♪Bob and Brad ♪
♪the two most famous ♪
♪physical therapists ♪
♪on the internet. ♪
- Hi folks. I'm Bob Schrupp, physical therapist
- Brad Heineck, physical therapist.
- Together we are the most famous physical therapists
on the internet.
- In our opinion, of course, Bob.
- Hey Brad, you wanted to show us some amazing-
how you can make some amazing progress,
someone who's had a stroke,
in their walking.
How you can progress that along.
- Right.
You know, the person's had a stroke.
In this situation,
it's gonna be the left side of the brain,
the right side is gonna be affected.
You can see Bob and I both have tape on our right leg.
That's a reminder for you.
And as well as for us
that that's our involved side
in this situation
the person's gonna be lucky enough
to have fairly good use of the arm.
Although it's not real critical, it is with the walker.
But the biggest thing we're gonna focus on
is balance, walking,
and how can that person advance that involved leg,
so it swings through
and they can put weight on it
and balance and walk functionally without falling.
- So Brad's got some neat little hints
and techniques that you can use
both as a therapist
or if you're a family member working with somebody
- Right. Right...
- these are things you can try on your own.
- We do get quite a few comments
from people that aren't, they don't have therapy.
- They don't have access to 'em. Right.
- Right. And they're looking for things they can do
with their friends or family members at home.
And believe me,
there's gonna be a number of things here
that I think will help.
- By the way,
I do see a couple people that are just coming in
to make a comment.
- Sure enough!
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Brad and I have this thing, that we want to be liked.
- Yeah.
- So, all right.
- Carry on!
- Let's get going.
- Okay. So once, you know, someone's had a stroke
they're at home or in the clinic,
one of the first things I do is,
you know, get 'em up on their feet
and see if that leg,
here we got the tape here,
Is that leg gonna accept weight,
or is it gonna buckle?
Obviously, if it's gonna buckle,
we're gonna work on strengthening exercises.
In this situation, the person can bear weight
and fairly stable on it.
So if they, you know, get 'em to have a walker,
I think we can see that leg in there,
and I'll have the person stand,
check without hand-hold,
make sure they're safe,
hands back on,
and then I'll go weight shift.
So can they put all the weight to the right leg
without having this happen?
Okay.
So, and if that looks good,
well, then we progress to the next step.
We can go to some marching
and can the person go up like this and like this.
And not only looking to see if the knee flexes,
but does the knee hyperextend like that.
Because that's a real common quadriceps weakness
that happens with a stroke leg.
Okay. So we're gonna look at that and assess that.
If they have good enough stability with the marching
then we're gonna go right into walking.
Okay. And what I'm gonna do
is I'm gonna show you some gait problems
that are pretty common.
- Some walking problems that are common.
- So here we got the tape, that's the weak leg.
A lot of times the toe will drag,
we have foot drops.
The toe is unable to lift up and dorsiflex
so you have clearance and that toe drags
which is obviously a big problem,
'cause it can cause you to fall down. Okay.
- So it could be weakness in the hip or in the foot itself.
- Exactly.
- Or anywhere along the chain there
might be causing you difficulty.
- It's a good point.
And that's what therapists are thinking.
And if you're not a therapist,
you might see the foot drop
and you might just think,
"Oh, the problem is down there."
- In the ankle.
- In fact it may be up here,
part of it is up here.
- Right.
- Another thing with foot drop is you might hear this
- Foot slap
- Foot slap.
- Yeah.
- It's the same problem.
I've got a patient
that I've been working with recently
and he has this:
his toe goes out to the side and he's dragging it.
- That's very common too.
- Right. Exactly.
So we're gonna show you a couple of really neat tricks
on how to do that in just a little bit.
Okay. If things are going okay with a walker
and you can go a hundred feet,
couple hundred feet, on the flat
and think, well, maybe we should progress to the cane.
- Sure.
- So Bob, why don't you show some examples with a cane?
- So I'm gonna move the cane forward then my foot.
- Yeah.
- I might have trouble moving that foot forward.
- Right. So, and this is very typical.
You're gonna use the cane on the opposite side.
This leg is good.
He's got pretty good balance between the cane and here,
but that stroke leg is really
having a hard time coming forward.
Okay. This is a technique that I've used
over the years and it works really well.
We'll go-
- We'll face this way. Yeah.
- Straight towards.
So what you're gonna do is,
Bob has a gait belt on
so I'm gonna use that to grab,
always have a gait belt if there's a risk for fall,
and I'm gonna come around,
I call it the hip-hugger technique,
around here and my hip is going to Bob's hip,
and I got pretty good control.
I'm not being shy here.
I need to know where his hip is
and I need to help guide it.
