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Stroke Rehabilitation @ No Barriers Foundation

Stroke is a common condition seen by many physiotherapists, often leading to motor dysfunction and in some cases permanent disability. The rehabilitative objective of stroke patients is based on independent living by improving their functional disabilities. Therefore, rehabilitation training for stroke patients should focus on improving flexibility, muscular strength, coordination, and sense of balance to maintain an independent lifestyle through the recovery of physical functions. Rehabilitation treatment needs to be consistent and long-term.

Exoskeleton has in recent years emerged as a reliable and safe alternative to standard physiotherapy rehabilitation techniques. At the No Barriers Foundation, the exoskeleton is used to provide rehabilitation training and for walking assistance to patients affected by post-stroke disability. Lower-limb rehabilitation robots such as the Ekso GT we currently operate can help patients to carry out reasonable and effective training to improve the motor function of paralysed extremity in a safe effective manner. Exoskeleton rehabilitation allows high intensity repetitive and progressive gait training that is not achievable in many settings.

Another piece of equipment we have at our disposal is the EasyStand Glider which helps many clients in many ways. For example, in stroke survivors aids the reduction in tone while increasing joint range of motion. The EasyStand Glider features state-of-the-art active standing technology found in no other stander. Active standing provides lower body range of motion and upper body strengthening. There are several excellent research studies documenting the benefits of passive standing programs for an individual’s long-term health. The EasyStand Evolv stander allows the user to move in and out of standing without having to be lifted or transferred making it ideal for exercise in its own right but also as an adjunct to the exoskeleton training performed.

Reformer training involves low and intermediate intensity resistance and repetition that matches the patient’s physical ability and can be a remedial exercise program that can improve physical ability and influence quality of life. With hemiplegia, there is a strong tendency to shift completely to the unaffected side, which only reinforces the weakness and poor motor control of the affected side. Reformer Pilates helps to correct that.

At the No Barriers Foundation, we offer a creative rehabilitation program experience that considers both physical and mental components of rehabilitation for improving balance, strength, mobility and ability to walk when using specialist exercise therapy for recovering functions in stroke patients.

Contact us at hello@nobarriers.ie for more details

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Things we all need to know about stroke

Only a person who has survived a stroke survivor can really understand what it’s like living post stroke although that does not always mean that we can’t help and relate to the warrior within. During these difficult times with Covid-19 many people will suffer a stroke or be recovering from a stroke with reduced services all over the country. It can be a long road………. warrior like!!

However, the more we understand what stroke recovery involves, the more we can help our friends, family members or loved ones recover. However, to do this it’s important to be educated about stroke and how it affects a survivor every day.

As a physiotherapist we always want to make sure that we are using the most effective evidence-based tools to rehab someone post stroke. However, the physical injuries from stroke are only one part of the rehabilitation process and rather than focusing on the physical challenges post stroke I want to look at the hidden challenges for many.

I have NOT suddenly become stupid!!

A stroke is a “brain attack” that reduces the brain of oxygen rich blood. The resulting damage post stroke may affect different skills, like language and speaking. However, this does not mean the person has lost intelligence. Rather, it means they might need more time to find the right words………. Just be patient!

Again, Be Patient!!

Recovery from a stroke can often mean relearning the simplest tasks like it was the very first time. This can be very frustrating for stroke survivors so be patient!! Be patient with when chatting to someone as memory both short- and long-term memory may be affected but remember it’s not personal if someone can’t remember your name or where you live.

If a stroke survivor nods off it’s simply the brain healing and has nothing to do with laziness.

Stroke causes damage to the brain that must be healed. Just like any injury the brain requires time to heal. When a stroke survivor is overcome with regular tiredness early in their rehabilitation it’s not because they’re being lazy. It’s because their brain is healing and requires rest to recover. Tasks that once felt effortless may require a tremendous amount of effort now.

If I need help, I will ask.

Recovering from a stroke for many requires some help from those around you, however, always remember the stroke survivor needs to do as much as they can for themselves. The reasons for this are simple movements or tasks are important for recovery, so avoid helping too much. If a stroke survivor needs help, most often hey will ask.

