What rehabilitation approach is recommended for a patient to achieve a split stance in 7 months?

Rehabilitation Approach for Achieving Split Stance in 7 Months

A goal-based, progressive rehabilitation program that incorporates balance training, strength exercises, and functional mobility is recommended to achieve split stance within 7 months.

Assessment and Initial Phase

Initial Assessment

• Perform a comprehensive mobility assessment using validated tools:
  • Timed Up and Go (TUG) test (>12 seconds indicates increased fall risk) 1
  • 4-Stage Balance Test (inability to hold tandem stand for 10 seconds indicates fall risk) 1
  • Evaluate current weight-bearing capacity and gait pattern

Early Phase (Weeks 1-4)

• Begin with immediate protected weight bearing if medically cleared 1
• Start with low-intensity exercises (40-50% of maximum capacity) until 10-15 minutes of continuous exercise can be achieved 1
• Focus on:
  • Isometric quadriceps exercises for muscle reactivation 1
  • Electrostimulation for quadriceps re-education if needed 1
  • Proper positioning and splinting to preserve joint mobility 1
  • Closed kinetic chain exercises to improve stability 1

Improvement Phase (Weeks 5-16)

Progressive Loading (Weeks 5-8)

• Gradually increase exercise intensity to 50-60% of maximum capacity 1
• Extend exercise duration to 15-20 minutes per session 1
• Implement:
  • Concentric and eccentric strengthening exercises 1
  • Balance training with visual feedback 1
  • Weight shifting exercises in parallel stance

Advanced Loading (Weeks 9-16)

• Further increase intensity to 60-70% of maximum capacity 1
• Extend exercise duration to 20-30 minutes 1
• Progress to:
  • Dynamic balance activities with visual feedback 1
  • Semi-tandem stance practice (working toward 10-second holds) 1
  • Cycle training to improve standing balance 1
  • Resistive muscle training (3 sets of 8-10 repetitions at 50-70% of 1 repetition maximum) 1

Functional Phase (Weeks 17-28)

Split Stance Training (Weeks 17-20)

• Implement specific split stance exercises:
  • Static split stance holds with support
  • Weight shifting in split stance position
  • Gradual reduction of support during split stance

Functional Integration (Weeks 21-28)

• Apply the FITT-PRO approach (Frequency, Intensity, Type, Time, and Progression) 1
• Practice functional activities in split stance position:
  • Reaching tasks while maintaining split stance
  • Controlled stepping forward and backward
  • Direction changes while in split stance

Exercise Parameters

Frequency

• 3-5 sessions per week for patients with functional capacity >5 METS 1
• Daily sessions for patients with lower functional capacity 1

Duration

• Progress from 10-15 minutes initially to 30 minutes per session 1
• Include 3-4 repetitions for each stretch, holding static stretches for 10-30 seconds 1

Intensity

• Follow the "traffic-light method" of progression through phases 1
• Advance to next phase only when specific goals of previous phase are achieved 1
• Use Borg Rate of Perceived Exertion scale to monitor intensity (aim for 12-14, "somewhat difficult") 1

Important Considerations

Safety Precautions

• Ensure correct gait pattern during weight bearing 1
• Monitor for pain, effusion, or increased temperature during and after exercise 1
• Maintain normal breathing patterns during exercises 1

Progression Criteria

• Progress in order of: duration, then frequency, then intensity 1
• Readjust training intensity when patient can perform at decreased perceived exertion 1
• Continue rehabilitation for the full 7 months to ensure goal achievement 1

Common Pitfalls to Avoid

• Progressing too quickly can lead to setbacks or injury
• Neglecting proper form during exercises reduces effectiveness
• Failing to continue maintenance exercises after achieving split stance may result in regression 2
• Non-compliance with prescribed protocols increases risk of complications 1

By following this structured, progressive rehabilitation approach, patients can systematically work toward achieving a split stance within the 7-month timeframe while minimizing the risk of complications and optimizing functional outcomes.