Q: Please advise exercise and diet for a patient suffering from right-sided paralysis for 2 and a half years. Medicines prescribed by the neurosurgeon are continuing for 3 years and the blood sugar and pressure are normal.

A:Two and a half years is a long time and spasticity must have set in. 1. To reduce the spasticity, a soothing massage can be given. No stimulating movements should be used as they enhance spasticity. 2. Full passive movements for all the joints affected with special attention to shoulder and hand should be given. Care should be taken that these movements are given smoothly and slowly to ensure the stretching of the spastic muscles to their full extent. Care must be taken not to jerk the limb. 3. Postures relating to patients limbs should be proper as abnormal postures block the flood of impulses and do not allow proper postures to be super- imposed. These include postures while lying, sitting and walking. 4. Early active movements should be simple and possible for all joints, but should take place in only one joint at a time. Later involve other joints for a controlled movement. 5. Relaxation for the whole body must be learnt. 6. Strengthening exercises for the upper as well as the lower limb are a must and all strengthening exercises taught during the recovery period should be done. 7. Coordination and balancing exercises for the lower limbs should be done. Cycling is a good exercise for this. 8. You can also do rolling on the grass if possible or spread a few mattresses on the ground and do the same. 9. Squatting and step climbing are good exercises for balance and coordination. 10.It should be remembered that the unaffected side of the body may bear considerable strain, so strengthening exercises for hip extensors and abductors (taking the hip backwards while lying on your stomach and taking the hip sideways-upwards while lying on your side) should also be done. 11. Grasping exercises for the hand are a must. Each case has to be judged on it's merit and treated accordingly. Please remember you need to keep patience with such patients. Rehabilitation at this stage is going to be slow. It has to be kept in mind that exercises are basically aimed to give independence to the patient for normal activities of daily living like feeding, dressing, toilet training, walking etc; the aim is not the perfection of exercises and movements. I suggest you consult a nutritionist for a proper diet.