Recovery and Rehabilitation-- A Lifelong Journey

Developed By: Mark Mañago PT, DPT, NCS

Board Certified Neurologic Physical TherapistUniversity of Colorado Health

Aurora, CO

Objectives

• Rehabilitation as a lifelong journey• Rehabilitation goals and success factors• Physical therapy interventions• Sample interventions and examples• Review main points• Questions

Rehabilitation: A Lifelong Journey

• Important for everyone yet different for everyone

• Does not undo damage caused by stroke • Helps restore optimal health and function

Rehabilitation: A Lifelong Journey

• Goals of rehabilitation:– Prevent complications– Reduce disability– Maximize function– Improve independence– Build strength and endurance– Teach compensatory strategies

Rehabilitation Team

Physical TherapistSpeech Therapist

Occupational TherapistPhysician

NurseSocial Worker

Dietician

Successful Rehabilitation

• Amount of damage and location of damage

• Skill of rehabilitation team• Cooperation and support of

family and friends• Commitment to rehab program

Physical Therapy Interventions

• Wide variety of strategies, technologies and techniques

• Not every intervention is appropriate for every person

• Skilled evaluation and customized treatment plans are essential for maximizing benefits

Physical Therapy Interventions

• Basic principles: – High repetition: Practice, practice, practice!– Goal-oriented action (vs. isolated movement)– Lifelong practice and commitment– Early intervention is key BUT important changes can

be made years after stroke– Plateau in progress is normal and continuous therapy

is not always necessary

Physical Therapy Interventions

• Body weight-supported treadmill training (BWSTT)– Part of body weight is

supported in a harness system

– Shown to improve walking speed in chronic stroke

Physical Therapy Interventions

• BWSTT – Walk as fast as possible, 2 mph is ideal– Up to 3 people help control legs, feet and hips– Best 2-3x week, 20 min/ session, 12 total

sessions– Best if can already walk 30 ft without assistance– Can use robotic arm to control limb but no more

effective than therapist control

Physical Therapy Interventions

• Hydrotherapy– Pool therapy also unweights

body for easier stepping, balance and control

– Better than BWSTT for those not able to stand or walk without assist

– Can also help with muscle and joint pain

Physical Therapy Interventions

• “Forced Use” of affected limb– “Force” the use of the affected limb by limiting use of

unaffected limb– Skilled therapist can set up tasks that increase weight

bearing of affected leg or use of affected arm– With high repetition and goal-directed tasks, can lead

to improvements in function, balance and walking

Physical Therapy Interventions

• Constraint-induced Movement Therapy (CIMT)– “Force” use of affected arm by restraining unaffected

arm with mitt and/ or sling– Intense, “massed” practice, with specific tasks– 2 weeks, 90% of waking hours– 2 weeks, 6 hours a day of therapy

Physical Therapy Interventions

• Constraint-induced Movement Therapy (CIMT)– Best to have wrist and finger extension > 10°– Be able to walk without assistive device – Have minimal spasticity– Shows improvement in chronic stroke up to 2 yrs after

treatment– Difficult to implement at times in clinic because of time

and billing but different protocols being tested

Rehabilitation Summary

• Important for everyone yet different for everyone• Does not undo damage caused by stroke • Reduce disability, maximize function/

independence • Build strength and endurance• Lifelong journey that depends on:

– Amount of damage and location of damage– Skill of rehabilitation team– Cooperation and support of family and friends– Commitment to rehab program

Questions?