Tratamiento del pié en fisioterapia neurológica

The foot is an area of ​​the body of extreme importance. It is seen as the base that sustains our whole body when we are standing or when we walk and an alteration in one or both feet induces alterations of postural control, that is, balance and consequently in gait.
In the neurological patient, Multiple Sclerosis, Friedreich’s Ataxia, stroke, among other pathologies of the nervous system, it is common to find alterations of the foot, such as:

  • Structural alterations: loss of the plantar arch, claw toes, etc.
  • Hypertonia or Spasticity: foot in equine or equine-varus
  • Hipotonia: flat foot
  • Joint instability:
  • Sensitivity: hyperreflexia, hypesthesia, etc.

By presenting alterations of the foot the patient can experience the reduction of balance reactions, known as ankle balance strategy, and therefore see their balance compromised. It is known that to improve the recruitment of these equilibrium reactions so necessary to standing posture, it is advisable to perform a structural preparation work such as:

  • Liberation of amplitudes or joint ranges, often limited by spasticity and often called equine foot;
  • Muscle recruitment and its potentiation, especially in the foot lift muscles;
  • Reciprocal innervation and coordination between muscle groups of the foot,
  • Among others

The preparation of the foot as a base of support and support of the body also includes a sensitive approach, that is, improving the sensitivity of the joint complex of the foot. The foot contact with the ground and therefore must present tactile or tactile capacity preserved. Kinesthesia, proprioception or deep sensitivity are also crucial to balance and gait. At all times we should be able to identify the weight that supports our joints of the feet and compare them to know if we are more or less inclined to one side or another, in front or behind.
Finally, the load. The ankle-foot joint complex is composed of large and strong joints, capable of receiving and supporting body weight. However, it is not just that the joints support the weight, but that the muscular system is able to keep them aligned in order to guarantee our balance in any situation (inside and outside the home, barefoot or with shoes, standing or moving, with light or low light, etc.).
As you can see, from the physiotherapy we have many tools to work the foot and improve the balance, either reducing spasticity and equine foot, strengthening the muscles that raise the foot or improving their sensitive perception.
Soon we will talk about how the foot behaves during walking and how physiotherapy can help patients with pathologies or neurological diseases.

El impacto de la discapacidad en la vida sexual de los individuos con enfermedades neurológicas

Individuals with acquired neurological diseases (such as stroke, head trauma, spinal cord injury, etc.) suddenly see their lives limited by alterations and functional, motor, sensory, and cognitive problems, among others. In addition to these limitations that on their own lead to a disability, there are other affected areas such as family, work, social life and even sexuality.
The motor, sensory, emotional and cognitive disability of patients with neurological disorders interrupts the sexual life of those affected and their respective partners and spouses.
The therapists of the rehabilitation team of the Neurorehabilitation Clinic of Sant Cugat del Vallés (Barcelona) recommend that patients overcome the tabu, shyness, shame and talk about this issue with a doctor, neurologist, psychologist, physiotherapist and even social worker. Different professionals can help in the search of strategies and therapeutic options (pharmacological and non-pharmacological) to face problems related to sexual life (erection, ejaculation, fertility, orgasm, reproduction, etc.).
Neurological patients, whether due to brain or spinal cord disease, may experience different symptoms or alterations that affect sexual activity. For example, the sensitive alteration can affect aspects related to the excitement or pleasure sensation, the motor alteration can affect the aspects related to the erection or ejaculation and even emotional alterations can influence the sexual libido and behavior.
Communication can also be a limiting factor to address the issue. Patients with aphasia (comprehension, expression, mixed, others) may have difficulty expressing their concern about the sexual issue, either with rehabilitation professionals, or at home with their partners. In a similar way it happens at an emotional level. Patients usually see their life changed completely, their body is not the same, they feel useless, unwanted, insecure of their family role and their position as a couple. Thus, we must assume that any type of disability can lead to an interruption and limitation in your sex life.
Nowadays you can find several therapeutic strategies apart from the help and impulse that is received by the professionals (psychologist, occupational therapist, physiotherapist). Some of the best known options are sensory and sensory stimulation, neuroprosthetic implantation, sensitive substitution therapy, transcranial electrostimulation, vibro-stimulation among others.
There are strategies for men and women equalizing the importance of sexual life in both genders, at different ages and for people and couples with different needs.
With this, in the Neurorehabilitation Clinic, we do not forget that a patient is a person with needs and demands in different areas. One of the objectives as a therapeutic team is to help the individual and his family achieve a better quality of life.

