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Right in the Middle : Selective Trunk Activity in the Treatment of Adult Hemiplegia - Patricia M. Davies

Right in the Middle

Selective Trunk Activity in the Treatment of Adult Hemiplegia

Paperback Published: 11th May 1990
ISBN: 9783540512424
Number Of Pages: 277

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What is it that characterises Pat Davies' second book about hemi- plegia and makes it so special? It is a book which committed ther- apists can really use in their practical work with patients. We ther- apists need such books. The engagement and enthusiasm must come from us. It is similar to a good cookbook. Admittedly one has to know something about cooking but when learning the secrets of haute cuisine - not just the expensive frills but the real refinement- then theoretical dissertations are not very helpful. In practice com- ments like "you just have to have the right touch" are useless. Many books are disappointing because the reader cannot learn how to put theory into practice, as the author does not disclose the true secrets of his success, perhaps not really wanting the eager stu- dents to "bake a good cake" for example. Such is not the case with this book. In the first theoretical chap- ter "The Normal Trunk - Evolutionary and Anatomical Consider- ations" the reader is given information about the significance of the normal anatomical relationships in the development of the body segments: the pelvis, thorax and head. The second chapter, "Aspects of Trunk Control," deals with the muscular control of movement within each of these inherently mobile segments. In the terminology of "Functional Kinetics" the different types of muscle activities are described, defining the importance of the selective use of the musculature in reaction to the pull of gravity.

"This book is Pat Davies's second on hemiplegia. Her original book, Steps to Follow, was a must ... Right in the Middle does not replace her first book but adds extra information to it." British Journal of Occupational Therapy It focuses on a subject that has been all but ignored up to now in rehabilitation literature: selective trunk activity. The book gives clear, concise instruction, illustrated by a wealth of photographs, to help therapists learn how to observe and improve selective trunk activity. ..". packed with clinical suggestions for handling the patient ... I strongly recommend Right in the Middle..." Physical Therapy (J.of the Americ. Physical Therapy Assoc.)

