Patient Empowerment Programme, New Territories West Cluster 中風後的物理治療 進階復康運動 Post-Stroke Physiotherapy Advanced Rehabilitation Exercises 博愛醫院物理治療部製作 produced by Physiotherapy Department, POH
Cerebral Vascular Accident (Stroke) means the brain damage caused by deficiency of blood supply to brain cells. According to the extent and location of the brain damage as well as the clinical presentations, stroke can be categorized to severe, moderate and minor stroke. Further brain cells damage or secondary complications are preventable with appropriate early intervention. Physiotherapy is crucial in stroke rehabilitation, especially in the period of 6 months post-stroke. Stroke patients can regain ambulation and manipulation functions through motor re-learning, so as to increase the independency in daily activities and resume normal social life. In addition, it is scientific-proven that consistent rehabilitation training can continuously stimulate neuro-plasticity. This pamphlet introduces a series of advanced rehabilitation exercises for patients suffering from minor stroke and patients with good rehabilitation progress after stroke. Daily practice of specific exercises is encouraged in order to optimize functional ability. The following exercises integrate physiotherapy to traditional Tai Chi Chuan (TCC) with regard to sports science. TCC emphasizes on body alignment, correct posture, proper muscle activation and, most importantly, body-mindfulness of different TCC forms.
Exercises in Supine Lying Exercises in Four-point Kneeling Exercises in Standing
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Method: Stand with feet apart as shoulder width. Elongate the spine, depress shoulders, expand chest and posteriorly tilt the pelvis. Hold the posture for 10 seconds and then slowly relax, repeat 5 times. Effect: To correct posture, improve core muscle strength and prevent musculoskeletal pain. This is fundamental for all exercises. 2
Exercises in Supine Lying Method: Lying flat and bend knees. Keep feet and knees apart as pelvic width. Contract abdominal core muscles and gluteus muscles meanwhile lift buttock up. Hold for 10 seconds, repeat 5 times. 3
Method: Lying flat and bend knees. Keep feet and knees apart as pelvic width. Raise one leg to 45 degrees inclination with bed. Contract core muscles and gluteus muscles meanwhile lift buttock up. Hold for 10 seconds, repeat 5 times. Effect: To increase strength of core muscles, abdominal muscles, low back muscles and gluteus muscles. 4
Method: Lying flat, legs slightly apart, bend one knee to the level of vertically above hip joint and make 90-90 degree, with toes up. Repeat with alternate legs for 10 times. This exercise can be progressed through increasing speed of motion. Effect: To improve strength of abdominal muscles and lower limbs muscles and also train lower limbs coordination. 5
Method: Lying flat and bend knees. Keep feet and knees apart as pelvis width. Contract abdominal core muscles and move the pelvis anteriorly and posteriorly (fro and back). Repeat 10 times. 6
Exercises in Four-point Kneeling 7
Method: Kneel on knees and supported by upper limbs, hands and knees apart as shoulder and pelvis width respectively. Contract abdominal core muscles and move the pelvis anteriorly and posteriorly (fro and back). Repeat 10 times. Effect: To increase the mobility of lumbosacral joint and strengthen core muscles, in order to refine gait pattern 8
Method: In four-point kneeling position and hold core muscles. Kick one leg backward up to hip level. Maintain the posture for 10 seconds and return to starting position. Repeat with alternate legs for 5 times. 9
Method: In four-point kneeling position and hold core muscles. Kick one leg backward up to hip level meanwhile the arm of contralateral side raise to shoulder level. Maintain the posture for 10 seconds and return to starting position. Repeat alternately for 5 times. Effect: To improve the muscle strength of back muscles, core muscles and gluteaus muscles, in order to improve balance ability 10
Exercises in Standing Method: Keep righting posture in standing, depress shoulders and both hands facing upward. Elevate both arms forward and upward to shoulder level. Elongate the arms from shoulder girdles to fingers joints. Maintain the posture for 10 seconds. Repeat 5 times. Effect: To strengthen upper back and shoulder girdle muscles 11
Method: Keep righting posture in standing, depress shoulders and both hands facing upward. Elevate both arms sideway and upward to shoulder level. Elongate the arms from shoulder girdles to fingers joints. Maintain the posture for 10 seconds. Repeat 5 times. Effect: To strengthen upper back and shoulder girdle muscles 12
