IMPORTANT INFORMATION AND EXERCISE TIPS FOR SITTING BALANCE RECOVERY IN STROKE/ PARALYSIS PATIENTS
IMPORTANT INFORMATION AND EXERCISE TIPS FOR SITTING BALANCE RECOVERY IN STROKE/ PARALYSIS PATIENTS
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Content
6.82 -> hello everyone, you are watching Physio classroom channel
9.74 -> and in today's video we are going to talk about
11.88 -> that stroke patients who develop paralysis in one half of the body
17.16 -> what all exercises should be performed
19.72 -> and what all important things should we note
22.92 -> to ensure development of early sitting balance
29.76 -> in many stroke patients it is seen
32.6 -> that when they are mobilized to sitting for the very first time
38.76 -> many stroke patients find it difficult to maintain their sitting balance
44.58 -> such patients are required to be supported in order to sit
48.52 -> now there can be many reasons for the stroke patients not being able to maintain their sitting balance
53.18 -> like for example if I am having left side paralysis
56.5 -> then in such case the patient can either fall towards the paralyzed side
59.32 -> or some patients might also have tendency to fall towards the normal side
66.9 -> in many stroke patients we see that they have tendency to fall backwards or forwards also
72.74 -> now some important reasons for this loss of balance are:
77.26 -> when the patient is falling to paralysis side
79.9 -> then the paralyzed side upper and lower limb are not able to support the body and prevent falling on that side
86.54 -> in some cases when the patient is falling towards the paralyzed side,
89.98 -> this information of falling to one side either does not reaches to brain or gets delayed
100.02 -> because even if my left side is paralyzed
103.42 -> and I am falling on my left side
105.12 -> then either I could stop myself from falling by using my left side
108.74 -> or I can use my right side, i.e. right side neck, trunk, upper limb and lower limb to prevent myself from falling on left side
118.86 -> because if I am falling on my left
120.96 -> then my neck and trunk will automatically go towards the right side
125.14 -> but when the sensation of falling towards the paralyzed side does not reaches brain or is delayed
129.4 -> then right side which is normal also fails to correct or maintain the balance
135.08 -> one more important reason due to which some stroke patients find it difficult to maintain sitting and standing balance
143.16 -> is that their spatial orientation of self or surrounding gets disturbed
147.68 -> now lets understand this spatial orientation problem with an example
155.28 -> so if I ask you a simple question:
157.94 -> that you appreciate this stick to be upright or vertical in this position?
161.6 -> or this position?
162.74 -> so your answer would be that i am perceiving this stick to be upright in this position
168.8 -> now can you imagine a situation in which
171.86 -> the stroke patient is not perceiving this as vertical
175.42 -> and instead perceiving this position as upright or vertical!
178.66 -> in such a situation
180.12 -> when we make the stroke patient sit
182.42 -> then they automatically lean towards one side
185.1 -> because he thinks that this is the upright position
187.84 -> and due to this problem, every time when we will make the patient sit
191.42 -> he will always lean his body to one side and so will have the tendency to fall
196.52 -> and this can be another reason due to which many stroke patient are unable to maintain their sitting balance
205.54 -> now lets talk about the important things that we should remember
210.26 -> and important exercise tips that we should follow which will help our patient to regain their sitting balance quickly
221.96 -> the first important thing that we should pay attention to is:
225.22 -> that when we make the stroke patient sit
227.62 -> then we need to ensure that
229.86 -> patient's both feet are well supported either on a foot rest if the couch/bed is high
242.06 -> or on the floor if the couch is low
248.72 -> if we want that our patient's sitting balance should recover fast
253.28 -> then we should always ensure that both feet are well supported
257.84 -> lets understand practically how supported feet can play an active role in early balance recovery
264.9 -> if i keep my both feet unsupported
268.18 -> and i ask someone else to push me
273.54 -> and i will try not to loose my balance
278.94 -> then I will have more difficult in maintaining my balance
281.38 -> So, Shubham now push me towards my left side
284.24 -> So you can see that my trunk moves too far on my left before I can recover my upright sitting balance
290.4 -> But if i keep my both feet grounder or supported
293.26 -> and now ask someone to push me
295.56 -> then I would be able to recover my balance quickly and there will be minimal movement in my trunk
299.28 -> as my feet are also now contributing in maintaining my sitting balance
302.82 -> second important thing we must consider is:
305.8 -> that the patient's paralysis side upper limb should be placed in a position
311.12 -> so that it can contribute or help the patient in maintaining sitting balance
315.06 -> like for example
316.9 -> If I am a left side paralysis patient and I am sitting
320.66 -> and my paralyzed hand is simply kept like this
324.48 -> then this hand will not be able to contribute in maintaining my sitting balance
329.04 -> But if we place the same hand in this position
332.52 -> so that when ever I sway to my left, there are more chances that my left hand can bear some of my body weight and help me in restoring my balance
340.92 -> so right hand placement can also help is gaining early sitting balance recovery
346.9 -> third important thing to note is:
350.04 -> that we must place a big mirror in front of the patient during balance training exercises
357.2 -> looking into the mirror helps the patient to understand easily and get feedback about how he is sitting and which side he is swaying etc.
