Post stroke client

B

bedfordfitness

0
Hello all, wondering if anyone else here has ever worked with a stoke patient? It has been about a year since her stroke now, and we seem to be doing ok... but was looking for some other advice as to how to teach her gait etc.
Her stroke was right side.
She still hikes her right hip, though less, and sometimes does not bend her knee. She has been getting BOTOX in her leg and arm, and now does not drag her toe as much and her arm stays more strait at her side.
Her biggest proplem is her hand, which stays pretty tight. I am trying to get her to use it more...

What are your opinions of massage to loosen the muscle? I spoke with one person and they said maybe it could make it worse because of the stimulation... like when she is doing leg exercises her hand will tighten up and pull up toward her chest...

I am also worried about her posture, she leans toward the right side, and we have tried stretching etc. but her proprioception is off and she cannot tell she is bending down. I think her obliques etc. must be tightening too...

Well, I guess since I don't know if any of you have ever had this situation I'll just leave it at that.

Thanks for your help.
 
Stretching and Massages might not help much at all, Those specific muscles might be in a constant state of constriction from a damaged "section" in her brain. If her brain is telling those muscles to constrict then no amount of massaging could help, and if a stretch is forced it could injure her.

She needs allot of rehabilitation (more then you could do on your own).
 
Well yeah, we do the stretching, which is a continuation of her physical therapy, but she has been discharged from physical therapy, so the fact remains that we still have to work her gait etc. Recovery from a stroke is not something that is going to happen overnight, but physical therapy simply is not covered for long term. She is still in occupation therapy for her arm, but that does not do a whole lot for her, electrical stimulation etc. My concern is trying to teach her to walk in a more normal gait.

I am glad you agree with the massage question. Have you had any experience with stroke patients? The stretching is something that has to be done, but exactly, massage could stimulate and make it worse.

At any rate, because she also has less feeling in the effected extremities she has a hard time translating what she is told into movement... Did not know if anyone would have any tips or favorite exercises say to eliminate foot drop, hip hike, and the increased tone in her hands.

So far I have her extending each finger, as well as her whole hand, and as much as possible she does arm raises etc.

Another big problem though is she has a real hard time with the adductors, exacerbated by the strength in the abductors and the habit of hip hiking. I am hoping this is something that we can improve apon... When doing supine exercises and her knees are bent, her right leg will just fall out to the side, and when attempting to lie prone and do leg curls, she drops her foot down, she has not control of the movement... so we are trying to strengthen this too, but like I said, looking for other tips from those with experience.

Thanks so much
 
I happen to specialize in stroke care. First of all, is she on any medication like Valium to relax her muscles? How often is she doing physical therapy, and may I ask her age?
 
She just turned 59 a few days ago, her one year mark is literally 18 days away. She is not on any meds except for blood pressure, but she is getting botox injections in her arm... not sure on the leg but I think she may be...

The physical therapist discharged her due to the simple fact that progress had slowed down too much (but she knew she would likely be continueing with a personal trainer, she had already discussed the possibility with her and myself). She has occupational therapy on her arm twice a week, but I know they do not ask her to do any active motions, it is always unilateral and passive, and she spends half an hour on the electical machine that has her hand extend and relax (sorry, I cannot remember the name of it.)
Now, I may be biased because I do not care for this particular therapist (according to those she works with it seems every patient does the same thing, regardless of capabilities etc.), but I am afraid any sort of postural problem or shoulder problem would go right past her simply because she doesn't look at the big picture much. My client has come so far, she may just chaulk any issues up to the stroke, that not everyone gets 100% better, and not want to deal with anything out of her regular routine... so this is why I am on this site looking for another person with experience in the matter. Even my client seems to think that her time with her is basically a waste (except the botox, which is helping now I think.)