Introductionp. 1
Theoretical Antecedentsp. 7
The Normal Trunk - Evolutionary and Anatomical Considerationsp. 9
The Vertebral Columnp. 12
Movements of the Vertebral Columnp. 12
Movements of the Rib Cagep. 14
Conclusionp. 15
Aspects of Trunk Controlp. 16
The Bridgep. 17
The Tentaclep. 17
The Bridge-Tentaclep. 18
Muscular Control of the Trunkp. 19
Anatomical Considerationsp. 21
Extensionp. 21
Shoulder Girdlep. 21
Abdominal Musclesp. 24
Respirationp. 27
Types of Muscle Actionp. 28
Conclusionp. 30
Problems Associated with the Loss of Selective Trunk Activity in Hemiplegiap. 31
Possible Reasons for the Bilateral Loss of Abdominal Muscle Activity and Tonep. 33
Loss of Selective Activityp. 34
Muscles of the Trunkp. 34
Muscles of the Trunk and Limbs Acting Simultaneouslyp. 35
Inability to Move in Normal Patternsp. 35
The Most Commonly Observed Problems Seen in Relation to Normal Motor Developmentp. 35
Difficulties with Breathing and Speakingp. 36
Distorted Configuration of the Rib Cagep. 37
Difficulties Observed in Lyingp. 37
Difficulties in Moving Between Lying and Sittingp. 43
Difficulties in Sittingp. 48
Difficulties in Standing Up from Sittingp. 49
Difficulties in Standingp. 49
Some Difficulties Observed in Walkingp. 53
The Stance Phasep. 53
The Swing Phasep. 54
Slow and Effortful Walking with the Stride Width Increasedp. 58
Associated Reactions in the Armp. 61
Difficulties in Moving the Armp. 61
Conclusionp. 65
Therapeutic Activitiesp. 67
Activities in Lyingp. 69
Facilitating Breathingp. 69
Moving the Chest Passivelyp. 69
Assisting Expirationp. 70
Facilitating Diaphragmatic Breathingp. 70
Flexion/Rotation of the Upper Trunkp. 72
Assisting Passive Movementp. 72
Facilitating Active Movementp. 73
Retraining Active Protraction of the Scapula with Activation of the Oblique Abdominal Musclesp. 75
Lifting the Elbows into the Airp. 77
Rolling to Pronep. 78
Rolling Towards the Hemiplegic Sidep. 78
Rolling Towards the Sound Sidep. 81
Flexion/Rotation of the Lower Trunkp. 83
Activating the Oblique Abdominal Muscles in Crook Lyingp. 85
Position of the Armsp. 86
Bridging, a Useful Activity for Regaining Selective Extension of the Hip Together with Abdominal Muscle Activityp. 89
Actively Controlling the Hemiplegic Leg Through Its Range of Movementp. 92
Conclusionp. 93
Moving Between Lying and Sittingp. 95
Sitting Up over the Side of the Bedp. 95
Fully Supportedp. 97
Less Assistancep. 97
No Supportp. 97
Lying Down from Sittingp. 97
Rocking in Crook Sittingp. 100
Moving the Trunk in Long Sittingp. 101
Long Sitting with Isolated Knee Extensionp. 102
Moving Towards Supine Lyingp. 103
Lying Down with the Trunk Rotatedp. 104
Conclusionp. 106
Activities in Sittingp. 107
Sitting with Both Legs over the Side of the Plinthp. 107
Selective Flexion and Extension of the Lower Trunkp. 107
Trunk Rotation with Flexionp. 109
Rotation of the Trunk with Both Arms Supported on the Same Sidep. 113
Rotating Towards the Sound Sidep. 113
Rotating Towards the Hemiplegic Sidep. 116
Active Movements of the Hemiplegic Arm Following the Inhibition of Spasticityp. 118
Weight Transference Sidewaysp. 120
Moving Towards the Hemiplegic Sidep. 122
A Progressive Sequence to Teach the Correct Movementp. 124
Moving Towards the Sound Sidep. 126
A Progressive Sequence to Teach the Correct Movementp. 127
Selective Side Flexion of the Lower Trunkp. 130
Active Side Flexion of the Trunk Against Gravityp. 132
Moving Forwards and Backwardsp. 135
Conclusionp. 136
Standing Up from Sittingp. 140
Therapeutic and Functional Activitiesp. 142
Bringing the Extended Trunk Forwardsp. 142
Standing Up from Sittingp. 146
Supported by the Therapistp. 146
Hands Supported on a Stoolp. 148
Weight Bearing on the Hemiplegic Leg Alonep. 150
Alternating Between Selective Extensor and Flexor Activity of the Trunk and Hipsp. 152
Incorporating Active Plantar Flexion of the Footp. 157
Legs Crossedp. 158
Performing an Additional Taskp. 158
Standing Up from a High Plinth or Bedp. 158
