Mat activities are one of the most important parts of rehabilitation programme of SCI patients. Mat exercises are included in the treatment programme as soon as weight bearing to spine is permitted.
To achieve the desired effect of the treatment programme, mat activities should be sequenced from easier to difficult and progression through sequence should be considered. The type of the mat activities, given to the patient is determined by the therapist on the basis of level of lesion and medical status of patient. The limit to which an activity can be performed and time taken to learn it depends on the ability of the patient. But therapist should work hard to improve the timing and speed of the patient.
Different mat activities taught to patient are:
For rolling to be effective, patient is required to learn to move the head, neck, upper limb, lower limb and trunk in a balance manner. Rolling is needed to improve bed mobility and to change position independently. Initially, rolling is taught to patient in mat but afterwards patient gets confidence to perform it over bed.
Action to role prone from supine position:
Rolling to prone can also be assisted by use of pillows under one side of pelvis or scapula if needed. The number of pillows is decreased in progression.
This position on mat activities given to cervical lesion patient facilitates head and neck control and strengthens serratus anterior and other scapular muscles. This position is very important to train the patient to gain stability is quadruped and sitting position. Prone on elbow position should be used carefully in lumbar injuries as this increases lumbar lordosis.
Action of patient:
This position is given to paraplegic patient because it requires strong pectoralis major and deltoid muscles. However, this activity is not appropriate to all paraplegics as excessive lordosis is produced. Prone on hand position is required to gain postural alignment during standing, ambulation and standing from floor with use of orthosis and crutches.
Position of hands in this position is same as standard push up position except that arms are laterally rotated.
This position is an important strengthening exercise for shoulder extensors and scapular adductors. The purpose of this position is to prepare patient for long sitting position. This position is assumed according to the comfort and disability of patient.
This position is achieved either from side lying position or by pushing the elbow over mat and lifting into this position. The later technique requires a strong abdominal muscle.
This kind of mat activities is given in quadriplegics to strengthen their biceps and shoulder flexors, which may be required for wheel chair propulsion.
Sitting position are important for various activities in daily life such as ADL, transfer, dressing, wheel chair mobility etc. Sitting is achieved easily by paraplegics, but it is ac difficult job for quadriplegics.
Stability in sitting position for quadriplegics is achieved by weight bearing through hands with flexed fingers, extended wrist, extended elbow and hyper extended and externally rotated shoulder.
Sitting position varies according to level of lesion.
In high level lesion, patient demonstrates poor sitting posture. Some patient with spared muscles of upper limb may achieve sitting position with the help of monkey pole.
Position of monkey pole:
Monkey pole is suspended over the midline of body or towards the supporting arm. The handle of pole should reach the patients extended wrist.
Action of patient:
Lifting is done to relieve continuous pressure over body part. Lifting from sitting position requires a great balance in sitting position.
Movements in mat can be achieved by different lifting technique.
Action of patient:
In this position, trunk lies horizontal to ground and body weight is distributed over both hands and both knees. It is also called as prone kneeling position. This is the first sequence in mat activities that allow weight bearing through hips.
This position helps to initiate control of muscle of lower trunk and hips. This position can either be achieved from prone on elbow position or from long sitting position.
To assume position from long sitting:
It is more difficultly to manage for patient with instability at trunk. In this position, centre gravity is raised, base is small and gravity falls near the edge of the base. This position is important to promote upright balance control. This position is best achieved from quadruped position.
Position of patient
Position of therapist
Action of patient
Action of therapist
Therapist manually guides the pelvis.