Steps to Follow: The Comprehensive Treatment of Patients with Hemiplegia by Patricia M. DaviesSteps to Follow: The Comprehensive Treatment of Patients with Hemiplegia by Patricia M. Davies

Steps to Follow: The Comprehensive Treatment of Patients with Hemiplegia

byPatricia M. Davies


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A true paradigm shift is taking place in the field of neurology. Earlier it was regarded as the science of exact diagnosis of incurable illnesses, re­ signed to the dogma that damage to the central nervous system could not be repaired: "Once development is complete, the sources of growth and regeneration ofaxons and dendrites are irretrievably lost. In the adult brain the nerve paths are fixed and immutable - everything can die, but nothing can be regenerated" (Cajal1928). Even then this could have been countered with what holds today: rehabilitation does not take place in the test tube, being supported only a short time later by an authoritative source, the professor of neurology and neurosurgery in Breslau, Otfried Foerster. He wrote a 100-page article about thera­ peutic exercises which appeared in the Handbuch der Neurologie (also published by Springer-Verlag). The following sentences from his intro­ duction illustrate his opinion of the importance of therapeutic exercises and are close to our views today (Foerster 1936): "There is no doubt that most motor disturbances caused by lesions of the nervous system are more or less completely compensated as a re­ sult of a tendency inherent to the organism to carry out as expedient­ ly as possible the tasks of which it is capable under normal circum­ stances, using all the forces still available to it with the remaining un­ damaged parts of the nervous system, even following injury to its sub­
Title:Steps to Follow: The Comprehensive Treatment of Patients with HemiplegiaFormat:PaperbackDimensions:514 pages, 23.5 × 15.5 × 0.01 inPublisher:Springer NatureLanguage:English

The following ISBNs are associated with this title:

