" THE SIXTH SENSE- 25 EXERCISES TO TRAIN SIXTH SENSE (SENSE OF JOINT POSITION) IN NEUROLOGICAL CASES - BY DR. VANDANA PATEL (PT)

 

Proprioception is one’s own sense of position of his/ her own body parts.

Proprioceptive information protects the joint from damage caused by movement exceeding the normal physiology, range of motion, and helps determine the appropriate balance of forces acting on the body.

Proprioception is a precursor of good balance, coordination, agility and adequate function.

Balance is achieved first followed by coordination and finally agility. The order is important because agility depends upon coordination and coordination depends on balance. Balance exercises starts with the static activities and progresses to dynamic activities as the balance improves.

All exercises progress from simple to complex. Simple exercises include activities in which the patient has only one or two items of concentration. It also involves activities performed slowly and deliberately in controlled situations and environment. Distraction should be avoided in this stage.

Progression from simple to complex occurs only after mastering the simple exercises. Activities can be made more complex by performing simple activity at a faster pace or by requiring a more powerful output with control. Progression also made by performing more than one task simultaneously.  A task can become more complex when one of the feedback mechanisms is restricted, as when patient perform the simple activity with eyes closed.

 

 LOWER EXTREMITY EXERCISES AND PROGRESSION

1.   Static balance activities begin with stork stand with eyes open. The goal is to stork stand for 30 sec without touching elevated foot to the floor. If the patient has difficulty in this position then the patient can begin with stance in the tandem position with injured leg in back position. Progression can be made by eyes closed. 

2.  Balance activities progress from stork standing with eyes closed to stork standing on unstable surface such as mini-trampoline, foam rubber pad, or foam roller, eyes open and eyes closed.

3.   One can increase the difficulty by making the patient perform a distracting activity such as playing catch.

4.    After mastering static balance, patient can be progressed to dynamic balance. Activities such as running, lateral movements, and backwards movements can be included.

5.   More advanced dynamic activities such as jumping, cutting, twisting and pivoting can be included. They begin as low level activities, performed at slower speed with balance and control; which can then progressed to faster speed.

 

6.   Some activities like jumping can be started with the use of both legs and then progress to unilateral activities as the patient gains skill and confidence.

7.  In final stages of dynamic movements, the exercises are advanced to mimic specific sports situation.   

8.   Toe walking

9.   Heel walking

10. Cross body leg swings

11.  One leg balancing

12.  Forward – Backward leg swing with knee flexed and extended successively

13.   One leg squats

 

14. Runner’s pose: To do these, stand relaxed with erect body posture, with your feet roughly under your shoulders. Then, swing your right thigh ahead and upward until it is parallel with the floor (your leg should be flexed at the knee as you do this, so that the lower part of the leg should be pointing almost directly at the ground, i.e., it should be nearly perpendicular with the ground); as you swing your thigh ahead and up, simultaneously bring your left arm forward, as you would do during a normal running stride. 

Hold this position for a couple of seconds, while maintaining relaxed stability and balance, and then bring your right foot back to the ground and your left arm back to a relaxed position at your side. That will complete one pose.

15.   Toe skipping

16.   Heel skipping

17.   High bench step ups

18.   One leg balancing on rocker board

19.   Rocker board lunges

20.   One-leg balancing with perturbations

 

  UPPER EXTREMITY EXERCISES AND PROGRESSION

 

21. Initial open kinetic chain proprioceptive exercises can include proprioceptive neuromuscular facilitation rhythmic stabilisation. Rhythmic stabilisation can be progressed to closed kinetic chain exercises. In closed kinetic chain, the exercises can be progressed from co-contraction without movement, to movement on stable surface, to movement on an unstable surface.

22.   Activities can be performed using Swiss ball.

      -  Patient lies prone on a Swiss ball with feet off the floor. Begin with both hands on the floor and then raise the uninvolved arm to balance for 30 sec.

      - Patient lies prone on a table with lower extremities on the table and hands on the Swiss ball. The Swiss ball is rolled outwards and position is held for 30 sec.

      - Progression for both exercises can include the patients moving the ball using only the arms to propel the ball forward and backward and from side to side.

          - Further progression can include resistance to movement. 

 

23. In active repositioning, therapist moves the injured arm into a position and then returns to starting position. With eyes closed, patient attempts to position the arm as it was placed.

24. Passive repositioning occurs when therapist passively moves the patients uninvolved arm into a position and patient then moves the injured extremity into the same position. Progression from eyes open to eyes closed can be made. 

25. Proprioceptive neuromuscular facilitation exercises using manual resistance, tubing provide for strength and proprioceptive gains. Proprioceptive exercises start slowly and increase in speed as the patient is able to maintain control of the arm throughout the activity.

To know about the basics of proprioception do visit instagram page @tinyyears_physicaltherapy

 💙💙💙💙💙 

👂👀👃👅💁💪

 

 

 

 

References:

1.       Peggy A. Houglum, The ABCs of Proprioception; Therapeutic Exercises For Musculoskeletal Injuries; 2^nd edition; Chapter 8, 260-273

2.       Todd S. Ellenbecker, Prioprioception and Balance Training and Testing Following Injury; Knee Ligament Rehabilitation; 2000; Churchill Livingstone; Chapter 26, 361-383

3.       Darcy A. Hmphred, Interventions for clients with movement limitation; Neurological Rehabilitation; 5^th edition; Mosby Elsevier,2007; Chapter 9, 187-281