Practical 2: Stroke and TBI

Lack of Momentum Exercises

1. Rocking Practice (Rocks anterior/posterior) "weight on butt to weight on heels", use PVC squares or parallel bars to guide motion

2. "Blast off drills" Push yoga ball away while standing

3. Superman punch

Overuse of Unaffected/Unequal WB Exercises

1. Staggered Stance Practice (Affected leg tucked under, unaffected leg forward)

2. Paper under affected foot "crush it"

3. Box or foam under unaffected foot to decrease reliance

Poor Timing/Lack of Coordination Exercises

1. Metronome STS (3 rocks, 1 stand)

2. Rehearse Task breakdown (Flexion, pause, momentum transfer, pause, extension)

Reliance on UE/Arm Use Exercises

1. Use UE to facilitate LE, push both hands into affected knee and force quad engagement

2. Raised Surface STS, requires less force

Plopping Exercises

1. Mini Squats

2. Counting Descent (You can't sit until 5)

Poor Postural Setup Exercises

1. Scoot and Set (Scoot to edge, hide your feet, tuck your butt)

2. PVC Bar Reaches (Initiates forward lean for trunk control)

3. Start tall, cue scapular retraction, APT)

Affected Leg Flopped Exercises

1. Tuck and tilt setup (tuck your foot and tilt forward)

2. Theraband tied around knees to prevent leg flop

3. Active foot placement drill (have pt use UE to place both feet under knees then perform STS)

Lack of Extension Exercises

1. Tuck your butt, cue for posterior chain activation

2. Hip Drive, put a target in front of pts hips: (Hit my hand with your hips)

3. Bridges, mini RDLs

Facilitation/Blocking for Buckling Exercises

1. Front approach (shin to shin contact), stabilize during STS

2. Side approach (Wrap your foot around pts food to PF to cue HC)

General Foundation for all Transfer Exercises

1. Inchworm scoot to edge (part practice to improve setup)

2. Staggered stance practice

3. Head hips coordination (cue patient to look away from where your butt is going

Divers Exercises

1. Scoot and hold

2. Ball or beanbag toss (toss to opposite side before standing to cue for forward drive with hips)

3. Verbal Impulse (You stay until I say go)

4. Break transfer into task (practice just forward lean, then pause, then transition to lift off)

Roundabouts Exercises

1. Colored Floor Targets (foot lands on the assigned color for current direction)

2. Bolster on Wrong Side to block redirection

Use Affected Side More Exercises

1. STS towards affected side (squash the paper with affected foot"

2. UE Weighing on affected thigh and press down during rise

3. Ball or toy under foot "crush it" for sensory input and WB cue

Leapers (Excessive Extension)

1. Squat Pivot transfers, reduces the need for full extension

2. Limbo drill

3. Rocking practice

4. Look over my shoulder cue to keep trunk forward

Halfway There's Exercises

1. Pool noodle barrier

2. Landing target drill to cue to land on

3. Transfer board if safety is concern

Pusher's Syndrome Exercises

1. Midline Mirror Training (bring your shoulder back to me)

2. PT unaffected side, lightly pull

3. Slide transfer to pushed-toward side

4. Table arms support (support for midline)

Bonus Transfer Techniques

1. High-Low surface practice to stimulate real world barriers

2. Add mild cognitive task to promote automaticity

Hip Hike Exercises

1. Wall drill (walk with affected side near wall, "don't kick the wall" to decrease circumduction

2. Cone walks/Line walking (forces smaller, deliberate swing to avoid lateral deviations)

3. PT Facilitation, hand on iliac crest, guide hip down and forward during swing

Hip Drop Exercises

1. Hip check gait, pt walks close to PT and taps PT with hip to cue for level pelvis

2. Step-down practice

3. PT facilitation (apply light downward pressure on stance-side of glute)

Knee Buckling Exercises

1. PT block to stand in front or behind knee with thigh to block bucking

2. Step and hold (step forward with affected leg and hold, emphasize heel strike and extended knee) cue knee stays tall, no buckle)

3. PT facilitation with quad "push into my hand"

4. TKE Band assist

5. Affected leg forward, unaffected back, slow AP, ML weight shifts, "don't let the knee buckle"

6. Squeaky toy under heel to cue loading

Hyperextension Exercises

1. Duck walk, promote knee flexion to avoid hyperextension

Foot Clearance Exercises

1. Hurdles and Step overs

2. ACE Wrap in DF and Eversion

Foot Slap Exercises

1. Rockerboards

2. March and tap

3. Heel rocker walk

Decreased Stance Phase on Affected limb Exercises

1. Metronome gait to equalize step timing

2. Tip toe on unaffected side, force WB on affected side

3. Toe taps on steps (unaffected leg taps up, affected leg remains in stance) could also do lateral weight shifts before hand

Decreased Proprioception Exercises

1. Eyes closed Weight Shift

2. Foot tapping + tactile cueing

3. Textured surface walking

No Arm Swing exercises

1. Hold weighted object to cue awareness and control

2. Ziti stick arm swing in sync with gait

Trunk Instability exercises

1. Head turns during ambulation to improve trunk control

2. Seated perturbations in standing before walking