SELF REHABILITATION BOOKLET - Beyond Stroke

1 SELF REHABILITATION BOOKLETFOR HEMIPLEGIC PATIENTSH PITAL RAYMOND POINCAR , GARCHES, UNIT INSERM 1179 FONDATION GARCHESC LINE BONNYAUD, KRUTIKA JINWALA, NICOLAS ROCHEDRAWN UP WITH THE SUPPORT OF ALLERGANTHIS self- REHABILITATION BOOKLET is designed to support exercises aimed at people with deficits after having undergone a cerebrovascular accident (CVA). Upon returning home, REHABILITATION is often reduced or even abandoned compared to the period of hospital admission. However, it is recognised that continuing to do the prescribed exercises has beneficial effects on functional capabilities and the possible associated motor recovery. There is therefore a real interest in continuing intensive REHABILITATION at home together with liberal physiotherapy to maintain skills, facilitate improvements and avoid exercises presented in this BOOKLET are the result of the expertise of different medical and paramedical practitioners working within our institution.

2 The BOOKLET is aimed at assisting the patient and under no circumstances is it the result of a census conference. This BOOKLET should be considered a tool and not as a comprehensive guide to good practice. Therefore, it is entirely possible that practitioners who treat you will recommend an exercise different to those proposed in this BOOKLET to work on the same function. Some exercises in this BOOKLET have nevertheless been the subject of scientific studies and have revealed their relevance to improve patient motor function in association with the therapeutic care implemented by your medical aim during the preparation of this BOOKLET was to propose simple exercises to you that can be performed alone, safely and which are not harmful and require material that everybody has at choice of exercises is the responsibility of your doctor or physiotherapist who deals with your regular care because they are the people who know best which exercise will enable you to achieve the fastest , we wish you to know that while no REHABILITATION technique has been revealed to be superior to another.

3 It is now broadly acknowledged that recovery increases the more REHABILITATION is practised. The data from our study reveal that 30 minutes of self- REHABILITATION improves the recovery of patients who have undergone a CVA even several years after this occurred. These 30 minutes of exercises include 10 minutes of exercise aimed at the function to improve, 10 minutes of stretching exercises and 10 minutes of muscular strengthening. We therefore recommend where possible that you spend at least 30 minutes a day on the self- REHABILITATION exercises that have been prescribed for sincerely hope that you find this BOOKLET useful and that it will enable you to continue to move best wishes for your work. Mrs C line Bonnyaud Professional physiotherapist, graduate in human sciences and member of the motricity unit of H pital Raymond Poincar Garches Nicolas Roche, doctor in medicine, specialised in physical medicine and REHABILITATION , university graduate in neuroscience, manager of the motricity unit of H pital Raymond Poincar Garches France; member of the Inserm 1179 exercises l ARM PLACED IN FRONT.

4 11 l ARM PLACED ON ITS SIDE ..12l LIFTING THE ARMS ..13l EXTENDING THE ELBOW /1 ..14l EXTENDING THE ELBOW /2 ..15l TURNING THE FOREARM ..16l EXTENDING THE WRIST ..17l EXTENDING THE FINGERS ..18l EXTENDING THE THUMB ..19 Muscular Strengtheningl LIFTING AN OBJECT ..20l EXTENDING THE ELBOW ..21l LIFTING THE WRIST ..22l OPENING THE HAND ..23 Functional Exercisesl DRAWING A LINE ..24l MOVING A BOTTLE ..25l MOVING A BOTTLE ..26l TURNING A BOTTLE ..27l USING A SPOON ..28l HAIR BRUSHING ..29l HOLDING A BOTTLE ..30l OPENING A BOTTLE ..31l HOLDING A CUP ..32l TURNING ON A TAP ..33l WRITING ..34l TURNING PAGES ..35l THROWING A BALL ..36l THROWING A BALL ..37 TO SOMEBODYUPPER LIMB ARM6 OVERVIEWS tretching exercisesl SITTING ON YOUR HEELS .. 39l EXTENDING YOUR LEG .. 40l STRETCHING YOUR CALF /1 .. 41l STRETCHING YOUR CALF /2.

5 42 Muscular Strengtheningl EXTENDING YOUR LEG OUTWARDS .. 43l EXTENDING YOUR LEG BACKWARDS .. 44l LIFTING YOUR KNEE .. 45l EXTENDING YOUR KNEE .. 46l BENDING YOUR KNEE .. 47l STANDING ON TIPTOES .. 48l LIFTING YOUR TOES .. 49 Functional Exercisesl GETTING UP / SITTING DOWN .. 50l STANDING ON ONE LEG /1 .. 51 l STANDING ON ONE LEG /2 .. 52l STANDING ON ONE LEG /3 .. 53l STEPPING OVER OBSTACLES /1 .. 54l STEPPING OVER OBSTACLES /2 .. 55l WALKING IN A ZIGZAG .. 56l STAIRS /1 .. 57l STAIRS /2 .. 58l STAIRS /3 .. 59l PICKING UP OBJECTS FROM THE FLOOR .. 60l KICKING A BALL .. 61 l KICKING A BALL TO SOMEBODY .. 62 LOWER LIMB LEGOVERVIEWl GETTING UP FROM THE FLOOR WITH A CHAIR /1 .. 64l GETTING UP FROM THE FLOOR WITH A CHAIR /2 .. 65l GETTING UP FROM THE FLOOR WITHOUT A CHAIR /1 .. 66l GETTING UP FROM THE FLOOR WITHOUT A CHAIR /2.