Sorry, I know this is a long read, but anything you can tell me to help me get through this I would appreciate. (By the way, she is beginning to volunteer at the rehab place she goes to, she used to be a nurse and is going a bit stir crazy).:p
 
I would see about getting her to a facility that specializes in post-stroke care. Valium would probably work wonders to relax those muscles. I've seen clients who were completely contracted that were able to stretch their limbs out after meds and intense therapy. You have to have a therapist that believes in her, and is willing to put forth extra effort. When her arm pulls toward her chest, that is due to brain injury (lack of oxygen in this case). There isn't a whole lot that can be done for this, but in time, she should improve. It's just going to be a very long road to recovery!
 
How does Valium effect people though, in their mental abilities etc.?

I don't know if she would be willing to change her rehab places, because this place is supposed to specialize in post-stroke (!) I just think the physical therapist stinks... But if it continues this way, especially if she doesn's respond to her questions about posture and gait, then I'll definately bring it up. Thank you so much for your help.
 
Hi -I am the About(dot com) Guide to Strokes, an RN and the widow of a 5 year stroke survivor - your topic came through my Google alerts for stroke and I thought I might could help you out.
I am amazed that she is receiving Botox in the arm and leg but not the hand. The hand is the most common place it is given. She has post-stroke spasticity – Botox is one of the preferred treatments because it is given locally with no systemic side effects.
Valium would not be a good choice for many reasons; Baclofen would probably be the drug of choice. The bad news is that most oral meds for spasticity are very sedating and it is difficult for a sedated person to exercise or to have therapy or even any quality of life.
I guess I am not allowed to post urls, but I do have medically researched spasticity information on the site, as well as post-therapy exercise recommendations. The best exercises for her hand are gentle range of motion exercises which should be done 3 or more times a day. It is best to teach your client to do them herself vs. someone doing it for her – it can help the brain recognize (and have to “deal with”) the neglected side.
As for hiking her hip, she is most likely moving her leg to walk from her hip – stroke survivors with hemiplegia often learn to walk with hip movement, because the hip will generally come back before the smaller muscle groups. She may have very little use of the leg below the hip.
Research suggest that a treadmill is the best exercise for stroke rehab – if she could walk outside it would be even better – it is more challenging to walk on uneven surfaces and it would help with her balance issues.
Don’t give up on her! Most doctors and therapists will automatically write someone off just because they had a stroke. She can and will continue to improve as long as she is trying and pushing herself.
I hope I don’t come across as trying to be a know-it-all – I certainly don’t – I am just passionate about helping stroke survivors.
Good Luck!
Suzanne
 
Suzanne,
Thank you so much for your reply. Yes, one very good reason she is not on any other meds for the spasticity is so that she can continue on with a good quality of life. Like I said, she is volunteering now and is wishing she could drive etc. I don't know how I feel about the driving (she cannot talk and exercise at the same time so I wonder how her attention span would be driving???)

At any rate, I am wondering if you know any tricks for the re-teaching of gait. While I have her walking circles around her stair well, I cannot wait until the weather gets better so she can go outside. I have been having her work on her hamstrings. She could not do a prone hamstring curl with her right side without dropping the foot down to the floor (I had to catch it each time) so I now make her squeeze both legs together and do them at the same time. We did that for three sessions, then tried again to do the single leg... and she did it! It was great.

Now I am afraid the hip is a bit off, because her shoulders are even when she sits, but standing she is all thrown out of proportion. While the physical therapists I spoke to about it said it will stay that way, I may refer her to a chiropractor... if I can find one who has worked with a stroke patient before.

Oh, and one point of concern I have is that though her calves are tight and may be spastic, I want her to work them with calf raises to help her with the pushing off portion of walking. Is this a bad idea???

She did have a talk with her doc and they will be giving her more Botox in the hand, what a relief!
That will be a couple months though...
She does have exercises she does on her own, as I don't really want to waste the time she is paying me for on things she CAN do on her own... like the prayer exercise, where she presses her hands together in front of her... I wonder if she really does them every day though.

I will check out your web site for some new and exciting exercises. I like her to do yoga, pilates, and TiChi... but like a good mix of things, because it is all about her ability to function normally.