Method: Stand with righting posture with both hands facing upward. Slowly side-flex your trunk with spinal elongation. Maintain 10 seconds at limit of the range. Repeat 5 times for both sides. Effect: To strengthen and stretch core muscles of back. In Traditional Chinese Medicine, the gall bladder meridian is stretched, which can improve absorption ability in gastro-intestinal system. 13
Method: Stand with righting posture with both hands facing upward. Keep both legs fixed and spine in elongated; then rotate your trunk to one side. Maintain 10 seconds at limit of the range. Repeat 5 times for both sides. Effect: To strengthen and stretch core muscles of back. To increase the mobility of cervical, thoracic and lumbosacral joints. 14
Method: Keep righting posture in standing. Weight shift to one leg meanwhile elongate the spine. Slowly bend another knee to hip joint level and hold 10 seconds. Repeat alternately for 5 times. 15
Method: Keep righting posture in standing. Weight shift to one leg meanwhile elongate the spine. Slowly bend another knee to hip joint level and circulate. Repeat alternately for 5 times. Effect: To strengthen core muscles and lower limbs muscles, in order to improve balance 16
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Method: Keep righting posture in standing with legs slightly apart. Slowly bend one knee to hip joint level to make 90-90 degree with toes up. Repeat the movement with alternate legs for 10 times and progress through increasing speed of motion. Effect: To improve lower limbs coordination, so as to improve gait pattern 18
Method: Keep righting posture in standing with legs slightly apart. Raise both arms to shoulder level with palms facing down. Slowly press arms down to waist level meanwhile bend knees to squat. Repeat the movement for 10 times. Effect: To improve lower limb joints proprioception and muscle strength 19
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Method: Keep righting posture in standing with legs slightly apart. Slowly elevate and circulate the arms sideway and cross at the throat level. Effect: To improve upper limbs coordination This exercise can be progressed through combining depressing arms with semi-squatting. 21
Keep semi-squatting in righting posture in standing. Raise left hand and depress right hand meanwhile trunk rotate to left side; then depress left hand and raise right hand meanwhile trunk rotate to right side. Repeat the movement for 10 times. This exercise can be progressed through combining with lower limbs sideway weight shifting. To improve upper limbs active control and coordination. 22
Method: Keep righting posture with weight shifting to the back leg meanwhile toes up of the front leg and then slowly weight shift to the front leg. Repeat the movement for 10 times. 23
Effect: To improve fro and back weight shifting as in walking. To strengthen core muscles and lower limbs muscles, so as to improve balance and gait pattern. his exercise can be progressed through combing with upper limbs exercise, such as holding a virtual ball. 24
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Method: Keep righting posture with weight shifting to the right back leg meanwhile toes up of the left front leg and right hand on left wrist. Forward weight shift to left leg and depress left arm. Lastly, push right arm forward. Repeat the movement for both sides for 10 times. This exercise can be progressed through combining upper limbs movements with alternately stepping forward. Effect: To improve upper and lower limbs dynamic coordination as well as weight shifting in walking 26
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Method: Keep righting posture in standing with legs apart. Stabilize lower limbs. Turn left palm facing down and form a beak ; rotate your trunk to left side and right hand place on left wrist. Move right hand levelly to the right side meanwhile rotate your trunk to the right, left hand place on right wrist. Repeat the movement for 5 times. This exercise can be progressed through combining sideway shifting of lower limbs. Effect: To improve upper and lower limbs coordination and fine motor control 28
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Method: Keep semi-squatting in righting posture. Raise arms and cross at chest level meanwhile raise right knee. Open arms with right hand reaching forward meanwhile kick right leg forward. Hold for 5 to 10 seconds. Repeat alternately for 5 times. Effect: To strengthen core muscles and lower limbs muscles to improve balance. To improve upper and lower limbs coordination. 30
鳴謝 : 新界西醫院聯網病人啟力基金 ACKNOWLEDGEMENT Patient Empowerment Programme, New Territories West Cluster 2016 年 2 月初版 February, 2016 First Publish