hello every one you are watching physio classroom channel and in today’s video we are going to talk about the important physiotherapy exercise tips that a stroke patient should know before choosing any exercise for better paralysis recovery so the first thing that I want to share with you all is how the stroke patients and their family members should find out whether the exercises that are being done by stroke patient are going to be helpful in paralysis recovery or not. so the first question i want to ask you is this who tiers more during and after the exercise therapy session? patient or the therapist/care giver? if during an exercise therapy session, patient is relatively passive and is not doing much work and all the exercises are being done by someone else on the patient then this is not going to benefit the patient at all!! first we need to understand this that there is no problem in the patient’s body patient is finding it difficult to move one side of the body because the control from the brain towards one half of the body is lost or weakened now if any exercise for stroke patient is being done in such a manner that the patient’s upper limb and lower limb are being moved repeatedly in a passive manner then such exercise are not going to activate the patient’s brain so lets understand this with an example we often see that when stroke patient are not able to move one side of the body like for example lets imagine that this is a left side paralysis patient and patient is not able to move his left upper limb so, many a times patient’s caregivers are taught exercises in which they are taught to repeatedly bend and straighten the patient’s fingers repeatedly bend and straighten the elbow or repeatedly lifting and moving the shoulder up and down now in these type of passive exercises there in no participation from the patient all the effort comes from the person who is doing the exercise on the patient so in a way the stroke patient is not being exercised, instead the one who is doing the exercises on patient gets exercised now what we need to understand here is this that we should never choose such type of exercises for stroke patients because such type of exercises do not have any positive effect on patient’s brain recovery so what should we do? we should select our exercises in such a way that the limb movement should also occur and the patient’s brain should also get activated now lets take an example of such exercise in this stroke patient, I apply some oil on the palm of the paralyzed hand and now I ask the patient to try and apply the oil using his hand on his hairs and at the same time helping the patient to perform the activity and like this I can help the patient to apply oil on head now while doing this activity, the patient’s shoulder, elbow, wrist and hand also moves and I can further encourage the patient to try different movements like scratching head etc Now what happens when we choose such type of activity as an exercise is that patient also tries to perform the task and contribute physically and mentally So we should avoid passive movement therapy in stroke patients in which we are simply bending and straightening the patient’s limbs doing passive movement therapy does not activates brain, but it does lead to a development of a problem stroke patient’s upper and lower limb starts getting stiffer with time and when we move the stiff limb repeatedly in a passive manner then we are actually applying force against the tightness present in limbs and the number of times we apply our force against the limb tightness patient start becoming stiffer and stiffer with time so always avoid such type of passive movement exercises on the other hand you might have noted that when I asked the patient to try and apply oil using his paralyzed hand on his hairs then I has no need to tell the patient to bend the fingers, bend the elbow, lift the shoulder etc. Brain automatically starts reacting to the functional task as there are motor patterns stored in the brain’s memory for different types of task when we choose an activity or a task as an exercise for the patient which he/she has done innumerable number of times in his life then patient’s brain becomes more sensitive and starts reacting to the exercise and the patient also finds it interesting and easier to perform such type of task oriented exercises next important thing that we should pay attention to while exercising stroke patients is that we should always treat the patient as a whole it should never happen that upper limb treatment will be done separately, lower limb separately, balance therapy separately etc treating the patient as a whole and not individual body parts is the best way for good functional recovery after stroke this can be understood with an example as I mentioned previously in my last two videos of hemiplegia rehabilitation series how stroke patient’s limbs start assuming characteristic posture due to increase in tone/ tightness (upper limb assumes flexion position and lower limb gets fixed in extension) So lets understand with an example to make it clear what I mean by “treat the patient as a whole” just before you saw how I gave the patient a functional task to apply oil in his hair with paralyzed hand now during this exercise, I can’t neglect the patient’s leg I have to also ensure that while doing this exercise there should not be any abnormal increase in tone/tightness in patient’s lower limb or the lower limb should not attain any abnormal attitude or position during the exercise Now to ensure this what I need to do is to keep the patient’s paralyzed leg in this position (anti-spastic position) and to make it easy for the patient to keep the leg in this way, we can keep the normal leg over the affected one So I mentioned in my first video of hemiplegia series how abnormal tightness develops in stroke patients now it should never happen that when we are reducing tightness in upper limb then at that time tightness increases in lower limb or we are reducing tightness in lower limb and upper limb becomes stiffer in the process if we allow this; then our treatment will be unsuccessful we have to try and ensure that when ever we exercise the stroke patient, then there should not be any abnormal increase in tone or tightness in any part of the patient next important thing that we should pay attention to while exercising stroke patient is that never choose an activity or an exercise that is too difficult for the patient to perform do not choose an activity which when attempted by the patient results in failure like for example, lets imagine that I am a left hemiplegic patient and my therapist asks me to try and lift the glass placed in front of me Now I don’t have that much control or strength in my upper limb that I could lift my arm and hold the glass like this then what will I do? I will try to perform the task and when I will find out that I am not able to complete the task then I will try harder and while trying harder i will try and recruit the other muscles of my body in an abnormal way and in the process I will abnormally tighten my muscles the similar thing can also be seen in normal individuals when a normal person wants to lift some thing and is unable to do so then he will try harder become stiffer during the attempt Another important reason for stroke patient’s limbs becoming tight and stiff is when we start making them stand and walk prematurely when patient’s brain has not yet developed that much control to support and balance the body in standing and walking and we as caregivers many a time motivate our patient “walk, walk, walk, try, try, try” now what actually happen is that patient still has lot of fear of falling and he feels that if he tries to walk, then he will fail to walk normally So the patient tries to put extra effort to prevent himself from falling and to walk normally and in the process the patient becomes abnormally tight and stiffer So avoid any such exercises which are too difficult for patient to perform next import thing to consider while exercising stroke patient is that we should also ask our patient; what he/she wants to do? many a times while selecting the exercises for stroke patients, the decision making is either done by the family members or the therapist but do we ever ask our patient that what he/she would like to do? if we can convert the activities of patient’s liking into therapy then patient will participate more actively and happily in therapy sessions and this will also activate the patient’s brain more effectively thereby improving the therapy outcomes next important thing that we should consider before exercising patients is that we should make two lists for the patient one is the problem list or weakness list which includes the challenges and second should be the patient’s strength list which includes the positive findings often while planning and doing therapy we only consider the patient’s problems or weaknesses like for example my patient is too stiff, has poor movement control, poor posture and balance etc. but we never make patient’s strength list; like for example my patient is a young stroke patient, was an active sports person, is highly motivated etc. we should also make use of the strength list while designing and planning exercise therapy sessions we should not solely focus only on patient’s weaknesses (also try to make use of positives in your patient) next import thing to take note of is that we need to modify and change the patient’s thinking attitude or thought process in a positive manner patient often thinks that he/she will start doing activities from paralyzed side once he will get better for example patient thinks that I will hold a glass and drink water from paralyzed side once I will get better I will wear clothes using paralyzed side once I get better we need to tell and motivate patient that If you will start doing your daily activities using paralyzed side then you will get better! So this change in patient’s attitude from “I will do this only after I will recover” to “If I will try doing this then I will recover” plays a key role in faster and better recovery and now at the end of this video I want to ask you all a question that I often ask my stroke patients and their family members. this question helps the patient and their care giver understand better about whether the exercises that are being done by stroke patients are going to be helpful or not? the question is: whatever exercise you have chosen for the patient; did the stroke patient ever performed similar kind of activity or movements when he was completely normal and healthy? or will the patient do similar kind of activity or movement after he recovers from stroke? we can understand the question from an example a stroke patient has been taught to use his normal hand to move the paralyzed upper limb like moving fingers, elbow and shoulder so the stroke patient can ask himself; did I ever performed such kind of activity or movement when I was not a stroke patient? or would I be performing these movements once I get better ? if the answer to both the questions is “No”. then such exercises are not going to do help in any functional recovery of the patient exercise should always be those tasks or functions or movements which the patient has performed innumerable number of times in his life (like daily activities of living) motor patterns and memory of such functions or movements are quite strong in the brain when we utilize such activities in the form of exercises then patient’s brain gets activated and therapy sessions have better outcomes or results I sincerely hope that the information that I shared with you all in this video are going to be very helpful for the stroke patients and their family members do let us know your feedback to this video by liking and commenting. do share this video with maximum number of people on social media so that it can reach to someone in need keep learning, keep sharing and stay connected.