But don't worry, I know her progress will be slow, but it will continue!:eek:
 
Just wanted to add -- I worked for one of the best stroke centers in the United States, (voted in top 50 by U.S. News and World Report) and I personally have seen great results with Valium for contracted clients. You can adjust the dosage as needed to prevent over-sedation. I am glad you got your questions answered, but I just wanted to add that so you don't overlook a very helpful drug. It's worth a shot. I've seen a patient whose legs were contracted all the way to his chest, finally stand again after working with our physical therapists and taking a regimen of Valium and other muscle relaxants. We also taught him to speak again. Unfortunately he left our facility and went to an extended care program where they didn't have time to work with him, and he lost his mobility again. It's a neverending battle, but it can be done. Best wishes!
 
Please help with Post-Stroke Information

My mom just had a stroke on the 4th of April. I am searching for information on the subject. She is 78. The only effect on her has been the movement of her left side. She is getting movement back in her arm but the leg is not doing as well. I am scared to death! She is the most important person in my life. In your post it seems you may could help me with some infomation since I am clueless and everything I read at this point seems to make no sense at all. You mentioned post stroke exercises? What can I do to help her. Please help me!

tnyorkiemom


StrokeGuide said:
Hi -I am the About(dot com) Guide to Strokes, an RN and the widow of a 5 year stroke survivor - your topic came through my Google alerts for stroke and I thought I might could help you out.
I am amazed that she is receiving Botox in the arm and leg but not the hand. The hand is the most common place it is given. She has post-stroke spasticity – Botox is one of the preferred treatments because it is given locally with no systemic side effects.
Valium would not be a good choice for many reasons; Baclofen would probably be the drug of choice. The bad news is that most oral meds for spasticity are very sedating and it is difficult for a sedated person to exercise or to have therapy or even any quality of life.
I guess I am not allowed to post urls, but I do have medically researched spasticity information on the site, as well as post-therapy exercise recommendations. The best exercises for her hand are gentle range of motion exercises which should be done 3 or more times a day. It is best to teach your client to do them herself vs. someone doing it for her – it can help the brain recognize (and have to “deal with”) the neglected side.
As for hiking her hip, she is most likely moving her leg to walk from her hip – stroke survivors with hemiplegia often learn to walk with hip movement, because the hip will generally come back before the smaller muscle groups. She may have very little use of the leg below the hip.
Research suggest that a treadmill is the best exercise for stroke rehab – if she could walk outside it would be even better – it is more challenging to walk on uneven surfaces and it would help with her balance issues.
Don’t give up on her! Most doctors and therapists will automatically write someone off just because they had a stroke. She can and will continue to improve as long as she is trying and pushing herself.
I hope I don’t come across as trying to be a know-it-all – I certainly don’t – I am just passionate about helping stroke survivors.
Good Luck!
Suzanne
Click to expand...
 
I am so sorry to hear about your Mom. I don't think I am allowed to post a link here - but I write the stroke section for About(dot com) and have many, many medically researched and reviewd articles about stroke effects and rehab there.

It is very good that her arm is coming back so soon. Usually the leg comes back before the arm. Your Mom will need rehab by a Physical Therapist. Is she in the hospital? The best thing would be to go to an inpatient rehab facility from the hospital, where she can receive PT several times each day. After the inpatient rehab, she may qualify for and benefit from rehab in a skilled nursing facility. She can also receive it as an out patient and from home health care.

Depending on the severity of the stroke most stroke survivors progress from the hospital to inpatient rehab to either a skilled nursing facility (for rehab), out patient therapy or home heath care. The therapists will teach you and her the exercises she needs to do outside of therapy.

Depression is extremely common after a stroke and can really impact a person's motivation to participate in rehab activities.

Also, don't forget about stroke prevention. 80% of strokes are considered to have been preventable and having had a stroke puts her at risk for a repeat stroke.

Best Wishes -
 
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