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00:00Hi, patient. How are you doing today?
00:04We're going to be doing some exercises
00:08to get you ready for walking eventually. And in order to do that we want to start
00:12kind of on the mat here where it's nice and safe and you're protected and we can
00:16practice strengthening some of the muscles that you're going to need for the crutches later.
00:20We have your braces on order. Once they come we can start getting you up in
00:24parallel bars more. In the meantime, we can be doing some things here to get you ready.
00:28Alright, first position here we're going to have you lying on your back
00:32and some of the muscles we need to strengthen. What are some of the muscles?
00:36Triceps. Triceps I heard.
00:40So you can find all sorts of things to do. There's not a right and wrong.
00:44This is where there's going to be a lot of correct answers. There's a lot of things you can do.
00:48So for triceps, I'm going to have you
00:52keep your elbow on the table here and just push your hand right down into that
00:56ball. Okay? I don't want her just to do this because that would be a different
01:00muscle. It would be okay to strengthen shoulder extensors because we need those
01:04for ambulation too. But during the check off I'll be asking you what muscle
01:08are you trying to strengthen? So make sure you're specific as to whether
01:12it's triceps or if it's shoulder extensors. Okay?
01:16Autismous dorsi. Okay. So we could do a bunch of different muscle groups.
01:20We could put the ball in between her arm here.
01:24Kind of between the elbow and the chest. Keep your hand up toward the ceiling and just
01:28squeeze in that way. Why don't I want her to do like this?
01:32That would be internal rotators instead of adductors.
01:36So make sure you're having the patient do it the correct way. Okay?
01:40She's a paraplegic patient so she won't be able to move from the waist down.
01:44So, you know, I'm not going to be asking her to do quads and hamstrings. That type of thing.
01:48We could do some manual strengthening of the
01:52triceps. You know, there's all sorts of things you could do in this position. Okay?
01:56If she had the quadratus lumborum,
02:00we could do some of the hip hiking
02:02in this position. So patient,
02:04what I'm going to have you do
02:06is I'm going to kind of pull your leg
02:08down this way. What I want you to do
02:10is to make your hip come up toward your shoulder
02:12or something. So I'm going to kind of look like this
02:14type of movement. Okay?
02:16First time I'm going to help you. Ready?
02:18Go ahead and pull up and back down.
02:20Now I'm going to resist a little bit. Pull up.
02:22Okay? So I can give her some resistance even on that.
02:24Most of my resistance is up here
02:26kind of at the pelvis area.
02:28Give her some resistance.
02:30Okay? So you get some ideas of things you could do
02:32in this position.
02:34Okay? Next position is?
02:36Prone.
02:38Okay? So if she hadn't learned
02:40it in bed already, we would teach her how to
02:42roll over into the prone position.
02:44What do you think is the best way to teach her here?
02:46Elephant. Elephant.
02:48Okay. So in bed did they already teach you how
02:50to do your rolling? Yes, they did.
02:52Okay? So you know that we have the...
02:56...leg lifter.
02:58...leg lifter.
03:00Okay. And which side do you want to roll toward?
03:04All right. So I probably would have her scooch
03:08over to that side first.
03:10Okay? For now just for the sake of time.
03:12We've already done it in the bed so let's
03:14use the time well here.
03:16And then we would have her put that leg over
03:18the top of this leg.
03:20And then she would do the elephant roll.
03:22I would be on this side so she would roll toward me.
03:24Okay, so if she needed my help I'm here.
03:26One, two, three.
03:28She's good.
03:30She's good. Okay?
03:32In the prone position if your patient automatically gets
03:36up onto her elbows that's okay.
03:38It's pretty uncomfortable to be flat prone on a mat.
03:42Your face or her.
03:44So it's okay if she goes right up onto her elbows there.
03:46Okay, patient.
03:48So what are some things we could do here?
03:52Any ideas?
03:54Shoulder extension.
03:56Okay, shoulder extension.
03:58Try down flat for a minute.
04:00Okay?
04:02We could have her do some...
04:04If she were a kid maybe I would have her say okay we're going to pretend
04:06that you're Superman.
