Training of neuro Patients during pandemic is essential .physiotherapy include Relaxation Techniques, Brain training and most important Home Programm,Balance Training aa=nd gait training ,Diet Plan

1. BY
DR NERUSU.SAI PRIYANKA
TRAINING OF NEURO
PATIENTS DURING
PANDEMIC SITUATIONS

2. CONTENTS
 STRESS MANAGEMENT DURING COVID 19
o Jacobsons Relaxation Technique
o Chair Aerobics
o Brain Training
o Yoga Therapy
o Breathing Exercises
 HOME PROGRAM FOR STROKE PATIENTS
o Exercise Program
o Constraint Induced Movement Therapy
o Balance training
o Gait training
o Diet plan

3. INTRODUCTION
 In January 2020 the World Health Organization
(WHO) declared the outbreak of a new coronavirus
disease, COVID-19, to be a Public Health Emergency
of International Concern.
 Older adults, especially in isolation and those with
cognitive decline/dementia, may become more
anxious, angry, stressed, agitated and withdrawn
during the outbreak or while in quarantine.

4. INSTRUCTIONS TO PATIENTS TO
PROTECT FROM COVID 19
 Provide practical and emotional support through informal networks
(families) and health professionals.
 Share simple facts about what is going on and give clear
information about how to reduce risk of infection in words older
people with/without cognitive impairment can understand. Repeat
the information whenever necessary.
 Instructions need to be communicated in a clear, concise, respectful
and patient way.
 It may also be helpful for information to be displayed in writing or
pictures.
 Engage family members and other support networks in providing
information and helping people to practise prevention measures
(e.g. handwashing, etc.).
 If there is an underlying health condition, make sure to have access
to any medications that you are currently using. Activate social
contacts to provide with assistance, if needed.

5. INSTRUCTIONS TO PATIENTS TO
PROTECT FROM COVID 19
 Be prepared and know in advance where and how to get
practical help if needed, like calling a taxi, having food
delivered and requesting medical care. Make sure you
have up to two weeks of all your regular medicines that
you may require.
 Learn simple daily physical exercises to perform at
home, in quarantine or isolation so you can maintain
mobility and reduce boredom.
 Keep regular routines and schedules as much as possible
or help create new ones in a new environment, including
regular exercising, cleaning, daily chores, singing,
painting or other activities. Keep in regular contact with
loved ones (e.g. via telephone, e-mail, social media or
video conference).

6. STRESS MANAGEMENT
JACOBSONS RELAXATION TECHNIQUE
 Jacobson’s relaxation technique is a type of therapy that focuses on
tightening and relaxing specific muscle groups in sequence. It’s also
known as progressive relaxation therapy.
 By concentrating on specific areas and tensing and then relaxing
them, you can become more aware of your body and physical
sensations.
BENEFITS:
Practicing relaxation techniques can have a variety of health benefits
such as:
 Relieving anxiety
 Reducing work-related stress
 Lowering blood pressure
 Reducing the likelihood of seizures
 Improving the quality of sleep

7. JACOBSONS RELAXATION TECHNIQUE
HOW TO PERFORM :
Feet
 Try to Bring attention to the feet.
 Point feet downward, and curl toes under.
 Tighten toe muscles gently, but don’t strain.
 Notice the tension for a few moments, then release, and notice the relaxation.
Repeat.
 Become aware of the difference between the muscles when they’re tensed and when
they’re relaxed.
 Continue to tense and relax the leg muscles from the foot to the abdominal area.
Abdomen
 Gently tighten the muscles of your abdomen, but don’t strain.
 Notice the tension for a few moments. Then release, and notice the relaxation.
Repeat.
 Become aware of the difference between the tensed muscles and the relaxed
muscles.

9. JACOBSONS RELAXATION TECHNIQUE
Shoulders and neck
 Very gently shrug your shoulders straight up towards
your ears. Don’t strain.
 Feel the tension for a few moments, release, and then
feel the relaxation. Repeat.
 Notice the difference between the tensed muscles
and the relaxed muscles.
 Focus on the neck muscles, first tensing and then
relaxing until you feel total relaxation in this area.

10. CHAIR AEROBICS
 Seated aerobics is a great way to train your
cardiovascular system and get fit all without
standing up.
 Chair Core Exercises for Seniors Strengthening
core and abs is crucial for improving balance and
stability.
 Perform these chair core exercises for seniors to
improve muscular foundation and protect from
accidental falls. The seated exercises are great for
lower back, abs, and glutes.

