We use all the basic procedures and many of the techniques when working with our patients in standing and walking. Resistance, appropriately used, increases the patient's ability to balance and move. When the strong motions are resisted in standing and walking, irradiation will facilitate contraction of weaker trunk and lower extremity muscles. These weaker muscles will contract whether or not braces or other supports are used. There are occasions, however, when the patient's medical or physical condition does not allow successful work against resistance. In those instances the therapist gives whatever assistance is necessary but continues to use all the appropriate basic procedures such as voice, manual contact and even approximation if it is effective.
As the patient's ability increases he or she must be allowed and encouraged to stand and walk as independently as possible. During these practice ses a
Fig. 12.5a,b. Manual evaluation of gait without resistance or approximation; patient with right hemiplegia
Fig. 12.5a,b. Manual evaluation of gait without resistance or approximation; patient with right hemiplegia sions, no verbal or physical cueing should be given, and only the assistance necessary for safety. Allow patients to solve problems and correct mistakes on their own. Alternate resisted gait training with independent walking during a treatment session. After an activity is mastered, resisted work is used for strengthening.
Resisted gait activities can be used to treat specific joint and muscle dysfunctions in the upper and lower extremities. For example, exercise the lateral and medial ankle muscles by resisting sideways stepping. The shoulder, elbow, wrist, and hand are exercised when the patient holds the parallel bar while balancing or moving against resistance.
The PNF techniques are useful when working with the patient in gait. Rhythmic Initiation, Replication, and Combination of Isotonics help the patient to learn a new motion or to move to a position. Use of Stabilizing Reversals and Rhythmic Stabilization to facilitates stability. Using Dynamic Reversals will reduce fatigue and promote coordination. Use Relaxation techniques to improve functional mobility.
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