Скачать или смотреть More Than Just Movement: The Truth About Walking After Stroke - Part 2

This video, "More Than Just Movement: The Truth About Walking After Stroke - Part 2," features Dr. Sam from Neuro Thrive PT discussing interventions for improving walking after a stroke.

Key takeaways from the discussion include:

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Neuroplasticity and Recovery [02:13]: The brain's ability to change and form new pathways is crucial for stroke recovery. To promote this, interventions should be:

High Intensity [02:48]: Pushing oneself to a 6-8 out of 10 effort level, with higher heart rates, to challenge the brain and improve blood flow.

High Repetition [03:12]: Getting as many steps and repetitions as possible, both during and outside of therapy sessions, is vital for skill improvement.

Task Specificity [04:16]: To improve walking, one must actually walk. Working on balance or strength in isolation may not directly translate to better walking balance or function. Challenges should be integrated into real walking activities.

Tools and Techniques for Walking Recovery

Treadmill Training [06:09]: Treadmills are excellent for getting repetitions, tracking progress, and challenging various aspects of walking, such as:

Speed [06:45]: Increasing speed improves propulsive drive and endurance.

Balance [07:05]: Letting go of rails, using one rail, or walking sideways/backwards challenges balance during walking.

Incline [07:24]: Increases challenge, improves push-off strength (calf), and strengthens glutes.

Overground Training [09:18]: Walking on varied surfaces (pavement, grass, gravel, sand) and in different environments (inclines, declines, around people) provides diverse challenges for balance and environmental awareness.

Targeting Foot Drop [11:09]: While isolated dorsiflexion exercises have benefits, it's crucial to integrate them into functional tasks like:

Walking over hurdles [11:45]

Stair climbing [11:57]

Walking on an incline [12:04]

Monitoring when dragging begins to track endurance improvements [23:05].

Progression and Adaptation

Challenging Devices [14:18]: Gradually moving away from assistive devices (wheelchair, walker, cane) in a safe and planned manner.

Give and Take [15:12]: Understanding that challenging one aspect of walking (e.g., speed) might require more support for another (e.g., balance), and vice versa. For example, holding onto treadmill rails when increasing speed [15:50], or walking slower when focusing on balance without a device [16:16].

Integrating Therapy into Daily Life [19:18]: Incorporating walking practice into everyday activities like errands or moving around the house to increase repetition and make therapy more enjoyable and sustainable [19:29].

Addressing Specific Concerns

Drop Foot and Tone [21:04]: If drop foot is due to tone rather than weakness, continuous practice helps with endurance and muscle relaxation. Braces (AFOs) or ankle-to-shoelace devices can assist with foot clearance [22:05]. Prepping muscles with stretching, relaxation, and gentle movement before exercise can improve range of motion for strengthening [25:52].

Robotic Assisted Therapy [29:26]: For chronic stroke recovery, robotic assistive therapies like Locomat and Cyberdyne are generally not recommended as they may lead to passive movement without carryover to real walking. They are more suited for conditions like spinal cord injury [29:50]. Anti-gravity treadmills (like Alter G) might be a better option for some [30:53].

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