fcasucci3
1 post
May 20, 2009
8:47 AM
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Looking for unique ways to help out a patient with regaining movement and ultimately usage of Right side of his body. He had a severe stroke that has rendered his right leg with partial movement and gait abnormalities but can walk with every slow movement. In addition patient has limited movement of Right brachium, no usage from elbow down. Can use right Biceps in curl after working left side curls. I am thinking of trying TMR and also Constraint-induced movement therapy (CI). Has anyone used TMR on a stroke patient before? Any advice anyone can provide will be appreciated. Thanks in advance for your help.
Frank A. Casucci III LMT
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SusanPEDPT
69 posts
May 20, 2009
5:14 PM
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Hi Frank! It's great to see someone looking for new ways to help a patient! Your are headed in a great direction checking out TMR. One of my pediatric patients has CP with a left hemiparesis. He has been making rapid gains w/ TMR. There is much similarity between the adult w/ a hemi and child w/ CP so I hope my thoughts help. A key to appreciating the power of this technique is to consider the problem as a WHOLE body problem. When I was looking at a body part or muscle and only looking at the same place on the opposite side of the body, I was not giving the patient the full advantage of TMR. If you study the technique and realize the importance of ranking which foundational movement is most restricted, you may find that doing ankle dorsiflexion is what improves shoulder adduction. I would encourage you not to limit yourself to looking at just how to do a biceps curl. The system I've developed for children can be applied to adults. Using the FAB5 and looking for 100% symmetry can be used both for strength and range to improve functional issues.
My 2 cents on CI is that perhaps it works because the good side is struggling to work inside the constraint. When the therapist thinks it is keeping it from moving that is helping it may in fact be having the good side move against the restraint thus producing active resistive exercise on the good side. I used to use CI but haven't needed to bother w/ it since using TMR for all my patients.
Susan
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DthuePT
9 posts
Jun 03, 2009
6:11 PM
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I have seen with pts with flexor tone on L side, mostly in the hands to UE's, but in LE also. the OT was working with him for the most part on his hands, however one day I was experimenting with the tone hand. I had him sqeeqe his cane as hard as possible on the right, upon relaxation (after 5sec hold)the left hand's tone dramatically dropped. so I did this several times and each attempt the hand would relax. would be interesting to try this across the body. good luck
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