LEVEL 3 GAIT TRAINING EXERCISES FOR STROKE/ HEMIPLEGIA PATIENTS
LEVEL 3 GAIT TRAINING EXERCISES FOR STROKE/ HEMIPLEGIA PATIENTS
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Content
9.034 -> Hello everyone, you are watching Physio classroom channel
11.867 -> and in this video of hemiplegia rehabilitation series
14.867 -> we are going to talk about
16.767 -> that when stroke patients are able to perform level 1 and level 2 gait training exercises with ease
23.8 -> then how we should make them perform level 3 gait training exercise
29.367 -> level 3 gait training involve those exercises in which
33.667 -> the hemiplegic side lower limb still remains in contact with the ground
44.034 -> whereas for the first time now the normal side leg is made to leave the contact of the floor
56.834 -> so one can notice that we are in no hurry to move the stroke patient walk
61.9 -> we first want to improve the stability component in stroke patient
67.067 -> the stroke patient must become confident in bearing weight and balancing body on paralysis side leg with ease
77.734 -> at this point, we need to understand one important thing
80.834 -> that if the patient has not developed good stability control on the paralyzed side
83.834 -> then whenever the patient will try to move the involved leg
86.5 -> the movement will not remain in control of the patient
90.1 -> and the paralyzed side leg will move forward in and awkward manner with circumduction
96.1 -> and at the same time weight bearing and balancing on paralyzed side leg will remain difficult
101.034 -> therefore it is often seen that when the paralysis patient walks,
105.267 -> he/ she is not able to lift and place the normal side leg infront of the paralyzed side leg (i.e. has shorter step length)
111.1 -> and most of the time patient is walking some what like this
115.667 -> so lets now try and understand how to perform level 3 gait training exercises with some practical examples
122.2 -> if you can notice that in all my gait training videos
125.567 -> I am always emphasizing on keeping a support on the paralyzed side
129.867 -> the support can be a movable or a stable one as required
132.9 -> using such a support on the paralyzed side during performance of gait training exercises
138.267 -> facilitates recovery and good upper limb control in stroke patients
141.567 -> and I will also be posting lot many videos on exercises to facilitate upper limb recovery on Physio classroom channel
148.034 -> so the first exercise that I often teach to my stroke patients during performance of level 3 gait training is
157.134 -> that while keeping all the body weight on the paralyzed side lower limb,
161.234 -> and pushing down on the support from the paralyzed side upper limb
163.334 -> and then the patient has to lift the normal side leg and place it forward by making contact with only the heel
169.6 -> and then again lift the normal leg up and placing it behind by making contact only with the toes
173.667 -> so this is what the patient has to do
175.6 -> making contact with the heel forward and with the toes backward
180.034 -> so we can simply call this as heel - toe exercise
184.4 -> if the Physiotherapy students or the practitioners will watch this exercise
189.434 -> then they can easily conclude that we are training an important phase of the gait cycle
195.167 -> in which we are focusing on improving the stance time of the paralyzed side limb and swing time of the normal side lower limb
205 -> because quite often it is seen that when the stroke patient walks
209.4 -> then he/ she is not able to balance the body on the paralyzed side for long time
212.7 -> and therefore the normal side lower limb is also not able to remain in air (swing phase) for longer period
218.734 -> and we can treat this issue with our simple and effective heel - toe exercise
224.667 -> we can also involve the patient in some functional task/ activity during the performance of the exercise
229.567 -> and at the same time we can use the verbal feedback (eg. counting numbers) to increase the stance time and swing time on paralyzed and normal side respectively
237 -> for eg. we can instruct the patient to place heel and toe on count of 2
243.967 -> or to increase the time we can count up to 5 and say place your heel on count of 5
248.367 -> and place your toe on count of 5
251.6 -> so that the patient gets this feedback to keep the normal leg in air for longer period of time
257.567 -> and so bear the body weight on paralyzed side for longer periods
260.867 -> in the second exercise of level 3 gait training
263.634 -> we can place a low stool or foot rest or a brick in front of the patient
269.6 -> and now we have to motivate and instruct the patient
271.834 -> to bear weight on the paralyzed side upper and lower limb
275.3 -> and lift and place the normal leg on the foot rest kept in front
279.934 -> and then bring the leg back
282.034 -> so this again is a very simple exercise
283.934 -> it is as if the patient intends to climb the stair and return back again after reaching first step
290.5 -> in this exercise also we have to motivate the patient
294 -> to perform it as slow as possible with intention to bear body weight on paralyzed side for longer time
299.267 -> because it is common to observe that when patient tries to perform this exercise initially
302.9 -> the speed of execution is fast and the foot comes down banging on the step
308.1 -> so to control this speed of exercise is very important
310.6 -> to ensure that the normal side leg remains in air for longer periods
313.934 -> and paralysis side leg bears body weight and maintain body balance for longer periods
320.2 -> so now lets finally have a look at the third and final example of level 3 gait training exercise
326.334 -> this exercise is more advance than the previous two exercises
330.6 -> and to perform this exercise the patient must have very good stability (balance)
336.167 -> to perform the third exercise the patient has to be brought near a staircase
342 -> in this exercise you are going to see
344.5 -> how we are going to train for both stability and mobility of the paralyzed side lower limb simultaneously
354.5 -> the starting position to perform the third exercise will be
357.834 -> to make the patient stand in front of the staircase
361.134 -> patient will then be helped to grab the railing from the paralyzed side hand
367 -> the patient can also be helped to weight bear on the hands by providing support if required
372.8 -> now the patient's paralyzed side lower limb will be placed on the first step
378.534 -> now from here we have to motivate and instruct the patient to weight bear on paralyzed side
384.434 -> and now lift and place the normal leg on the second step
388.3 -> and then bring the normal leg back to starting position
390.8 -> so this again is a very good exercise to improve stability and mobility on the paralyzed side lower limb
398.534 -> if the patient initially is not able to place the normal leg on second step
402.1 -> then patient can be instructed to use both hands for support and then perform the exercise
407.567 -> if still the patient is not able to do then he/ she can be asked to place the normal leg on the first step
414.434 -> and then gradually training the patient to be able to place the normal leg on second step
418.3 -> the exercise can be made more advanced by asking the patient o place the normal leg on the third step
424.5 -> the goal of the exercise is again to emphasize
427.5 -> on improving stability by maximally weight bearing on paralyzed side for longer period of time
435.467 -> and this will help a lot in making the patient walk normally
438.367 -> so this was how we can use the level three gait training concepts to design different types of exercises for stroke patients
445.652 -> and thus improve the patient's stability component
448.734 -> when stroke patients start preforming level three gait training exercises with ease
453.334 -> then we can progress the patient to level 4 , 5, and 6 gait training exercises
459 -> in which we are going to see how patients will be motivated
464.567 -> and taught how to start moving the paralyzed side lower limb with control
468.767 -> I sincerely hope that the information shared in this video is going to be helpful for you all
473.834 -> and utilizing this knowledge lots of stroke patients can improve their quality of walk
482.3 -> see you all soon in our next video
485.315 -> till then, keep learning, keep sharing and stay connected
Source: https://www.youtube.com/watch?v=vyN_BDe-AYQ