Emotional Fragility During Recovery

Occasionally the emotional part of the brain may be affected by the stroke, some stoke survivors may laugh, and some may cry at various times throughout their recovery and for various reasons. This does not always mean they are sad or that they are laughing at something inappropriate it’s sometimes difficult for some stroke survivors to control their emotions. It’s a condition called emotional lability. Put yourself in the shoes of a stroke survivor. If everything suddenly changed, and you had no control over it, wouldn’t you feel emotion too?

Finally, the goal for any stroke survivor is to get back to “normal” this maybe the old normal or new normal.

Please remember when you meet someone that has survived a stroke the challenges they have faced already and will face during recovery are varied from the emotional, behavioural, and even personality changes never mind the physical deficits that may occur after stroke.

We can all help by allowing stroke survivors or stroke warriors to be themselves in the now instead of what was in the past.

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Home Exercises Post Stroke

Exercises to complete at home during Covid-19 for post-stroke individuals.

Summary
While you are self-isolating at home, you can and should be keeping physically active. Your physical and mental health with greatly benefit from regular exercise. In this post you will find a few simple exercises you can do at home, using household items.

Exercise Guidelines

Avoiding inactivity during these challenging Covid-19 times is very important. Any amount of exercise is better than none. If you have any questions regarding adapting exercises to your specific needs please do not hesitate to contact No Barriers. Exercise of any form will be beneficial at this time but a combination of aerobic and strength has a better balance. Try to get outside for a walk, staying within 2km of your home and maintaining social distancing guidelines when you’re out.

Scheduling Exercise

It is best to exercise in routines of at least 30 minutes. But even as little as 10 minutes of physical activity at a time can provide health benefits. If possible, spread out your exercises throughout the week. The more time you spend exercising, the better you will feel.

Warm-Up

Always make sure to do a short warm up to prepare your body for exercise. Some examples on how to warm up are; a 5 minute walk, jumping jacks, running on the spot or skipping.

The following exercises can be done with two water bottles, two cans of beans, two bags of sugar or any household items like the above. These exercises can also be done with no weight at all if that is more suited to your abilities, you will still get great benefits from it.

Single- Arm Front Raise

•Stand straight holding a water bottle in each hand with
an overhand group. Hold water bottles in front of thighs
with palms facing thighs, keeping arms straight.
•Raise left arm straight out in front up to shoulder level,
lower again and lift opposite arm.
Your palms must always face down for this exercise.

Repetitions: 10
Sets: 3

Bicep Curls

•Start with feet shoulder width apart and a bottle
in each hand.
•Keep your elbows close to your sides and start to bend
elbow and bring hands up towards shoulders.
•Try not to swing your hips to get the weight moving.
•Hold at top position for one second and slowly lower to
start position.

Repetitions: 10
Sets: 3

Tricep Kickbacks

•Hold two water bottles with an overhand grip,
stand tall with chest up and core braced. Bend
at hips while keeping back flat.
•Bring your upper arms to your sides, Begin by pushing
the water bottles back and behind you.
•Pause at the top of the movement and slowly
lower the water bottles and begin again.

Repetitions: 10
Sets: 3

Shoulder Press

•Holding two water bottles, stand straight,
with your feet shoulder width apart..
•Raise the water bottles to head height by rotating
arms forward and up.
•Elbows should be bent to 90 degrees. This is the
starting position.
•Using only your arms, extend through your shoulders and
straighten out the elbows, overhead. Hold for one second
and squeeze shoulder muscles.
•Slowly return to start position.

Repetitions: 10
Sets: 3

Cool Down

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Looking After Your Lungs With SCI

Spinal cord injury (SCI) often leads to impaired breathing. Many factors in SCI can contribute to poor lung function with obesity, smoking and the connection between posture and lung performance having been proved significant. For many SCI (level dependent) the muscles responsible for breathing are often weakened. This weakness reduces the volume of the lungs (lung capacity), the ability to take a deep breath and cough, and puts them at greater risk of lung infection. Just like other muscles of the body, it’s is possible to train the breathing (respiratory) muscles to be stronger.

Not all spinal cord injuries will result in impaired breathing. The level of your spinal cord injury plays a huge part in determining whether your ability to breathe will be compromised. Following damage to the spinal cord, the following muscles of respiration (breathing) may be affected if you have a spinal cord injury above T10:

Diaphragm – It is supplied by C3, 4 and 5. It is the main muscle responsible for inspiration (breathing in).