11. CHAIR AEROBICS
 Improved flexibility
and range of motion
 Decreased joint pain
and stiffness
 Improved muscle strength
and balance
 Increased blood circulation
 Elevated mood
and concentration
 Lowered stress levels

12. BRAIN TRAINING
 Brain training (also called cognitive training) is a
program of regular activities purported to maintain or
improve one's cognitive abilities.
 Cognitive training reflects a hypothesis that cognitive abilities
can be maintained or improved by exercising the brain,
analogous to the way physical fitness is improved by
exercising the body.
 When it comes to brain training or [mind games] the goal is to
enhance the mind’s capacity to do some of these pivotal
mental functions.
 Brain training activities includes:
o Solving puzzles
o Attention Tasks
o Memory Tasks

13. YOGA THERAPY
 Yoga is an ancient Indian discipline that includes meditation, controlled breathing
techniques and exercise for preserving overall health and healing various ailments.
 Yoga is the best way of relieving stress and anxiety and features among tips for
fighting against covid 19
 It is indeed the ultimate medication for
all diseases, practiced and propagated
by great yogis.
 Top 8 Yoga Poses for Stress Relief:
o Balasan - child pose
o Uttanasana – standing forward bend
o Setu banda sarvangasana –Bridge pose
o Adho muka savasana –Down Dog pose
o Uttithita trikonasana – Extended traingle pose
o Marjaryasana – cat pose
o Uttana Shishosana - Extended Puppy Pose
o Savasana - Corpse Pose

14. BREATHING EXERCISES
 Breathing exercises, although simple, are very effective when experiencing an
anxiety attack or feeling stressed esp during this pandemic situation.
 They work by slowing the heart rate and calming the individual on a psychological
level.
 Focusing on breathing slowly and the rhythm of chest will help to slow your heart
rate and naturally calms all of the body systems involved in body’s fight-flight-or-
freeze response.
4-7-8 Breathing
 The 4-7-8 breathing technique, also known as “relaxing breath,” involves breathing
in for 4 seconds, holding the breath for 7 seconds, and exhaling for 8 seconds.
OTHER TECHNIQUES ARE :
 Pursue lip breathing Exercises
 Diaphragmmatic breathing Exercises
 Breath Focus Technique
 Lions Breath
 Equal Breathing
 Sitali Breathing

15. REHABILITATIVE BOOKLET FOR
STROKE PATIENTS DURING COVID 19
 Stroke rehabilitation during this pandemic is a holistic
appraoach.
 Providing a home exercise program (HEP) to patients is one
of the most fundamental and important aspects
of physiotherapy.
 Patients who adhere to their prescribed exercises are
significantly better at achieving their goals and demonstrate a
greater increase in physical function.
 Home program during this pandemic should include :
 Exercise Program : Stretching , strengthening , hand program,
balance training , gait training , CIMT
 Diet Program
 General precautions and instructions as menionesd earlier

16. POSITIONING
 The aim of positioning the patient is to try to promote optimal
recovery and comfort by modulating muscle tone, providing
appropriate sensory information, increasing spatial
awareness, improved ability to interact with the
environment and prevention of complications such as
pressure sores, and contracture.
 Arm Support devices such as a Lap Tray may be used to assist
with arm positioning for those at risk of shoulder subluxation
 Education and training around correct manual handling and
positioning should be provided to the individual with stroke,
their family/carer
 Elevation of the limb when resting should be considered for
individuals who are immobile to prevent swelling in the hand
and foot.

17. EXERCISE PROGRAM
 To strengthen the muscles that stabilize the shoulder
a. Lie on back with arms resting at your sides.
b. Keep elbow straight,
lift affected arm to shoulder
level with hand pointing to the ceiling.
c. Raise hand toward the ceiling,
lifting shoulder blade from the floor.
d. Hold for three to five seconds,
and then relax, allowing shoulder
blade to return to the floor.
e. Slowly repeat the reaching motion
several times.
f. Lower arm to rest by side.

