Physical Therapy (PT)

After a stroke or protracted bed rest, range of motion frequently becomes limited. Restricted range of motion can cause pain, impair a person’s ability to function, and heighten the risk of skin disintegration and pressure ulcers. Typically, as individuals age, their range of motion decreases, but this decline does not prevent healthy senior adults from caring for themselves.

measures the maximum angle through which a joint can travel. In addition, the therapist determines whether restricted motion is caused by stiff muscles or taut ligaments and tendons. If the source is stiff muscles, a joint may be stretched more forcefully. If stiff ligaments or tendons are the cause, moderate stretching is attempted, but sometimes surgery is required before range-of-motion exercises can be effective. When tissues are warm, stretching is usually most effective and least irritating. Therefore, clinicians may first administer heat.

There are three types of range-of-motion exercises:

Active exercise: This form is for individuals who can independently exercise a muscle or joint. They must independently manipulate their appendages.
Active-assistive exercise: This sort is for individuals who are able to move their muscles with minimal assistance or who can move their joints but experience discomfort when doing so. Individuals manipulate their own limbs with the assistance of a therapist using their hands, bands, or other apparatus.
Passive exercise: This sort is for individuals who cannot engage in physical activity. No effort is necessary on their part. The therapist moves their extremities, among other objectives, to prevent contractures (the persistent stiffening of muscles due to lack of movement).

Active-assistive and passive range-of-motion exercises are performed with care to prevent injury, though some distress is unavoidable.

To enhance range of motion, the therapist must move the affected joint beyond the point of discomfort without causing residual pain. (pain that continues once the movement is stopped). A sustained, moderate stretch is more effective than a brief, intense stretch.

Numerous forms of exercise enhance muscular strength. All entail gradually increasing the resistance. When a muscle is extremely frail, movement against gravity alone is adequate. Stretch bands or weights are used to progressively increase resistance as muscular strength increases. In this manner, muscle size (mass), strength, and endurance are enhanced.

These exercises can assist individuals with coordination and balance issues, typically as a result of a stroke or brain damage. The purpose of coordination exercises is to facilitate the completion of specific duties. The exercises consist of repeating a movement that engages multiple joints and muscles, such as lifting up an object or touching a body component.

Initially, balance exercises are performed using parallel bars, with a therapist positioned directly behind the individual. In a swaying motion, the individual transfers weight between the right and left legs. Once this exercise can be performed safely, forward and backward weight shifts are possible. When a person has mastered these exercises, they can perform them without parallel bars.

The ability to walk (ambulate) — independently or with assistance — may be the primary objective of rehabilitation. Before beginning ambulation exercises, standing balance must be achieved. People typically grasp onto parallel bars and shift their weight from side to side and front to rear to better their balance. The clinician stands in front of or behind them to ensure their safety. Before beginning ambulation exercises, some individuals must enhance the range of motion of a joint or their muscle strength. Some individuals require orthotic devices, such as braces.

When individuals are ready for ambulation exercises, they may begin on parallel bars before progressing to walking with mechanical aids such as a walker, crutches, or cane. Some individuals are required to wear a fall-prevention harness, which is administered by their therapist.

As soon as individuals are able to walk securely on a flat surface, they can be instructed on how to step over curbs and ascend stairs. When ascending stairs, they are instructed to put their unaffected leg forward first. To descend the stairs, patients are instructed to put their injured leg down first. The phrase “good is up, bad is down” can be used to aid in recall. Family members and caregivers who assist individuals in walking should learn how to properly support them.

A combination of range-of-motion, muscle-strengthening, and ambulation exercises is used to counter the effects of prolonged bed rest or immobilization. General conditioning exercises help improve cardiovascular fitness (the ability of the heart, lungs, and blood vessels to deliver oxygen to working muscles), as well as maintain or improve flexibility and muscle strength.

For many people (particularly those who have had a hip fracture, an amputation, or a stroke), transfer training is a critical goal of rehabilitation. Being able to move safely and independently from bed to a chair, a wheelchair to a toilet, or a chair to a standing position is essential to remaining at home. People who cannot transfer without help usually require 24-hour assistance. Caregivers may help them transfer using special devices, such as a gait belt or harness.

The techniques used in transfer training depend on the following:

Whether people can bear weight on one or both legs
Whether they can balance well
Whether they are paralyzed on one side of the body

Sometimes, assistive devices can be useful. Those who have difficulty rising from a seated position may benefit from a chair with a raised seat or a seat-raising mechanism.

Also read: Benefits of Physical Activity

If a person has been confined to bed for several weeks or has suffered a spinal cord injury, their blood pressure may drop rapidly upon standing, causing them to feel disoriented. (orthostatic hypotension). A tilt table may be used to assist such individuals. This procedure may retrain blood vessels to constrict (narrow) and dilate (widen) appropriately in response to changes in posture, thereby aiding in the regulation of blood pressure when changing positions. People are restrained by a safety harness while lying face-up on a padded surface with a footboard. Depending on how well individuals tolerate it, the table is progressively tilted until they are virtually upright. The gradual change in posture restores the blood vessels’ capacity to constrict. The duration of the erect position depends on how well individuals tolerate it, but should not exceed 45 minutes.

The tilt-table procedure is performed daily, once or twice. Its effectiveness fluctuates based on the nature and severity of the impairment.