04:08What I want you to do is lift your head way up.
04:10And then also lift your hands way up like this up behind you.
04:12Hold it, hold it, hold it.
04:14Even higher, higher, higher, higher.
04:16If I wanted to I could do some resistance, relax.
04:18Okay?
04:20So I could do some things like that.
04:22We could do press-ups.
04:24She probably wouldn't be able to do push-ups.
04:26You wouldn't have the muscles here in order to be able to keep a nice flat plank.
04:30So I'll put your hands right underneath your shoulders.
04:32Okay?
04:33And what I'm going to have you do is just press so that your shoulders come up really high.
04:38And now go ahead and straighten out your elbows to do that.
04:40So push even higher.
04:41Good.
04:42So that would be a press-up and back down.
04:44We could do it with the hands in different positions in order to kind of pull in some different muscle groups.
04:50I want you to go ahead and get on your elbows.
04:53So we're going to put your elbows right underneath your shoulders.
04:55Okay?
04:56That's in a good position there.
04:58Okay.
04:59All right.
05:00And then what I want you to do is I want you to shift over onto this arm and then reach the other hand up and touch the ball.
05:09Good.
05:10And I'm going to make it a little bit harder this time.
05:12Same hand.
05:13Reach it way out there.
05:14Good.
05:15Now this hand reach it way out there.
05:18Good.
05:19So again we're getting some shift and lift type activities in.
05:23My hand is right there next to her so if I need to I can help give her just a little direction to get back in position if she should need it.
05:30Okay?
05:31Go ahead and I'm going to have you just scooch over for a minute so I can demonstrate something to you.
05:37Okay.
05:38When you are on crutches later you're going to be doing a thing that's called the jack knife.
05:42Okay?
05:43You can get whatever position if you're more comfortable on your side to look at me whatever's comfortable for me.
05:48You're going to be doing something called the jack knife.
05:52The jack knife when you're using your crutches later you're going to be pushing down really forcefully with your hands at the same time that you kind of flick your head forward.
06:00And what that does is that breaks the spine alignment up so that it kind of takes you out of that alignment and that allows you to bring your feet forward by using momentum.
06:11Okay?
06:12So we're going to start practicing that a little bit on the mat here.
06:16So what that will look like is you'll be pushing up with your hands at the same time that you'll flip your head forward.
06:23It'll just kind of look like that.
06:24Okay?
06:25They're not going to be able to use their hip muscles in order to get up but they can eventually use their hands in order to get them in a quadruped position that we were talking about.
06:37So right now we can just start kind of getting them used to pushing up, flicking their head forward.
06:42Okay?
06:43So let's go ahead and have you do that.
06:46Okay?
06:47So it's just going to be a real quick movement.
06:50It's going to feel really silly to you.
06:51It doesn't feel like you're doing much.
06:52Okay?
06:53So as you're straightening your hands, yep, really fast.
06:57Okay?
06:58But I wouldn't be able to use my hands.
07:00Your head, can you look at me for just a second?
07:02Okay.
07:03Your head is going to be really hard to throw slow.
07:06Okay?
07:07Okay.
07:08Okay.
07:09But just like that it's going to be starting, okay?
07:12Okay.
07:13Alright, so we've started doing some things with the jackknife.
07:16It'll make more sense later as we get into other positions.
07:19Okay, next position.
07:21Long sitting.
07:22Okay, long sitting to get from prone to long sitting.
07:25All she's going to do, remember she's a paraplegic patient, so all she's going to do is start walking her hands up and then eventually kind of turn around so she'll be facing that direction.
07:34Like this?
07:35Yep.
07:36Push it over?
07:37Yep, and I'm on the side when she's going toward.
07:40Once she's in position, I can kind of get there.
07:45I'm in position here to help.
07:47I can be in half kneeling, I can be kneeling, whatever I need to.
07:51Okay, what are some things we can do here?
07:53Shift and lift.
07:55Shift and lift.
07:56Okay, let's start first just with your hands to the side.
08:00And all I want you to do first is do forward and backward shifting.
