Steps to Follow: The Comprehensive Treatment of Patients with Hemiplegia

ISBN-13: 9783540607205 / Angielski / Miękka / 2000 / 514 str.

Patricia M. Davies; D. J. Br]hwiller; R. Gierig

Opis

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"

Spis treści

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.

Blurb

In the 15 years since publication of the first edition, Steps to Follow has gained a worldwide reputation among professionals as a unique practical guide to the treatment of neurologically impaired patients. This second, completely updated edition incorporates significant practical advances in early and later neurorehabilitation and in the understanding of the problems confronting both patients and those who work with them. The relevant therapeutic activities to improve functional ability and quality of life following a stroke are described in detail twith the help of 750 photos showing patients in action during treatment: - Practical ways in which patients can be helped to interact more normally with their environment and so regain their independence, in spite of the perceptual disorders often associated with hemiplegia - More detailed explanation of hand function and more in-depth analysis of normal walking - Revised chapters on the various therapeutic activities, including new means of stimulating selective movements in order to counteract increases in muscle tone - Deeper understanding of abdominal muscle activity, which is relevant to retraining balance reactions and sitting and standing - A new chapter demonstrating how David Butlers concept of the mobilisation of neural structures throughout the body can be of inestimable value - Examples of ways in which therapists, nurses and relatives can help very severely disabled patients to avoid the development of secondary complications or overcome existing difficulties - Ways in whicfh the patient can maintain mobility and continue to make progress even after cessation of treatment, by exercising at home and participating in sporting and other leisure activities.