Article:  Stroke Rehabilitiation Using a Fitter

by Margaret Johnstone FCSP, Scotland

Fitter can assist in a planned program of stroke rehabilitation. In early stroke rehabilitation the early stroke patterns must be advanced until reflexes are re-intgrated into cortical control. After the client is well versed in spasticity inhibiting and rolling patterns, progress to kneeling and crawling activities. Then, using Fitter and the necessary air splint, assign specialized exercises to assist recovery from the brain damage of stroke. To limit the development of spasticity the antigravity muscles must be inhibited; the forearm and hand must be used in extension patterns, and the rest of the body used in flexion patterns.

The following photos and illustrations show some of the very useful exercises I have used with stroke damaged patients. Many of the patients are quite capable of using Fitter in kneeling and sitting positions but with some I would not risk balanced standing and rocking from side to side. The boy shown here took several weeks to master this exercise after rehabilitation was started. He hoped to get back to skiing.

I have written a handbook for therapists called Therapy for stroke, Building On Experience published by Churchill Livingstone, Edinburgh, London, Melbourne, New York and Tokyo, 1991.* It gives an introduction to the pressured garments while while presenting a practical way to advance through motor and sensory loss.

1. Crawling Position

With air splints in position to inhibit flexor tone in the forearm/hand and with a small inflatable boot to inhibit the extension of the ankle, Fitter is used to allow the client to push the arm forward in the required inhibiting position. Tension (or resistance) against this forward thrust is given by the weakest of the four tension cords hooked underneath Fitter. As weight is withdrawn from the forward thrust, Fitter’s resistance then assists the arm back into the starting position. This is a valuable exercise with ease of repetition.

2. Side to Side Thrust

With the legs in the inhibiting flexion pattern and keeping the trunk straight, laterally shift on Fitter from the knees to the trunk. This combines lateral trunk stretching with a useful shoulder exercise. The involved hand may require a stabilizing strap over Fitter’s platform to keep the hand in proper position.

3. Sitting Position

Sitting on Fitter offers several ways of presenting valuable exercise. As illustrated here pulling the body weight forward towards the heels brings in a useful hamstring exercise. The hamstrings are invariably very weak and must be reeducated to rehabilitate stability of the knee. Thrusting forward on the stabilized hand helps to exercise the whole affected side of the body in a total inhibiting pattern, providing the heels assist in the pull forwards.

4. Standing Position

Toward the end of rehabilitation, some clients may be ready to tackle exercise 4, but I would not attempt it with the elderly. The young man illustrated here was keen to get back to skiing, two years after a stroke. He took several weeks to master this exercise and it was obvious that his balance and motivation improved remarkably with the use of Fitter.

* Other books by Margaret Johnstone on stroke rehabilitation include:

All published by Churchill Livingstone; Margaret Johnstone FCSP

Further enquires should be directed in writing to: