Staying Mobile & Active Post Stroke. Kevin Lockette PT Ohana Pacific Rehab Services, LLC Honoulu- Kailua

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1 Staying Mobile & Active Post Stroke Kevin Lockette PT Ohana Pacific Rehab Services, LLC Honoulu- Kailua

2 Aging Process Changes in body composition Loss of muscle tissue/increase fat tissue Loss of bone mass/skeletal height/declining posture Osteoarthritis/joint pain Loss of Flexibility Increase risk of disease/disability Loss of function independence

3 Additional challenges Late affects of a stroke can result in: Spasticity Weakness Balance Disturbances Loss of Mobility

4 SPASTICITY

5 SPASTICITY A common symptom post-stroke defined as hypertonus or simply too much muscle tone. Spasticity may limit or totally restrict purposeful movement. Contributes to fatigue. Spasticity may cause foot drag, poor control of limbs, or generalized stiffness. Spasticity is a dynamic condition and can be increased physical and emotional stresses.

6 Managing Spasticity Oral Medications: Ex. Baclofen, Tizanidine, Dantrolene, Diazepam. Side effects include drowziness. Approximately 5% of drug reaches affected areas. Botox injections: Used for very focal spasticity. Best outcomes when used in smaller distal muscle groups. Intrathecal Baclofen Pump: For strong, global spasticity. MS shows a very high sensitivity so much lower doses are prescribed. Gait and balance may initially be worse with dampened muscle tone.

7 Managing Spasticity Con t Exercise: Only work joints/muscle groups that you can isolate/control. Focus on muscle groups that oppose the spastic muscle groups Think Function

8 Weakness Loss of strength is a prominent condition in MS. The degree and progression of weakness varies greatly due to difficulties in transmitting electrical impulses. Weakness is typically asymmetrical.

9 Exercise

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13 Managing Weakness EXERCISE: The amount of coordination, strength, balance, & spasticity will dictate your program. Balance and trunk stability will determine what mode of exercise is best. Your exercise program should be individualized. Your exercise program volume, intensity, and scheduled time should coincide with your normal daily activities to avoid fatigue.

14 Managing Weakness EXERCISE CON T: Avoid warm temperatures. If Swimming or exercising in the water check the temperature. It should be cool versus warm. Take rest breaks as needed. Maintain a moderate to less-than-moderate exercise intensity to avoid fatigue. If balance is impaired, exercise seated or on a mat rather than in stance. Do not exercise during exacerbations (Worsening of your symptoms).

15 Exercise: Flexibility Stretching/Flexibility exercises can help relieve effects of mild spasticity, balance problems and some types of pain. Stretching can assist in maintaining range of motion (ROM) for ADLs and Mobility. ROM exercises can assist in preventing contractures in the presence of moderate to strong spasticity.

16 Exercise: Flexibility Con t BASIC STRETCHING RULES: No bouncing: Hold static stretch to build up soft tissue tension so change can occur in tissue length. Bouncing can cause tears in muscle/tendon. No pain-just pull: Stretching should cause sensation of tension or light discomfort but not pain.

17 Balance Disturbances & Loss of Mobility Assistive Devices: Canes (single point, small base, large base) Ankle Foot Orthosis (AFO) Walkers (pick-up, front wheeled, 4 wheeled) Manual Wheelchairs Powered Mobility (power wheelchairs, scooters)

18 Modify Environment "For many, it might as well be Mt Everest."

19 Environment Lighting Throw Rugs Clutter Low toilets Cabinets/storage height Low surfaces Padded/Plush Carpet

20 Modify environment Lighting: Night Lights Throw Rugs: Remove or Double sided carpet tap Clutter: Clear pathways Low toilets: Raised Toilet Seats Cabinets/storage height: rearrange Low surfaces: Identify chair Padded/Plush Carpet: Consider alternative flooring

21 Physical Therapy Identify risks Teach exercise program Teach Balance strategies Assess needs for adaptive equipment & Mobility Home assessments