2. INTRODUCTION
• Functional re-education techniques are
those techniques which are used in
re-education of lost functions.
Restoration of function is important in
achieving the patient's rehabilitation.Re-
education of function requires the co-
operation of all who come in contact
with him.
3. ***
• RE-EDUCATION CAN BE DONE
• 1)ON MAT
• 2)ON RE-EDUCATON BOARD
• 3)USING PARALLEL BAR
• 4)USING SUSPENSION THERAPY
• 5)USING HYDROTHERAPY
4. FUNCTIONAL RE-EDUCAION ON
MAT
• A normal individual perform activities such as
rolling, getting up from lying position
etc,independently day to day life usually in
bed or floor. But a person physical
impairment finds difficult to do so.
• Therapist teaches methods and techniques o
carry out such activities independently
usually on mat as it provide large BOS and
low COG, hence known as mat activities.
5. Mat activities
• Common mat activities are;
• 1)rolling
• 2)prone on elbow
• 3)prone on hand position
• 4)hook lying
• 5)bridging
• 6)quadruped position
• 7)sitting-long sitting, short sitting
• 8)kneeling
• Half kneeling
6. ROLLING
• Rolling generally progress from log rolling to
segmental rolling
• It is roll from supine to side lyingprone or
from prone to side lyingsupine.
• Log rolling produces movement of the entire
trunk as a unit around the longitudinal axis
of the body.
• Segmental rolling is a progression from log
rolling. In segmental rolling either the upper
or lower segment of the trunk moves
independently while the other is stabilized.
7. ROLLING
• Techniques to facilitate rolling are:
• Flexion of the head and neck with rotaion:It
is used to assist movement from supine to
prone position.
• Extension of head and neck with rotation: It
is used to assist the movement from prone
to supine position.
• Both the hand are clasped, elbow fully
extended and shoulder flexed unto 100-110
• Cross the leg over the other, the upper leg is
towards the side of rolling.
9. PRONE-ON-ELBOWS
• This position provides weight bearing
on elbows and forearm. The posture
provides stability of gleno humeral joint
co-contraction of scapular musculature,
and improving head and neck control
• The position should be progress in the
following manner:
11. Prone-on-elbow
• Initially the patient should try to assume and
maintain the position for few to several
minutes with out without assistance. during
this timing activities like reading books
,watching TV can be incorporated.
• Patient should try to maintain the posture
independently.
• Weight shifting to lateral direction can be
started
• Activities like writing, page turning, ball
squeezing etc can be used.
12. PRONE ON HAND
• It is the intermediate position between
the prone on elbow and quadruped
positions.
• From prone on elbow the position,
patient fully extends his elbows. In this
perdition BOS and COG becomes more
higher. The weight is born on
hands,wrist,elbow and shoulders
14. Progression takes place in the
following manner
• Same with prone on elbow
• Final step is performed in the form of
push ups in prone position which is
also helpful in increasing strength of
triceps,brachii and pectorals major.
15. HOOK LYING
• The patient is in supine position with hip
and knee flexed and feet flat on the
floor or mat surface.
• In this position the BOS is large and
COG is lower.
• Patient performs lower trunk rotation by
swinging the lower extremity side to
side.
17. BRIDGING
• The patient is in hook lying position and elevates
his pelvis off the mat surface.
• Progression of the activities takes place in the
following sequences
• 1)Asume and maintain the position with or without
assistance.
• 2)Maintain the position independently
• 3)Elevation of the pelvis off the mat then again
depressing it on the mat, it is perform several times.
• 4)Resistance can be given on the ASIS.
• 5)Decrease the angle of hip and knee flexion.
19. CLINICAL IMPLICATIONS OF
BRIDGING
• 1)Improves pelvic mobility
• 2)Strengthens low back and hip
extensors
• 3)helpful for using bed pan
• 4)Relieve pressure.
20. QUADRUPED
• In this position the patient bear weight in all the
four limbs.
• The patient usually goes in quadruped position from
prone on elbow or prone on hand position.
