Table 3 Details of intervention protocol that was administered
Rationale | Treatment activities |
|---|---|
Week 1 | |
To improve upper limb and trunk muscle strength | Core stability: Static abdominals, partial curls, and trunk rotations. PNF: Rhythmic initiation and active-assisted symmetrical UL and LL, D1, and D2 flexion-extension along with pelvic and scapular patterns in reclining positions in bed. Stretching: B/L hamstrings, calves, invertors groups of muscles. |
Promote limb coordination and gaze stabilization (continued in every week) | Frenkel’s exercises: Fowler’s position for ataxia in UL and LL movements in PNF diagonal patterns using auditory and visual cues starting involving single joint (assistance was provided if needed). Eyes open, active eye and head movements between two stationary targets as self-selected speed. |
Week 2 | |
Promote upper limb muscle strength and coordination | PNF patterns progressed to active and bilateral patterns in Fowler’s position. |
Improve postural control in sitting | RS and SR with minimal manual resistance in quadruped and bridge positions. |
Improve upper and lower limb coordination | Frenkel’s exercises in EOB position with minimal support (emphasizing on multiple/combination joint movements in functional patterns). |
To improve strength of intrinsic muscles of hand | Exercises to improve strength of intrinsic muscles of hand were incorporated. |
Week 3 | |
Promote dynamic sitting control and anticipatory postural reactions | Sitting EOB: Starting with midline and then multidirectional reach outs under supervision. RS and SR with manual resistance in sitting EOB. EOB: small amplitude perturbations in all four directions. |
To initiate and train sit to stand transition | Incorporated as per the biomechanical principles and facilitatory techniques of NDT. |
To impart lower limb weight bearing and proprioception in standing | Supported standing holding onto a walker for 5 min, keys points of control at bilateral hips and knees. |
Week 4 | |
Promote muscle strength | Progression with 1/2 kg weight cuffs for UL/LL muscles in mass functional patterns. |
To improve limb coordination | Frenkel’s exercises with dynamic reversals for limbs to further enhance strength and coordination. |
Initiate gait training with facilitation | Functional lower limb patterns required for gait in parallel bars with therapists support and cues. |