Transferring the Patient onto a High Bedp. 158
Standing Up and Returning to Sitting from a High Plinth or Bedp. 161
Weight Taken on the Hemiplegic Legp. 161
Weight Taken on the Sound Legp. 163
Conclusionp. 164
Activities in Standingp. 166
Important Considerations Before Standing Activities Are Begunp. 166
Activities to Train Selective Trunk and Leg Movementp. 168
Tilting the Pelvis Forwards and Backwardsp. 168
Weight Bearing on the Hemiplegic Leg with Abduction and Adduction of the Contradateral Hipp. 169
Bending the Trunk Forwards and Bringing It to the Vertical Againp. 171
Bending the Trunk Forwards and Returning to an Upright Position While Standing on a Sloping Surfacep. 174
Weight Bearing on the Hemiplegic Leg While Placing the Sound Foot on a Stepp. 177
Weight Bearing on the Hemiplegic Leg with the Sound Leg Abductingp. 182
Hip Extension with Abduction and Outward Rotationp. 185
Active Plantar Flexion of the Ankles with Flexed Kneesp. 186
Controlling the Hemiplegic Leg Actively Against Gravityp. 189
Active Control of the Hemiplegic Leg when the Hip Is Extendedp. 194
Moving the Arms Actively While Standingp. 194
Holding a Pole in Both Handsp. 194
Hitting a Ball with a Polep. 194
Hitting a Balloon Away with the Hemiplegic Handp. 196
Conclusionp. 196
Ball Activitiesp. 197
Ball Activities in Supine Lyingp. 198
Lifting the Ball off the Bed with Both Legsp. 201
Abducting and Adducting One Leg with the Other Leg Supported on the Ballp. 205
Ball Activities in Prone Lyingp. 209
Lying Prone on the Ball with Weight Supported Through Both Armsp. 209
Lower Trunk and Hip Flexion with Both Knees Supported on the Ballp. 209
Rotating the Trunk Until Only One Trochanter Is Supported on the Ballp. 212
Ball Activities in Sittingp. 213
Flexing and Extending the Lumbar Spinep. 214
Lateral Flexion of the Lumbar Spinep. 215
Bouncing on the Ballp. 218
Walking Both Feet Forwards Until Only the Shoulders Are Supported on the Ballp. 219
Ball Activities in Standingp. 221
Standing on One Leg with the Other Foot on a Moving Ballp. 221
Conclusionp. 223
Walkingp. 224
Observing, Analysing, and Facilitating Walking - Theoretical Considerationsp. 225
Rhythm and Cadencep. 225
Step Lengthp. 225
Position of the Feet on the Floorp. 226
The Kneep. 226
The Pelvisp. 227
The Trunkp. 227
The Armsp. 227
The Headp. 227
Maintaining Balancep. 228
Facilitating Walking - Practical Considerationsp. 228
Footwearp. 228
Assisting Hip Extensionp. 229
Facilitating Walking Backwardsp. 230
Tipped Backwards Without Taking a Stepp. 230
Taking Steps Backwardsp. 231
Facilitating Walking Sidewaysp. 235
Towards the Sound Sidep. 235
Towards the Hemiplegic Sidep. 236
Facilitating Walking Forwardsp. 239
Stabilising the Thorax and Moving the Trunk Forwardsp. 239
Facilitation to Prevent Side Flexion of the Trunk and Associated Reactions in the Armp. 242
Supporting the Hemiplegic Armp. 242
Holding a Ballp. 243
Holding a Pole in Both Handsp. 244
Applying Pressure to the Patient's Chestp. 244
Facilitation Using Stimulating and Inhibitory Tappingp. 248
Stimulating Tapping over the Hip Extensorsp. 248
Stimulating Tapping for the Lower Abdominal Musclesp. 250
Inhibitory Tappingp. 250
Facilitation to Narrow the Stride Widthp. 252
Walking Along a Linep. 252
Walking Along a Plankp. 254
Facilitation to Re-establish Rhythmp. 255
Using a Tambourinep. 255
Bouncing a Ball with the Sound Handp. 257
Bouncing a Large Ball with Both Handsp. 257
Imitating the Therapist's Stepsp. 259
Facilitating Walking on the Toesp. 260
Walking with the Head Moving Freelyp. 261
Throwing and Catching a Ballp. 263
Beating a Tambourinep. 265
Conclusionp. 265
Referencesp. 269
Subject Indexp. 273
Table of Contents provided by Publisher. All Rights Reserved.

ISBN: 9783540512424
ISBN-10: 354051242X
Audience: General
Format: Paperback
Language: English
Number Of Pages: 277
Published: 11th May 1990
Publisher: Springer-Verlag Berlin and Heidelberg Gmbh & Co. Kg
Country of Publication: DE
Dimensions (cm): 23.37 x 15.49  x 2.03
Weight (kg): 0.43