08:06So lean forward, lean backward as far as you can, under control.
08:11And remember, depending on how much tongue muscle she has, she may not be able to go very far back.
08:16Okay, so she can kind of get a feel for where her center is with this.
08:20And then we're going to lean side to side.
08:23Good.
08:24And the other side.
08:26Okay, can you do a push up?
08:28Good.
08:29And if you want to make it even harder for more distance up, you can put those however they're comfortable for your hands.
08:39And do a push up.
08:41Okay, what were some of the progressions that we talked about with sitting balance?
08:46Remember about lifting and then moving over to the side?
08:49So I'm going to eventually have you move your hips over this way.
08:52So let's move this hand out to the side.
08:54This one in as close as you can get it.
08:56You're going to lift up and move your hips over to the left.
08:59That's not the shift and lift?
09:01No, that's more shifting the hips to the side.
09:04Oh!
09:05Shift and lift is where you shift the weight onto one side and lift the other hand right
09:09up.
09:10Okay?
09:11So I like for reaching it over and out or something.
09:14Okay?
09:15So she could do some shifting of the body back and forth.
09:18We could do some trunk muscles.
09:21So what I want you to do is just kind of sink right down.
09:24Okay?
09:25And sit up as straight as you can.
09:27Really arch your back.
09:28Okay?
09:29And slouch down again.
09:31Slouch, slouch, slouch.
09:32And sit right up and use those back muscles so we can get some trunk musculature in there.
09:37She's definitely going to need that in order to keep an upright position.
09:40Okay?
09:41We could do the shift and lift that you were talking about.
09:43We talked about doing some fanny walks.
09:46Okay?
09:47Which way is going to be easiest for her to go first?
09:49Backward.
09:50Backward.
09:51Okay?
09:52Okay?
09:53So a patient.
09:54Can somebody get off my head at where to go?
09:59Oh, here's one.
10:00Oh, thank you.
10:01It's behind the floor.
10:02That's too close.
10:04Okay.
10:05Okay.
10:06All right.
10:07This way I can help you a little bit if you need a nudge.
10:12Okay?
10:13You sure?
10:14Yeah.
10:15That's a good exercise.
10:16Too tight or is that okay?
10:19No.
10:20Okay.
10:21All righty.
10:22Okay.
10:23So go ahead and hold of the things.
10:24Move them back just slightly and then lift your body weight up.
10:28And basically your body should come just like a nudge.
10:30Okay?
10:31Okay?
10:32Okay.
10:33Okay.
10:34So go ahead and hold of the things.
10:37Move them back just slightly and then lift your body weight up.
10:40And basically her body should come just in between her shoulders there.
10:43Okay?
10:44So go back right again.
10:45Okay?
10:46And then when she gets good at that, we can go forward.
10:49If she has a hard time with her feet moving, remember we can put the pillowcase underneath
10:54her feet.
10:55If she goes forward and her legs kind of bow out a little bit, that's okay.
10:58We'll just actually let them do that once.
11:00So go ahead and go forward a little bit.
11:02And bow.
11:03Okay?
11:04And then stop right there.
11:05Shift to this side.
11:06Use that hand to straighten out your leg.
11:08So she would just kind of work her way down that way.
11:13Yeah?
11:14Would you take their shoes off?
11:16You could.
11:17It's just as easy to put the thing underneath it.
11:20They may not have shoes on when they come.
11:22Depends on where they are in the process.
11:25They might have their braces on at this point.
11:27They may not.
11:28Depends on if they have them yet or not.
11:30So yeah, you could take them off.
11:32Do you need their braces on?
11:34It depends on what you want to work on.
11:36If you're going to be getting, like from prone to standing position, which we're going to be doing on Thursday.
11:41You know, obviously then you want to put them up with the braces.
11:45Most of this stuff you're not going to need the braces on.
11:48Yeah.
11:49Okay?
11:50So you got an idea of some of the things to do on hands and knee, or excuse me, on long sitting position?
11:55So the shift and lift is just going to the one side and then?
11:59It's shifting onto one hand and lifting the other hand.
12:02Okay.