ISBN - 10:354060720X

ISBN - 13:9783540607205

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Table of Contents

1 Problems That Cannot Be Seen Directly.- Problems Related to Disturbed Perception.- Some Common Problems Associated with Disturbed Perception.- Reciprocity of Perception and Learning.- Disturbed Perception and Learning.- Implications for Therapy.- Guided Movement Therapy (Guiding).- Therapeutic or Intensive Guiding.- Using Verbal Instructions.- How the Patient is Guided Therapeutically.- Choosing a Task.- Additional Considerations When Choosing a Task.- Guiding When Giving Assistance.- Guiding the Patient in a Standing Position.- Considerations.- 2 Normal Movement Sequences and Balance Reactions.- Analysis of Certain Everyday Movements.- Rolling Over from Supine to Prone.- Sitting, Leaning Forwards to Touch the Feet.- Standing from Sitting on a Chair.- Standing up from the Floor.- Going Up and Down Stairs.- Walking.- Balance, Righting and Equilibrium Reactions.- Lying on a Surface That Tilts Sideways.- Sitting on a Surface That Tilts Sideways.- Sitting, Being Drawn Sideways by Another Person.- Sitting with Both Legs Flexed and Turned to One Side.- Sitting, Reaching Out to Grasp an Object.- Standing, Tipped Backwards.- Standing, Tipped Forwards.- Standing, Tipped Sideways.- Standing on a Tilting Surface, Such as a Tilt-Board.- Automatic Steps to Maintain or Regain Balance.- Steps to Follow.- Balancing on One Leg.- Protective Extension of the Arms.- Task-orientated Arm and Hand Movements.- Considerations.- 3 Abnormal Movement Patterns in Hemiplegia.- Persistence of Primitive Mass Synergies.- The Synergies as They Appear in Association with Hemiplegia.- In the Upper Limb.- In the Lower Limb.- Abnormal Muscle Tone.- Typical Patterns of Spasticity or Hypertonicity.- Placing.- Reappearance of Tonic Reflex Activity.- Tonic Labyrinthine Reflex.- Symmetrical Tonic Neck Reflex.- Asymmetrical Tonic Neck Reflex.- Positive Supporting Reaction.- Crossed Extensor Reflex.- The Grasp Reflex.- Associated Reactions and Associated Movements.- Abnormal Tension in the Nervous System.- Disturbed Sensation.- Considerations.- 4 Practical Assessment - a Continuing Process.- The Aims of Assessment.- Recommendations for Accurate Assessment.- Specific Aspects of Assessment.- Recording the Assessment.- The Comprehensive Evaluation.- The Head.- The Trunk.- The Upper Limbs.- The Lower Limbs.- Sitting.- Standing.- Weight Transference and Balance Reactions.- Walking.- Comprehension.- The Face, Speaking and Eating.- Sensation.- Functional Abilities.- Leisure Activities and Hobbies.- Considerations.- 5 The Acute Phase - Positioning and Moving in Bed and in the Chair.- The Arrangement of the Patient's Room.- Positioning the Patient in Bed.- Lying on the Hemiplegic Side.- Lying on the Unaffected Side.- Lying Supine.- General Points to Note When Positioning the Patient.- Sitting in Bed.- Sitting in a Chair.- Re-adjusting the Patient's Position in the Wheelchair.- Learning to Propel the Wheelchair Independently.- Self-assisted Arm Activity with Clasped Hands.- Moving in Bed.- Moving Sideways.- Rolling Over Onto the Hemiplegic Side.- Rolling Over Onto the Unaffected Side.- Moving Forwards and Backwards While Sitting in Bed.- Sitting Up Over the Side of the Bed.- Lying Down from Sitting Over the Side of the Bed.- Transferring from Bed to Chair and Back Again.- The Passive Transfer.- The More Active Transfer.- The Active Transfer.- Incontinence.- Constipation.- Considerations.- 6 Normalising Postural Tone and Teaching the Patient to Move Selectively and Without Excessive Effort.- Important Activities for the Trunk and Lower Limbs in Lying.- Inhibiting Extensor Spasticity in the Leg.- Retraining Selective Abdominal Muscle Activity.- Control of the Leg Through Range.- Placing the Leg in Different Positions.- Inhibition of Knee Extension with the Hip in Extension.- Active Control at the Hip.- Selective Hip Extension (Bridging).- Isolated Knee Extension.- Stimulating Active Dorsiflexion of the Foot and Toes.- Rolling Over.- Activities in Sitting.- Correcting the Sitting Posture.- Selective Flexion and Extension of the Lumbar Spine.- Placing the Hemiplegic Leg and Facilitating Crossing It Over the Other Leg.- Stamping the Heel on the Floor.- Coming From Sitting to Standing.- Weightbearing with Selective Extension of the Leg.- Trunk Extension with the Hips Flexed.- Activities in Standing with Weight on the Hemiplegic Leg.- Pelvic Tilting with Selective Flexion/Extension of the Lumbar Spine.- Standing with a Rolled Bandage Underneath the Toes.- Flexing and Extending the Weight-bearing Leg.- Coming off a High Plinth onto the Hemiplegic Leg.- Stepping Up onto a Step with Weight on the Hemiplegic Leg.- Activities in Standing with Weight on the Sound Leg.- Releasing the Hip and Knee.- Taking Steps Backwards with the Hemiplegic Leg.- Placing the Hemiplegic Leg.- Allowing the Leg to Be Drawn Forwards Passively.- Considerations.- 7 Retraining Balance Reactions in Sitting and Standing.- Activities in Sitting.- Moving to Elbow Support Sideways.- Transferring the Weight Sideways.- Progressing with the Activity to Include All Components of the Balance Reaction.- Sitting with Legs Crossed - Weight Transference Towards the Side of the Underneath Leg.- Reaching Forwards to Touch the Floor.- Reaching Forwards with Clasped Hands and Trunk Extended.- Activities in Standing with the Weight on Both Legs.- Shifting Weight from Side to Side with Both Knees Flexed.- Pushing a Ball Away with Clasped Hands.- Playing with a Balloon.- Being Tipped Backwards.- Activities in Standing with the Weight on the Hemiplegic Leg.