18. EXERCISE PROGRAM
 To strengthen the shoulder muscles as well as those which
straighten the elbow
a. Lying on back, grasp one end of
an elasticized band in each hand with
enough tension to provide light resistance
to the exercise, but without causing
undue strain.
b. To start, place both hands alongside
the unaffected hip, keeping your
elbows as straight as possible.
c. Move your affected arm upward in a diagonal direction, reaching out to the
side, above your head, keeping your elbow straight**.
d. Your unaffected arm should remain at your side throughout the exercise.
e.During the exercise, stretch the band so that it provides resistance.

19. EXERCISE PROGRAM
 To strengthen the muscles which straighten the
elbow
a. Lie on back with arms resting at
your sides and a rolled towel
under the affected elbow.
b. Bend affected elbow
and move hand up toward shoulder.
Keep elbow resting on the towel.
c. Hold for a few seconds.
d. Straighten elbow and hold.
e. Slowly repeat several times.
Note: Try not to let the hand roll in towards your mid-
section/stomach.

20. EXERCISE PROGRAM
 To improve hip control in preparation for
walking activities
a. Start with your unaffected
leg flat on the floor and affected
leg bent.
b. Lift affected foot and cross
affected leg over the other leg.
c. Lift affected foot and un-cross,
resuming the position of step b.
Repeat the crossing and un-crossing motion several times.

21. EXERCISE PROGRAM
 To enhance hip and knee control
a. Start with knees bent,
feet resting on the floor.
b. Slowly slide the heel of affected
leg down so that the leg straightens.
b. Slowly bring the heel of affected
leg along the floor, returning to
the starting position.
b. Keep heel in contact with the floor throughout the
exercise.
Note: foot will slide more smoothly if do this exercise
without shoes.

22. EXERCISE PROGRAM
 To improve control of knee motions for walking
a. Lie on unaffected side
with the bottom knee bent
for stability and affected arm
placed in front for support.
b. Starting with affected leg
straight, bend affected knee,
bringing the heel toward buttocks,
then return to the straightened position.
c. Concentrate on bending and straightening knee while
keeping hip straight.

23. EXERCISE PROGRAM
 To improve weight shift and control for proper
walking technique
a. Start with knees bent, feet flat
on the floor and knees close together.
b. Lift hips from the floor and
keep them raised in the air.
c. Slowly twist hips side to side.
Return to center and lower
hips to the floor.
d. Rest. Repeat motion.
Note: This exercise may be difficult for some stroke survivors
and it may worsen back problems. Do not do it if experience
pain.

24. EXERCISE PROGRAM
 To improve balance, weight shift and control to prepare
for walking activities
a. The starting position is on hands and knees.
Weight should be evenly distributed on both
arms and both legs.
b. Rock in a diagonal direction back
toward right heel as far as possible, then
as far forward toward left hand as possible.
c. Repeat motion several times, slowly
rocking as far as possible in each direction.
c. Return to center.
e. Rock in a diagonal direction toward right
hand. Move as far back as possible in each
direction slowly.

25. EXERCISE PROGRAM
 To simulate proper weight shift while strengthening
hip and pelvis muscles
a. Stand facing a countertop or
other firm surface for support.
b. Shift weight onto right leg
and lift knee straight.
c. Return to center with
both feet on the floor.
d. Shift weight onto left leg and lift
e. right leg out to the side keeping back
and knee straight.
e. Repeat several times, alternating lifts.

26. EXERCISE PROGRAM
 To reduce stiffness in the trunk and promote the body
rotation needed for walking
a. Sit on a firm straight chair with
both feet flat on the floor.
If necessary, a firm mattress,
sofa, or wheelchair may be used.
a. Interlace fingers.
c. Bend forward and reach with
hands toward the outside of right foot,
rotating trunk.
d. Move hands upward in a diagonal direction toward left shoulder,
keeping elbows as straight as possible.
e. Repeat the motions, moving hands from left foot to right
shoulder.