Intercostals – They are supplied by T1 – T11. These are small muscles that are attached to the ribs and help stabilise the rib cage and assist in inspiration (breathing in) and expiration (breathing out).

Abdominals – They are supplied by T6 – T12. They assist in expiration (breathing out). They work most during forced expiration such as coughing, sneezing, blowing your nose, shouting and choking.

Accessory – They are supplied by C1 – C8 and a cranial nerve. These are muscles in the neck. They normally only work to assist breathing during exercise or stress. In high tetraplegics they may become the main inspiratory muscles.

You can help prevent the collection of secretions in the following ways:

  1. Deep Breathing Exercises

When deep breathing, you expand more of your lungs than when breathing normally. This extra expansion helps prevent the airways from being blocked with secretions/-mucus or from collapse. To help clear secretions take 4 to 6 deep breaths at a time. Try to hold each breath for 2 or 3 seconds. For maximum benefit do the exercises in a variety of positions such as sitting, sitting upright (will help with abs strength also) or alternate lying on your right and left side.

  1. Pursed lip breathing

This simple breathing technique makes you slow down your pace of breathing by having you apply deliberate effort in each breath. Practice using this breath 4 to 5 times a day when you begin in order to correctly learn the breathing pattern.

To do it:

  1. Relax your neck and shoulders.
  2. Keeping your mouth closed, inhale slowly through your nose for 2 counts.
  3. Pucker or purse your lips as though you were going to whistle.
  4. Exhale slowly by blowing air through your pursed lips for a count of 4.
  1. Diaphragmatic breathing

Belly breathing can help you use your diaphragm properly. Do belly breathing exercises when you’re feeling relaxed and rested. Practice diaphragmatic breathing for 5 to 10 minutes 3 to 4 times per day. When you begin you may feel tired, but over time the technique should become easier and should feel more natural.

To do it:

  1. Lie on your back with your knees slightly bent and your head on a pillow.
  2. You may place a pillow under your knees for support.
  3. Place one hand on your upper chest and one hand below your rib cage, allowing you to feel the movement of your diaphragm.
  4. Slowly inhale through your nose, feeling your stomach pressing into your hand.
  5. Keep your other hand as still as possible.
  6. Exhale using pursed lips as you tighten your stomach muscles, keeping your upper hand completely still.

You can place a book or small weight on your abdomen to make the exercise more difficult. Once you learn how to do belly breathing lying down you can increase the difficulty by trying it while sitting in a chair.

During Covid-19 it is especially important to keep your lungs clear and healthy. Should you require further information please email me at stephen@nobarriers.ie

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Exercising at Home with Spinal Cord Injury During Covid-19

Summary

  • If you have a spinal cord injury (SCI), you can and should be physically active.
  • Your health will benefit from regular exercise after SCI.
  • Your exercise program should include three parts: stretching, aerobic exercise, and strength training.
  • Setting goals, recognising potential barriers, being prepared, and learning about resources can help you have a successful exercise program.
  • With so many options, you can find an exercise program that is right for you.

Introduction

People with SCI are more likely than the general population to have health problems related to weight gain, changes in cholesterol, and high blood sugar. People with SCI are also at higher risk of cardiovascular disease. Not being active may contribute largely to these problems.

Normal, everyday activities aren’t enough to maintain cardiovascular fitness in people with SCI. Regular exercise can help to reduce the risk of health problems after SCI.

Importance of Regular Physical Activity

  • Improves energy levels and ability to take part in activities
  • Strengthens muscles
  • Increases flexibility
  • Improves mood
  • Improves sleep
  • Decreases pain
  • Helps achieve and maintain a healthy weight
  • Improves cholesterol
  • Improves blood sugar
  • Decreases the risk of heart disease

Because of these benefits, exercise is more than just fun—it’s a form of medicine that can be a powerful tool for preventing and treating many health conditions.

Exercise Guidelines

Exercise regularly based on your abilities. Avoiding inactivity during these challenging Covid-19 times is very important. Any amount of exercise is better than no exercise. If you require assistance in anyway contact us at No Barriers to discuss your specific needs. Exercise of any form will be beneficial at this time but a combination of aerobic and strength has a better balance.

