Steps To Follow

Tone.- 4.6 Joint Range.- 4.7 Muscle Charts.- 4.8 Recording the Assessment.- 4.8.1 The Head.- 4.8.2 The Trunk.- 4.8.3 The Upper Limbs.- 4.8.4 The Lower Limbs.- 4.8.5 Sitting.- 4.8.6 Standing.- 4.8.7 Weight Transference and Balance Reactions.- 4.8.8 Walking.- 4.8.9 Negotiating Stairs.- 4.8.10 Getting up from the Floor.- 4.8.11 Comprehension.- 4.8.12 The Face, Speaking and Eating.- 4.8.13 Sensation.- 4.8.14 Functional Abilities.- 4.8.15 Considerations.- 5 The Acute Phase - Positioning and Moving in Bed and in the Chair.- 5.1 The Arrangement of the Patient's Room.- 5.2 Positioning the Patient in Bed.- 5.2.1 Lying on the Hemiplegic Side.- 5.2.2 Lying on the Unaffected Side.- 5.2.3 Lying Supine.- 5.2.4 General Points to Note When Positioning the Patient.- 5.2.5 Sitting in Bed.- 5.3 Sitting in a Chair.- 5.4 Self-Assisted Arm Activity with Clasped Hands.- 5.5 Moving in Bed.- 5.5.1 Moving Sideways.- 5.5.2 Rolling over on to the Hemiplegic Side.- 5.5.3 Rolling over on to the Unaffected Side.- 5.5.4 Moving Forwards and Backwards While Sitting in Bed.- 5.5.5 Sitting up over the Side of the Bed.- 5.6 Transferring from Bed to Chair and Back Again.- 5.6.1 The Passive Transfer.- 5.6.2 The More Active Transfer.- 5.6.3 The Active Transfer.- 5.7 Incontinence.- 5.8 Constipation.- 5.9 Considerations.- 6 Normalising Postural Tone and Teaching the Patient to Move Selectively and Without Excessive Effort.- 6.1 Activities in Lying.- 6.1.1 Inhibiting Extensor Spasticity in the Leg.- 6.1.2 Control of the Leg Through Range.- 6.1.3 Placing the Leg in Different Positions.- 6.1.4 Inhibition of Knee Extension with the Hip in Extension.- 6.1.5 Active Control at the Hip.- 6.1.6 Bridging (Selective Hip Extension).- 6.1.7 Isolated Knee Extension.- 6.1.8 Stimulating Active Dorsiflexion of the Foot and Toes.- 6.2 Activities in Sitting.- 6.2.1 Isolated Extension and Flexion of the Pelvis.- 6.2.2 Placing the Hemiplegic Leg and Facilitating Crossing It over the Other Leg.- 6.2.3 Stamping the Heel on the Floor.- 6.2.4 Weight-Bearing with Selective Extension.- 6.3 Activities in Standing to Train Weight-Bearing on the Hemiplegic Leg.- 6.3.1 Improving Extension of the Hip with External Rotation.- 6.3.2 Standing with a Rolled Bandage Under the Toes to Maintain Dorsiflexion.- 6.3.3 Coming off a High Plinth on to the Hemiplegic Leg.- 6.3.4 Stepping up on to a Step with the Hemiplegic Leg.- 6.4 Activities in Standing to Train Selective Movement of the Hemiplegic Leg.- 6.4.1 Releasing the Hip and Knee.- 6.4.2 Taking Steps Backwards with the Hemiplegic Leg.- 6.4.3 Placing the Hemiplegic Leg.- 6.4.4 Allowing the Leg to Be Drawn Forwards Passively.- 6.4.5 Walking Along a Line with the Legs Outwardly Rotated.- 6.5 Rolling Over.- 6.6 Considerations.- 7 Retraining Balance Reactions in Sitting and Standing.- 7.1 Activities in Sitting.- 7.1.1 Moving to Elbow Support Sideways.- 7.1.2 Transferring the Weight Sideways.- 7.1.3 Sitting with the Legs Crossed - Weight Transference Towards the Side of the Underneath Leg.- 7.1.4 Stimulating Head and Trunk Reactions by Turning Both Flexed Knees to the Side.- 7.1.5 Reaching Forward to Touch the Floor.- 7.1.6 Reaching Forward with Clasped Hands.- 7.2 Activities in Standing with the Weight on Both Legs.- 7.2.1 Both Knees Flexed - Weight Transference Sideways.- 7.2.2 Pushing a Ball Away with Clasped Hands.- 7.2.3 Playing with a Balloon.- 7.2.4 Being Tipped Backwards.- 7.3 Activities in Standing with the Weight on the Hemiplegic Leg.- 7.4 Activities Where the Weight Is on Alternate Legs.- 7.4.1 Going up and down Stairs.- 7.4.2 Moving on the Tilt-Board.- 7.4.2.1 With Weight Transference Sideways.- 7.4.2.2 With Transference Forwards and Backwards.- 7.4.3 Stepping Sideways with One Leg Crossing over in Front of the Other.- 7.4.3.1 Moving Towards the Hemiplegic Side.- 7.4.3.2 Moving Towards the Sound Side.- 7.5 Activities in Standing with the Weight on the Sound Leg.- 7.5.1 Kicking a Football with the Affected Foot.- 7.5.2 Sliding a Towel or Piece of Paper Forwards with the Affected Foot.- 7.6 Considerations.- 8 Encouraging the Return of Activity in the Arm and Hand and Minimising Associated Reactions.- 8.1 Activities in Supine Lying.- 8.2 Activities in Sitting.- 8.3 Activities in Standing.