• 28 year old man

  • acute cerebral hemorrhage

  • slight reduction in tactile input

Casus: Hemiplegia left

Herman’s story

Herman was rushed to hospital 6 weeks ago because of acute cerebral hemorrhage. Initially he experienced a paresis on the entire left side and there was a slight neglect along the affected side. Sensitivity studies showed only a slight decrease in tactile input.

Herman made fairly quick progress and now already sits independently from a supine position. Axial sitting balance is currently insufficient. Herman sometimes dares to sink away and does not seem to be fully aware of this. With verbal instruction, however, he can relatively easily bring himself to the correct posture. Due to a shortage of proprioception, he still remains somewhat dependent on this feedback.

From sitting to standing you can manage completely independently, although Herman can sometimes have some difficulties in keeping the balance. With insufficient concentration, he may still suffer from retropulsion. Standing independently succeeds (with sufficient attention) even for short periods.

Goals

  • Improve static balance (in both standing and sitting)

  • Improve strength and endurance

  • Applying relaxation therapy and techniques

  • Extend Range of Motion (ROM) left side

  • Automation is in position (Z-S)

  • Improve proprioception

Integration of Matti inside therapy

How can Matti support Herman?

Using the Heatmap and Center of Mass tool, Herman’s posture (sitting and standing) and balance can be visualized for both the therapist and Herman himself. In this way, the abstract concept of balance can be made more concrete and better practiced.

Whack-a-light

See how the game is played and where the settings are adjusted to suit your patient.

  • Execution: Dropouts (Step Out Mode)

  • To help improve endurance, the overall Time Limit can be increased progressively.

  • To help improve Herman’s ROM, the Mole Distance can be increased slowly. Since this setting focuses on only one side, the degrees of movement of the hip can be built up gradually.

  • The Button Hold Time can be increased gently with each increase in the Mole Distance to improve the static balance on the affected side in addition to the ROM.

Balance Orchestra

See how the game is played and where the settings are adjusted to suit your patient.

  • Execution: in a Sit, Stand or with Hands (four-point position)

  • Again the Time Limit can be increased to stimulate endurance. A longer practice time results in a longer stance phase and a longer focus on static balance and control and sense of balance.

  • By increasing the Weight Range, control of the weight over both supports can be better practiced. This further stimulates static balancing skills and targeted movement control. A higher weight range will expect the center of gravity to move further to either side. This setting can be gradually adjusted to allow Herman to step further out of his “comfort zone” and help move the support from the right side to the center. By adjusting the Target Range, any increase in the weight range can be practiced gradually. Raising this slider will make the game easier.

  • Via the Bias setting you can gradually work towards the midpoint balance. By bringing this setting closer to zero you can practice step by step.

  • The Heatmap can always be consulted here to evaluate the pressure distribution over the feet.

Twister

See how the game is played and where the settings are adjusted to suit your patient.

  • Execution: two buttons: Hands (Upper Limb Exercise) and Feet (Static Balance). With four buttons you practice the four-point position.

  • The main way to increase the difficulty is to increase the Maximum Button Distance. This value should provide a good challenge without making the game impossible.

  • During this exercise, the Heatmap can certainly come in handy to see if Herman puts enough pressure on the buttons or not. This exercise can look at the support on both the hands and the knees or feet (depending on the starting position).

Simon says

See how the game is played and where the settings are adjusted to suit your patient.

  • Execution: Dropouts

  • Increasing the Time Limit will lead to longer exercise, which will improve overall endurance.

  • By adjusting the Sequence settings, the game can challenge Herman cognitively, while progressively helping to increase his ROM. By adjusting the position of the buttons or using the standard setup, Herman is practiced in all quadrants. Specific degrees of movement can be further stimulated by using the linear button positions.