12:03So what would you call the exercise where they're like moving the push up blocks to the side
12:07and then lifting their bottom up and scooching to that side?
12:10I would just say like they're shifting their pelvis to the side.
12:12Okay.
12:13So just push up blocks.
12:14I don't know the specific name.
12:15Okay.
12:16We could make one up.
12:17I'd love to hear anything.
12:19Okay?
12:20So we've done a little bit of trunk stuff.
12:23We've done some triceps.
12:24We've done some balance things.
12:26We've done some shift and lift.
12:27So we've done a good variety of things here in the long sitting position.
12:31The next position is?
12:33Hands and knees.
12:34Hands and knees.
12:35Okay.
12:36There's two ways to get from hands and knees.
12:37If she needed to rest right now, she could rest down and then I'd eventually get her into prone
12:42and we'd go to hands and knees.
12:43If she didn't need to rest right now, we can go straight from this position to hands and knees.
12:48So it's going to be all these.
12:52Okay.
12:53By the way, we have two mats.
12:54We have this one.
12:55We have a red one.
12:56This one is nicer because it's slippery.
12:58The red one is kind of sticky.
13:00So you can use both of them just so you know.
13:02This one is the easier one to move on.
13:05Okay, patients.
13:06In order to get to your hands and knees, what we're going to do in just a second is we'll
13:11probably go in that direction.
13:12Okay?
13:13Because we have more room.
13:14And what you're going to do is we're going to put you in the side sitting position,
13:17which means we're going to have your knees that way and your feet this way.
13:20And then with this hand, once we get you in that position, you're going to do kind of a one,
13:25two, and you're going to use momentum to get right over and put this hand on the floor over
13:30there.
13:31And your knees will automatically go into the right position.
13:33Okay?
13:34However, because you are paralyzed from the waist down right now, it's going to be really
13:39hard for you to hold that position until you kind of find your center.
13:42So I'm going to kind of stand behind you and help support your pelvis.
13:46Okay?
13:47So that will be my position in all of this.
13:50So let's start off by having you shift onto that arm and get these legs into position.
13:55Bend them or bring them up.
13:58Bend them just like that.
14:00That one up, sorry.
14:02Oh man, my knees cannot take that position anymore.
14:06Alright.
14:07And then what you're going to do is with this hand, remember, you're going to do one,
14:11two, and on three you're going to kind of fling it right around there.
14:15Get some momentum going.
14:16And I'm going to help at the belt.
14:18Okay.
14:19And it will also help.
14:20Let's put this foot right on top of that one so it's not crossed when you're done.
14:24Are you ready?
14:25Yep.
14:26Okay.
14:27I just want to hold your belt here.
14:30Okay.
14:31Okay.
14:32One.
14:33Really big.
14:34Two.
14:35Three.
14:36There you go.
14:37Okay, I can actually help get her back up into position here.
14:40Okay.
14:41Now, I'm going to let go of you for a second.
14:43Okay.
14:44With paraplegia, she's not going to have a lot of support.
14:47She can't move her hips forward, backward, left, and right.
14:50Okay.
14:51So I need to be on the pelvis, at the gait belt, whatever works.
14:55If she goes too far back, my knees are going to be there to stop her.
14:58Okay.
14:59If she goes too far forward, she can use her hands to stop herself.
15:02Okay.
15:03So once we're in this position, I want you to find your center.
15:06Kind of lean back as far as you can without losing support.
15:11Okay.
15:12And just kind of shift around forward, backward, left and right.
15:16Do you feel how you can kind of find that center?
15:18Yeah.
15:19I don't know.
15:20It's hard to tell.
15:21I mean, I can feel my legs.
15:22Yeah, that's true.
15:23Okay.
15:24Okay.
15:25If she had a hard time, I could move her knees just a little bit further apart.
15:28Give her a little bit bigger base.
15:30If her hips get behind the knees, she's just going to fall right back so her bottom line
15:36is on her feet.
15:37Okay.
15:38So she wants to keep her hips just slightly ahead of her knees.
15:41Which means her arms are going to get tired really fast.
