee behind a abs
673.02 -> really tall so normally with him you ran
676.17 -> out of room ah yeah we'd have to have
677.55 -> another another three or four feet to go
679.98 -> around his way so another one would go
681.72 -> on and eat here no oh this will go
683.79 -> around the waist
684.57 -> oh yeah I got your that and what I like
686.67 -> to do is at this point I'm going to wrap
690.75 -> it around here so like this right and
695.07 -> then I'm going to go like that we may
697.05 -> have to hold it here and you can work
700.47 -> with this or you can just go right to
702.029 -> here and go to a belt loop yeah now I
704.67 -> would take it around and then tie it
705.899 -> right here yeah go ahead and walk
708.209 -> towards the camera that is do you feel
709.95 -> all that yeah it's really hard to turn
712.35 -> my foot out right now right this works
714.209 -> out really good because this is a real
715.92 -> problem with a lot of people and it
718.68 -> gives me a little bit of lift on the
720.12 -> foot to read sure go ahead one more bomb
723.41 -> so yeah it's definitely it's almost
727.05 -> feels like I'm a robot on this side that
729.51 -> you know it's it's it's assisting my leg
731.79 -> right it's really weird it is and you
734.82 -> know you can do this for and hopefully
737.31 -> the idea is you only going to do this
738.45 -> for a couple weeks and after that the
740.52 -> muscles regenerate the grind action of
742.62 -> strength and then you don't need it
743.79 -> anymore I really like this idea Brad
745.62 -> it's really a good progression it is a
748.2 -> neat little trick that works really well
750.57 -> and it doesn't cost $2,000 like if you
753.06 -> get a custom brace made that sometimes
755.1 -> they work and somewhere I don't in the
756.69 -> external rotation so now let's say we go
759 -> through this for two or three weeks the
761.43 -> leg is not strengthening the toll is not
763.529 -> coming up at that point you may need to
766.5 -> go with an orthotic or now we have we
770.399 -> got a couple earphones yeah just look
773.01 -> like a custom one that actually is is
775.5 -> actually as hinges in it and this is a
777.9 -> molded AF all that
780.08 -> really quite pricey that one's off the
781.7 -> shelf so these going here they go inside
784.31 -> the shoe both of them though we normally
786.53 -> have to buy a bigger size shoe to make
788.39 -> them work so that we're not going to get
792.5 -> into that we've got you know just on
794.3 -> that assuming things are going well what
797.45 -> we want to finish up with Bob is Scouts
802.75 -> so the right leg is the wheat leg
805.76 -> weak leg you don't want to go up first
809.21 -> with the right leg up with the strong
812.9 -> leg in here up with the strong in here
817.1 -> and I ran out of steps here and then
819.53 -> going back down down with the weakly yep
822.38 -> cane has to leave grab onto that
824.3 -> handrail down with the weak leg down
827.72 -> with a weak list so we always say when
829.82 -> you're going up to heaven you want to
831.02 -> leave with the good leg you're going
832.28 -> down to a chi double toothpicks you when
834.44 -> I leave in the bed lay exactly lab so
836.72 -> once again Bob we're going through the
839.42 -> whole thing I'm sick some different
840.95 -> parts of the body except for we can fix
843.17 -> this mining except for a broken heart
844.58 -> yeah but we're working and after I think
847.1 -> it's some of the duct tape on the leg
848.54 -> would be good I have the right color
849.98 -> today and put it up there yeah put it
851.66 -> wrap around that baby Thanks
861.99 -> you
Source: https://www.youtube.com/watch?v=GSbjwzyuUoo