Physical therapy for a hemiplegic patient with a tendency to fall when gargling in the sitting position

Abstract

We performed physical therapy for a patient with left hemiplegia after cerebral infarction. The patient had reduced safety and stability because of a tendency to fall to the left when gargling while seated in a wheelchair. The patient’s wheelchair sitting position showed posterior tilt of the pelvis due to poor left hip flexion, with further depression of the pelvis on the left and leftward tilt of the trunk on abduction of the left hip. Therefore, the patient’s wheelchair sitting position showed excessive leaning into the backrest on the left. The patient was able to hold water in his mouth in this position, but when he spat out the water, the thoracic vertebrae showed excessive flexion due to poor left hip flexion. Thus, the patient fell to the left when the trunk lifted away from the backrest, compromising safety and stability in the sitting position. To enable the patient to gargle safely, we trained him to keep a symmetrical sitting position, with forward tilt of the pelvis using hip flexion while preparing to spit. Because the patient had cognitive impairment, physical therapy was challenging. By involving the family, we were able to perform physical therapy. As a result, the patient was able to keep a symmetrical wheelchair sitting position with improved safety when gargling, despite the challenge posed by the patient’s cognitive impairment.