Effects of a Stroke:
A stroke is the result of damage to nerve cells in the brain caused by either:
• A blockage of a blood vessel or
• Bleeding into the brain
Either of these can result in difficulties with movement. A bleed or blockage
on one side of the brain affects movement on the opposite side of the body.
This is known as hemiplegia: ‘hemi’ = half and
‘plegia’ = paralysis. One side of the body is weaker. The problems caused by
stroke are different for everyone. They can vary from mild to severe and may
include:
• Muscle weakness, or slowness of movement of the
- Arm and leg
- Trunk
- Face and tongue
• Changes in muscle stiffness (this can vary from floppy to very stiff)
• Poor balance
• Decreased coordination
• Tremor/shaking (of your arm or leg)
• Loss of awareness/neglect of the weak side
• Numbness or tingling
• Decreased awareness of temperature, pressure, or pain
• Difficulties judging your position in space and distance from objects
• Double vision
• Nystagmus: uncontrolled left/right or up/down eye movements
• Visual field loss: able to see only part of what is actually being looked
at
• Sensitivity to light, especially bright sunlight
• Extreme tiredness/fatigue
• Decreased concentration
• Changes in mood
• Changes in behavior and personality
• Difficulty expressing yourself or finding it hard to understand others.
Positioning: How to Give Support to your Weak Side
LYING IN BED
• Arm supported
LYING ON YOUR STRONG SIDE
• Shoulder and hip forward
LYING ON YOUR WEAK SIDE
• Arm resting on the bed palm up
Rolling onto your Side in Bed
LIE ON YOUR BACK
To roll onto your strong side
1. Turn your head towards your strong side
2. Clasp both hands in front of you or bring your weak arm
Across your body - do not lift your arm up above
90 degrees (shoulder level)
3. Bend your weak leg so that your foot is flat on bed or
bend both legs up
4. Push down through your weak foot
5. Roll over
HELPER CAN
• Clasp your hands and move
your arms across your body
• Lift your weak leg up and hold
your foot flat on the bed
• Instruct you to “reach forward
towards me and roll over”
To roll onto your weak side
1. Raise your head and turn towards your weak side
2. Clasp both hands in front of you
3. Bend your strong leg and keep your foot flat on the bed
4. Push off with your foot
5. Roll your hips and shoulder toward your weak side
Exercises to Help the Return of Movement in Arm and
Hand
LYING ON STRONG SIDE
1. Your helper supports your weak arm throughout
2. Reach forward
LYING ON BACK
1. With hands clasped, reach towards
the ceiling; do not go past 90 degrees
if you have any shoulder pain
2. With arms bent, push both elbows
away from your body. Helper resists on the strong side to
encourage the weak side to move
3. Shoulder shrugging - lift both shoulders up towards your
ears.
Exercises to Strengthen Back and Stomach Muscles
LYING ON YOUR BACK, WITH KNEES BENT, FEET FLAT
1. With both knees bent up, and
feet on the bed, draw your
tummy in and flatten your back
into the bed. Hold to the count
of five, then relax. Repeat.
2. From the middle take both
knees to one side, and return.
Repeat to the other side
3. Clasp your hands together in front
of you, reach forward and raise
your chin towards your chest.
Try to hold to the count of five
4. Repeat the above exercise moving
your arms and head to your weak
side. Try to hold to the count of five
5. With your arms by your side, pull
your shoulder blades together
Exercises to Strengthen Hip
LYING ON YOUR BACK WITH
YOUR KNEES BENT, FEET FLAT
1. Slowly bend and straighten
your weak leg, keeping
your foot on the bed
HELPER CAN
• Support your leg while you
lift it up toward your chest
• Help you to slowly move
it part way down
• Help you to bend it up again
• Try to control the
movement so it becomes easier and smoother
2. Lift both hips (bridge) hold them up
for 10 seconds then relax. Start by
lifting up only 2-3 cm off the bed.