OCCUPATIONAL THERAPY AT HOME

Occupational therapy is a socio-sanitary discipline that focuses on the treatment of people who have a deficit in the performance of their daily activities and occupations, from the most basic such as grooming or clothing, to more complex tasks such as money management or the care of the home. Its purpose is to improve the autonomy of the person, and improve the quality of life.

An intervention from occupational therapy at home allows us to transfer to daily life all the objectives that are worked on in physiotherapy, neuropsychology and speech therapy sessions. In each person’s own environment it will be possible to adapt to the individual and personal needs of each one.

At home we analyze the activities that are carried out in order to detect difficulties or abilities and skills. We also analyze the current role that each one develops in their environment. Many times after suffering a brain damage the person changes the roles of home and happens to depend on a third person to perform their daily activities. These roles, instead of adapting to advances in rehabilitation, tend to become chronic and family members adopt the role of caregiver and the patient has a more passive role in the basic activities of cleanliness and self-care and in household chores.

 


For this reason, in the Neurorehabilitation Clinic we believe that it is very important to be able to make a TO intervention to encourage, help and train the different tasks and daily activities, to improve the autonomy and to change the role of the affected person to be more active and participative. Advice and recommendations are given on changes and adaptations that facilitate accessibility and mobility within the home. An example of a TO session at home could be participating in the kitchen. From choosing the dinner looking at what is in the fridge, prepare the food (clean, cut food and cook) all training the use and management of devices that facilitate the realization of the activity (as would be a kitchen table for hemiplegia) . Throughout this process the person works on motor, neuropsychological aspects (such as remembering the steps to be taken, preventing what we need to cook, being alert to unexpected events or organizing time and space), aspects of speech therapy (oral language, reading, comprehension) of language) and emotional aspects. Other examples would be to put and empty the dishwasher or the washing machine and even leave home alone and be able to move around the neighborhood (on foot or in a wheelchair) autonomously and safely.

WHAT DO VIDEOCONSOLES BRING US IN THE FIELD OF NEUROREHABILITATION?

Current video games have developed a technological evolution that allows their use, not only in the field of leisure, but also for therapeutic purposes.

Thanks to the capture of movements by the Kinect system allows users to control and interact with the console without having to have physical contact with a traditional video game controller, through a natural user interface that recognizes gestures, voice commands and objects and images. The video game offers a virtual reality that allows you to create an avatar of the person who introduces you to the game and stimulates it physically, cognitively and sensorially.

In the field of motor rehabilitation, several studies have been carried out that show favorable results in neurological affectations.

The latest-generation video consoles (Nintendo Wii ®, Kinect for Microsoft Xbox ®) allow you to work on balance, gait, functionality and upper-extremity activity and tolerance to effort. These mechanisms allow us to perform objective assessments of equilibrium, postural control, and upper extremity mobility.

The advantages of these systems is that combined with the conventional rehabilitation allows to base the therapy in the principles of motor learning: active participation of the patient physically and cognitively, repetitions of functional movements, to give a feedback visual, auditory and constant proprioceptive of the movements performed and maintain an interest and motivation while performing the tasks.

One drawback of the game consoles is the level of difficulty that often involves the neurological patient, by implementing specific software for cognitive or motor neurorehabilitation. Several examples of these software are: Neuroathome®, Biotrak®, VirtualRehab®, SONRIE®, Neurorehabilitation Training Toolkit® o Rehabcity.

LSVT exercise program for Parkinson treatment

Recently, we have made an interesting discovery for the treatment of patients with Parkinson’s. It is an exercise program called LSVT (Lee Silverman Voice Treatment). Created initially with the aim of improving motor disorders related to speech (LSVT LOUD), recently it has been extended to address the treatment of limbs (LSVT BIG) of patients with Parkinson’s.

The objectives of the therapy are:

  • Increase the range of movement: volume at the level of speech and wider movements at the level of the extremities (arms and legs).
  • Sensory Recalibration: to help patients recognize movements with greater amplitude as normal.
  • Exercises can be performed autonomously and allow attention to action to be trained, which facilitates the long-term maintenance of the treatment results.
  • The intensity in which this therapy is performed drives the mechanisms of neuroplasticity and motor learning.

 

In the following link you can see an example of LSGT BIG exercises.

 

Whether you are therapists or patients, if you are interested in receiving training in LSVT therapy for the treatment of motor symptoms of Parkinson’s do not hesitate to contact the Neurorehabilitation Clinic.

Virtual Reality in Neurorehabilitation

Virtual reality is a technological system that has gained ground in neurological rehabilitation in recent years, although it has begun to develop in the 60s. Virtual Reality is used to artificially create sensory information from an interactive virtual environment being perceived as real and thus favoring exploration, commitment, curiosity and motivation.

