Functional

re-education
DR MAMTA CHAINANI ,
ASSISTANT PROFESSOR,
YMT COP
Understanding terminology

 Functional –
day –to-day functions performed by a person
 Re-education –
Educating something which is already known by an individual
 Functional Re-education
Person already knows the functions/ movements but is nit able to perform due
to disease or ailment
The motto is – ‘making a
man independent’
 How to start with ?

Case
A 45yr old man suffering from RT sided hemiplegia has been referred to our
physiotherapy department . He’s lying in bed since 1 week , not able to move in bed
or get up from bed. He lives with his wife at home with no children. His wife has a
full day 8 hrs job, she cooks and keeps breakfast and lunch at the side table besides
the bed so that he eats by himself with his left hand. She comes back and notices
that he hasn’t eaten at all and hence she comes to know that he was not able to get
up or turn in order to eat . She explains all this to you and asks for a solution.
HOW can we help ?
Functional Re-education methods

 On- mat
 On- re-education boards
 Using parallel bar
 Using suspension therapy
 Using hydrotherapy
 Functional re-education program

 The program consists of various activities / movements which are taught to

the patient to make him Independent .
 It consists of pre-ambulatory mat activities and ambulatory training
Starting with…
1. Rolling
9. Side sitting
2. Supine to side lying
3. Side lying to prone lying 10. Sitting
4. Prone to side lying
11. Kneeling
5. Side lying to supine
6. Elbow prone lying 12. Kneel sitting
7. Hand prone lying
13. Half kneeling
8. Elbow side lying-quadruped
position 14. Standing

15. Walking.
The sequence

 In the functional re-educational training, sequence of progressions of position like

the development of milestone of the child from lying to walking.
 Depends on the condition and level of his independence the program can be
designed.
 Depending on the condition,the sequence can be planned and multiple postures
may be overlapped.
 Sequence can be varied from one patient to another
How does it help?

It helps to…
 Improve coordination and balance.
 Increase strength and endurance of muscle.
 Increase pelvic stability.
 Increase the dynamic and static stability.
 Enhance the proprioceptive function.
 Improve postural stability.
 Improve the ambulatory skills.
The activities
Rolling activity – from supine to side lying
; bed/mat
 It requires total flexion-with-rotation of body which is initiated by head and neck
 There are four ways this activity can be performed.
 Selection of a particular way, depends on patient’s side of weakness, muscle effort and strength.
a. Trunk rotation facilitation by strong pull by left hand
using fixture at the side of bed.
Right side weak/ paralysed Vid 2
b. The right arm may used to pull, thrust or swing
across towards right hip
Left side affected/ weak/paralysed

 VID 4
c. The left leg can be hooked at the side of the bed and by
flexing and adducting can assist rotation of trunk and
pelvis of the opposite side
Right side affected
d. With the help of right side knee flexion and pressure
exerted from same foot can lift and push same side of
pelvis upward and over, hence rolling movent of other side
trunk can be completed

 Vid 4
Purpose and Use of rolling activity
 To assist in nursing procedures
 Patient gains measure of independence
 First part to start with various series of movements
Roll – supine to side-lying to prone and
reverse
 The unaffected arm initiates and gives direction to the movement, to come in
side lying position, when the movement is continued the prone position is
reached.
 Before attempting roll the therapist must check if the patient can tolerate the
position
 Pillows can be kept to the side of roll to control the movement
Purpose of roll
 Helps to combat and counteract the effects of long term recumbency in bed. as
from long time flexed positions in bed, patient gets to be in extension position
which can prevent limitation of extension movement
 the total roll over provides another and different activity for the patients who can
roll right over to prone position
Bridging
The position – from crook lying position the pelvis is lifted to form the keystone to an
arch the supports of which are the shoulders and the feet.
Technique of bridging

 The stability of the legs in crook position can be helped with until it is established,
with aids such as sandbags, footboard or wall.

 By exerting downward pressure on the patient’s knees and at the same time in the
direction of the thighs towards hip joints, the therapist facilitates movement of
extension through the legs to the hips and lower back to lift the buttocks off the
bed.

 vid
Purpose of bridging
 For bed-bound patient, bridging makes bedpan routine easier for everyone.

 By lifting off buttocks from bed, helps to relieve pressure from pressure sensitive
areas.

 Extensibility of hips and lumbar regions are combined to combat the long term effects
of the flexor situations and efficiency of extensor muscles is maintained

 Makes easier for dressing activities e.g. pulling up pants.

 Forearm support side lying

 This position is reached by rolling to one side and then pushing up with the elbow to
support the upper trunk with the whole forearm
Purpose of forearm support side lying

 The position is a step / enroute from lying to sitting

 Used for reaching the bed side table without sitting up completely

 Used outdoors or on floor for reading or enjoying the view

 Pressure on shoulder region stimulates activity in the shoulder region

Prone lying with forearm support
 From prone position to forearm support

 Vid
 Purpose and uses of prone lying with
forearm support
 Useful for counteracting stooping position when there is minimal loss of extensibility of
head and trunk.

 Arm supports in this position stimulates all muscles of shoulder region to stabilise
position. Rocking activity in this position can be useful for some shoulder conditions

 Extensibility of hip joints and lumbar spine is maintained

 Creeping movements which propel the body along floor using arms can be commenced
for other methods of ambulation
Sitting – on side of the mat /bed
Hitching and Hiking

Ability to take weight on the arms, lift and move the pelvis is essential for transfers
for wheelchair patients, e.g from bed to chair
Prone kneeling

Prone kneeling on the four foot position may be reached from prone lying when
flexion is initiated by bending the head forward to put chin on the chest, then by
walking the hands backwards as the hips and knees bend.
Purpose &uses

 It is a starting position for ‘crawling’ which gives patient the mobility at floor
level

 Partial weight bearing through the hip joints is a step towards weight bearing in
erect positions

 Partial weight bearing on the arms stimulates activity in the shoulder area which
leads to development of strength and mobility.
Crawling

 When balance and stability has been established in prone kneeling patients can
begin to practice lifting a hand or knee from the floor to balance ‘on three legs’

 Crawling can be done in any chosen direction e.g forwards., backwards, sideways