So Bob's having a hard time
bringing that right foot forward.
And I'm not gonna drag it forward
by reaching down and grabbing it.
I'm gonna throw his right hip forward.
And there it goes.
- Yeah.
And I didn't do anything there.
He lifted it for me.
- Yep.
- So he's really pulling on my pelvis here.
- Right.
- Is what you're doing.
- Right.
- And you're pulling it up and around like that.
And you know, after time
you can maybe help a little bit less.
- Exactly
- And you're hoping I do more and more over time.
- Right. One thing I'll do is
I'll give a lot of verbal cues.
Okay, Bob, bring that right foot forward.
Bring it forward.
Just like that.
Bring it forward.
There you go.
Up too far.
Bring it back where it belongs.
Back. There you go.
Okay, take the next step.
Bring the cane forward.
Now bring that right foot forward.
I'm gonna help you.
And there we go.
And actually these muscles over here in the hip,
I'll kind of bump a little bit,
to kinda wake 'em up.
Anything to get his brain
to communicate with that right side.
- Yeah.
Get more visual or feedback.
- Right. Whether it's verbal and you can use visual.
And the way you do that is you put a mirror,
a full-length mirror in front of the person,
and then you do that together.
And once the person can see that leg, sometimes...
- They can make the connection.
- Right. There's a lot of little tricks
- Right.
- That therapist use with strokes
and these are just a few of 'em.
- Yeah. You wanna give as many senses,
you're gonna bring in as possible.
So, you know, you got auditory
and visual and then you can also feel.
- Right, tactile.
- Tactile, right.
- So you got three things going all at once.
It's very, it's taxing for the person with the stroke
because they're working very hard and the mind
isn't ready for it yet but you have to push it.
- Yep. You have to get start hoping
some of the other parts of the brain are gonna help out.
- Okay. Now let's go to the technique,
if the person has foot drop
and that toe is dragging
and you're trying to get that toe up
so that it'll swing through.
And this is where, if you're at home,
and you're gonna need some TheraBand
or some stretch band,
where I'm gonna actually recommend
the brand named TheraBand
because if you go online and if you look,
they sell it in five yard or six yard lengths,
otherwise you gotta buy a big roll
like they do at the therapy department.
- Yeah. And those are expensive
- For 150, $200 and you don't need that much.
- Right.
- And then they sell other ones,
they're only five feet long.
Well, that's not long enough.
You need something that's gonna be
about two to three yards long,
and it will break.
Mine broke here and I don't really know why.
If you get it on a sharp edge it broke.
This one just broke.
I tied a knot in it.
- This is some pretty thick stuff.
Isn't it?
- Well, you're gonna want to get, not the yellow,
that's the lightest,
you're gonna probably want the orange or the red.
That's the colors I'd recommend to the TheraBand.
- Okay.
- Okay. So.
- So you have a length.
How long, Brad?
- Well, if you double it up, it should come up
shoulder at least, because of the knot
this got shorter.
I liked up the chin.
- Okay.
- If you double it, it should go to the chin.
I'm gonna make this work.
It's a little forgiving because it's a stretch.
Step on it, at the mid-lengths.
You're gonna cross it, double cross it,
make the cross down by the toe.
Then you're gonna go behind the knee.
There you go.
See how the X going across the knee.
We're gonna go to the front,
make a cross across the front.
And then we're gonna go around and you can tie it back here.
Or if you have long enough loops, tails, you can
- You might be able to tie it in the front.
- Exactly.
I'm not gonna tie a knot in there
'cause I'm gonna hold it.
Now I showed my wife this
and she said, "That's dangerous
because this is gonna cut circulation off to their leg."
And that's a good point,
but you're only gonna leave this on
while you're working with a person for 20 minutes.
- Right. This is not on all day.
- Right. You don't put this on
and then leave the person walk around with it all day.
'Cause it is a circulation problem at that point.
- Yeah, I think it would take a while
before it started cutting off circulation
- Yeah. And we're being pretty conservative.
But sometimes you need to be that way.
So what's happening here is a TheraBand
is literally pulling my toe up
and behind here, it's keeping my knee,
remember the hyperextension we talked about,
it helps prevent that, and it gives support around the hip.
- It's giving maybe a little bit of hip flexion?
Or not?
- A little bit.
Yeah. 'Cause it's pulling right here.
Yeah. Right.
- It really works the chain the way musc-
- It really stabilizes things without,
and yet you can move but yet it helps.
- Right.
- I mean, unlike a knee immobilizer,
which just, you know, locks you in place
and you're not able to move at all.
- This flows with the body.
- Right.
- So to speak.
So normally I was walking like this.
