lower motor neurone paraplegic

[spandanphysio]

hello everyone, I have case of fracture L1, 2 and a half years back. He has still weak glutei grade 3 in right 2++ in left. Also has only tibialis anterior in foot 5 in right side 3+ in left side. Others muscles are functionally normal. I want to achieve independent standing for him. Which ex's specially yo recommended to strengthen plantar flexors which have 1++ in both side. and glutei. Is it possible after 2 and half years to strengthen such extent? And yes also needed your valuable solutions for pelvic floor strengthening.regards..

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[physiobob]

If he has such weak calf muscles then he needs orthoses for both ankles., either AFO or SAFO's. Once you can give him stability there perhaps work in sitting to begin with. This might be on a ball. You could also do reaching tasks using a standing frame or tilt table to stimulate some trunk/gluteal activity.

[gcoe]

30 months is quite a long time in terms of recovery. He may have some limited potential if strengthening exercises haven't already been applied. However I think further improvement is likely be limited. A trial of intensive strengthening would tell you. Using FES in combinatin with volitional effort for the weaker muscles - particularly the plantar flexors might be worth trying. However even if you make some strength gain it may not be big enough to translate to a functional gain.

However at this stage I would be thinking of making therapy very functionally oriented with task oriented training. Given what you describe he should be able to manage some level of independent standing already at least of a relatively high surface. He should be managing some sort of walking at least with an aide as you say most muscles in the are of normal strength except for the hip extensors and plantar flexors. Is he? If not perhaps you need to go back and reassess his lower limb strength in more detail

[spandanphysio]

thanx both of u for ur kind rply.yes physiobob i tried afos he is able to stand with it.but patient isn't ready pychologically for it.i advise him that y for medial wedge support atleast in shoe.that yet he has not done.hw can i stimulate purely gluteal activitiy on ball and standing,pls if u can deacribe here as there is pblm of trick movts whn i trying to activate glutei.i m doing manual resisted in side lying backward and side walk to strenghen extensors and abductors.and yes gcoe right now he is able to walk idnipendentlay with slight wedling gait but can't maintain erect position more than 5- 10 seeconds.i also notice increased lumbar lordosis moderately nowdays .he walks with thin hockey stick.drives car manages all adl avtivities well.main pblm is unable to stand indipendantly and walk for long distance.he has weak glutei(3 in righr 2++ in left),abductors(3++ in right,2++ in left) all other hip muscle have normal power.in foot only tibialis anterior and calf muscle r active Ti.An(4+ in right,3 inleft),calf (2 right,2+ left).he is able to maintain kneel standing position comfor tablely.kindy ad u r valuable suggestion and yes any light weight ,cosmetic orthosis available in u r region kindy guide for it as patient is affortable.