Passive Movements

[mattd8a]

Anybody actually recommend any evidenced based practice for passive movements prior to gait retraining or just to alleviate lower limb spasticity following CVA.

It seems to be such common practice but most people are not convincing in their arguments for it.

"It seems to work" isn't convincing anybody else apart from physios!!!!!

Top tips appreciated

Matt

[Gawaine]

i haven't read much literature on the importance of stretching the lower limbs... i have found some good stuff on the importance of stretching the upper extremity, particularly the internal rotators of the shoulder...

but it IS common knowledge that we must maintain flexibility and certain specific ranges of motion if we want to have our patients be able to ambulate with a normal gait pattern...
so consider this: i stretch and mobilize an ankle that has a 5 degree plantarflexion contracture... i gain 10 degrees-- so it now has passive range of motion of 5 degrees dorsiflexion... now what?? just forget about it?? we ALL know that it'll end up losing what we've gained if we just let the patient go about their day... so obviously we need to use splinting, casting, etc, to our advantage... placing this foot into an ankle-foot-orthotic would then be ideal...
now, i don't really think i need a research article to tell me that maintaining a 0-5 degree dorsiflexion range is better than a 5 degree plantarflexion contracture....

sometimes people worry so much about the literature and evidence-based practices... what about simple logic??


patrick, MPT

[clarett]

Passive movements aren't used for alleviating spasticity - they simply don't. What they do as Gawaine mentioned is maintain range (hopefully - rather than dealing with it retroactively). I believe that there is quite a lot of literature on stretching retroactively - most of it controversial and based around the question of how long you need to do it for it to be effective - try using stretching as one of the search words.
As for using them prior to gait retraining I'm not sure quite what you're asking - in the same session, just before gait training or in the build up toward being able to start gait training?