♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
- Do you wanna start this time?
- No, no, I can't. You always start.
- Hi, I'm Bob Schrupp, Physical Therapist.
- I'm Brad Heineck, Physi...cal Therapist.
Wow. - Even the thought of it
threw him off!
And together, we are the most famous physical therapists
on the internet.
- In our opinion, of course, Bob.
- Brad, today, we're gonna talk about
best walking and balance home program
for after having a stroke or injury,
or maybe you have Parkinson's,
or something causing you to not have good balance.
- Right, if you're having problems walking,
maybe had some falls,
you feel unstable on your feet,
these are some excellent exercises
that you can do to get you more stable.
But, these are not something you want do by yourself.
You need to have someone to assist you.
And... - And did you notice, Brad...
Slip that around Brad,
so it doesn't look like anything weird.
- Yeah. (laughs) - Alright.
Brad's got a gait belt down there, so I can hold onto it
while he's doing his activities
so he doesn't lose his balance at all.
And Brad did come up with a little device here,
very simple to make,
that serves as a good tool for-
- Oh, it works great.
Yeah, I use it in the clinic
and it's very inexpensive, very effective.
So, common things that this can help correct:
if you're having problems when you walk,
and Lonnie, if you can get down to the feet...
Get the pointer out here.
If the person is scissoring,
or one foot catches the backside,
Parkinson's people do this lot,
it could be with a stroke, too.
Yep. And that can cause a fall
when that foot comes in, down you can go.
So we wanna talk about,
how can you do something
to make the person, to get those feet,
to get that proper gait pattern
so they have better balance
and are not tripping on themselves?
Should we go right into that, Bob?
- Well, before we do that, Brad,
I notice we have a couple new people that have joined us,
so, howdy! - Oh, there's three.
I see three. - Yeah.
Boy, we go from three to...
we go from several hundred to three.
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Brad and I have, you know,
had imaginary friends as children,
and we would like to try to get some real friends now.
- Well, speak for yourself, Bob.
- Alright, let's go ahead.
So this is the board you made.
- Right. Well, I didn't make it, I just bought it.
Went down to the store, it's a 2x4.
It was a 8 foot one,
I cut it down, just because it was easier to haul in my car.
But 8 foot one works a little bit better.
Even a 10 foot one would work fine if you can transport it.
And I put a piece of blue tape on it,
just so it's easier to see with the camera,
but you may wanna do that as well,
because sometimes, people...
- Yeah, visually have difficulty.
- Exactly.
- Anything you can do to enhance it
is gonna help out.
- It depends on, you wanna have some contrast
between that and the floor.
- By the way, ignore the tape on the floor.
It has nothing to do with what we're doing today.
- That was, yeah, that was some other training
that we were working on.
So here we go...
We've got this.
Now, you can, depending on the ability
of the person walking,
if they're using a walker and they're scissoring,
that's the nice thing about this,
you can just get the walker in here.
- And you can have someone hold on to the belt if need be.
I'm not gonna hold onto the belt,
but that option is there.
- Exactly. Depends on how unsteady the person is.
Now, you can put the 2x4 vertically, like this,
or you can put it like this,
depending on what they're comfortable with.
I'm gonna keep it like this so we can see,
and you simply walk through like this.
And if they step on the board, it's no good.
They can feel that,
and they can realize,
"well, I've got to get my feet over."
- Gives them immediate feedback.
- Yep. It forces the person
to keep their feet out wide,
and you can practice forward
and backwards.
Once they get good, they don't need a walker anymore.
- Now, Brad, you were mentioning, by the way,
is that you had a patient with Parkinson's
that actually had the freezing episodes
where he had difficult... - Right.
- But this would break it up. - Right, yep.
He would have that thing where his back foot
would catch like this
and then if I say, "get it out,"
or he would, he could force himself, eventually,
to get going.
Once he could get walking, it would be fine,
but when he walked over a board,
or with a board between his legs,
everything just went smooth.
Like, it just turned it right off.
And I've done a number of things that-
the problem I had, I couldn't get carry-over with it
- Right. - to without the board,
but it was very interesting,
so, you know, I'm hoping someone who's studying Parkinson's,
maybe there's someone that, you know...
- To carry it over. - Yep, exactly.
- To real life.
- So, again, you can use the cane, you know,
again, someone would be holding,
or there, if you need it.
And start with two canes,
and once you get better, you can just, you know,
go to one cane,
and you can progress to no canes
once you get to that point. - Sure.
- So, a good thing for scissoring.
The next thing
is just stepping over things,
making sure that your foot's not dragging.
If one's dragging, or when you're working in the kitchen,
you find out that the person's dragging
when they're stepping sideways
working, you know, at the countertop...
- It puts you at a higher risk for falling.
- Right.
So, I've got a nice exercise for that.
You use the board, okay?
For this one, you're not gonna use a walker.
If the worse person's using the walker, you could,
but it kind of gets in the way.
- Again, someone could hold onto the belt
while you're doing this.
- Use a cane. And it's very simple,
you just step over in here,
and then we sidestep,
and back and over,
and sidestep.
Now, I'm watching my feet, okay?
And I'm paying attention, if it's my patient,
are they watching their feet?
And it's okay if they do,
but then, at the same time, I'm gonna say,
"let's do it again, but I want you to look straight ahead
and make sure you don't touch that 2x4."
And it's different story
when you don't have that visual feedback,
but it's important, 'cause you want someone
to have that proprioception,
or that awareness of where their feet are.
