Stroke rehabilitation involves physiotherapy beginning soon after the stroke occurs to regain function and mobility. Physiotherapists evaluate the patient to determine disabilities to address, like weakness, limited range of motion, or walking problems. Rehabilitation focuses on overcoming problems through exercises and can continue long after hospitalization with home programs. One challenge is learned nonuse where patients avoid using affected limbs, so physiotherapists teach ways to manage without full limb function or regain ability. Practice is important to relearn skills like switching tasks.

1. STROKE
Stroke rehabilitation is sometimes an uphill climb.
the aim of regaining function as quickly as possible at the
expense of the affected limb
Physiotherapists begin stroke rehabilitation very soon after
the stroke has occurred, while the patient is still in acute
care.
The physiotherapist will first do an evaluation to determine
what disabilities must be dealt with during stroke
rehabilitation.

2. Rehabilitation begins on the day of the stroke. This initially consists of
positioning and passive stretches to maintain muscle and joint range,
together with a close liaison with medical staff. Early mobilisation of the
patient is encouraged as soon as possible when the medical condition
allows.
possible problems are: lack of strength and endurance, limited range of
motion, problems with sensation in the limbs, and troubles walking.
Stroke rehabilitation will focus on the problems that the patient displays.
One problem of stroke rehabilitation is called learned nonuse. This is when
stroke patients do everything in their power to avoid using limbs that have
been affected by the stroke. If left to their own devices, they will cripple
the limb further by letting it atrophy through nonuse.

3. Patients will learn to use limbs that the stroke
has made temporarily useless.
During stroke rehabilitation, it will be
determined whether these limbs will reach
their previous potential.
If not, the physiotherapist will teach the
patients ways to manage without their full
use of the limbs.

4. It can be a difficult task of stroke rehabilitation
to help victims relearn switching from one
task to another- Perceptual problems
This is partly because of problems in the brain.
This is why practice is so important. The more
times physiotherapists help a patient with
this, the easier it becomes.

5. Recent studies have revealed that stroke rehabilitation
can continue long after the hospital stay. In the past,
stroke victims were given a short round of
physiotherapy during the time they were in the
hospital and for a few weeks shortly afterwards.
New research shows that physiotherapy can promote
more advanced stroke rehabilitation if it is continued
progressively at home.
Patients will learn to walk better. They will gain strength
to do daily chores. They will also achieve better
posture and more balance, which can prevent falls.

6. • Exercises to improve strength, flexibility and cardio-vascular
fitness.
• Retraining movement to achieve improve coordination,
balance and control.
• Spasticity management.
• Contracture management.
• Management of shoulder subluxation and shoulder pain.
• Mobility retraining to improve independence and provide
access to social, leisure and community-based activities.
• Education and support for the person, their family and
carers in managing physical impairments.
• Assessment for aids and appliances such as splints, braces

7. STRENTHENING

8. SCI
Sports injuries and car accidents, among other
injuries, can cause spinal cord injury.
As always with physiotherapy, the first step is
evaluation.
An important issue in spinal cord injury is the
level of the damage.

9. If a physiotherapy program is not followed faithfully, the
spine will begin to atrophy below the level of the spinal
cord injury. The spine will shrink and the whole body
below that point will become weaker as time goes by.
Physiotherapy for spinal cord injury involves exercising
and stimulating the nerves and muscles below the
level of the damage.
The physiotherapist will give exercises where the patient
lies on the side, back, or stomach and works out or sits
up and works out.

10. • Prevention and management of muscle
contractures
• Establishment and monitoring of a daily standing
programme
• Balance work in sitting and/or standing
• Strengthening of all remaining active muscle
groups
• Cardiovascular fitness
• Wheelchair skills and leisure activities

11. Mat Exercises
• Rolling practise
• Performing lie to sit
• Sitting balance training
• Practising sit to stand
• Gait re-education
• Stepping and stairs practise
• Outdoor mobility
• Transfer practise
• Hand and arm exercises
• Wheelchair skills

12. MAT EXERCISES

13. With all these therapies, spinal cord injury patients
can sometimes restore themselves to earlier
functioning.
Spinal cord injury research is being conducted
constantly. Physiotherapy is one of the fields
that are being explored. One study is putting
spinal cord injury patients in harnesses over
treadmills stimulating walking.
Physiotherapy gives hope for spinal cord injury
patients. It allows them to have the most normal
functioning that they are currently able to have.

14. Physiotherapy and Traumatic Brain
Injury
People with traumatic brain injury (TBI) often
experience a diverse range of physical
problems.
These problems may be related to the injury to
the brain itself, other orthopaedic injuries
sustained at the time of the injury,
or the effects of disuse and immobilization
that occur following the extended time when a
person is confined to bed or a wheel-chair

15. The injuries sustained are usually more severe
and take longer to recover from than other
types of neurological problems.
Although the majority of a person’s recovery is
achieved in the first 12 months following the
injury, recent research has demonstrated that
significant improvements can be made for up
to 5-10 years

16. Physiotherapy treatment may include:
• Exercises to improve strength, posture, flexibility and
fitness.
• Retraining movement to improve coordination, balance
and control.
• Mobility retraining to improve independence and
provide access to social, leisure and sporting activities.
• Education and support for the person, their family and
carers in managing physical impairments.
• Assessment for aids and appliances such as splints and
wheelchairs.

