SOMEBODY Please Teach Us to Turn

Rebecca Dutton
Home After a Stroke

September 14, 2014

The photo shows the turns I take to prepare a glass of iced tea and a bowl of cereal with a sliced banana for breakfast.  I put the banana on a paper plate to hold the banana still while I slice it.

The photo is so complicated that I omitted the turns I make to get out yogurt to take my pills.  I will not even try to diagram the turns it takes to prepare a hot meal.  Walking in straight lines in the PT gym and walking around the block at home did not prepare me for this.  After I fell and broke my forearm while turning I got scared.  I learned to take itsy bittsy baby steps until I complete a turn before taking normal size steps in the new forward direction.

Help is emerging.  Chen and associates trained stroke survivors on a straight or a turning-based treadmill (1).  See the parallel bars in the diagram on right. Subjects who trained on the turning-based treadmill were significantly better at turning 360 degrees in place and standing on a cushion with both eyes closed and arms crossed over their chest.  Turning away from a kitchen counter is done by stepping backwards as you turn so information from the inner ears about how far from vertical you have stepped back is crucial.  Paradoxically, the turning-based treadmill group also walked significantly faster in a straight line with more equal time weight bearing on each foot as they walked.

PTs and OTs need to incorporate these findings into clinical practice.  Learning to turn needs to begin with how to turn around after you shut the bathroom door and again after you flush the toilet.

1. Chen, I, Yang, Y, Chan, R, Wang, R. Turning-based treadmill training improves turning performance and gait symmetry after stroke. Neurorehabilitation and Neural Repair. 2014;28 (1):45-55.

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SOMEBODY Please Teach Us to Turn

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