During stroke treatment, proper positioning of the patient is essential to control the development of spasticity and to help faster improvement in later stages.
Preferably, the patient is placed sideways and supine generally avoided.
ON THE AFFECTED SIDE: The shoulder should be prolonged and flexed. The elbow and wrist should extend. The forearm should be supinated. The pelvis should be in prolonged position. Hip and knee should be in neutral position. ON THE SOUND SIDE: The arm should rest on the pillow that is held in front of the patient. The scapular waist should be maintained in protraction and slight elevation. The shoulder is maintained in slight abduction and flexion with the elbow and wrist in an extended position. The forearm must be in the supine position. The pelvis should be kept in protraction. The hip should be slightly abducted and flexed. The knee should be slightly flexed and the ankle should be in a neutral position.
PHYSIOTHERAPY IN THE FIRST STAGE (FLACCID MAINLY):
Returning from supine to sidelying
One of the first activities in which the physiotherapist should work in the treatment is to turn to one side and the other. The patient must not always remain supine, but must soon learn to use his trunk; that is to say, the scapular waist and the pelvis to turn around and lie down on one side during a part of the day.
If the patient turns and lies on the healthy side, with the affected arm facing up, the shoulder and arm should move forward, the elbow should extend and the affected leg should be in a natural semi-flexion position.
If the patient turns and lies on the affected side, the shoulder on that side should be placed forward again with the elbow extended and supinated. This position helps prevent shoulder retraction and the development of spasticity of the flexor with pronation of the affected arm.
Patients shake hands, then raise your arms.
On this shoulder the belt moves forward and upwards. Then the patient's arms move, with their hands clasped in the chest. With hands together, the patient turns to the healthy side, keeping the shoulder well in advance.
Laying on sitting
The physiotherapist holds the patient's affected hand, his arm rotated externally and extended diagonally forward at shoulder height, while the patient slowly lies down, using his healthy arm to support himself. In this way, the physiotherapist will avoid retraction of the shoulder and flexion of the affected arm. Then the patient raises the healthy leg on the bed. If possible, you should bend the affected leg in the knee and place it on the bed, while the nurse helps a little by raising it below the knee.
Sitting and standing
A foam rubber mat should be placed in front of the bed to stand. The therapist should never be on the healthy side of the patient when he sits, stands or walks, since he can use his healthy side. If you take weight from your affected side, the patient will gradually overcome their fear of falling.
Read the full article "Early Treatment and Positioning in Patients with Stroke" written by Dr. Vishwas Virmani (PT) at Practo.com here: https://www.practo.com/healthfeed/early-treatment-positioning-in -stroke -patients-26596 / post
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