User Manual

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Stroke Rehabilitation Using A Pro Fitter
By Margaret Johnstone FCSP, Scotland
The Pro Fitter can assist in a planned program of
stroke rehabilitation. In early stroke rehabilitation
the early stroke patterns must be advanced until
reflexes are re-integrated into cortical control.
After the client is well versed in spasticity
inhibiting and rolling patterns, progress to
kneeling and crawling activities.
Then, using the
Pro Fitter and the necessary air splint, assign
specialized exercises to assist recovery from the
brain damage of stroke.
To limit the development
of spasticity the anti-gravity muscles must be
inhibited; the forearm and hand must be used in
extension patterns, and the rest of the body used
in flexion patterns.
The following photos and illustrations show some
of the very useful exercises I have used with
stroke-damaged patients. Many of the patients are
quite capable of using the Pro Fitter in kneeling
and sitting positions but with some I would not risk
balanced standing and rocking from side to side.
The boy shown here took several weeks to master
this exercise after rehabilitation was started. He
hoped to get back to skiing.
I have written a handbook for therapists called
Therapy For Stroke, Building On Experience
published by Churchill Livingstone, Edinburgh
London, Melbourne, New York and Tokyo, 1991.
It gives an introduction to the pressured garments
while presenting a practical way to advance
through motor sensory loss.
1. Crawling Positions
With air splints in position to inhibit flexor tone
in the forearm/hand and with a small inflatable
boot to inhibit the extension of the ankle, the
Pro Fitter is used to allow the client to push the
arm forward in the required inhibiting position.
Tension (or resistance) against this forward thrust
is given by the weakest of the four tension cords
hooked underneath the Pro Fitter. As weight
is withdrawn from the forward thrust, the Pro
Fitter’s resistance then assists the arm back into
the starting position. This is a valuable exercise
with ease of repetition.
2. Side to Side Thrust
With the legs in the inhibiting flexion pattern
and keeping the trunk straight, laterally shift on
the Pro Fitter from the knees to the trunk. This
combines lateral trunk stretching with a useful
shoulder exercise. The involved hand may require
a stabilizing strap over the pro Fitter’s platform to
keep the hand in proper position.
3. Sitting Position
Sitting on the Pro Fitter Offers several ways of
presenting valuable exercise. As illustrated here,
pulling the bodyweight forward towards the
heels brings in a useful hamstring exercise. The
hamstrings are invariably very weak and must be
reeducated to rehabilitate stability of the knee.
Thrusting forward on the stabilized hand helps to
exercise the whole affected side of the body in a
total inhibiting pattern, providing the heels assist
in the pull forwards.
4. Standing Position
Toward the end of rehabilitation, some clients
may be ready to tackle exercise 4, but I would
not attempt it with the elderly. The young man
illustrated here was keen to get back to skiing,
two years after a stroke. He took several weeks to
master this exercise and it was obvious that his
balance and motivation improved remarkably well
with use of the Pro Fitter.
Other books by Margaret Johnstone FCSP, on stroke rehabilitation include:
Restoration of Motor Function in the Stroke Patient - A Physiotherapist’s Approach; The
Stroke Patient - A Team Approach; Home Care for the Stroke Patient - Living in a Pattern;
Restoration of Normal Movement After Stroke. All published by Churchill Livingstone.
1. 2. 3. 4.