Progress to keeping your hips level
HELPER CAN
• Keep your leg in the mid-line
• Support your leg as you move and stop it falling out
3. Lift your knee and foot toward
your chest. Keep it steady, do not let it fall out
LYING ON YOUR BACK WITH
YOUR LEGS STRAIGHT
1. Push your feet apart keeping your
heels on the bed, knees straight
YOUR HELPER CAN
• Resist on the strong side. This uses your
strong side to strengthen the weaker side
• Show you how to push your heels into the
bed with feet apart and knees straight
2. Turn your knees and feet in toward one another and then out
Exercises to Strengthen Knee
LYING ON YOUR BACK
1. Put a rolled towel under your weak
knee. Lift your foot up and hold
your knee straight. Slowly lower it
Exercises to Strengthen Ankle
LYING ON YOUR BACK
1. Start with your toes pointing down,
try to pull them up. This will be
easier with your knee slightly bent.
2. Place your weak leg bent over the side of the bed.
Lift your hip and knee and pull up your foot
HELPER CAN
• Help you lift your weak leg up
3. Sitting with your feet flat on the floor
4. Pull all your toes up
5. Try to keep your foot in the midline
6. Progress to moving only your weak foot
General Protocol of ICU Physical Therapy
• Protocol for conscious patients need O2 support:
A- Improve ventilation:
1- Breathing exercises: deep breathing exercise.
Frequency: 3 breaths / 3 sets / 5 times daily.
2- Strength abdominal muscles with graduation.
Frequency: 5 repetitions / 3 sets / twice daily.
3- Relaxed positions of breathing: leaning forward from sitting or standing
on table or wall.
Frequency: 5 minutes / twice daily.
4- Stretching exercises for accessory muscles of respiration as sternocledo
mastoid, scaleni, upper trapezius.
Frequency: 20 seconds / 3 repetitions / twice daily.
5- Massage for chest muscles and neck muscles.
Frequency: 5 minutes / twice daily.
B- Improve clearance of secretions:
1- Postural drainage.
Frequency: 5: 10 minutes for each position / twice daily.
2- Percussion and vibration.
Frequency: 3 : 5 minutes after postural drainage / twice daily.
3- Active cycle of breathing technique.
Frequency: 3 breaths / 3 sets / according to presence of secretions.
4- Autogenic breathing exercise.12
Frequency: 3 breaths / 3 sets / according to presence of secretions.
5- Huffing and coughing exercise.
Frequency: 3 repetitions / 3 sets / according to presence of secretions.
C- Improve mobility of patient:
1- Active assistive ROM (AAROM) or active ROM (AROM).13
Frequency: 5 repetitions / 3 sets / twice daily.
2- Circulatory exercises.
Frequency: 8 repetitions / 3 sets / twice daily.
3- Mobility of the patient: (e.g. bed mobility, high sitting position, sitting
out of bed, sitting balance, sit to stand, walking, tilt table, standing hoists,
upper limb or lower limb ergometry, exercise programs).
Frequency: twice daily
• Protocol for unconscious patients on O2 support or on mechanical
ventilation:
A- Improve ventilation:
1- Breathing exercises:
Frequency: 3 breaths / 3 sets / 5 times daily.
2- Massage for chest muscles and neck muscles.
Frequency: 5 minutes / twice daily.
3- Facilitatory techniques for abdominal muscles as squeezing, massage.
Frequency: 3 minutes / twice daily.
4- Positioning: supine, semi supine, side lying, prone, semi fowler
position.
Frequency: each 2 hours.
B- Improve clearance of secretions:
1- Postural drainage.
Frequency: 5: 10 minutes for each position / twice daily.
2- Percussion and vibration.
Frequency: 3: 5 minutes after postural drainage / twice daily.
3- Stimulation of cough reflex by pressure on trachea, on mid rectus
abdominus muscle after end of inspiration, along lower costal borders
during expiration.
C- Improve mobility of patient:
1- Passive ROM (PROM).
Frequency: 10 repetitions / 3 sets / twice daily.
2- Turning of patient.
Frequency: each 2 hours.
Process of weaning from mechanical ventilation:
1- Weaning criteria.
2- Spontaneous breathing trail.
3- T – tube.
4- Extubation and O2 mask.