Scheduling Exercise

It is best to exercise in routines of at least 30 minutes. But even as little as 10 minutes of physical activity at a time can provide health benefits. If possible, spread out your exercises throughout the week. The more time you spend exercising, the more health benefits you’ll get!

Options for Exercising

One of the great things about exercise is that so many options exist. Exercise can occur as part of your daily routine. Exercise can be done easily in your home.

Examples of stretching include:

  • Using your standing frame
  • Using exercise bands

Examples of aerobic exercise include:

  • Rowing with exercise bands
  • Pushing your wheelchair briskly

Examples of strength training include:

  • Weightlifting
  • Using resistance bands

Occasionally you may think you need special equipment to exercise, however adapt think outside the box ask us to help there are many ways to keep fit and healthy during these times.

Choose goals that you can easily achieve but that are challenging.

If you require any help with a programme in the home email me at stephen@nobarriers.ie 

 

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Functional Electrical Stimulation

What is Functional Electrical Stimulation (FES)?

Functional Electrical Stimulation (FES) is the application of electrical current to excitable tissue to improve or restore functions lost in neurologically compromised subjects” (Peng et al., 2010).

Electrical stimulation is focused in certain skin surface areas of the body such as the calves and thigh to activate paralysed or weakened muscles using electrodes

Varying types of current can be applied that influence the specificity, effect, ease of application and comfort. For optimal effects the peripheral nervous system is required to be intact, so the neurological compromise is central nervous system (brain and spinal cord) in origin.

This is not to say effects cannot be gained with damage to the peripheral nervous system, but they are likely to require much higher levels of current and will generate smaller, less powerful contractions.

The benefits of FES

Using FES will create patterned movement in conjunction with for example the exoskeleton which will enable the muscles to work and perform activities even though they may be weak or paralysed through neurological disease or injury. This activity will:

  • Improve blood sugar homeostasis
  • Enhance cardiovascular function
  • Enhance endothelial function
  • Decrease chronic inflammation
  • Regulate hormone levels
  • Preserve/build musculoskeletal & neuromuscular integrity
  • Decrease depression, increase cognition

How does FES fit into rehabilitation therapy?

During passive rehabilitation muscles are moved mechanically so in theory muscles don’t do any of the work. Active rehabilitation such as using the exoskeleton and FES together allows muscles to do the work they are meant to do. This is achieved either by an individual moving their muscles on their own, or when muscles are activated by FES.

This means that active rehabilitation ensures muscles are working and performing the activity.

At what stage of rehabilitation is it best to use FES?

FES stimulation can be applied at any stage across the entire continuum of care from the acute phase to chronic intervention. For some FES is a short-term intervention. Whilst, for others, where recovery is longer or less function is regained, patients may benefit from using FES long term at a facility such as that provided by the No Barriers Foundation.

Which pathologies are FES most beneficial for?

FES is useful for stroke and spinal cord injury with strong evidence that FES can make an impact are spasticity and pressure ulcers in SCI. For the stroke group the benefits are likely to be improved movement and enhanced motor control.

Contact us today at hello@nobarriers.ie for more information

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Exoskeleton & Stroke Rehabilitation

Stroke is the leading cause of serious long-term disability with many survivors sustaining functional limitations in activities of daily living as a result of stroke. Many stroke survivors have long-term walking impairment due to hemiplegia or hemiparesis. Impaired ambulation due to hemiplegia or hemiparesis is associated with increased fall risk, limited community participation, and an overall decreased quality of life.

Post-stroke, the long-term goal of rehabilitation is successful reintegration into the community, with recovery of walking ability as a key functional objective. This recovery of function is achieved with progressive, task-specific, repetitive training based on the principles of motor learning and neuroplasticity. Targeted rehabilitation can help to reorganise the brain to relearn skills that may have been lost during, or because of, stroke, with the goal of helping survivors regain their independence. Rehabilitation goals may include coordinating leg movements, shifting weight to walk, or balancing during sit-to-stand transfers.

Functional Improvements

Advances in technology are changing the rehabilitation process. Robotic exoskeletons used during stroke rehabilitation assist with walking during the recovery process by providing earlier mobility and restored independence. Exoskeletons may enhance post-stroke gait training, helping to guide weight shifts and improve step patterns and cadence and enabling individuals to stand and walk over ground early in the recovery process.