15:44Okay.
15:45In this position, we can do that cat and camel.
15:47Put your back kind of slouch right down.
15:50And then arch your back up like a mad cat.
15:52There you go.
15:53And back down again.
15:54And back up.
15:55We can do some shift and lift.
15:58We could have, you know, puzzle pieces or something in front of her to do.
16:02We could have a walker hands to the right some.
16:05So is that just to strengthen their back muscles?
16:09Yeah, to get those core muscles.
16:11I'm going to let go of you for a second.
16:12To get the core muscles.
16:13Because once she stands up, she's going to have to be able to put herself into, like,
16:18the Y ligament position and kind of adjust in different ways.
16:22So she's going to need some of those core muscles.
16:24So we don't have to worry about her head too much moving up and down like her neck.
16:27Correct.
16:28Yeah, we're looking more at the trunk itself.
16:31Can paraplegics be on their all fours?
16:34I mean...
16:35Once, yeah, this person will get used to knowing how far back they can go without losing their
16:39balance.
16:40Okay.
16:41If they go forward, once you're forward like this, they can support on their hands.
16:46If they go too far forward, you can see how they're just going to fall right down out of
16:51the quadruped position.
16:52So it's a balancing act.
16:54Okay?
16:55Alright, we're going to go straight from this position to the kneeling position.
17:00So watch carefully how I do this, okay?
17:03Because it's kind of hard to explain.
17:06Okay, patient.
17:07What I'm going to have you do is I'm going to put my knee really close to your nose.
17:11So just hold still for a second.
17:12It's okay.
17:13Okay.
17:14Alright.
17:15Okay.
17:16Now what I'm going to have you do is take this hand and put it on my knee.
17:19This one?
17:20Uh-huh.
17:21Now your other hand on my knee.
17:23Okay.
17:24Okay.
17:25And then go ahead.
17:26Yeah, like I want to fall for that.
17:27Okay.
17:28And I have you here so I can support you.
17:29Now put this hand on my shoulder.
17:31Put this hand on my other shoulder.
17:33And then I'm going to walk in the front.
17:35Okay.
17:36Okay.
17:37So I'm going to do that again in just a second so you can see it.
17:40Okay.
17:41Can that be seen okay?
17:42Uh-huh.
17:43Okay.
17:44In this position then, we're going to talk about that Y ligament.
17:47That's that Y ligament.
17:48So we want to really make sure that your hips are in front of your knees at this point.
17:52When you're standing up, your hips will be in front of your ankles.
17:55Okay.
17:56Get your braces out.
17:57Okay.
17:58In this position, we can do some shifting.
18:01Okay.
18:02And it's mostly going to be from the waist up.
18:05She'll be doing her shifting.
18:06Now we can do some shift and lift.
18:08What I want you to do, if you have both hands on my shoulders right now, I want you very gently
18:13to touch one of them on the top of my head and back to the shoulder.
18:17Okay.
18:18Good.
18:19Okay.
18:20So she can do some shift and lift.
18:22And with a real patient, go ahead and be the patient therapist for a second.
18:25Okay.
18:26So with a real patient, they're going to be on their Y ligaments.
18:29It's probably going to be, you know, this type of thing.
18:31They're going to be really frightened and scared to try to do that.
18:34Okay.
18:35That's why I'm gentle.
18:37Let me see here.
18:39We could also do, I could do some, you know, when I'm pushing on her.
18:43Go ahead and fight me.
18:44Don't let me push you.
18:45Okay.
18:46If that throws her off too much here, then I may not be able to do that one.
18:50Okay.
18:51There's not going to be a lot they can do in this position, but just kind of get used to
18:54using the hands, moving the hands around.
18:57Okay.
18:58To get back down, we're going to go the opposite of what we did before.
19:01Okay.
19:02I'm going to go to that side just so it can be seen on the camera a little bit better.
19:05So stay still for a minute.
19:06You can keep leaning on me.
19:07It's okay.
19:08I'm going to put my knee up.
19:10Yep.
19:11Put that hand down.
19:12Another hand.
19:13Okay.