In the neurological clinic of physiotherapy in Sant Cugat del Valles, we integrate Virtual Reality systems in neurorehabilitation of patients with stroke, spinal cord injury, multiple sclerosis and other neurological diseases. The objective of their integration is to increase the effectiveness of the treatment according to the scientific evidence, to increase the adherence of the treatment by the users and to provide opportunities and sensations not achieved by conventional methods.

In the field of the rehabilitation of diseases and especially of the deficits caused by the injuries of the nervous system, an important development of different systems and tools is observed. Many of these tools are focused on the treatment of the cognitive system (example: alteration of memory), motor system (example: leg movement) and sensory system (example: neuropathic pain).

An example of the application of Virtual Reality systems in the rehabilitation of patients in this neurological center is in alteration of balance. The alteration of balance can lead to a reduction in the practice of physical and ambulatory activity, limiting participation in activities of daily life and deterioration of the quality of life. With a virtual reality system, the therapist can provide the patient with the right environment for the work of balance without exposing him to risks. In this case activating the visuo-vestibular system involved in the maintenance of balance, gait etc.

There are several published studies that conclude that interventions based on Virtual Reality are effective in the treatment of balance and gait deficit after the Cerebral Vascular Accident or Stroke. However, intervention protocols can not be constructed since the therapist has the fundamental role of assessing and developing the most appropriate therapeutic plan for each patient.

Dos ejercicios que debes realizar si tienes un pie equino

If you have an equine foot due to your neurological injury, here are some tips so you can prevent capsular retractions, joint stiffness and muscle shortening. In the case that you already have them, it will be a matter of spending more time, but following these recommendations you could improve the contact of your foot with the ground and get better mobility for your foot.

As you should know, due to your joint misalignment, when you support the foot while standing or walking, there is a large part of the weight of the body that falls on the tip and the lateral part of the foot. Therefore what you should work is the support of the heel and the internal part of it.

You must do the exercises barefoot to allow the foot contact with a flat surface and control the supports well.

  • First exercise: place the flat foot on the floor and bend the knees keeping the heel in contact with the ground. Direct the knees inward if you notice that you lack support on the inside of the foot.
  • Second exercise: get yourself a wedge with a slight inclination and stand on top. A good idea is to place it in a place in your house where you spend a few minutes a day, in the basin sink, for example. In this way you will ensure you perform the exercise daily.

If you have difficulties to perform these exercises do not hesitate to contact the physiotherapists of the Nerorehabilitación Clinic to make an assessment and we can help you in the realization of them.

Formación profesional

The Neurorehabilitation Clinic of Sant Cugat del Vallés, Barcelona, ​​apart from being specialized in the treatment of patients with neurological diseases, is also a Training Center for Healthcare Professionals.
As a training center for professionals in the area of ​​neurological rehabilitation (physiotherapy, occupational therapy, speech therapy and psychology), the Neurorehabilitation Clinic ensures quality training accredited and controlled by the Commission for Continuing Education of the Health System of the Ministry of Health.
Controlled and well-planned training favors scientific progress in the field of neurorehabilitation, providing not only scientific knowledge but also new technical skills to the professionals in question, be they physiotherapists, occupational therapists, speech therapists or psychologists.
With the training service, courses, seminars and workshops for therapists, the Neurorehabilitation Clinic aims to provide conditions to update the knowledge of professionals, improve the qualifications of the staff of health institutions that receive patients with neurological diseases or pathologies (Stroke, Sclerosis Multiple, Parkinson’s disease, etc.). Apart from taking into account the theoretical knowledge and application of techniques and treatment approaches, the organization of the Neurorehabilitation Clinic seeks to provide professionals with skills for the correct recognition and assessment of patients and the development of clinical reasoning.

The Neurorehabilitation Clinic looks for specialized training and for that it organizes courses of special interest to the rehabilitation professions such as:

  • Training courses in the Bobath Concept for physiotherapists and occupational therapists
  • Scapular motor control course for physiotherapists and occupational therapists
  • Upper limb rehabilitation training course in neurological patients
  • Neuropsychology workshop for physiotherapists, occupational therapists and speech therapists
  • Mirror therapy workshop in the neurological patient
  • Course of postural control and balance in the neurological patient
  • Course of manual therapy for neurological patients addressed to physiotherapists
  • Workshop on the use of accessible technology in neurorehabilitation
  • Among others

If you are active in neurological rehabilitation or have special interest in this area, consult our training programs or contact us.