366.16 -> So we need not every time tell the patient to correct his sitting posture and balance; patient himself can correct by getting visual feedback from the mirror
373.6 -> next important thing to take note of while making a stroke patient sit who still cannot maintain his upright sitting balance is:
381.68 -> that how and how much of support should be given to stroke patients
387.16 -> many a times it is seen that the stroke patients are given too much support during sitting
391.76 -> because of which no demand is put on the stroke patient to maintain his/ her own sitting balance
396.1 -> giving too much support will delay early sitting balance recovery in stroke patients
402.74 -> so if we will give more support than is required then it will not help in activating the patient's brain
408.52 -> balance recover will only come when we will be able to make the patient's brain realize or experience that he is falling to one side.
418.44 -> sensation of body sways or falling is very important for facilitating balance recovery
425.6 -> so now lets practically understand how we should support the patient
430.04 -> and also what sort of exercise should be done to facilitate early sitting balance recovery in stroke patients
437.3 -> so when the stroke patient is made to sit, he/ she finds it difficult to bear weight on the paralyzed side upper and lower limb
448.58 -> and also the patient finds it difficult to sit upright and tends to remain in stooped posture
456.82 -> so in such a situation we need to sit beside the paralyzed side of the patient
461.8 -> and we need to keep our leg over the patient's hand and thigh like this
469.14 -> So when no one was sitting beside me like this
473.52 -> then I was not able to bear weight on my paralyzed side hand and foot
479.66 -> but when someone sits like this beside the patient, the patient now starts bearing weight on the paralyzed hand and foot
488.6 -> now the only problem that is left is that the patient still is not sitting upright
491.96 -> so for this we need to keep our one hand over the patient's chest
496.42 -> and provide a directional cue to the patient to make him understand that he can also sit upright
503.24 -> gradually we need to decrease the support that we are giving to the patient
508.72 -> and motivate the patient to maintain upright sitting on his own
514.66 -> so as you can see; one hand of the therapist is over the chest
519.78 -> through which the therapist is continuously giving a cue that I need to maintain this position and not to attain a stoop posture
526.6 -> similarly the other hand of the therapist is placed slightly above the patient the patient's elbow from behind
532.26 -> and this hand is also giving a cue to the patient to push down and extend the elbow to facilitate weight bearing and support the body from falling towards the paralyzed side
542.82 -> Now sitting like this the therapist can fully control the movements of the patient
548.92 -> Therapist at will can let the patient fall a little towards the paralyzed side
552.94 -> and motivate the patient to try and control the fall and come back to upright sitting
557.38 -> therapist at will can also make the patient move backwards or forwards or towards the normal side
567.12 -> gradually like this we can train the patient to control the body movements and make him think what needs to be done in order to control the sway or fall
576.58 -> Now lets talk about some important exercises
579.62 -> to facilitate early balance recovery, these exercise should be chosen based on the direction in which the patient is falling or loosing his balance
588.1 -> now lets assume that the patient is falling more in the backward direction
591.74 -> so in such a situation the patient should be made to do an exercise or an activity which demands the patient to come forward
597.94 -> so like for example we can keep a table in front of the patient and ask the patient to write his name on the paper kept on the table
606.44 -> so when the patient will perform such kind of activity, the patient's brain will understand that it can control the backward falling of the body by moving the body forward
614.88 -> so the patient will learn to control the backward falling
618.12 -> similarly if the patient is falling more towards the paralyzed side,
621.42 -> the patient will need exercise or activity that demands the patient to move the body toward the normal side
624.96 -> like for example the patient can be asked to bring back a pen kept at a distance on the normal side
630.2 -> so training like this the patient's brain will get lot of stimulus and gradually the patient will learn how to control the body movements and prevent oneself from falling
642.04 -> there are lot many exercises that can be done to train sitting balance in stroke patients
646.82 -> but the main aim of making this video was to emphasize on important points and exercise selection criterias to facilitate early sitting balance recovery in stroke patients.
661.84 -> i sincerely hope that the information shared in this video
665.08 -> will not only be helpful for the hemiplegia patients and their family members
668.62 -> but also be equally helpful for the physiotherapy students and young practioners
672.6 -> who have started seeing and treating stroke patients will also find it a helpful resource
680.12 -> do let us know how you felt about this video of the hemiplegia rehabilitation series through likes and comments
686.24 -> see you all in our next video
688.56 -> till then keep learning, keep sharing and stay connected
Source: https://www.youtube.com/watch?v=PyhPyQQEWF0