- 8.4 Stimulation of Active and Functional Movement.- 8.4.1 By Applying an Excitatory Stimulus.- 8.4.2 By Using the Protective Extension Reaction.- 8.4.2.1 In Sitting.- 8.4.2.2 In Standing and While Walking.- 8.4.2.3 In a Kneeling Position.- 8.4.3 By Using the Hand for Simple Tasks.- 8.5 Considerations.- 9 The Re-education of Functional Walking.- 9.1 Important Considerations Before Facilitating Walking.- 9.2 Facilitation.- 9.2.1 Standing up and Sitting down.- 9.2.2 Walking.- 9.2.2.1 With Assistance Given to Either Side of the Pelvis to Facilitate Hip Extension and Weight Transference.- 9.2.2.2 With Both the Patient's Arms Held Behind Him, Extended and Externally Rotated.- 9.2.2.3 With Rotation Assisted from the Patient's Shoulders.- 9.2.2.4 With One Arm Held Forward and Upward in External Rotation.- 9.2.2.5 With the Hemiplegic Arm Resting on the Therapist's Shoulder.- 9.2.2.6 With One Hand Against the Patient's Thoracic Spine and the Other Flat Against His Sternum.- 9.3 Protective Steps to Regain Balance.- 9.3.1 Walking Backwards.- 9.3.2 Walking Sideways.- 9.3.3 Steps to Follow.- 9.4 Supporting the Hemiplegic Foot.- 9.4.1 Using a Bandage.- 9.4.2 Using a Calliper.- 9.5 Going up and down Stairs.- 9.6 Using a Stick.- 9.7 Considerations.- 10 Some Activities of Daily Living.- 10.1 Therapeutic Considerations.- 10.2 Personal Hygiene.- 10.2.1 Washing.- 10.2.2 Brushing Teeth.- 10.2.3 Having a Bath.- 10.2.4 Having a Shower.- 10.3 Dressing.- 10.4 Undressing.- 10.5 Eating.- 10.6 Driving a Car.- 10.7 Considerations.- 11 Mat Activities.- 11.1 Going down on to the Mat.- 11.2 Moving to Side-Sitting.- 11.3 Activities in Long-Sitting.- 11.4 Rolling.- 11.4.1 Rolling to the Hemiplegic Side.- 11.4.2 Rolling to the Unaffected Side.- 11.4.3 Rolling over to a Prone Position.- 11.5 Prone Lying.- 11.6 Moving to Prone Kneeling.- 11.7 Activities in Prone Kneeling.- 11.8 Activities in Kneel-Standing.- 11.9 Activities in Half-Kneel-Standing.- 11.10 Standing up from Half-Kneeling.- 11.11 Considerations.- 12 Shoulder Problems Associated with Hemiplegia.- 12.1 The Subluxed or Malaligned Shoulder.- 12.1.1 Causative Factors in Hemiplegia.- 12.1.2 Treatment.- 12.1.2.1 Correcting the Posture of the Scapula.- 12.1.2.2 Stimulating Activity or Tone in the Stabilising Muscles Around the Shoulder.- 12.1.2.3 Maintaining Full Pain-Free Range of Passive Movement.- 12.1.3 Conclusion.- 12.2 The Painful Shoulder.- 12.2.1 Causative Factors.- 12.2.1.1 Loss of the Scapulohumeral Rhythm.- 12.2.1.2 Inadequate External Rotation of the Humerus.- 12.2.1.3 Lack of the Downward Gliding Movement of the Head of the Humerus in the Glenoid Fossa.- 12.2.2 Activities Which Frequently Cause Painful Trauma.- 12.2.3 Prevention and Treatment.- 12.2.3.1 Overcoming Early Signs of Pain.- 12.2.3.2 Management of the Severely Painful Shoulder.- 12.3 The "Shoulder-Hand" Syndrome.- 12.3.1 Symptoms Arising in the Hand.- 12.3.1.1 Early Stage.- 12.3.1.2 Later Stages.- 12.3.1.3 Final or Residual Stage.- 12.3.2 Causative Factors in Hemiplegia.- 12.3.2.1 Prolonged Plantar Flexion of the Wrist Under Pressure.- 12.3.2.2 Overstretching of the Joints of the Hand May Produce an Inflammatory Reaction, with Oedema and Pain.- 12.3.2.3 Fluid from an Infusion Escapes into the Tissues of the Hand.- 12.3.2.4 Minor Accidents to the Hand.- 12.3.3 Prevention and Treatment.- 12.3.3.1 Prevention.- 12.3.3.2 Treatment of the Established Syndrome.- 12.4 Considerations.- 13 The Neglected Face.- 13.1 Important Considerations for the Facilitation of the Movements of the Face and Mouth.- 13.1.1 Movements Associated with Communication.- 13.1.2 Movements Associated with Eating and Drinking.- 13.1.2.1 Solids.- 13.1.2.2 Liquids.- 13.2 Dentures.- 13.3 Appropriate Treatment for the Common Difficulties.- 13.3.1 For Difficulties Associated with Non-verbal Communication.- 13.3.2 For Difficulties Associated with Speaking.- 13.3.3 For Difficulties Associated with Eating.- 13.4 Oral Hygiene.- 13.5 Considerations.- 14 Out of Line (The Pusher Syndrome).- 14.1 The Typical Signs.- 14.2 Specific Treatment.- 14.2.1 Restoring Movements of the Head.- 14.2.2 Stimulating Activity in the Hypotonic Trunk Side Flexors.- 14.2.3 Regaining the Mid-line in Standing.- 14.2.4 Climbing Stairs.- 14.3 Considerations.- 15 The Home Programme.- References.