How to improve your shoulder joint with wiping rehabilitation! Also suitable for frozen shoulder and stroke | column | 日常で気軽に実践できる片麻痺のリハビリ方法や機能を低下させない生活習慣などを解説

Accurate evaluation and assessment are important in wiping rehabilitation. The seemingly simple movement of sliding a towel actually involves complex interactions of trunk stability, joint coordination, and cognitive function. Evaluations are performed at each stage of the movement, and clarifying the issues leads to an appropriate training plan.

Graded evaluation points

The movement is observed in three stages: start, middle, and end.

Specific observation items and evaluation criteria

Perspectives on hemiplegia and flaccid paralysis

In hemiplegia, the recovery stage is grasped using the Brunnstrom stage (Brs), and attention must be paid to the emergence of compensatory movements, especially in Brs1 to 3. Movement is possible from Brs4 onwards, but there are still issues with coordination and smoothness. In flaccid paralysis, the main problems are decreased muscle tone and unstable support, and evaluation focuses on "continuity of movement" and "repetitiveness" rather than "muscle strength".

Range of motion and balance assessment practice

We check the range of motion (ROM) of the shoulders, elbows, and wrists, which are involved in the smoothness of movement, as well as the trunk's ability to maintain a sitting position. These evaluations are essential for analyzing how joint movement restrictions and poor posture affect towel manipulation.

When assessing wiping movements, multifaceted perspectives are required, including not only musculoskeletal mobility but also posture balance, cognitive load, and repetitiveness of movements. The results of the assessment are reflected in the rehabilitation plan and directly linked to individual support content and environmental settings (adjustment of desk height, selection of support tools). This allows for more practical support for improving ADL.

Towel wiping training for beginners

Towel wiping rehabilitation is one of the exercise therapies that can be easily done at home for various cases such as stroke, shoulder joint contracture, and decreased upper limb function. The biggest advantage, especially for beginners and elderly people who have just started rehabilitation, is that it is easy to incorporate into daily life without using any training equipment.

The most important thing when starting training is to ensure a safe posture. The basic posture is to sit deep in a chair with the pelvis firmly upright and the soles of the feet firmly on the floor. Adjust the desk height so that you can keep your elbows slightly bent and your back comfortably straight, which will help distribute the strain on your shoulder joints, elbow joints, and wrist joints.

At the start of the movement, lightly grasp the towel with both hands and place it in the center of the desk. From there, slide it from side to side and back and forth. The key point is to be careful not to raise your shoulders and to be aware of the proper movement of your shoulder blades. Also, by not overextending your elbows during the movement, you can prevent excessive tension in your elbow joints and forearm muscles.

Below is an example of a towel wiping training menu recommended for beginners.

To make it a habit, it is effective to fix it to a time in your daily life that is easy to incorporate (after breakfast, before bathing, etc.). Also, if you experience pain or discomfort, do not force yourself to continue, but stop temporarily and consult a specialist.

In order to sustain the effects of training, it is effective to "split the training into several sessions throughout the day, doing it in small increments." Rather than continuing for a long period of time, "continuity" and "accuracy" are more important for functional recovery. For elderly people, it is ideal to concentrate on one movement and complete it in a short period of time to avoid cognitive fatigue.

In addition, when starting training, we recommend cooperation from family members and having a visiting rehabilitation instructor check the training. In particular, for people with hemiplegia or flaccid paralysis, even if they appear to be able to move, muscle tension or impaired sense of direction may affect the quality of their movements, so feedback from a third party is effective.

Acrylic cones and applied training menu for advanced users

For those who have made wiping rehabilitation at home a habit and have stabilized their movements to a certain extent, we can introduce more difficult applied training using acrylic cones and alternative tools to further improve upper limb function.

An acrylic cone is a cone-shaped transparent plastic device that can be used as a target to improve visual-motor coordination. It is effective in improving attention and motor accuracy by adding the cognitive element of "moving your hand accurately along a target" to the action of wiping a desk with a wiping towel or cloth.

