ANY SENSORY STIMULUS WHICH IS NON PURPOSELESS IS USELESS

During sensory facilitation in neuro rehabilitation we use tapping, weight bearing, and joint compression to facilitate the motor control in upper limb. Most of the time therapist use weight bearing through upper limb either in prone on elbows, quadruped, or in sitting weight bearing through upper limb with hand kept either sideways or backward. Most of the time we don’t even think what is our objective of this exercise and which purpose it is used. Even we don’t plan that, are we trying to do heavy joint compression or light joint compression. What is the purpose of the joint? Is it heavy joint compression or light joint compression? Wrist and elbows are not meant for heavy joint compression. Wrist and elbows are for the purpose is for light activity and skillful activity. By doing this heavy joint compression in the lengthened range of ling flexors, we overstretch the long flexors. This increases the movement arm of flexor tendons and this cause’s excessive flexion force and flexion attitude of the flexors in every movement of wrist and hand and skillful movements. Already it is difficult to activate finger flexors and teach release of fist and this over action of flexors makes it more difficult. So we should avoid weight bearing through hand in fully extended fingers.

Instead of giving sensory stimulation in functional positions we need to give sensory feedback during functional activity & task specific position. This helps in sensory integration of sensory feedback with motor control in given task, given task parameters and contextual factors.

Principles of Bobath Approach

BOBATH APPROACH

K. Bobath & B. Bobath developed treatment designed to increase normal movement patterns in children with cerebral palsy & adult with acquired hemiplegia. Their treatment focuses on restoring normal movements & eliminating abnormal movements.
 Bobath principles

• The goal of the treatment to retrain normal movement responseson the patient’s hemiplegic side.
• The therapist should avoid activities & exercises that increase abnormal tone to strengthen abnormal movement responses & should use treatment techniques to suppress or eliminate these patterns.
• The therapist should use treatment activities & exercises that encourage or strengthen normal movement patterns in trunk & extremities.
• The therapist should help the patient use existing motor control on the hemiplegic side for functional performance.
• When the patients lacks adequate strength & control of the affected arm & leg for normal functional/occupational performance. The therapist should develop compensations & adaptations that encourages use of the affected side & decrease the development of abnormal movement & asymmetrical postures.

Note: These are some of my notes taken from book; Adult hemiplegia by Bertha Bobath.

How to reduce the walking synergy & circumduction gait?

Walking synergy is cause of difficulty in hip knee flexion and their weakness. in short they r not able to reduce the length of the hemiplegic leg during swing phase, which normally we do.
if we cant reduce the length then increase the length of opposite limb. give a half inch raise on normal leg footwear. this will help in reducing the length and reducing effort then reducing synergy. it ll also helps in increasing speed of walking.
increased speed also improves hip knee flexion. which will help in reducing the synergistic pattern/hemiplegic gait.