FUNCTIONAL REEDUCATION TECHNIQUES

PRESENTER BY

ARAMBAM MEITEILEIMA CHANU1ST YEAR, MPT(NEURO)

INTRODUCTION

• Functional re-education techniques are those techniques which are used in re-education of lost functions. Restoration of function is important in achieving the patient's rehabilitation.Re-education of function requires the co-operation of all who come in contact with him.

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• RE-EDUCATION CAN BE DONE

• 1)ON MAT

• 2)ON RE-EDUCATON BOARD

• 3)USING PARALLEL BAR

• 4)USING SUSPENSION THERAPY

• 5)USING HYDROTHERAPY

FUNCTIONAL RE-EDUCAION ON MAT

• A normal individual perform activities such as rolling, getting up from lying position etc,independently day to day life usually in bed or floor. But a person physical impairment finds difficult to do so.

• Therapist teaches methods and techniques o carry out such activities independently usually on mat as it provide large BOS and low COG, hence known as mat activities.

Mat activities

• Common mat activities are;• 1)rolling• 2)prone on elbow• 3)prone on hand position• 4)hook lying• 5)bridging• 6)quadruped position• 7)sitting-long sitting, short sitting• 8)kneeling• Half kneeling

ROLLING

• Rolling generally progress from log rolling to segmental rolling

• It is roll from supine to side lying\prone or from prone to side lying\supine.

• Log rolling produces movement of the entire trunk as a unit around the longitudinal axis of the body.

• Segmental rolling is a progression from log rolling. In segmental rolling either the upper or lower segment of the trunk moves independently while the other is stabilized.

ROLLING

• Techniques to facilitate rolling are:• Flexion of the head and neck with rotaion:It

is used to assist movement from supine to prone position.

• Extension of head and neck with rotation: It is used to assist the movement from prone to supine position.

• Both the hand are clasped, elbow fully extended and shoulder flexed unto 100-110

• Cross the leg over the other, the upper leg is towards the side of rolling.

ROLLING

PRONE-ON-ELBOWS

• This position provides weight bearing on elbows and forearm. The posture provides stability of gleno humeral joint co-contraction of scapular musculature, and improving head and neck control

• The position should be progress in the following manner:

PRONE ON ELBOW

Prone-on-elbow

• Initially the patient should try to assume and maintain the position for few to several minutes with out without assistance. during this timing activities like reading books ,watching TV can be incorporated.

• Patient should try to maintain the posture independently.

• Weight shifting to lateral direction can be started

• Activities like writing, page turning, ball squeezing etc can be used.

PRONE ON HAND

• It is the intermediate position between the prone on elbow and quadruped positions.

• From prone on elbow the position, patient fully extends his elbows. In this perdition BOS and COG becomes more higher. The weight is born on hands,wrist,elbow and shoulders

PRONE ON HAND

Progression takes place in the following manner

• Same with prone on elbow

• Final step is performed in the form of push ups in prone position which is also helpful in increasing strength of triceps,brachii and pectorals major.

HOOK LYING

• The patient is in supine position with hip and knee flexed and feet flat on the floor or mat surface.

• In this position the BOS is large and COG is lower.

• Patient performs lower trunk rotation by swinging the lower extremity side to side.

HOOK LYING

BRIDGING

• The patient is in hook lying position and elevates his pelvis off the mat surface.

• Progression of the activities takes place in the following sequences

• 1)Asume and maintain the position with or without assistance.

• 2)Maintain the position independently• 3)Elevation of the pelvis off the mat then again

depressing it on the mat, it is perform several times.• 4)Resistance can be given on the ASIS.• 5)Decrease the angle of hip and knee flexion.

BRIDGING

CLINICAL IMPLICATIONS OF BRIDGING

• 1)Improves pelvic mobility

• 2)Strengthens low back and hip extensors

• 3)helpful for using bed pan

• 4)Relieve pressure.

QUADRUPED

• In this position the patient bear weight in all the four limbs.

• The patient usually goes in quadruped position from prone on elbow or prone on hand position.