The following applied training menu is possible:

If you don't have an acrylic cone, you can use a colored cone or a paper cup that you can buy at a 100-yen shop instead. What's important is the structure of the movement, which is to "keep a clear target in mind while moving," and it's more important to clarify the training content and its purpose than the material of the equipment.

One thing to be careful of when training is that excessive force or awkward postures can be used in an effort to achieve precision in movement, so it is safe to always check your posture in a mirror or have a third party observe you. In particular, people with hemiplegia are prone to compensatory movements due to strong muscle tension, and they may end up using force when abducting the shoulder joint or rotating the trunk, so caution is required.

In addition, when stepping up training, it is advisable to proceed in the following three stages.

1. Target contact in one direction (e.g. right front only)
2. Random contact in multiple directions (e.g., front, back, left)
3. Following multiple instructions in a timed sequence (e.g. touching three places in 10 seconds)

Gradual load adjustment not only maintains and improves function, but also increases self-efficacy.

Wiping for frozen shoulder (combined with Codman exercises)

Frozen shoulder (periarthritis of the shoulder) is a common symptom seen in adults over 40 years old, and when it is accompanied by contracture, it has a large impact on daily life, so appropriate exercise therapy is required from an early stage. In particular, self-training using wiping movements is highly regarded as an effective means of gradually increasing the range of motion of the shoulder joint while avoiding pain.

To perform wiping safely and effectively, it is first necessary to create a posture that matches the direction of shoulder joint movement and the restricted area of the joint capsule. Smooth movements on the desk using a towel naturally bring out movements such as abduction, flexion, and horizontal abduction, and it is important to prevent excessive strain on muscles and joints.

Especially in the early stages of rehabilitation, it is necessary to achieve the goal of "moving the joint" while avoiding weight on the shoulder, so it is recommended to use Codman exercises (pendulum exercises) in combination. Codman exercises are a method of moving the shoulder joint with a natural pendulum movement without tensing the muscles around the shoulder blade, and are easy to perform even for those with severe range of motion restrictions.

Combining wiping with Codman exercises using the steps below can be effective in improving function.

By progressing in stages like this, you can avoid defensive contractions caused by pain and safely expand the range of motion of your joints. One thing to note is that it is important to thoroughly control your posture so that you do not shrug your shoulders or tilt your trunk as a compensation during the movement. The ideal course of action is to start under the guidance of a rehabilitation professional and then practice at home once you have become accustomed to the movement.

Frozen shoulder may heal naturally, but if contracture remains, it can significantly limit activities of daily living, such as putting on and taking off clothes or tying your hair, so incorporating simple, sustainable exercises such as wiping is very effective.

Wiping to reduce the burden on the elderly

For the elderly, rehabilitation that can be easily incorporated into their daily lives is directly linked to ensuring continuity. Wiping movements are ideal for the elderly, as they require little equipment and space, and can be performed with a light load. However, as muscle mass and flexibility of joints and ligaments decrease with age, careful attention must be paid to the selection of equipment and the maintenance of the exercise environment.

First, when selecting equipment, use towels or cloths that slide easily, and avoid materials that are too slippery. Also, adjust the height of the desk or table so that your forearms can rest naturally when you bend your elbows slightly at 90 degrees. It is preferable to use a chair that is stable and has a seat that is not too low.

Below is a table summarizing some ideas that seniors can take with peace of mind.

When performing wiping, it is important to focus on the quality of the movement. Rather than doing it many times, it is more effective to perform each movement carefully and with concentration. Also, if you are worried about maintaining your posture, using a backrest or cushion for support can help reduce falls and strain.

Furthermore, if a caregiver is nearby, it is important to provide support that respects the individual's independence by only providing assistance by "holding their hands." This will give the individual a sense of accomplishment by being able to do it on their own, and will increase their motivation for the next training session.

Rehabilitation for the elderly is an important element that not only restores function, but also helps maintain quality of life and prevents isolation. Wiping is an effective way to create an opportunity for this, and it is necessary to create a safe, secure, and sustainable training environment while respecting the individual's wishes.

Wiping rehabilitation is one of the least stressful exercise therapies for those suffering from frozen shoulder, hemiplegia, and the decline of upper limb function in the elderly. In particular, tabletop exercises using towels and acrylic cones are effective in restoring flexibility and coordination to the shoulder, elbow, and wrist joints without putting excessive strain on the joints. It is now attracting attention because the content practiced by rehabilitation professionals in clinical settings can be applied at home.