And then if you put something like this
on a real patient, all of a sudden, you get it,
it starts to go through.
And you don't need all that help
that I was giving Bob before.
Okay. Now.
- And once that happens, you know,
the person can make the connection
and they can start using their own,
you know, hopefully make the neural connections,
and start using their own body to do it.
- Right. With repetition.
- Right.
- The mind starts to take over
and it remembers, oh yeah.
And it makes the new synapses, if you will.
There's a, heh, I don't wanna get into all the details,
that's pretty complicated.
The other thing is if the person was walking
and they drag their foot, external rotation.
- Yeah. They're turning their foot outward,
which is very common after a stroke.
'Cause they, a lot of times that hip adductor
comes back first before the hip flexor.
- Should we do this one on you Bob?
- Sure.
- Okay.
You can use the same length TheraBand,
put that around the toe
and this is easier to do it on someone else.
And I'm gonna put two wraps down
around the toe to keep it semi-tight around the toe.
- So you went, you crossed over twice.
- Yep.
You can do it once. I'm doing it twice.
You work with it a little bit
and you'll know the little tricks.
That's if you're a little bit,
just do a little experience.
Now, the toe goes out this way.
We're gonna go the opposite direction
- Going in between the legs first.
- Yep.
And then we come around
- So basically you're gonna make a spiral.
Right, Brad?
- Yep. The opposite direction
- Yeah.
- Of the problem.
I like this, go right behind the knee.
Okay.
- Okay.
I'm gonna bring it there.
I take that.
I didn't mean behind the.
In fact, I actually-
- Behind the calf.
- Yeah. Yeah.
- Not behind the knee.
Behind the calf.
- Bob's really tall.
So normally with him...
- You ran outta room, huh?
- Yeah.
We'd have to have another,
another three or four feet
to go around his waist.
- So another one would go underneath here?
- Nope. At this point-
- Oh this one goes around the waist then?
Oh yeah, I gotcha.
- And what I like to do is at this point
I'm gonna wrap it around here.
- Oh like this.
- Right. And then I'm gonna go like that.
We may have to hold it here.
And you can work with this
or you can just go right to here and go through a belt loop.
- Yeah. I would take it around and then tie it right here.
- Yeah.
Go ahead and walk towards the camera then.
Do you feel how that pulls your toe in?
- Yeah, it's really hard to turn my foot out right now.
This works out really good.
'Cause this is a real problem with a lot of people.
And it gives me a little bit of lift on the foot too, Brad.
- I'm sure.
Go ahead. Walk forward, Bob.
- So yeah. It's definitely,
it almost feels like I'm a robot
on this side that, you know,
it's assisting my leg.
- Right.
- It's really weird.
- It is.
And you know, you can do this for, and hopefully
the idea is you're only gonna do this for a couple weeks.
And after that the muscles regenerate the connections
and strength and you don't need it anymore.
- I really like this idea, Brad.
It's really a good progression.
- It is.
It's a neat little trick that works really well.
And it doesn't cost $2,000,
like if you get a custom brace made
that sometimes they work
and sometimes they don't.
- Right. And the external rotation. So.
- Now, let's say we go through this
for two or three weeks,
the leg is not strengthening, the toe is not coming up.
At that point, you may need to go with an orthotic.
Or...
- Yeah, we have.
- We got a couple AFOs.
- Yeah.
- Here. I just-
- This is a custom one
that actually has hinges in it.
And this is a molded AFO
that these are really quite pricey.
That one's off the shelf.
- So, these go in here, they go inside the shoe.
Both of them though, you normally have to buy
a bigger size shoe to make them work.
So we're not gonna get into that.
We've got an actual video just on that.
- Yeah.
- Assuming things are going well,
what we wanna finish up with, Bob, is steps.
So the right leg is the weak leg.
You don't want to go up first with the right leg.
Up with the strong leg, in here.
Up with the strong, in here.
And I ran outta steps here.
- Yep.
- And then going back down-
- Down with the weak leg.
- Yep. Cane has to lead. Grab onto that handrail.
Down with the weak leg. Down with the weak leg.
- So we always say,
when you're going up to heaven,
you wanna lead with the good leg.
- Yep.
- And when you're going down to H E double toothpicks,
you wanna lead with the bad leg.
- Exactly, Bob.
So once again, Bob, we're going to the whole thing
on fixing different parts of the body, except for.
- We can fix just about anything except for a broken heart.
- Yeah.
But we're working on that too.
- Yep.
- I think it's some of this duct tape
around the leg would be good.
- Yeah.
- It's got the right color today.
- Put it up there.
- Yeah. Put it wrapping around that baby.
- Thanks.