For gait rehabilitation after stroke, the technology applications typically include a wearable device such as a robotic exoskeleton, with hip and knee motors providing assistance during walking. A key part of the rehabilitation process is therapy progression, and exoskeleton technology provides options to encourage progress and document improvements. The device chosen should have options for asymmetrical control of the lower limbs and facilitate pre-gait training, transfers, stepping, and balance training.

Additional Benefits

While functional improvement is the primary goal of stroke rehabilitation, exoskeleton devices also have the potential to empower and motivate patients. Initial gait training sessions in the exoskeleton often include meaningful walking time indoors and outdoors, which can improve patient morale, motivation, and enthusiasm. Over the past year using the Ekso GT exoskeleton, we have also seen increased steps per session, improved gait symmetry and balance, and improvements in functional independence throughout many patients rehabilitation.

The ultimate goal of the No Barriers Foundation is always be to maximise recovery of function to support the patient’s ability to maintain independence at home and in the community.

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Healthy Workplace = Happy Workplace

It turns out that a lack of exercise in our lives is a silent killer. The World Health Organisation lists physical inactivity as the fourth biggest risk factor for death in adults across the world.

The latest research shows when it comes to heart disease, leading a sedentary life is as great a risk factor as smoking and obesity. In fact, inactivity in terms of disease risk, is more dangerous than being overweight.

If you spend long periods of time sitting, this is particularly bad news, as it increases your risk of heart disease, obesity, diabetes and cancer. The most current research has shown that even normal weight individuals that are inactive, are at risk of developing disease. There is a molecular pathway that is essential to burning fats, that shuts down with inactivity, and that subsequently increases your risk of developing heart disease.

And unfortunately you can’t bank the benefits of exercise from your youth, hoping it will help you 40 years down the line. The ideal scenario is to have been active throughout your lifespan, but research has shown that your health can benefit from physical activity at any age, meaning it doesn’t matter when you start, as long as you start!

Physical activity performed regularly, can help to prevent and manage over 20 chronic medical conditions. These include coronary heart disease, stroke, type 2 diabetes, cancer, obesity, mental health problems and musculoskeletal conditions.

And the good news is that we can combat the negative effects of prolonged sitting (total of 8 hours or more) with regular physical activity. The reality is that hectic schedules can make it seem impossible to fit workouts into your busy week. The prospect of packing a gym bag, trudging to your local gym, working out, showering, changing, and trudging back to where you came from, can feel like a lot of effort. But when we neglect exercise, we not only put both our physical and mental health at risk, but we also negatively impact our productivity and effectiveness at work.

And you would be surprised at the number of opportunities there are in a working day, to increase your activity levels.  You can in fact accumulate activity that is beneficial to health, in lots of different ways during the day.

 

17 Ways to Be More Active at Work

– Thinking on your Feet – Why it Pays to Be Physically Active at Work Client Newsletter

– Stretching Exercises for the Workplace

– Strengthening Exercises for the Workplace

– Why Posture Matters

– Optimal Desk Posture Infographic

– Carpal Tunnel Infographic

– Preventing and Treating Carpal Tunnel Syndrome

– Carpal Tunnel Rehabilitation Exercise Sheet

As physiotherapists we can help with a wide range of issues caused by long periods of sitting at a desk, including back and neck pains, tingling in your hands, carpal tunnel syndrome, even regular headaches experienced at work.

Please get in touch through our website at www.nobarriers.ie or email hello@nobarriers.ie if you need advice.

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Exoskeletons Role in Physical Rehabilitation

Originally designed for heavy lifting in factories, the role of exoskeletons has increased in healthcare in recent years more specifically neuro physiotherapy rehabilitation. A robotic exoskeleton suit is made functional by a combination of motors, actuators, and electromechanical and hydraulic systems, all powered by an on-board battery and a computer system designed to mimic the natural gait of the user. In Donegal, thanks to the generous funding of the community an EksoGT is available exclusively for rehabilitation. The EksoGT robotic device helps stroke patients and people with spinal cord injuries regain their mobility sooner, giving them computer guidance to regain a proper gait. It is used under the guidance of trained chartered physiotherapists.

 

For more information email hello@nobarriers.ie

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