• Progression of the activities takes place in the following manner:

• 1) Weight shifts in forward, backward and side to side direction can be incorporated.

• 2) Raising of one of the upper limb and bearing weight on rest of the 3 limbs.

• 3)raising of one of upper limb and contralateral lower limb. Increase the time gradually for 2 and 3.

QUARDRUPED

CLINICAL IMPLICATIONS

• Patient weight bearing on lower extremity joints (step towards weight bearing in erect positions).

• Strength and mobility required for so many functional activities by upper extremities.

• Functional activities such as cleaning floor, gardening (planting seeds and weeding) can be used to teach static and dynamic stability of quadruped position.

• When balance and stability have been achieved in quadruped, crawling may be started. This activity facilitates the co-ordination of the whole body including reciprocal movement of the arms and legs as require in walking.

SITTING

• Sitting is the position which requires and facilitates trunk control and balance. It also allows some amount of the weight to be born by upper extremity. There are 2 forms of sitting need to be practiced.

1. Long sitting2. Short sittingLong sitting – patient sits with knees fully

extended; hips flexed hands may or may not support the upper part of the body weight (hands may be position laterally, posteriorly or anteriorly with relation to pelvis).

LONG SITTING

SHORT SITTINGPatient sits on high surface (bed, chair etc) with knees at the edge

making hip and knees 90 degree flexed and feet flat on the floor surface. BOS is smaller than long sitting.

Progression of the both positions may take place in following sequence – (patient usually progress from long sitting to short sitting).

1.Initially patient assumes and maintains position with support.2. Patient raise one hand placing the weigh on other one. He repeats

the movement with other hand.3. Patient sits independently without any external or hand support.4.Patient performs activities such as ball throwing (light to heavy

weight), clapping overhead etc.5.Push ups in both type of sittings should be performed with or without

push up blocks. Increase the number of repetitions gradually.

KNEELING

• Patient comes in to kneeling position (hips extended and knee flexed at 90 degree) from quadruped position and bears weight on both the joint. This position also improves trunk pelvis control and upright balance. The BOS is smaller and COG is higher as compared to sitting

• Progression may take place in following manner.

1.Patient shifts weight from one to other knee.2)Ball throwing and other activities should be performed.3)Kneel walking would be the final progression for the

kneeling position.

HALF KNEELING

• Patient assumes the position as shown in the figure. The limb which lies posterior bears more weight.

• This position improve pelvic control ,hip extension, and ankle and knee movement

• Progression takes places in the following manner:

• 1)weight shift from one limb to other and even interiorly and posterior.

• 2)Upper limb activities such as ball throwing light to heavy weight) peg lifting and clapping etc.

KNEELING

HALF KNEELINGHALF KNEELING

KNEEL WALKING

Re-education with hydrotherapy

• It is indicated in

• 1)Paralysis

• 2)Quadriparesis

• 3)Cerebral palsy

• 4)hemiparesis

Principles1)The upward force in the waterWhich work against the gravity reducesThe weight stress on weight bearingJoints in standing.

II)The force of gravity and buoyancy balanceEach other and minimized the muscularEfforts in standing.

III)The water provide resistance againstThe movements of the body and extremityAll these 3 functions of water makeThe patient stand up more comfortablyIn the water than the land

.The therapist stabilized the pelvis and trunk

Exercises in water

Lifting one hand in air then otherHand and then both hand.Patient learns these exercise and afterFew sessions of treatment improves his Balance and co ordinationNow remove the stabilization andAllow the patient to stand without Support and does the exercises

Exercises such as-bending trunk forward,backward,sideward,are addedLater on with the little stabilization At pelvis.

Lower limb exercises such as placeThe limb foreward,backward,and sidewardLift it up with flexion of hip and kneeAnd hold for 10 counts.Bend both the knees And then extend them.

Functional re-education with suspension unit

• Suspension therapy is the exercise unit or frame which is known as Guthrie smith which muscles are strengthened by using ropes, pulleys and slings

• It is mainly used to allow the muscle to contract actively in the gravity eliminated position or against gravity and subsequently improve the muscle strength, joint range of motion and decrease the pain and muscle spasm.

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