Hydrotherapy - Group Training Session

As I said in previous posts I have been working in a clinic with stroke patients. I had to make an exercise program that was applicable to groups of around 6-10 patients with varying symptoms and that would also allow easy modifiability if a patient is unable to do a certain exercise. Below is a copy of the exercise plan created:

Exercises	Physiotherapeutic problem	Goals	Things to be noticed (e.g. support words)
Gait: walking with long steps	- Paresis due to CVA - Limited ROM due to spasticity - Atrophy of unused musculature - Decreased single leg balance - Short steps - Unequal step length - lack of hip and knee flexion	- Single leg balance and weight bearing - increase step length - Facilitate movement of the paretic side - mobilize joints - build overall strength - Patient can step further outside BOS - Increase step length - Make step length more equal	Facilitate better rotation
Walking with high knees	- Paresis due to CVA - Decreased hip flexion (hip flexor muscle strength or motor neuron signal inhibition) - Decreased single leg stance	- Dynamically stretch the gluteal muscles   - improve hip flexor strength (iliopsoas) - facilitate use of motor neurons creating hip flexion - Single leg balance improvement - facilitate movement of the paretic side
Walking with kicking heel towards butt	- Decreased knee flexion - Decreased single leg balance - Decreased motor	- strengthen knee flexors - dynamic stretching of the quadriceps - Single leg stance improvement
Side stepping	- Weakened ad-/abductors - inability to control medio-lateral sway		-Gluteus medius and minimus & opposite hip adductors
Walking backwards	- Cognitive deficit - Weakened lower extremity - Inhibited recruitment patterns	- Provides a challenge to the patient cognitively - strengthen the quadriceps, hamstring, tibialis anterior and gastrocnemius	Extend back “lift up your chest”
Opposite knee to elbow	- Lack of single leg stance balance (inability to control weight shift well) - Weakened core Decreased coordination	- practice weight shift - strengthen the core - improve coordination while dual-tasking
Leg lifts	- Decreased hip flexor strength - decreased single leg stance balance time	- Strengthen iliopsoas and quadriceps - Give dual task to the patient to encourage balance - increase clearance by increasing hip flexion - increase single leg stance time	a.     Straight leg b.     Try to touch with hand
Rotation of the trunk	- Reduced mobility of trunk - Reduced motor output to trunk muscles - Weakened trunk muscles	- Improve ROM of the trunk - Activates and dynamically stretches (list on the right) - Resistance in the water strengthens the muscles on the right	·       - Rectus Abdominus ·       - External Obliques ·       - Internal Obliques ·       - Transversus Abdominus ·       - Quadratus Lumborum
Horizontal hand movement through water	- shortened pectoralis and rhomboids - limited ROM - weakened scapular musculature (serratus ant., levator scap, pectoralis min., rhomboids, trapezius)	Using reciprocal movements the pectoralis lengthens when the scapular retractors activate and visa versa - increase ROM - increase strength - improve scapulohumeral rhythm	a.     Front to back b.     Switch to other hand
Pool noodle @ side	- Weakened abductor/adductor muscles - Weakened rotator cuff muscles paretic side	- Strengthen latissimus dorsi & deltoid muscles - Strengthen teres major and supraspinatus	Adduction à abduction
Pool noodle @ front	- Weakened pectoralis, lat. dorsi and deltoid muscles	- Strengthen the listed muscles	Anteflexion à extension
Hip extension kicks from the bar	- Weakened gluteal muscles	- Improve gluteal strength
Swim kicks with noodle under armpits	- Disassociation of lower extremities	- Strengthen lower extremity muscles
Bicycle pedalling w/ noodle under armpits	- decreased aerobic endurance - decreased core strength	- Increase the patients aerobic capacity and core strength, which can be transferred to everyday life.
Water ai chi	- Reduced lower limb strength & ROM - Stressed from lifestyle change - Reduction in balance	- increase ROM  - Wide stance squat posture à isotonic strengthening - Relaxation of the patient - Improve balance
Stretching	- reduced mobility	- improve muscle length and mobility	- Hamstrings/ plantar flexors - quads/ hip flexors - sides - chest/ arm flexors. adduction