• Progression of the activities takes place in the
following manner:
• 1) Weight shifts in forward, backward and side to side
direction can be incorporated.
• 2) Raising of one of the upper limb and bearing weight
on rest of the 3 limbs.
• 3)raising of one of upper limb and contralateral lower
limb. Increase the time gradually for 2 and 3.
22. CLINICAL IMPLICATIONS
• Patient weight bearing on lower extremity joints (step
towards weight bearing in erect positions).
• Strength and mobility required for so many functional
activities by upper extremities.
• Functional activities such as cleaning floor, gardening
(planting seeds and weeding) can be used to teach static
and dynamic stability of quadruped position.
• When balance and stability have been achieved in
quadruped, crawling may be started. This activity
facilitates the co-ordination of the whole body including
reciprocal movement of the arms and legs as require in
walking.
23. SITTING
• Sitting is the position which requires and
facilitates trunk control and balance. It also
allows some amount of the weight to be born
by upper extremity. There are 2 forms of sitting
need to be practiced.
1. Long sitting
2. Short sitting
Long sitting – patient sits with knees fully
extended; hips flexed hands may or may not
support the upper part of the body weight
(hands may be position laterally, posteriorly or
anteriorly with relation to pelvis).
25. SHORT SITTING
Patient sits on high surface (bed, chair etc) with knees at the edge
making hip and knees 90 degree flexed and feet flat on the floor
surface. BOS is smaller than long sitting.
Progression of the both positions may take place in following sequence
– (patient usually progress from long sitting to short sitting).
1.Initially patient assumes and maintains position with support.
2. Patient raise one hand placing the weigh on other one. He repeats
the movement with other hand.
3. Patient sits independently without any external or hand support.
4.Patient performs activities such as ball throwing (light to heavy
weight), clapping overhead etc.
5.Push ups in both type of sittings should be performed with or without
push up blocks. Increase the number of repetitions gradually.
26. KNEELING
• Patient comes in to kneeling position (hips extended and
knee flexed at 90 degree) from quadruped position and
bears weight on both the joint. This position also
improves trunk pelvis control and upright balance. The
BOS is smaller and COG is higher as compared to sitting
• Progression may take place in following manner.
1.Patient shifts weight from one to other knee.
2)Ball throwing and other activities should be performed.
3)Kneel walking would be the final progression for the
kneeling position.
27. HALF KNEELING
• Patient assumes the position as shown in the
figure. The limb which lies posterior bears more
weight.
• This position improve pelvic control ,hip
extension, and ankle and knee movement
• Progression takes places in the following
manner:
• 1)weight shift from one limb to other and even
interiorly and posterior.
• 2)Upper limb activities such as ball throwing light
to heavy weight) peg lifting and clapping etc.
35. Principles
1)The upward force in the water
Which work against the gravity reduces
The weight stress on weight bearing
Joints in standing.
II)The force of gravity and buoyancy balance
Each other and minimized the muscular
Efforts in standing.
III)The water provide resistance against
The movements of the body and extremity
All these 3 functions of water make
The patient stand up more comfortably
In the water than the land
.The therapist stabilized the pelvis and trunk
36. Exercises in water
Lifting one hand in air then other
Hand and then both hand.
Patient learns these exercise and after
Few sessions of treatment improves his
Balance and co ordination
Now remove the stabilization and
Allow the patient to stand without
Support and does the exercises
Exercises such as-bending trunk forward
,backward,sideward,are added
Later on with the little stabilization
At pelvis.
Lower limb exercises such as place
The limb foreward,backward,and sideward
Lift it up with flexion of hip and knee
And hold for 10 counts.Bend both the knees
And then extend them.
37. Functional re-education with
suspension unit
• Suspension therapy is the exercise unit or frame
which is known as Guthrie smith which muscles
are strengthened by using ropes, pulleys and
slings
• It is mainly used to allow the muscle to contract
actively in the gravity eliminated position or
against gravity and subsequently improve the
muscle strength, joint range of motion and
decrease the pain and muscle spasm.