- Activities During Which the Weight Is on Alternate Legs.- Going Up and Down Stairs.- Transferring Weight Sideways on a Tilt-Board.- Transferring Weight Forwards and Backwards in Step-Standing.- Stepping Sideways with One Leg Crossing Over in Front of the Other.- Activities in Standing with the Weight on the Sound Leg.- Kicking a Football.- Sliding a Towel or Piece of Paper Forward.- Considerations.- 8 Encouraging the Return of Activity in the Arm and Hand and Minimising Associated Reactions.- Activities in Supine Lying.- Activities in Sitting.- Activities in Standing.- With a Gymnastic Ball.- With a Balloon.- Inhibition of Hypertonicity in Standing.- Stimulation of Active and Functional Movements.- By Applying an Excitatory Stimulus.- By Using the Protective Extension Reaction.- Retraining Selective Flexion of the Arm and Hand.- By Using Specific Therapeutic Activities.- By Using the Hand for Simple Taskss.- Considerations.- 9 Re-educating Functional Walking.- Considerations for Treatment.- When to Start Walking.- The Facilitation of Walking.- Instructing Nursing Staff and Relatives.- Important Features of Walking and Associated Difficulties.- Practical Ways to Facilitate Walking.- For Standing Up.- For Sitting Down.- For Walking.- Self-inhibition of Associated Reactions.- Protective Steps to Regain Balance.- Backwards.- Sideways.- Steps to Follow.- Supporting the Hemiplegic Foot.- Using a Bandage for Provisional Support.- Choosing an Orthosis.- Going Up and Down Stairs.- Using a Walking-stick or Cane.- Considerations.- 10 Some Activities of Daily Living.- Therapeutic Considerations.- Personal Hygiene.- Washing.- Brushing Teeth.- Having a Bath.- Having a Shower.- Dressing.- Underwear.- Socks.- Trousers.- A Shirt or Jacket.- A Pullover or T-shirt.- Shoes.- An Outdoor Coat.- Putting on a Brassiere.- Taking off a Brassiere.- Undressing.- Eating.- Driving a Car.- Considerations.- 11 Mat Activities.- Going Down Onto the Mat.- Moving to Side-Sitting.- Activities in Long-Sitting.- Rolling.- Rolling to the Hemiplegic Side.- Rolling to the Unaffected Side.- Rolling Over to a Prone Position.- Prone Lying.- Moving to Prone Kneeling.- Activities in Prone Kneeling.- Activities in Kneel-Standing.- Activities in Half-Kneel-Standing.- Standing up from Half-Kneeling.- Considerations.- 12 Shoulder Problems Associated with Hemiplegia.- The Subluxed or Malaligned Shoulder.- Factors Predisposing to Subluxation.- Causes of Subluxation in Hemiplegia.- Treatment of the Subluxed Shoulder.- Conclusion.- The Painful Shoulder.- Possible Causes of Shoulder Pain.- Activities Which Frequently Cause Painful Trauma.- Prevention and Treatment.- Conclusion.- The "Shoulder-Hand" Syndrome.- A Hand Syndrome (HS), not a Shoulder-Hand Syndrome (SHS).- Symptoms Arising in the Hand.- Causes of the Hand Syndrome in Hemiplegia.- Prevention and Treatment.- Considerations.- 13 The Neglected Face.- Important Considerations for Facilitation of the Movements of the Face and Mouth.- Movements Associated with Nonverbal Communication.- Movements Associated with Speaking.- Movements Associated with Eating and Drinking.- Dentures.- Appropriate Treatment for the Common Difficulties.- For Difficulties Associated with Nonverbal Communication.- For Difficulties Associated with Speaking.- For Difficulties Associated with Eating.- Oral Hygiene.- Considerations.- 14 Out of Line (the Pusher Syndrome).- The Typical Signs.- Predisposing Factors.- Specific Treatment.- Restoring Movements of the Head.- Stimulating Activity in the Hypotonic Trunk Side Flexors.- Regaining the Midline in Standing.- Starting to Walk.- Climbing Stairs.- Considerations.- 15 Including Nervous System Mobilisation in the Treatment.- Adaptation of the Nervous System to Movement.- Elongation of the Neural Canal.- Elongation of Peripheral Nerves.- Elongation of the Autonomic Nervous System.- Lengthening Mechanisms.- Loss of Nervous System Mobility Following a Lesion.- Effect on Target Tissues.- Problems Associated with Abnormal Tension and Loss of Mobility.- The Tension Tests for Assessment and Treatment.- The Tension Tests.- Using the Tension Tests as Treatment Techniques.- Combining the Tension Tests and Their Components with Other Therapeutic Activities.- Mobilising Peripheral Nerves Directly.- Conclusion.- 16 Maintaining and Improving Mobility at Home.- Maintaining Mobility Without the Help of a Therapist.- Common Sites of Increased Hypertonicity and/or Loss of Range of Motion.- Ensuring the Patient's Participation.- Specific Exercises for Muscles and Joints.- To Prevent Shoulder Stiffness.- To Inhibit Extensor Hypertonus in the Lower Limb.- To Maintain Supination of the Forearm.- To Maintain Full Dorsal Flexion of the Wrist.- To Prevent Shortening of the Flexors of the Wrist and Fingers.- To Prevent Shortening of the Achilles Tendon and Toe Flexors.- To Maintain the Full Range of Horizontal Abduction with the Elbow Extended.- Automobilisation of the Nervous System.- Rotating the Neuraxis.- Mobilising the ULTTI.- Mobilisation of the Slump in Long-Sitting.- Some Additional Active Exercises.- Leisure Activities and Hobbies.- Interests Other than Sport.- Sporting Activities.- Conclusion.- 17 References.- 18 Subject Index.

From Our Editors

This excellent book focuses on the Bobath concept and how it approaches rehabilitation as a process that equips the patient for a full life, rather than setting arbitrary goals for functioning in a sheltered environment. A superb resource, Steps to Follow: A Guide to the Treatment of Adult Hemiplegia Based on the Concept of K. and B. Bobath -- Second Edition includes techniques for correcting abnormal movement, facial difficulties, walking and balance.