19:14And then put that hand down on the floor.
19:16The other hand down.
19:17Okay.
19:18And then you can go down under the problem position or whatever.
19:21Okay?
19:22You want to see going up again just to do a feel for her or do you have it?
19:26Yeah.
19:27Okay.
19:28Okay.
19:29So go ahead and get on hands and knees again.
19:30Where you were.
19:31Okay.
19:32So I'm going to put my knee really close to your nose.
19:33Okay.
19:34So just warn the patient that that's coming.
19:37Put either hand.
19:38It doesn't matter which hand on my knee.
19:40Hand on the other.
19:41Okay.
19:42This hand on my shoulder.
19:43This hand on the other shoulder.
19:45And then I just walk around.
19:47That's really hard if I try not to use my lower extremity.
19:50Okay.
19:51All right.
19:52Yes.
19:53Do you have any patients with patients who are larger than therapists with that?
19:56Like you're supporting their weight temporarily?
20:00I should still be able to do that.
20:03If I feel like, you know, it's a really heavy patient or somebody you're under control of.
20:08I could get a chair.
20:10Maybe a wall right here with a chair next to it and they could use the chair to go up.
20:14So just have them close to a wall where the chair can be stabilized against the wall.
20:19Okay.
20:20Um.
20:21Go ahead and get back down on your tummy for a minute.
20:23We'll do one more thing.
20:24Hoist.
20:25All right.
20:26The other thing we're going to do is get from prone to hands and knees position.
20:31Okay.
20:32This is where we said we're going to do the jack knife.
20:35Okay.
20:36So when she does this, the whole idea, I'm going to hit where you can see me here.
20:41Um.
20:42You're going to push really hard with your hands.
20:44Not yet.
20:45Um.
20:46And when you push hard with your hands, you're going to flick your head forward.
20:49What that's going to do is it should make her spine bend slightly so that she can kind
20:55of get her hips up a little bit.
20:57And then she'll be able to push backward with her hands in order to get to the hands and
21:01knees position.
21:02Okay.
21:03Let me show what it's going to look like first.
21:06Because I just love getting up and down.
21:08Okay.
21:09So I'm in this position.
21:11We're going to end up in hands and knees.
21:13So we're starting here.
21:14Starting with my head up.
21:16Okay.
21:17I'm going to push really hard with my arms, my extensors.
21:20And at the same time that I flick my head forward, which causes my spine to flex.
21:25And that should make my hips come up a little bit.
21:27Okay.
21:28So it's going to go one, two, three.
21:29Go like that.
21:30And then I'm pushing backward.
21:32And then walking my hands back.
21:34Okay.
21:35Is that kind of like the worm, you know?
21:38I need to be the opposite of the worm.
21:41The opposite of the worm.
21:42Because the worm you kind of arch.
21:44This one you want to flex.
21:46Okay.
21:47Okay.
21:48To help her, I need to straddle the patient kind of be where I can get hold of her pelvis.
21:53Excuse my backside to you here.
21:56Are you ready?
21:57You kind of understand what we need to do?
21:58I think so, yeah.
21:59Okay.
22:00Now if the patient were sliding at all, what I can do is I can flex her foot up so it's
22:06kind of in a dorsiflex position there.
22:08And I can still help in this position here.
22:11Ready?
22:12So she doesn't just slide backward.
22:14Okay.
22:15On three.
22:16One, two, three.
22:17Good job.
22:18Okay.
22:19Once she's there, if I need to, I can get right there to keep her from sliding backward.
22:23Okay.
22:24Go ahead and go back down.
22:25Let's do it one more time just so they can see.
22:28Again, this is only necessary if she's sliding.
22:31So if it weren't necessary, I would just be in this position.
22:35Ready?
22:36On three.
22:37One, two, three.
22:39Okay.
22:40I would want to see the head flip forward a little bit more.
22:42Yeah.
22:43Okay.
22:44Go ahead and go back down.
22:45Okay.
22:46All right.
22:47You get the idea?
22:48All right.
22:49Look at this.
22:5010.50.
22:51Let's take a few minutes to practice.
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