Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Sunday, December 10, 2023

Improving Strength and Mobility with Healthy Stability: A Case Report

If your therapists don't understand that the way to get to this is 100% recovery protocols; then you don't have a functioning therapist!

Improving Strength and Mobility with Healthy Stability: A Case Report

Written By: Lori Duncan, DPT, MTC, CPT

 

 

As therapists, we are always trying to optimize our patient’s function and independence. This requires a combination of strength, mobility, and stability. So where do we start?

Over the years, I have found that stability is often missed, skipped, or devalued in a patient’s rehabilitation program; however, the first 6-8 weeks of muscle gain is a chit-chat between the muscle and brain. This is neuromuscular recruitment (i.e. stability or motor control) not a change in muscle fiber size. In general, poor stability results in poor symptom resolution, and decreased strength and function. This is a schematic I use (I draw this for my patients) to show them the relationship of mobility, stability, and strength. Notice that strength is below, or after, mobility and stability. Yet so many rehabilitation programs begin with strength.

Here is a case report of a patient I am currently treating to illustrate the importance of the stability link to optimize our patient outcomes.

 

Clinical Notes:

September 2023: A 47-year-old man presented with significant right quadriceps atrophy after experiencing rhabdomyolysis from a compression injury in July 2023. He had been in rehab for 4+ weeks prior to our meeting but was still experiencing significant knee pain, functional weakness with stairs, and right quad a trophy.

For review, rhabdomyolysis is when damaged muscle releases muscle cell contents (i.e. Myoglobin, creatine kinase, etc.) into the blood. This release of cell contents can then cause a host of different organ damage. Luckily, this patient was treated quickly enough and only had resultant muscle atrophy.

His program from August-September 2023 (prior to coming to my clinic):

  • Lunges, squats, bridging, and walking on the treadmill

Lunges, squats, and bridging are FABULOUS exercises, but they are very strength-based. For a patient dealing with such significant quad atrophy, this was simply too much on the system and he was loading his knee joint. Watch the progression we used to resolve his knee pain and develop his quadriceps muscle. It’s not strength-based movements at first. 

September 2023 (initial program at my clinic):

  • Stability/Mobility: Pilates-based movements for the VMO, glutes and quads
  • Stability/Mobility: Physioball supine walkouts and HS curls

October 2023 (after 1 month he reported his symptoms were improving and was able to negotiate stairs with more confidence):

  • Stability/Mobility: Continued Pilates-based movements
  • Stability/Mobility: BOSU kneeling and bird dog
  • Strength: SL squat assisted and only to mid-range
  • Carioca for coordination and improved confidence with RLE

November 2023 (after 2 months he reported he was able to get up and down from the floor without pain):

  • Stability/Mobility: Pilates side-series for glutes, VMO and RLE endurance
  • Stability/Mobility: Physioball forearm planks, lateral lunge supported
  • Stability/Mobility: BOSU SL kneeling, bird dog knee to nose and standing SL balance
  • Strength: SL squat + hover over the chair, squat to toes reach
  • Mobility isolated: prone quad stretch to tolerance, dynamic not static

This is only one example of how the emphasis on early stability and mobility will optimize patient symptoms and outcomes; the possibilities are endless for how to incorporate this principle into treatment. In the end, our role as clinicians is to meet each patient where they are at and progress them appropriately so they can have a healthy return to their life and independent function outside of rehab.

Interested in learning more? Attend any or all of my 4 Live Streams on Improving Strength and Mobility taking place January 26th & 27th. Hope to see you there!

 

Explore online continuing education courses from Lori below:

Strengthening Core Stability

Optimizing Functional Movement

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