https://pemf-devices.com/stroke-rehabilitation-with-pemf-therapy/

 

Ask a PT Response: "My sister in law developed this condition after participating in hurdles in track and it has been a battle to try to help control her pain. We tried a TENS unit which was somewhat effective for a few days but then became effective. She was unable to tolerate the habituation on her leg as the stimulki was too painful. She could tolerate aquatic aquatic therapy in a warm water pool but did not achieve any long lasting relief. She also tried accupuncture and chiropractor afer PT which was ineffective. Finally, she received a spinal cord stimulator which was able to significantly decrease her pain. She still has pain, but at least it is tolerable now. This is a very difficult condition to treat for PT's. If your patient only has a mild case, perhaps the various interventions you mentioned may be effective. I would try desensitization with various stimuli, mirror box therapy (motor programming), edema control, progression with weight bearing, and functional trianing. I hope this helps and best of luck to your patient."

 

Ask a PT Response: "One would need to incorporate hip extension, hip adduction and hip external rotation in order to achieve this motion. Since this patient suffered a stroke, definitely would need to determine if strength is the only limiting factor or if there are other factors involved, ie flexibility, joint mobility, motor programming, etc."
 

Ask a PT Response: "It sounds like you are doing the right things. For patients with this condition, I would determine the functional deficits he or she may be experiencing and break up that task into parts in the beginning and progress to the entire task once the patient is able to (ie. hip flex/marching -> step up/down fwd on 1 step with support -> step up/down without support on 1 step -> step up/down multiple steps with step to pattern with support -> step up/down multiple steps with reciprocal pattern with support, etc."

 

Ask a PT Response: "Brunnstrom and PNF are both forms of movement facilitation for stroke rehab, and they share the same goal of normalizing tone in hypotonic and flaccid patients. But they are slightly different in their delivery. 

 

With the Brunnstrom approach, patients are taught to use and control motor patterns during recovery; often are primitive syngergistic patterns of movement (via central facilitation).  This approach will be used immediately upon first day of stroke rehab for best early recovery.   

 

With PNF, patients use spiral and diagonal movement components to facilitate functional activities/movements (via peripheral facilitation).  Uses resistance to indirectly facilitate movement; resistance to strong components in order to facilitate the weaker components of movement.  More commonly introduced in the later stages of recovery.

 

Now the Bobath (or neurodevelopmental technique-NDT) differs significantly from Brunnstrom and PNF by using reflex inhibition to increase tone, which is all done without resistance.

 

For more information on the different techniques, check out the below article:

This article “Stroke Rehabilitation.”  Physical Medicine and Rehabilitation Board Review.

Cuccurullo S, editor.  New York: Demos Medical Publishing; 2004.

http://www.ncbi.nlm.nih.gov/books/NBK27209/

 

How the article defines PNF and Brunnstrom approaches:

Proprioceptive (or peripheral) Neuromuscular Facilitation (PNF) (Knott and Voss, 1968)

· Uses spiral and diagonal components of movement rather than the traditional movements in cardinal planes of motion with the goal of facilitating movement patterns that will have more functional relevance than the traditional technique of strengthening individual group muscles

· Theory of spiral and diagonal movement patterns arose from observation that the body will use muscle groups synergistically related (e.g., extensors vs. flexors) when performing a maximal physical activity

· Stimulation of nerve/muscle/sensory receptors to evoke responses through manual stimuli to increase ease of movement-promotion function

· It uses resistance during the spiral and diagonal movement patterns with the goal of facilitating "irradiation" of impulses to other parts of the body associated with the primary movement (through increased membrane potentials of surrounding alpha motoneurons, rendering them more excitable to additional stimuli and thus affecting the weaker components of a given part)

· Mass-movement patterns keep Beevor's axiom: Brain knows nothing of individual muscle action but only movement

Brunstrom approach/Movement therapy (Brunnstrom, 1970)

· Uses primitive synergistic patterns in training in attempting to improve motor control through central facilitation

· Based on concept that damaged CNS regressed to phylogenetically older patterns of movements (limb synergies and primitive reflexes); thus, synergies, primitive reflexes, and other abnormal movements are considered normal processes of recovery before normal patterns of movements are attained

· Patients are taught to use and voluntarily control the motor patterns available to them at a particular point during their recovery process (e.g., limb synergies)

· Enhances specific synergies through use of cutaneous/proprioceptive stimuli, central facilitation using Twitchell's recovery

· Opposite to Bobath (which inhibits abnormal patterns of movement)"

 

Ask a PT Repsonse: "I usually use the Respond handheld stim unit and cut the TENS electrodes so they are small circles and place them in the areas as per the chart.  I sometimes need to use a little tape to keep the electrodes in place and sometimes need to move them around quite a bit before I get any contraction, then usually keep it there for 5-8 minutes depending on the contraction.  When I can't find a contraction, I usually leave the estim on so that there is some feedback into the facial muscles.  I will also do some STM to the affected side of the face with lotion in circular motions and teach the patient to do this frequently throughout the day."

 

Ask a PT Response: "Treatment for paresis following herpes zoster infection includes analgesia for post-herpetic neuralgia, protection of the weakened muscles, maintenance of range-of-movement exercises, and a program of graduated strengthening exercises. General ankle ROM and isometric ankle strengthening exercises could be initially initiated with these patients. Treatment should be progressed as tolerated. Functional electrical stimulation could also be utilized to prevent muscular atrophy and to facilitate strengthening. Keep in mind that in most cases progress will more than likely be slow and may take up to 1 to 2 years to achieve desired outcomes. "