27. CONSTRAINT INDUCED MOVEMENT
THERAPY
 Intensive Constraint Induced Movement Therapy (minimum 2 hours of
active therapy per
day for 2 weeks, plus restraint
for at least 6 hours a day) should be
provided to improve arm and hand
use for individuals with 20 degrees
of active wrist extension and 10 degrees
of active finger extension.
 Trunk restraint may also be incorporated into the active therapy sessions at
any stage post-stroke.
 Advice the patient to use his affected arm more by arranging all the things
on affected side
o Keeping alarm , water bottle on the effected side of bed
o Keep all shampoos , soap and other things on affected side
o Doing all house hold activities using affected hand eg : turn on switches
with affected hand

28. STRETCHING
 Flexibility exercises can relieve muscle spasticity
problems, improve motor function, range of motion, and
prevent contractures.
 Stretching exercises can also prevent joint contractures,
muscle shortening, decrease spasticity, reduce joint
stiffness and improve a post-stroke patient's overall
function.
 Therapist should taught the right technique of active
stretching to the patient .
 Therapist even checks the patient through virtual
sessions atleast thrice a week .
 If patient cant do active stretch , right technique of
stretching should be taught to respective family member

29. HAND EXERCISES
 Palm Up and Down
 Wrist Bend Movement
 Wrist Side Movement.
 Rolling Movement.
 Wrist Curl.
 Grip and Release.
 Pen Spin.
 Coin Drop.

30. BALANCE TRAINING
 Practice of standing balance should be provided for individuals who
have difficulty
with standing. Strategies could include:
 Practising functional task-specific
training while standing
 Walking training that includes
challenge to standing balance
(e.g. overground walking, obstacle
courses)
 Providing visual or auditory
feedback
 Receive progressive balance training
 Recieve lower limb strengthening exercises
 Consider for an ankle-foot orthosis

31. GAIT TRAINING
 People who are able to walk independently after stroke should be
offered treadmill
training with or without body
weight support or other walking-orientated
interventions at a higher intensity than
usual care and as an adjunct to other
treatments.
 People who cant walk independently
are advised to walk with
o Any family member support
o Help of assistive devices :Hold the cane on contralateral side
o Therapist should check the gait pattern and correct them via virtual
session during this pandemic if direct vivit is not possible ..

32. DIET DURING COVID 19
 As we normally get vitamin D from the sun , people
with little or no sun exposure should consider taking
10 micrograms supplement each day .[ as there is
more staying in indoors than usual ]
 Eating garlic and taking herbal remedies can be act
as a an attempt to protect us

33. DIET PROGRAM
 Plan to eat a variety of foods each day.
• Eat at least five servings of fruits and vegetables per
day.
• Choose foods low in saturated and trans fats.
Eat Foods with Adequate Starch and Fiber
 Complex Substituting complex carbohydrates for
sugars is recommended. These foods include beans,
peas, nuts, fruits, vegetables, whole grain breads and
cereals.

34. DIET PROGRAM
Avoid Excess Sugar
 Sugar provides only empty calories to the body.
• Use less of all sugars, including white, brown and raw sugars, honey, and
syrups.
• Substitute fresh fruit or fruit canned in water or its own juice.
Avoid Excess Fat
 The intake of fat, particularly saturated animal fat, trans fat and
cholesterol, is a contributing factor in developing atherosclerosis, which is
associated with stroke and heart disease.
• Choose lean meat, fish, poultry, dried beans and peas as your protein source.
• Minimize use of eggs (no more than 3 a week) and organ meats (eg, liver).
Use only low-fat dairy products.
• Broil, bake or boil rather than fry foods. A spray vegetable oil coating may be
used.

35. DIET PROGRAM
Avoid Excess Sodium
Excess salt in your diet increases the risk of high blood
pressure, which is a major factor in heart disease and stroke.
Table salt is the primary source of dietary sodium.
• Limit your use of foods that have a high salt or sodium
content such as cured meats, potato chips, pretzels, salted
nuts, cheese, prepackaged dinners, baked desserts, and dried
fruits.
 Watch for hidden salt. Di-sodium phosphate, monosodium
glutamate, sodium nitrate, and any other sodium compound
in the list of ingredients indicates a high sodium content.
• Some over-the-counter drugs, especially antacids and
headache remedies, have a highsodium content.

36. SUMMARY
o Manage your stress by doing Jacobsons Relaxation
Technique ,Chair Aerobics,Brain Training,Yoga
Therapy,Breathing Exercises
 Do not skip your exercise program
 Choose your diet wisely
 Spend family time
 contact physician and physiotherapist whenever
needed

37. REFERENCES
 HOPE :A Stroke Recovery Guide by NATIONAL
Stroke Association
 ttps://www.bda.uk.com/uploads/assets/5c75ea19-
7b55-4281-86eaa3edda5a281a/BDA-Immunity-
graphic-download.png
 Physiopedia : stroke physiotherapy approaches

38. THANK YOU