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These articles first appeared in
Different Strokes.
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March 2008
My physiotherapist has
recommended Pilates to
strengthen my core
muscles but the thought
of attending a class with
able bodied people fills
me with dread and
embarrassment, and
getting on and off the
floor is very difficult. Do you have any
advice?
Pilates has developed to assist in the
rehabilitation of injured solders from
WW1. It is focuses on improving posture,
flexibility and breathing using gentle
exercises and stretches.
It can be a particularly beneficial form of
exercise for stroke survivors as it’s
usually the postural muscles – back,
tummy, bottom and hip – that are
affected. Improvements in these muscles
can lead to improvements in walking. The
breathing exercises can assist with
shoulder pain and help arm recovery.
Some of the shoulder muscles are called
upon to assist breathing, but over a
longer period, this can cause pain and
interfere with recovery.
The exercises are not always performed
lying on the floor. Many exercises are done
sitting and standing. There are even special
Pilates exercise “benches” the user lies on.
Pilates can be done as part of a group, or with
one to one supervision. I would suggest visiting
a couple of classes and meeting the people
attending. You could find a group that is
welcoming and supportive. Indeed you may
even find a small group attended by fellow
stroke survivors.
December 2007
Eight months after my stroke
I started to have severe pain
in the affected foot when
standing or walking due to
my toes curling. The pain has
spread to the ball of my
foot and is excruciating -
is there anything I can do
to relieve it?
Toe curling is often due to the
individual either ‘gripping’ with
the toes to help with balance, or
trying to lift the foot at the ankle
using the ‘toe-lifting’ muscles
rather than the ‘foot-lifters’. In
both cases, the ball of the foot is
pushed down against the sole of
the shoe or floor and is painful.
Your Physiotherapist should be
able to show you stretches that
lengthen the muscles on
the underside of your foot.
They can refer you to a
Podiatrist (foot specialist)
who can provide you with
an insole for your shoe
with a soft pad (‘met-raise’)
under the ball of your foot
that lifts up this area and
relieves the pain.
They can also make you a
support from soft putty (like
blue tack) that goes under
and between your toes and
blocks the curling.
Alternatively, Botulinum
injections to the small
muscles of the foot can be a
very effective way to stop the
muscles from clawing.
July 2007
I get terrible clonus
(involuntary muscular
contractions) if I
cannot get my heel
down so anything I do
barefoot, like a
shower, is very tricky.
I've heard that in
America they
cut the
Achilles
tendon,
which seems
rather extreme - is
there anything else
that might help?
You have clearly
identified the cause of
these involuntary
muscular contractions
which is the difficulty
some stroke survivors
have in getting the heel
of their affected leg flat
on the ground. This is
most often due to
shortening and/ or
spasticity in the muscles
of the calf. Barefoot
standing puts additional
stress on these muscles as the heel is not
supported.
Clonus can occur in
standing and also in
sitting and can be
troublesome for
wheelchair users as their
affected foot "bounces"
off the foot plate.
Many people have found
that by wearing plastic
boating shoes in the
shower, they have
sufficient support for the
heel and the clonus
does not occur. I would
recommend seeking a
course of Physiotherapy
to learn how to
stretch these
muscles so you
can lower your
heel to the floor.
With regards to surgery,
a less extreme option
would be having the
affected muscles
injected with Botulinum
toxin, and wearing a
series of splints that put
increasing stretch on the
calf muscle until the heel
reaches the ground.
This often takes
between 3 and 6
months. This would
require a referral to a
Consultant Physician or
Neurologist who
specialises in such
treatment.
March 2007
I find that the toes
of my affected foot
catch on the ground
and sometimes
make me trip. I have
been told that I have
a ‘dropped foot’.
What is
this and
can it be
helped?
The muscles that
help lift your foot at
the ankle are often
weakened following a
stroke causing the
foot to ‘drop’ (floppy
foot).
In some individuals,
the muscles in their
calf can get very tight
which forces the foot
to point down (spastic
foot/ ankle).
A plastic ankle splint
(Ankle Foot Orthosis/AFO) can help keep
your ankle at the
correct angle so that
the foot does not
catch on the ground.
The thickness and
hence strength of the
AFO depends on
whether the foot is
floppy or spastic.
Other special devices
can help. The Foot-
Up uses an ankle
strap and a piece of
strong elastic fixed
under the
shoe laces to
lift the foot
more
naturally.
www.technologyinmotion.
com
The Odstock Drop-
Foot Stimulator uses
a discreet electrical
muscle stimulator
triggered by a small
switch under the
user’s heel to activate
and potentially
strengthen the weak
foot-lifting muscles.
www.odstockmedical.
com
December 2006
After seeing my physio today, I
have a very stiff left shoulder,
which has been trying to
compensate for a weak hand;
she has given me a
rotator cuff strengthening
band. Can you tell me how
this works?
Muscles work often in pairs.
For example, the muscle at
the front of your upper arm
brings bends your elbow.
The muscle at the back of
your arm straightens it.
After a stroke some muscles
become short and tight whilst the
opposite muscle becomes longer
and weaker. The strengthening band will enable you
to strengthen the weaker muscles
around your shoulder whilst
stretching the tighter muscles.
You might want to ask your
Physio about providing a
shoulder pulley. This has two
handles and a length of cord
that runs through a pulley
which can be hung over a
door. It would enable your
right hand to lift up and
stretch your affected left
shoulder. Another device
would be the Saeboglide which is a
plastic pole with a sliding sleeve that
would also enable you to stretch
your shoulder and
strengthen your grip.