- All right today, we're gonna talk
about the most critical steps that you need to take
right after someone has had a stroke,
to improve their balance.
- Right.
Keep 'em upright
- Stay tuned.
- ♪ Bob and Brad, ♪
the two most famous physical therapists on the internet.♪
- Hi, I'm Bob Schrupp, Physical Therapist.
- Brad Heineck, Physical Therapist.
- And together, we are the most famous physical therapists
on the internet.
- In our opinion, of course, Bob.
- All right, as we already hinted towards Brad,
we're gonna talk about balance
after someone has had a stroke and the most
critical thing you need to work on first, is seated balance.
- Right. If you're not able to balance
in the seated position,
you're not gonna be able to stand and balance.
- Right.
- So this is the first step.
That's why it's critical,
we get this established before we go to the next step.
- And Brad's got a bunch of exercises you can do to start.
- Okay. Now this is, we don't know,
I don't know, where the person is,
that you're working with
but we're gonna start from the basics, okay?
Now here, Bob is gonna act like he's had a stroke.
He's leaning to his involved side, which is his right side.
I might put his hand down here,
just to get that arm working a little bit to start with,
but this is to the point where he's gonna fall over,
so I need to assist him, okay.
Now, I'm actually gonna get here so you can see better,
but I do like working with people
from this position as well if they've had a stroke.
And we're gonna hold that person up
and a lot of verbal cues.
Okay, Bob, I need you to get up tall,
and I'm gonna help 'em out,
push with this hand, Bob, there you go.
And now hold it right there.
Hold, hold, hold, and what'll happen sometimes
is they'll continue to go over
but we need to continue to work on verbal cues.
Tactile, in other words, have the hand
pushed down into here,
push into the shoulder as we,
we're trying to wake up this side,
wake up everything over here,
so it's good to give some physical cues,
as well as the verbal cues. Another-
- And the other thing is you wanna make sure you're
on a firm surface, right Brad?
- Right. We're gonna start out on a firm surface,
not on a bed.
A few other things you can do is
you can put a bigger mirror,
if you have one on wheels, you may,
or a wall mirror that you can get in front of the person,
so they can see themselves,
'cause they may not be aware that they're tipping over,
but visually, if they see it,
it's gonna help them get upright
because they're aware of it.
- And my experience is, it helps.
- Right.
- I mean, and you were telling of an instance
in which it didn't.
- Right. I, I had one person.
She did not want the mirror in front of her
because she saw how she looked after the stroke,
one side was different and it,
psychologically, it really was depressing for her.
So we did not use a mirror there so,
it's one of the precautions.
Um, okay, So.
- But I have a patient right now,
without a doubt, it's helped.
- Okay.
- She, she, she corrects herself when she sees herself
in the mirror.
- And you'll figure that out quickly,
you'll probably know it by knowing the person, okay?
Once you get to the person where they can
sit up in this position and you can let go, okay.
And Bob's holding it there,
and we're gonna go for, you know,
20, 30 seconds and it's kinda indefinitely.
Nice job, Bob.
We're gonna go to the next step,
and that is gonna be, we're not gonna do it here
but you're gonna imagine,
you're gonna put the person on a bed.
Because you get outta bed in the morning,
you have to sit up on the edge of the bed.
Sitting on the edge of a bed is much harder
than a firm surface like that
because you have this soft surface
and you may get this going on.
And so, on that soft edge of the bed, sitting up.
Okay Bob, let's sit up tall.
Okay. If you're gonna, if he starts going this way,
hand over here to hold yourself up.
Same thing as what we went through in the first spot
except for we're on that soft surface just like a bed
or using a bed itself.
The bed that they actually have is a good idea.
Okay. Going to the step three,
once they're able to sit on the bed with good control,
then we're gonna start pushing in all four directions,
in other words, straight from the front,
from the back, right side, and left side.
Okay? Okay, Bob, stand up tall.
Now, I'm gonna push you and don't let me tip you over.
I'm gonna push right on the sternum here.
Hold, hold, hold and relax.
Good job, Bob.
Now, I'm gonna push this way.
Hold. I'm pushing this direction, pushing him forward.
He's doing, oh, hold.
Come on, Bob. Push, push, push, push.
There you go.
We're gonna hold it for five to 10 seconds.
And relax, good job.
So, if he did good forward and backwards,
now I'm gonna go this direction
because I know that's his strong side.
