April 2005

For Therapists

Therapeutic Benefits of Forward Flexion
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Encouraging forward flexion is extremely beneficial to stroke survivors and can be used during any stage of recovery. I begin as soon as my patient is medically stable.

It lays the foundation for better function including transfers, sit to stand and self care. It also encourages better ROM of the hips and shoulders.

Begin by providing a good base of support with both feet flat on the floor. Position yourself on their weak side, resting your hand on their scapula or trunk.

Ask them to come forward, only to the point of any discomfort and NO further. Do not do this activity if they have had a hip replacement, other orthopedic considerations or a history of back pain.

Three or four times is usually enough. If your patient is fearful or can't flex as far forward, a therapy ball can be helpful.

Giving your patient a goal such as "reach for your shoe laces" can also make a difference. Making this a part of each treatment sessions will help your patient be more functional and less fearful.

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April 2005

For Families & Caregivers

One-Handed Shoe Tying
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"How do you tie shoes using just one hand?"

Here is an easy way. Learning one handed shoe tying gives stroke survivors the option of wearing any number of shoes in their closet. This technique eliminates the need for special Velcro shoes. You can use tennis shoes or any kind of shoe that has eyelets and laces.

First prepare the shoe for the stroke survivor. Unlace the shoe completely. Make a simple knot at one end and place it through the hole on the outside of the shoe. Put the knot on the same side as their strong side (the hand they'll be using to tie the laces).

Next, lace the shoes by going from the 'top down through' (for a hole corresponding on the other side). And from 'under up through' when going diagonally to the next level of eyelet.

At the top, go through the last hole a second time, to keep the shoe securely on the foot all day long. Now the shoe is ready to give the stroke survivor.

1. Teach them to make a simple loop (as in the letter 'c') starting up toward the ankle and then down toward the toe of the shoe.

2. Tuck the lace (toward the toe) under laces which span the last two holes at the top of the shoe.

3. Pull and cinch toward the strong side.

4. If the laces are too long, you can cut the laces. Just be sure to cut the end where the knot is, so the 'working' end doesn't become frayed.

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