Forum / Let's Discuss! / Stroke client - foot drop led to disjunction in lifting leg.

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Ann
On: July 24, 2015 08:49 AM
I have a client who suffered a stroke 3 years ago. As a result of the typical foot drop he began using his side body to lift his leg in forward movement. This was apparent when I placed him on all fours over the trapeze bar and had him lift his right leg. The bar tilted as he shifted into his left side. Because of his lack of feeling with muscle engagement I am having a hard time diagnosing which muscle he is actually using - obliques, hip flexors (psoas), QL. Sometimes I wish he was made of glass! I need movement pattern assessment ideas to help correct this movement pattern. Thanks for your input.
Casey
On: July 27, 2015 13:47 PM
Hi there Ann! This is a very interesting question! First I would try not to get overly focused on which muscle is dysfunctional leading to the lack of organization. Especially in the case of sub maximal neurological functioning due to something like a stroke, it can be much more beneficial to see the area as a collective whole in your problem solving and cueing. The best bet is to give him lots of closed kinetic chain work so he can feel and sense his body as best he can with lots of sensory cues. Lots of support from the equipment and warmed smartspines would be my recipe so that he has to reach into the support of these tactile cues to fill in the gaps of what his motor skills are missing. So in the above exercise as you describe it would be wonderful if he could press his foot into something (the upright on the cadillac, a ball, your hand) so that the whole system can start to communicate again, thus resulting in better organization in space. I would for a long time only work him in situations where his feet, hands, and torso are connected to the equipment in some way, so he can start to fill on the gaps of perception and even compare and contrast the feeling and sensation that he is experiencing from one side to the other. Once he has mastered this, then you can start to take away sensory info like a foot bar to challenge what he has already learned. Also with people who have had decreased neurological functioning, visual cues are massively important. Place post its as a visual cue of trajectory so that choreography of the arms or the legs have a step by step guide to help better instruct and inform the client of what is being asked of them in the movement. These seemingly small adjustments make a HUGE difference in feeling and commanding where they are in space! By widening your view and and treating the body as a whole, it will teach your client to use his whole self in every movement which will lead to much more functional movement success. Let me know how it goes! Much Love, Casey Marie Herdt
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