2. Recovery and Rehabilitation-- A Lifelong Journey Developed By: Mark Mañago PT, DPT, NCS Board Certified Neurologic Physical Therapist University of Colorado Health Aurora, CO

3. Objectives Rehabilitation as a lifelong journey Rehabilitation goals and success factors Physical therapy interventions Sample interventions and examples Review main points Questions

4. Rehabilitation: A Lifelong Journey Important for everyone yet different for everyone Does not undo damage caused by stroke Helps restore optimal health and function

5. Rehabilitation: A Lifelong Journey Goals of rehabilitation: –Prevent complications –Reduce disability –Maximize function –Improve independence –Build strength and endurance –Teach compensatory strategies

6. Rehabilitation Team Physical Therapist Speech Therapist Occupational Therapist Physician Nurse Social Worker Dietician

7. Successful Rehabilitation Amount of damage and location of damage Skill of rehabilitation team Cooperation and support of family and friends Commitment to rehab program

8. Physical Therapy Interventions Wide variety of strategies, technologies and techniques Not every intervention is appropriate for every person Skilled evaluation and customized treatment plans are essential for maximizing benefits

9. Physical Therapy Interventions Basic principles: –High repetition: Practice, practice, practice! –Goal-oriented action (vs. isolated movement) –Lifelong practice and commitment –Early intervention is key BUT important changes can be made years after stroke –Plateau in progress is normal and continuous therapy is not always necessary

10. Physical Therapy Interventions Body weight-supported treadmill training (BWSTT) –Part of body weight is supported in a harness system –Shown to improve walking speed in chronic stroke

11. Physical Therapy Interventions BWSTT –Walk as fast as possible, 2 mph is ideal –Up to 3 people help control legs, feet and hips –Best 2-3x week, 20 min/ session, 12 total sessions –Best if can already walk 30 ft without assistance –Can use robotic arm to control limb but no more effective than therapist control

12. Physical Therapy Interventions Hydrotherapy –Pool therapy also unweights body for easier stepping, balance and control –Better than BWSTT for those not able to stand or walk without assist –Can also help with muscle and joint pain

13. Physical Therapy Interventions “Forced Use” of affected limb –“Force” the use of the affected limb by limiting use of unaffected limb –Skilled therapist can set up tasks that increase weight bearing of affected leg or use of affected arm –With high repetition and goal-directed tasks, can lead to improvements in function, balance and walking

14. Physical Therapy Interventions Constraint-induced Movement Therapy (CIMT) –“Force” use of affected arm by restraining unaffected arm with mitt and/ or sling –Intense, “massed” practice, with specific tasks –2 weeks, 90% of waking hours –2 weeks, 6 hours a day of therapy

15. Physical Therapy Interventions Constraint-induced Movement Therapy (CIMT) –Best to have wrist and finger extension > 10° –Be able to walk without assistive device –Have minimal spasticity –Shows improvement in chronic stroke up to 2 yrs after treatment –Difficult to implement at times in clinic because of time and billing but different protocols being tested

16. Rehabilitation Summary Important for everyone yet different for everyone Does not undo damage caused by stroke Reduce disability, maximize function/ independence Build strength and endurance Lifelong journey that depends on: –Amount of damage and location of damage –Skill of rehabilitation team –Cooperation and support of family and friends –Commitment to rehab program

17. Questions?