6 67l GETTING UP FROM THE FLOOR WITHOUT A CHAIR /3 .. 68l GETTING UP FROM THE FLOOR WITHOUT A CHAIR /4 .. 69 ACKNOWLEDGEMENTS .. 71 GETTING UP FROM THE FLOOR8 FIGURE LEGENDSMOVEMENT DIRECTIONMUSCLE TO STRETCHHEMIPLEGIC LIMBTIMEREPETITION9 ARMUPPER LIMB10 ARM Stretching exercisesSIT IN FRONT OF THE TABLE WITH 2 BOXES ON THE TABLE (1 BOX IF DIFFICULT WITH 2)PLACE YOUR ELBOW AND FOREARM ON THE TOP BOXSTAY IN THIS POSITIONl A tablel A chairl 2 boxes ( shoes)l A towel on the top boxNECESSARY MATERIALTIMEREPETITIONSARM PLACED IN FRONT11 ARM Stretching exercisesSIT IN FRONT OF THE TABLE WITH 2 BOXES ON THE TABLE (1 BOX IF DIFFICULT WITH 2)PLACE YOUR ELBOW AND FOREARM ON THE TOP BOXSTAY IN THIS POSITIONl A tablel A chairl 2 boxes ( shoes)l A towel on the top boxNECESSARY MATERIALTIMEREPETITIONSARM PLACED ON ITS SIDE12 ARM Stretching exercisesLIE DOWN AND GRAB YOUR WRIST WITH YOUR HEALTHY HANDMOVE YOUR ARMS BACKWARDSMOVE AS FAR AS YOU CAN AND STAY IN THAT POSITIONl A bedNECESSARY MATERIALTIMEREPETITIONSLIFTING THE ARMS13 ARM Stretching exercisesPLACE YOUR ELBOW ON THE TABLE ON A TOWEL.

7 GRAB YOUR WRIST WITH YOUR HEALTHY HANDEXTEND YOUR ELBOW WITH THE HELP OF YOUR OTHER HANDSTAY IN THIS POSITIONl A tablel A chairl A towel on the tableNECESSARY MATERIALTIMEREPETITIONSEXTENDING THE ELBOW /114 ARM Stretching exercisesGRAB THE HEMIPLEGIC WRIST WITH THE OTHER HANDEXTEND YOUR HEMIPLEGIC ARM WITH THE HELP OF YOUR OTHER HANDSTAY IN THIS POSITIONl A chairNECESSARY MATERIALTIMEREPETITIONSEXTENDING THE ELBOW /215 ARM Stretching exercisesPLACE YOUR ELBOW ON THE TABLE ON A TOWEL. GRAB YOUR WRIST WITH YOUR HEALTHY HANDTURN THE FOREARM WITH THE PALM OF YOUR HAND FACING YOUEXTEND THE ELBOW WITH THE PALM OF YOUR HAND TOWARDS THE CEILING. STAY IN THIS POSITIONl A tablel A chairl A towel on the tableNECESSARY MATERIALTIMEREPETITIONSTURNING THE FOREARM16 ARM Stretching exercisesPLACE YOUR FOREARM ON THE TABLE WITH THE HAND HANGING OFFEXTEND YOUR HEMIPLEGIC ARM WITH THE HELP OF YOUR OTHER HANDSTAY IN THIS POSITION KEEPING YOUR FOREARM ON THE TABLEl A tablel A chairNECESSARY MATERIALTIMEREPETITIONSEXTENDING THE WRIST17 ARM Stretching exercisesPLACE YOUR FOREARM ON THE TABLEOPEN YOUR HAND AND EXTEND YOUR FINGERS WITH THE HELP OF YOUR OTHER HANDSTAY IN THIS POSITION KEEPING YOUR FOREARM ON THE TABLEl A tablel A chairNECESSARY MATERIALTIMEREPETITIONSEXTENDING THE FINGERS18 ARM Stretching exercisesPLACE YOUR FOREARM ON THE TABLEEXTEND THE THUMB WITH THE HELP OF YOUR OTHER HANDl A tablel A chairNECESSARY