- Show what happens, Brad, if they don't clear.
- Yeah, if they don't clear, this foot comes over.
- Sure. - Yep.
And then you get that,
and that's why you have to be right there.
'Cause if they don't clear it, they catch that 2x4,
then you gotta catch 'em so they don't fall.
- But again, they're getting that good feedback right away
if they're not stepping enough.
- Right. - And it's not so high
that it's real difficult. - Right.
- It's enough that they should be trying
to clear that up. - Exactly.
I mean, you could,
if they're doing really well,
and for some reason you want some higher steps,
you could turn the 2x4 on edge
and double the distance.
Well, more than double.
So, it was an inch and a half...
- And you put a piece a tape on this edge too, Brad.
- Yep. Yeah.
That's exactly right.
Here, let's do it this way, so they can see.
But it's just higher. So, exact same technique
but we're stepping... - Over a higher level.
- Yep, exactly.
Okay.
Now, the next one.
Now, this is more for balance. - Sure.
- We're gonna get away from the gait.
- Gonna park the plank. - Yeah, exactly.
I think we'll try this...
this way.
Again, you could start with this one.
- Sure. - With the walker again.
And we're simply gonna go walk
at a pace, you know,
normal distance between your feet, you know,
three or four inches, and walk.
And I'm looking to where I'm stepping and seeing.
Okay, and I'm gonna go backwards.
Again, if Bob was helping me,
he'd be close by, in case, you know,
because especially if you've got neuropathy,
or you can't feel that one foot,
and you come back, and one foot's off like this, you know.
So you really have to be careful.
And you could do a sprained ankle,
you could roll the ankle here as well,
so you have to be careful for that.
So this is something you really have to be careful
of what's going on, and really be aware.
So, not just the person doing it, but the helper,
all these little things.
Now, the next thing, if that's too easy,
I wanted to mention, do that forward and backwards,
looking at your feet.
And then, once they get real good at it,
then you can have 'em look at an object
straight in front of 'em, and repeat the training.
I'm gonna do it without the walker,
let's say the person is advanced.
We're gonna use two canes.
- Again, you're gonna have somebody with you.
- Yeah. Now, let's say they're advanced,
where this is becoming easy,
they're picking a point out,
they can feel when their foot is close to the edge,
and they can correct it,
they really got their proprioception,
they know where their feet are in space
as well as on the floor,
oh, my foot's off a little bit there,
I'm gonna get it to the center.
- You lost a cane tip too.
- Oh, look at that! (Bob laughs)
There, it's back!
Yeah, we'll have to crack that, Bob.
- Yeah. - Now, to make that one
a little more difficult,
heel to toe, the heel needs to touch the toe.
And this just makes it a little bit harder.
Now, I'm gonna look straight ahead
to make it even a little harder,
and I'm gonna feel that heel touch the toe.
I'm gonna know where my foot is on that board,
I can feel it.
Now, this can be really challenging
if the person, like with neuropathy, or that stroke,
and that one foot has... - Problems with sensation.
- Yeah, with sensation.
Then you really have to be a real important helper
and make sure you're watching,
so that they don't roll their ankle going off of this, okay?
And we're going back and back.
- That ankle may even have a brace on it.
- Exactly, yeah.
You could have AFO or you could use an ankle brace as well.
And then, this one,
is more of a balance one
and a little bit of a gait one,
but just step on the 2x4, this way,
it gets you forward and backwards support.
You get this, you know,
if the person is going backwards or forwards
and they're having problems with that,
along with stepping,
this kind of combines and challenges that as well.
So, we're stepping here,
and we're going back and forth
and taking the time, using the canes.
- What's nice about this one, Brad,
is a lot of your balance
comes from your ankles and your hips.
- Sure. - So this one is working both
- Yeah. - at the same time.
It's working your ankles,
they're having to work very hard to keep you on that board.
- Yeah. What's going on down here? (chuckles)
It's starting to get my ankles a little tired, actually.
- Sure, and then your hips have to work really hard too.
'Cause they're going side to side, so.
- This can, I'm sorry.
- No, I was just going to feel it myself,
how hard is this thing?
Oh yeah.
(in a wobbly tone) Oh yeah.
- I got a heel on, too, that doesn't help.
- Sure, yep.
- But this can help prepare the person
for walking on uneven surfaces outside,
if you have gravel, - Right.
- or you're in the yard,
this is one of those things that'll help 'em
get ready for that.
If they've just been walking inside
after their stroke or injury. - Right, in Minnesota,
we have to deal with winters
where you can't take people outside always
to work on these things.
- And they don't plow their roads.
You have gravel roads,
once in a while you get a concrete road in Minnesota,
but other than that, it's pretty rough over there.
- So, that's tough living. (Bob and Brad laugh)
I think he's putting a dig on Minnesota, by the way.
- Well, you know, from Wisconsin,
you have to do that when you can.
Oh Bob, once again, he is reverting back to the...
- My childhood. (Bob and Brad chuckle)
- Seriously, these are some really wonderful techniques.
Use 'em, but make sure you have a partner,
and be really aware of what's going on.
- We don't want any sprained ankles because of us.
- Exactly. - If it's not, you know,
if it's too advanced for you, don't be doing that.
Do the lower level ones.
- Right. And as therapists that have seen this, or see this,
they know exactly what we're talking about, so.
- And remember, we're not just pretty Brad.
- We're pretty ugly.
- No, we're pretty helpful and handy,
so we wanna make sure you subscribe to us.
- Take care.
(silence)