17. COORDINATIONS EXERCISIS

18. Multiple Sclerosis
• Symptoms of MS can include:
• Loss of motor (muscular) control
• Fatigue
• Visual disturbances and vertigo
• Continence problems
• Cognitive difficulties such as memory loss and
depression
There is currently no cure for MS however there
are a range of treatment options to assist the
person to manage their condition.

19. Physiotherapy and Nerve Injuries and
Neuropathies
• Nerve Injuries
Depending on the nerve or nerves injured,
impairment or loss of sensation and or
movement may be experienced.
Recovery of function is determined by the
severity, location and type of injury, as well as the
age of the patient and the presence of associated
injury.
Function may return within days, weeks,
months or not at all. Some injuries may require
surgical repair with varied prognosis.

20. Neuropathies
Guillain-Barré Syndrome
Physiotherapy treatment will accelerate your
recovery and lessen the severity of your
condition. Physiotherapy treatment will also
help you make significant improvements by
promoting your maximum functional
potential.

21. • Treatment of Nerve Injuries and Neuropathies is
established on an individual basis but often include:
• Stretching and mobilisation
• Assisted movement
• Graded exercise
• Sensory stimulation
• Pain management
• Education and support
• Prevention of secondary complications
• Assessment for aids and appliances such as splints and
braces

22. STRECHING

23. Motor Neurone Disease
• Exercises to maintain muscle strength for as long as possible and improve
energy levels.
• Stretching to lengthen tight muscles and joints and improve range of
movement.
• Minimising abnormalities of muscle tone.
• Advice on postural management to increase comfort and reduce pain
when sitting, standing or sleeping.
• Facilitating the use of efficient functional movement patterns including
the quality of walking.
• Activities to improve balance to help improve confidence and reduce the
risk of falling.
• Education and advice about MND
• Gentle massage to help reduce your anxiety.
• Hydrotherapy treatment will also help relax and stretch tight muscles and
help with mobility.

24. Parkinson's Disease
Physiotherapy treatment will promote your
physical function and your independence in
everyday life.
Physiotherapy will also focus on managing the
risk of falling. Physiotherapy treatment will
increase muscle strength, joint flexibility and
balance.

25. Physiotherapy treatment may include:
• Exercises to improve strength, movement,
posture, balance, co-ordination and fitness.
• Rehearsal of tasks found difficult. The
physiotherapist can assist with breaking these
activities into parts and provide strategies to
simplify the movement.
• Gait practice to enhance safety when walking.
• Education and support for the person with
Parkinson’s, their family and carers.

26. Cues
• Visual cues – flashing lights, triangles, black
stripes, light device and taped step length.
• Auditory cues – rhythmic auditory stimulation
(RAS) using a metronome and music with a
known rhythm.
• Attentional cues – dual tasks and use of
internal cues.

27. • Education and use of cues can improve
intrinsic falls risks.
• Large number of falls due to loss of balance
therefore balance exercises.
• AS common fall area’s e.g. bathroom where
turns occur, add cues.
• Encourage safe activity and regular medication
reviews

28. Muscular Dystrophy
Physiotherapy treatment will help make
activities easier to achieve by reducing pain
and improving joint flexibility and muscle
strength. Physiotherapy treatment will also
promote independence and maximise your
potential.

29. • Stretching to reduce muscle tension and joint stiffness.
• Exercises to increase muscle strength and energy levels. This will also
increase self-esteem and confidence with daily tasks.
• Passive and active movement of joints to improve flexibility and
circulation.
• Postural advice to increase comfort and prevent pressure sores when lying
and sitting
• Activities to improve balance and coordination
• Promote functional activities important to you
• Regular standing if necessary.
• Advice on mechanical support such as wheelchairs walking aids and
orthotic devices in order to maintain functional ability.
• Hydrotherapy and massage to relax sore muscles.
• Breathing control and assisted coughing if appropriate to maintain a clear
chest.

30. Vestibular Rehabilitation
• Vestibular Rehabilitation is a simple exercise
based treatment and was first introduced by
Cawthorne & Cooksey in 1946
– Noticed patients with balance problems often
refrain from moving their heads
– Developed a simple series exercises known as
Cawthorne-Cooksey exercises or Vestibular
Rehabilitation (VR)
– BPPV

31. Secondary symptoms may include:
• fatigue
• reduced concentration
• emotional factors such as fear of falling and/or
depression
• functional restrictions within the home or
workplace
• neck stiffness associated with avoidance of head
movement to prevent dizziness and
• headaches.

