- Hi, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And together we have the most
famous physical therapist on the internet, Brad.
- Well, in our opinion, of course, Bob
- What are we talking about today, Brad
- Today, we're gonna talk about strokes or a CVA.
And this is for if you're working with someone at home
and you're not familiar with how to do range of motion.
And let's say, Bob is our patient and he just had a stroke.
He's able to sit up and maintain his balance.
And every patient varies, but this is the assumption
that the person can sit up and maintain good posture
reasonably good posture.
And this would be the involved side.
This is the arm that had the stroke and it is very flaccid.
In other words, it just kind of hangs there.
If it, if it were to come off of here, it would just flop
down like that.
And what we need to do is give this range of motion
to all the joints.
So nothing gets tight and contracts, and also
so it maintains circulation and healthy joints, et cetera.
So the first thing you're gonna do is we're just
gonna take a hold of a whole arm right at the elbow.
And I like to grab here
and we're just gonna lift up the shoulder.
And
- One thing, Brad, when you lift up the shoulder deflection
or abduction, right after someone has a stroke
- Right?
- you shouldn't go much past 90.
- Right.
- Cuz they could get impingement.
I didn't know if you were gonna mention that.
- Yeah, I was working on that.
- Okay. Sorry.
- That's all right.
So yeah, we're just trying to get a feel for
if there is some tone or it's tight or not.
And like Bob says, we don't want to go up
like this right away.
- No
- You know, look at the person.
They may not be able to tell you that it hurts.
But a lot of times the facial expressions will.
And if you go up and the person starts to wince, you know
there's some pain going on and take it easy.
So the first session is just kind of
getting to know how the person's base range is
- Because the rotator cuff's not working, you're more
at risk for impinging or pinching things causing.
- Yeah.
- So you don't want to go up too high.
- Exactly. So that's the shoulder.
We're just gonna go inflex, we call it.
and then
- That's straight ahead.
- Out to the side and out to the side.
I usually even I'm a little more cautious with.
- Yeah.
- Okay, and you wanna try to keep the thumb up
- Yeah.
- On these.
- Exactly.
- So when you go out to the side, have the thumb up
don't have the arm turned down like that.
- Exactly. Yep.
Good point, Bob.
So you think about hitchhiking a little bit hitchhiking.
- Hitchhiking yep.
- And the same with going forward.
- Right. And the third one is I'm gonna hold the elbow here
and keep the humorous as part of the stationary
and simply go in and out and be careful coming out
because the shoulder is a little more vulnerable with that.
And it, once you start to feel some resistance
I would not go any further.
Be very cautious with this.
Particularly the first few times you do this.
- So when he is doing this one
he's maintaining the right angle here.
- Sure.
- Basically
- Exactly.
- He's going in.
He's going out, keeping the right angle
- Right.
- Again, we should maybe tell numbers.
How many times are we doing this?
- Well, I like to do between five and 10 repetitions.
If you're just getting started five times
it's probably adequate.
- Yep.
- And as you go on the next few days, you'll work your way
up to 10 repetitions.
Let's go down to the elbow.
Elbow's a little easier.
It's say hinge, joint.
So we just are going up and down.
We're gonna take it all the way to full extension.
If it goes freely and there's no pain and same with coming
up. Okay.
And down and up.
And the same thing I like to support here, here
you don't wanna support up here and work the elbow
we wanna support right around the, the joint itself.
And then we're gonna go to the wrist palm up.
I'll keep the hand here and palm down palm up and palm down.
Okay. And then we're gonna go to the wrist.
I like to hold the wrist right here.
Two thumbs here and extend the wrist and down in the wrist
extend the wrist and down the wrist.
Okay. And then I'll go right to the fingers.
- And remember I got dupuytren's contracture
- Yeah, Bob has a contracture.
That's been existing.
I'll do actually each finger and work
up and you're gonna work this carefully as well.
You know don't, if you feel some resistance work with it
see how patient tolerates it do not get aggressive.
Bob has a contractual right here
a real live one that he is had for years.
- Well.
- And this one's not going any further
so I'm gonna leave it.
I can work these joints
and here you can work all each joint individually.
The hand and wrist actually takes a bit
of time and patience
- Yeah.
- Sometimes
- Especially
- Especially if it's tight.
- Yeah.
Especially if it's tight.
- Yeah.
- And you wanna make sure you address it, the thumb you
I like to go in this plane.
The thumb's a kind of a complicated joint, cuz it goes so
many different directions and work this.
Now you're gonna do that.
After a few days, with any luck, the person's gonna be
able to start to help and they're gonna start to build
and move their arm.
Hopefully at that point then you do the exact same things
and then you're gonna have some verbal cues.
In other words, okay, Bob, let's lift your arm up, up, up
up. Help me as best you can help, help, help.
And then on the way down, you're gonna say no, let it down
slow, hold, hold, hold.
They're gonna do the best they can best they can.
And then back down, those always just start out with
take a lot of energy for the person's psych, you know
psychologically and physically.
So you probably are gonna do maybe three
or five of 'em to start out with
- Generally as a rule of thumb, they're gonna be
able to start holding it on the way down more
than they're gonna be able to lift it up
- Yeah
- to start off with.
- Exactly
- And generally improvement happens generally again,
starting at the shoulder and
- Yeah
- going out to the hands.
So usually the shoulder comes back.
Elbow comes back, wrist comes back, hand comes back.
- Yep, exactly.
- So
- Once that starts going better
and go ahead and help me out, Bob.
And he's now he's doing oh us like, wow
he's starting to lift and now go back down.
It's better control.
I can let go.
And it's starting to maintain again.
We're gonna do that with abduction as well as internal
and external rotation, the elbow, the wrist and the fingers.
You go through each one and see
if they're able to actively move it
and have them do as much as they can in less of me.
And then the finish it off.
Well, this isn't finish it off.
But for this video, the last thing I like to do is
if they're able to grip a little bit, there you go.
Now I want you to squeeze my hand.
A very natural thing.
People, everyone knows how to shake a hand
so they don't have to think a lot about it.
Now I want you to pull Bob, pull me towards you
and I'm gonna just give it a little resistance.
Pull, pull, pull Bob.
Now push me away.
Push, push, push, push, push.
And I'm not doing much here cuz his arm is real weak
but you're still getting some resistance.
We're getting some joint contraction
co contraction efforts.
Okay. Now I want you to hold your hand right there
and I'm gonna push you this way.
You push the other direction and I'm gonna let it go in
towards your stomach.
Okay? Now let's go the other direction, Bob.
And this way I'm gonna hold off on cuz the, again
the shoulder's vulnerable that way.
So actually right now we're just gonna stop on that.
Bob, the big one is pushed this way and push this way
and you can start going up.
There's more to this
but I think this is a good start for right now.
- Yeah. So, so
hitting on almost every direction, right?
- You're right.
- Giving some resistance and, and you can get a good
feedback you can get good feedback where the actual pushing
is.
- Exactly.
- So gives you a good start here for
if you're treating someone at home and a lot of people are
because insurances aren't paying what they should
- Right.
- And these are good to do
in addition to what even your therapist might be doing.
Make sure it's okay with them.
- Right? Exactly.
So again, the whole thing with a stroke
you're talking to the person you're monitoring
for pain and if you can touch that helps.
- Yeah. The impact.
- Yeah. So that they start moving because there's so much
going on as far as the healing of a stroke.
So good luck with your loved one or family
whoever you're helping with
cuz these exercises can do wonders.
- Yep. Good luck
(upbeat music)
- Bob and Brad, the two most famous physical therapist
on the internet.