8 MATERIALTIMEREPETITIONSEXTENDING THE THUMB19 ARM Muscular StrengtheningHOLD THE FULL BOTTLE WITH BOTH HANDSLIFT THE BOTTLE AS HIGH AS YOU CANl A tablel A chairl A small full bottleNECESSARY MATERIALTIMEREPETITIONSLIFTING AN OBJECTPUT THE BOTTLE BACK ON THE TABLE20 ARM Muscular StrengtheningPLACE YOUR ELBOW ON A TOWEL ON THE TABLEEXTEND YOUR ELBOWl A tablel A chairl A towel on the tableNECESSARY MATERIALTIMEREPETITIONSEXTENDING THE ELBOWEXTEND YOUR ELBOW AS MUCH AS POSSIBLE TO TOUCH THE TABLE WITH YOUR HAND21 ARM Muscular StrengtheningPLACE YOUR FOREARM ON A BOX WITH YOUR HAND HANGING OFFl A tablel A chairl A box on the tableNECESSARY MATERIALTIMEREPETITIONSEXTENDING THE WRISTEXTEND YOUR HAND AS HIGH AS YOU CAN KEEPING YOUR FOREARM ON THE BOX22 ARM Muscular StrengtheningPLACE YOUR FOREARM ON A BOX WITH YOUR HAND HANGING OFFl A tablel A chairNECESSARY MATERIALTIMEREPETITIONSOPENING THE HANDOPEN YOUR HAND AS MUCH AS YOU CAN WITH YOUR WRIST EXTENDED23 ARM Functional ExercisesFIND A RULER, PAPER AND PENCILPLACE YOUR HEMIPLEGIC HAND ON THE RULERl A tablel A chairl A ruler, a pencil.

9 A piece of paperNECESSARY MATERIALTIMEREPETITIONSDRAWING A LINEHOLD THE RULER STILL TO DRAW A LINE24 PLACE THE FULL BOTTLE NEXT TO THE BOX STANDING UPLIFT THE BOTTLE OVER THE BOX AND PUT IT DOWN ON THE OTHER SIDEARM Functional Exercisesl A tablel A chairl A boxl A small full bottleNECESSARY MATERIALTIMEREPETITIONSMOVING A BOTTLEREPEAT THE SAME MOVEMENT IN THE OPPOSITE DIRECTION25 ARM Functional ExercisesPLACE THE FULL BOTTLE NEXT TO THE BOX STANDING UPMOVE THE BOTTLE TO THE OTHER HAND OVER THE BOXl A tablel A chairl A boxl A small full bottleNECESSARY MATERIALTIMEREPETITIONSMOVING A BOTTLEPUT THE BOTTLE DOWN AND REPEAT THE SAME MOVEMENT IN THE OPPOSITE DIRECTION26 PLACE YOUR ELBOW ON A BOX WITH YOUR HAND HANGING OFF HOLDING A BOTTLE. HOLD YOUR ELBOW WITH YOUR HEALTHY HANDPLACE YOUR ELBOW AND TURN YOUR FOREARM WITH THE PALM OF YOUR HAND FACING THE TABLEARM Functional Exercisesl A tablel A chairl A boxl A towell A small full bottleNECESSARY MATERIALTIMEREPETITIONSTURNING A BOTTLEPLACE YOUR ELBOW AND TURN YOUR FOREARM WITH THE PALM OF YOUR HAND FACING THE CEILING27 ARM Functional ExercisesA SPOON ON THE TABLEPICK UP THE SPOONl A tablel A chairl A spoonNECESSARY MATERIALTIMEREPETITIONSUSING A SPOONLIFT THE SPOON TO YOUR MOUTH28 PICK UP THE BRUSH WITH YOUR HEMIPLEGIC HANDARM Functional Exercisesl A tablel A comb or brushNECESSARY MATERIALTIMEREPETITIONSDRESSING THE HAIRBRUSH YOUR HAIR29 ARM Functional ExercisesPLACE A BOTTLE ON THE TABLEl A tablel A chairl A small empty bottleNECESSARY MATERIALTIMEREPETITIONSHOLDING A

10 BOTTLEPICK UP THE BOTTLE WITH YOUR HEMIPLEGIC HAND OPEN THE BOTTLE WITH THE OTHER HAND30 ARM Functional ExercisesPLACE A BOTTLE ON THE TABLEl A tablel A chairl A small empty bottleNECESSARY MATERIALTIMEREPETITIONSOPENING A BOTTLEOPEN AND CLOSE THE BOTTLE WITH YOUR HEMIPLEGIC HAND, HOLD THE BOTTLE WITH THE OTHER HAND SO THAT IT DOES NOT TURN31 ARM Functional ExercisesIN FRONT OF A SINK WITH A RIGID PLASTIC CUPl A sinkl A rigid plastic cupNECESSARY MATERIALTIMEREPETITIONSHOLDING A CUPHOLD THE CUP WITH YOUR HEMIPLEGIC HAND AND TURN ON THE TAP WITH YOUR OTHER HAND32IN FRONT OF A SINK WITH A RIGID PLASTIC CUPARM Functional Exercisesl A sinkl A rigid plastic cupNECESSARY MATERIALTIMEREPETITIONSTURNING ON A TAPTURN ON THE TAP WITH YOUR HEMIPLEGIC HAND AND HOLD THE CUP WITH YOUR OTHER HAND33 ARM Functional ExercisesPLACE A PIECE OF PAPER AND A PEN ON THE TABLEPICK UP THE PEN WITH YOUR HEMIPLEGIC HANDl A tablel A chairl A piece of paperl A penNECESSARY MATERIALTIMEREPETITIONSWRITINGWRITE OUT THE ALPHABET34 PLACE A MAGAZINE ON THE TABLETURN THE PAGES WITH YOUR HEMIPLEGIC