I'm gonna push this way.
Hold, hold, hold, Bob.
Okay. Oh, he's tipping. He's tipping.
Good. Now come back up, Bob.
Okay. Now, I'm gonna go this direction
and see if he can hold this better.
And he is stronger this way.
Okay. He's holding good.
Which makes sense, 'cause he normally tips this way.
Now, Bob, I'm gonna push here again.
Now, you hold me.
Push against the side.
I'm gonna tap.
I'm gonna give verbal cues.
Push, push, push, come on Bob, you can do it.
And I'm gonna let 'em work into it.
I'm gonna help him out.
Again, push, push, push, Bob.
And this might take a few days, a week or two,
whatever it takes, you need to get that stabilization
against just a static or an isometric push and hold.
Okay. Once you get to the point where I can, hold Bob,
no matter what, you're gonna stand like a,
sit like a statue.
I'm sorry.
Push, push. Hold strong, don't let me move you.
Do not let me move you, Bob.
And now look at that, he's strong,
we've worked to that phase.
Okay. Now, the next phase.
Okay, Bob, just sit there.
Now, don't let me move you.
And I'm gonna do some what we call perturbations,
or pushes and forces, on him, without him knowing it.
So, I'm gonna give a little push here.
Okay. And ah, he's holding.
Bob, I want you to just be strong, be strong.
And now he knows I'm doing it, so he's stronger,
plus he may working off, everything's working together
and then without him knowing,
I'm gonna come from this side, he doesn't know it.
I'm gonna push here.
Oh, he held pretty good this way.
So that's good.
Okay. Sometimes as this, he knows that you're gonna do it.
So he is more aware of it.
Either way, you're working the mind,
you're working the body
and if you can do perturbations, or pushes
from any direction and they can maintain that, okay.
It might be if I push here
and he gets that sway that way, we're gonna keep working.
Okay. Bob, hold strong.
Be strong, be strong.
Hold it, hold it.
There you go.
He is getting better, getting stronger.
And once that's established, they can sit strong,
they can work against isometrics, perturbations,
then we're going into dynamic exercise.
This gets to be where it's fun.
Okay. What you can do-
- Now this is gonna depend on the involved arm;
how good it is.
If that arm is good enough to hold onto a ball
and throw it, that's really good.
We're gonna work with a ball toss, okay? Good.
Now, this is working that core balance.
And to be honest with you, if someone's had a stroke,
their arm is probably not gonna be good enough
to throw a ball.
Would you say that's true, Bob?
- Right, Right.
And that's where you may wanna do, as an alternative,
is maybe just some reaching with the other arm.
- Sure. Right?
- So let's say this is a devolved arm,
you might have, 'em reach up this way
and then reach across midline.
- Sure.
- And then reach down.
- Right. And you might give 'em, a target.
- Use the ball. Yep.
- Can, can you reach out here Bob and hold it?
And if you can hold it,
let's see if you can go over this way.
Eh, it's getting hard, it's getting hard.
And here you probably need two people,
one person holding the ball,
another person to help the person out
in case they start to tip.
Okay. Then we're gonna go over this way.
There you go.
And here, and then you want to get four corners,
I like to go here, here,
and now lower.
- This is gonna be the hardest one, right down here.
- Yep. Yep, down there.
And then over here. Okay.
And you get a system going 1, 2, 3, 4,
and then break it up, different things,
maybe five or six repetitions on each corner.
Okay? Now, the other thing about working
with stroke, stroke patients, as well as any patient,
is you gotta have a little humor with it right, Bob?
- Right.
- Yeah, and so, if, if, if I was working with Bob
and he had a stroke, I know he's a Viking fan,
I'm a Packer fan.
(laughing) So I'm not gonna take the, the Packer ball
and have him reach for it, 'cause you know
what he's gonna do, he's gonna punch it
and maybe that'll be, maybe that'll be
good therapy as well.
- Yeah.
- And then, if I'm gonna use this Viking ball,
I'm not gonna hold it,
I'm gonna throw it at 'em.
(Bob laughing)
No, I'm just kidding.
- We're both weeping because we both were in the playoffs,
and we both had bad playoff losses.
- Yeah, they were close games.
- Close games right to the end, so
- Right to the very last second, and we're still crying.
- We both had good years, so.
- All right, take care and good luck with your-
- Thanks a lot for watching.