For example, for frozen shoulder, a combination of Codman exercises and wiping movements can be expected to alleviate contracture and reduce pain. For hemiplegic patients, a step-by-step training menu according to the Brunnstrom stage and an approach incorporating visual and sensory feedback are effective. Furthermore, for elderly people, it is important to create an environment where they can continue safely by selecting the right equipment, adjusting their posture, and devising ways of assistance.

Many people worry, "I'm not sure if I can do it," or "How effective will it be?" However, by starting with a short period of time under the guidance of an occupational therapist, you can expect to see good results. In fact, many people who have incorporated it into their self-training at home report that their independence in daily activities has increased.

In rehabilitation, continuity produces the greatest effect. Wiping movements, which can be done within reasonable limits, are the perfect first step. If you are unsure of how to improve your condition, start with simple movements that can be done with tools you have around the house. If you leave it unattended, your muscle strength and range of motion will decrease, and your risk of becoming dependent on care in the future will increase. Taking action, even if it is just a little at a time, can make a big difference to your future body.

Power Assist Series Supports Hemiplegia Rehabilitation - LAP Corporation

LAP Corporation has developed and provides the Power Assist Series to support rehabilitation at home for people with hemiplegia due to cerebral infarction or accidents. This series is a robot that uses air pressure to gently move paralyzed joints in the fingers, ankles, and wrists to assist rehabilitation training. It can be easily used at home, enabling continuous rehabilitation. The product lineup includes the Power Assist Hand for fingers, the Power Assist Leg for ankles, and the Power Assist Wrist for wrists, and is compatible with the rehabilitation of each part of the body. Through these rehabilitation assistance robots, we will contribute to the recovery of function and improvement of the quality of life of everyone.

LAP Co., Ltd.
address	2-1-40 Oikawa, Atsugi City, Kanagawa Prefecture, 243-0212
phone	046-204-9343

inquiry

Q. Is wiping really possible even with hemiplegia? At what stage in the BRS system can I start?

A. Yes, wiping rehabilitation can be performed at each stage of Brunnstrom stages 1 to 6, even for hemiplegic patients. At stages Brs1 and 2, you start with passively sliding a towel, and at stages Brs3 and above, you can spontaneously perform vertical and diagonal movements as voluntary movement recovers. In particular, at stages Brs4 to 6, applied training to improve the coordination of muscles and upper limbs becomes important, and the use of acrylic cones and other tools makes it possible to improve motor accuracy. Evaluation by professionals and the creation of a stage-specific menu are the keys to effective recovery.

Q.What is the difference between wiping and sanding? Are there any criteria for choosing between them?

A. Both wiping and sanding are typical exercises used in occupational therapy, but there are clear differences in their purpose and the way they apply stress. Wiping is an exercise that improves the sense of direction and posture balance while comfortably expanding the range of motion of the shoulder and elbow joints by sliding a towel or other object. On the other hand, sanding involves a certain amount of resistance and is an exercise that puts more force into the muscles and joints, so it is intended to strengthen the muscles of the upper limbs and shoulder girdle. For the elderly and those with flaccid paralysis, it is safe and effective to start with wiping.

Q. Are there any key points to wiping rehabilitation that even elderly people can continue safely?

A. For elderly people to safely continue wiping rehabilitation, it is important to reduce the load of movement and adjust the environment. For example, it is essential to ensure that the towel slides smoothly by adjusting the height of the desk and the stability of the chair so as not to put an unnatural angle on the elbow and shoulder joints. In addition, it is also effective to use anti-slip sheets or towels with rubber bands if the grip strength of the fingers is weak. In fact, there have been cases where the facility performed the wiping two to three times a week and shoulder movement improved after six months. A design that allows for continuity and the support of the caregiver are directly linked to results.

Company name: LAP Co., Ltd.
Location: 2-1-40 Oikawa, Atsugi City, Kanagawa Prefecture, 243-0212
Telephone number: 046-204-9343