Proprioception.
Proprioception (the somatosensory system) deserves a page of its own because of its complexity. It is the ability to sense where your body is in relation to the environment. If you are standing up, are your feet flat on the ground? Are all of your toes firmly on the ground? Are your knees straight? Some patients after stroke cannot sense this and therefore have difficulty controlling their body position. Physical therapy interventions such as approximation and proprioceptive neuromuscular feedback (PNF) can provide proprioceptive feedback for the body to regain control. Furthermore, there are several types of PNF that will not be explained here, but each is proven to be effective in its own right.
Approximation
Simple approximation can be helpful for providing feedback through the joint of its position. Pressing on the joint yourself, or having another person provide compression through the joint provides a sensation to the joint of weight bearing. This sends signals through the joint and tendon receptors of weight bearing and how to respond. |
Bridges
Bridges are a good method of providing something called transference. For example, if a patient is having difficulty controlling the movement of one leg, having the other leg perform the action can actually cause recruitment of the muscles in the affected leg. This is known as transference. Also, having the weight of gravity press down through the knees, ankles, and even the compression within the spine and hips, acts as a form of approximation to increase proprioceptive feedback to the body. |
Push ups
This exercise provides the same benefit of the bridges for the upper body. A common impairment following stroke is shoulder subluxation, so providing proprioceptive information about the shoulder can help reduce the possibility of subluxation and further damage. Keeping the exercise easy enough that it can be performed with the use of only 1 upper extremity, but challenging enough that the other arm must attempt to participate is key to this intervention's success. |
Trunk Wrapping
This technique is great for providing the proprioceptive feedback through the abdomen and core. Because the key to producing good movement is a strong core, those with impaired trunk control after a stroke can benefit from abdominal wrapping in order to stabilize and produce more purposeful movements. |
Proprioceptive Neuromuscular Feedback (PNF)
PNF is a long used technique that has been proven to correct movement impairments. These patterns are meant to be on a diagonal plane and are meant to mimic typical movements. By moving through the patterns with some resistance, it simulates going through everyday movements. Additionally, for those who have less muscle tone, a quick stretch may be provided at the start of the pattern to provide a quick muscle activation to help the limb move through the pattern. Upper Body D1 Flexion - Shoulder (flexion, adduction, external rotation), forearm (supination), wrist (radial deviation), digits (flexion). Ex: reaching across for the seatbelt. D1 Extension - Shoulder (extension, abduction, internal rotation), forearm (pronation), wrist (ulnar deviation), digits (flexion). Ex: pushing up from a chair. D2 Flexion - Shoulder (flexion, abduction, external rotation), forearm (supination), wrist (radial deviation), digits (extension). Ex: reaching into a cupboard for a glass. D2 Extension - Shoulder (extension, adduction, internal rotation), forearm (pronation), wrist (ulnar deviation), digits (flexion). Ex: buckling the seatbelt. Lower Body D1 Flexion - Hip (flexion, adduction, external rotation), knee (flexion), ankle (dorsiflexion, inversion), digits (extension). Ex: ascending the stairs. D1 Extension - Hip (extension, abduction, internal rotation), knee (extension), ankle (plantarflexion, eversion), digits (flexion). Ex: rehab of posture. D2 Flexion - Hip (flexion, abduction, internal rotation), knee (flexion), ankle (dorsiflexion, eversion), digits (extension). Ex: swing phase of gait. D2 Extension - Hip (extension, adduction, external rotation), knee (extension), ankle (plantarflexion, inversion), digits (flexion). Ex: stance phase of gait. |