32. Exercises are tailored to the
individual’s needs and are designed to:
• Improve balance
• Improve walking pattern
• Reduce falls
• Increase independence
• Increase confidence
• Reduce disability
• Habituation & Repositioning

33. Physiotherapy following neuro-
surgery
Neuro-surgery may be performed for a variety of
reasons, such as excision of a tumor or clipping
of an aneurysm, Evacuations surgeries. Often a
period of rehabilitation is required following
neuro-surgery to help restore function.
Problems following neuro-surgery are specifically
related to the location of the surgery and may
vary considerably.

34. Exercises for Neuro Surgery
• Acute care PT
• Comma Stimulation
• Retraining movement to achieve improve
coordination, balance and control.
• Mobility retraining to improve independence and
provide access to social, leisure and community-
based activities.
• Education and support for the person, their
family and carers in managing physical
impairments

35. Geriatric Physiotherapy
Geriatric physiotherapy became a specialty of
physical therapy study in 1989. Since then,
physiotherapists have worked to understand
the problems of the aging.
There is a long list of problems dealt with in
geriatric physiotherapy.

36. The types of problems faced in geriatric
physiotherapy are grouped into three different
categories.
One category is the problems that happen
because the patient simply does not use their
limbs or does not exercise.
These problems can be addressed by
reconditioning through range-of-motion
exercises and other exercises.

37. Another category geriatric physiotherapy deals with
is cardiovascular disease, like heart disease and
stroke.
The third category is skeletal problems.
Eg: OA, knee or hip replacement surgeries
Because falls are such a problem, geriatric
physiotherapy is responsible for preventing many
falls because of work with balance and gait.
Some clinics focus entirely on balance issues for
the elderly.

38. PT IN FALLS
Individuals with neurological conditions &
Geriatric are often at an increased risk of
falls. Individuals with other conditions can
also be at risk of falling.
It is estimated that one third of over 65’s are at
risk of falling each year. Falls are a major cause
of ill health for older people and account for
62% of all fatal injuries in people aged 65 and
above.

39. Practices Proven to Prevent Falls
1. Evidence Based Exercise Programs:
These will include the following components3:
• Balance
• Muscle Strength
• Flexibility
Tai Chi is an example of a discipline which includes all
of these components.

40. 2. Environmental modification
• Removing risks from the home and the community
3. Education
• Presentations, handouts, demonstrations and
discussions
4. Assistive devices/protective devices
• Correct use of walkers, canes, scooters
5. Multifactorial Intervention
• Combining a number of the above interventions

41. Exercises
• Tai Chi
• Center of Gravity (COG) Control Training
– Seated Balance Activities
– Standing Balance Activities
– Floor-to-Standing Transfers

42. • Multi-sensory Training
– Forcing use of Somatosensory System
• On solid ground, eyes open
– Forcing use of Visual System
• On compliant surface, eyes open
– Forcing use of Vestibular System
• On compliant surface, eyes closed
– Eye-Head coordination exercises

43. • Postural Strategy Training
– Ankle, Hip, Step
• Flexibility Training
– Neck and upper body flexibility exercises
– Lower body flexibility exercises
• Kitchen Sink Exercises
• Gain muscle strength and flexibility
• Improve balance reactions and postural control
• Use walking aids more effectively
• Assist walking on uneven ground and around obstacles

44. BALANCING EXERCISES

45. GAIT TRAINING
Many neurological gait
Facilitation of Muscle
Inhibition of Muscles
External support
Walking Sideways to the Left, Walking Sideways
to the Right.
Exercises to Strengthen
Exercises to Abnormal Tone

46. Traditional

47. Current Trends

48. Aids & Adaptions
Many of the patients with neurological conditions cannot
carry on daily functions such as caring for themselves
and their homes.
physiotherapist can show you how to use recommended
equipment and will often teach you how to do things
in easier, safer, new ways to enable you to remain as
independent as possible.
The aids and adaptations that may benefit from depend
on current diagnosis / symptoms, individual housing
circumstances, lifestyle, and goals.

49. Aids & Adaptions
• Walking sticks
• Crutches Gutter frames
• Three wheeled walkers
• Four wheeled walkers
• Wheelchairs
• Seating systems
• Pressure relief cushions
• Access ramps
• Bath seats
• equipment /accessories to improve hand function
• slings
• Transfer boards / belts
• Leg lifters
• Adapted toilets

50. ASSITIVE DEVICE

51. ADL Training
Many people with neurological disorders experience
difficulties with everyday tasks, such as; getting in and
out of bed, on and off chairs, on and off the toilet,
washing / bathing yourself, getting dressed, getting
around your home, going up and down the stairs,
getting in and out of home
Medications or surgeries can help with some of their
problems, but many problems are ones they will have
to abide.
Physiotherapy can offer solutions that other branches of
medicine cannot.

52. ADL continue..
Exercises, as in most physiotherapy, include
Hand exercises and functional oriented
exercises
Physiotherapists may be able to make a plan so
that this is possible.

53. Thank You