How is therapy for hemiparesis delivered in during the rehabilitation of middle cerebral artery (MCA) stroke?

Updated: Feb 20, 2018
  • Author: Daniel I Slater, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Therapeutic progressions begin with static seated balance, emphasizing appropriate midline orientation, and progress to dynamic sitting balance with the ability to incorporate reach into any sitting activity. Reach is in any direction, not defined by distance or extremity. Balance involves the use of the entire body with internal and/or external support. [66] Various other tools assist in achieving balance; manual facilitation to trunk postural muscles and extremities, facilitation range of motion, and use of mirrors for visual feedback are examples. Achieving postural alignment is key to achieving successful and efficient weight shifts.

Once achieved, the progression moves to dynamic stability with transitional movements. These are movements from one posture to another or movements within a posture, providing a change in location and/or orientation in space; an is example is a transfer from one surface to another. [52]

Once postural stability is functional in sitting, a similar progression can be followed in standing. Standing static balance, weight acceptance, and weight shift are all prerequisites for successful gait training. Assisted balance work in quadruped, half, and tall kneeling on a therapy mat table are effective in challenging balance through transitional movements and increasing supported weightbearing on hemiparetic limbs for increased facilitation. Half and tall kneeling are valuable tools to assist in the progression to standing balance and weight shifting because of their shorter lever arms against gravity. These are also positions in which patients have greater surface area for external base of support, which helps to increase patient confidence and decrease fear of falling.


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