Diagonals part four: Stroke 2. Transfers in bed and the chain rules

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van de Rakt, Jan ; McCarthy-Grunwald, Steven (2016)
  • Publisher: Societa Scientifica Riabilitazione e Posturologia dello Sport
  • Subject: Z721 | Z722 | Z723

An individual's diagonals tend to be severely affected following a stroke. Therefore training needs to focus on restoring the diagonals and if possible the homo- lateral structure on the affected side. Maintaining overall movement in bed is extremely important promoting the individual's independence. In part 4 we must consider the whole process of rehabilitation especially considering their home environment. Exercises lying in a sideways position are the most effective form of task specific strengthening exercises that have a greater impact on the potential re-establishment of movement in bed for individuals, along with developing greater coordination in the homo-lateral structure, which could eventually lead to the possibility of balance control and walking. Exercises are structured to consider the need to relearn the movements themselves, then progress towards making them more practical activities of daily living (A.D.L.) movements, where the movements will be required throughout the day (with some assistance initially), removing this support over time as the skills develop towards independence for the individual. Training/learning requires repetition by variation of which there are a wide range of exercises to choose from, which require load bearing movements which help develop better coordination and muscle power. To provide a complete package of recovery, every movement will be discussed and analyzed, to identify the best movements with the least level of assistance as a starting place, to increase the overall potential of reducing this assistance towards independence in the future. The appendix provides information on the training of limbs (Especially the arms) using the chain rules. Too often we start with an ‘open chain’ which can sometimes be too strenuous for the individual and can sometimes be very challenging affecting the individuals performance and overall motivation to achieve their full potential. Training using the variety of method of the chains enable the tasks to be more achievable, so by using these learning/training rules can promote better recovery.
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