ISBN: 354051242X
TITLE: Right in the Middle
AUTHOR: Davies
TOC:

Introduction 1
Part I Theoretical Antecedents 7
1 The Normal Trunk Evolutionary and Anatomical Considerations 9
1.1 The Vertebral Column 12
1.1.1 Movements of the Vertebral Column 12
1.1.2 Movements of the Rib Cage 14
1.2 Conclusion 15
2 Aspects of Trunk Control 16
2.1 The Bridge 17
2.2 The Tentacle 17
2.3 The Bridge Tentacle 18
2.3.1 Muscular Control of the Trunk 19
2.3.2 Anatomical Considerations 21
2.3.2.1 Extension 21
2.3.2.2 Shoulder Girdle 21
2.3.2.3 Abdominal Muscles 24
2.3.2.4 Respiration 27
2.4 Types of Muscle Action 28
2.5 Conclusion 30
3 Problems Associated with the Loss of Selective Trunk Activity in Hemiplegia 31
3.1 Possible Reasons for the Bilateral Loss of Abdominal Muscle Activity and Tone 33
3.2 Loss of Selective Activity 34
3.2.1 Muscles of the Trunk 34
3.2.2 Muscles of the Trunk and Limbs Acting Simultaneously 35
3.3 Inability to Move in Normal Patterns 35
3.4 The Most Commonly Observed Problems Seen in Relation to Normal Motor Development 35
3.4.1 Difficulties with Breathing and Speaking 36
3.4.1.1 Distorted Configuration of the Rib Cage 37
3.4.2 Difficulties Observed in Lying 37
3.4.3 Difficulties in Moving Between Lying and Sitting 43
3.4.4 Difficulties in Sitting 48
3.4.5 Difficulties in Standing Up from Sitting 49
3.4.6 Difficulties in Standing 49
3.4.7 Some Difficulties Observed in Walking 53
3.4.7.1 The Stance Phase 53
3.4.7.2 The Swing Phase 54
3.4.7.3 Slow and Effortful Walking with the Stride Width Increased 58
3.4.7.4 Associated Reactions in the Arm 61
3.4.8 Difficulties in Moving the Arm 61
3.5 Conclusion 65
Part II Therapeutic Activities 67
4 Activities in Lying 69
4.1 Facilitating Breathing 69
4.1.1 Moving the Chest Passively 69
4.1.2 Assisting Expiration 70
4.1.3 Facilitating Diaphragmatic Breathing 70
4.2 Flexion/Rotation of the Upper Trunk 72
4.2.1 Assisting Passive Movement 72
4.2.2 Facilitating Active Movement 73
4.3 Retraining Active Protraction of the Scapula with Activation of the Oblique Abdominal Muscles 75
4.3.1 Lifting the Elbows into the Air 77
4.4 Rolling to Prone 78
4.4.1 Rolling Towards the Hemiplegic Side 78
4.4.2 Rolling Towards the Sound Side 81
4.5 Flexion/Rotation of the Lower Trunk 83
4.6 Activating the Oblique Abdominal Muscles in Crook Lying 85
4.7 Position of the Arms 86
4.8 Bridging, a Useful Activity for Regaining Selective Extension of the Hip Together with Abdominal Muscle Activity 89
4.9 Actively Controlling the Hemiplegic Leg Through Its Range of Movement 92
4.10 Conclusion 93
5 Moving Between Lying and Sitting 95
5.1 Sitting Up over the Side of the Bed 95
5.1.1 Fully Supported 97
5.1.2 Less Assistance 97
5.1.3 No Support 97
5.2 Lying Down from Sitting 97
5.3 Rocking in Crook Sitting 100
5.4 Moving the Trunk in Long Sitting 101
5.4.1 Long Sitting with Isolated Knee Extension 102
5.4.2 Moving Towards Supine Lying 103
5.4.3 Lying Down with the Trunk Rotated 104
5.5 Conclusion 106
6 Activities in Sitting 107
6.1 Sitting with Both Legs over the Side of the Plinth 107
6.1.2 Selective Flexion and Extension of the Lower Trunk 107
6.1.3 Trunk Rotation with Flexion 109
6.2 Rotation of the Trunk with Both Arms Supported on the Same Side 113
6.2.1 Rotating Towards the Sound Side 113
6.2.2 Rotating Towards the Hemiplegic Side 116
6.3 Active Movements of the Hemiplegic Arm Following the Inhibition of Spasticity 118
6.4 Weight Transference Sideways 120
6.4.1 Moving Towards the Hemiplegic Side 122
6.4.1.1 A Progressive Sequence to Teach the Correct Movement 124
6.4.2 Moving Towards the Sound Side 126
6.4.2.1 A Progressive Sequence to Teach the Correct Movement 127
6.5 Selective Side Flexion of the Lower Trunk 130
6.6 Active Side Flexion of the Trunk Against Gravity 132
6.7 Moving Forwards and Backwards 135
6.8 Conclusion 136
7 Standing Up from Sitting 140
7.1 Therapeutic and Functional Activities 142
7.1.1 Bringing the Extended Trunk Forwards 142
7.1.2 Standing Up from Sitting 146
7.1.2.1 Supported by the Therapist 146
7.1.2.2 Hands Supported on a Stool 148
7.1.2.3 Weight Bearing on the Hemiplegic Leg Alone 150
7.1.3 Alternating Between Selective Extensor and Flexor Activity of the Trunk and Hips 152
7.1.3.1 Incorporating Active Plantar Flexion of the Foot 157
7.1.3.2 Legs Crossed 158
7.1.3.3 Performing an Additional Task 158
7.1.4 Standing Up from a High Plinth or Bed 158
7.1.4.1 Transferring the Patient onto a High Bed 158
7.15 Standing Up and Returning to Sitting from a High Plinth or Bed 161
7.1.5.1 Weight Taken on the Hemiplegic Leg 161
7.1.5.2 Weight Taken on the Sound Leg 163
7.2 Conclusion 164
8 Activities in Standing 166
8.1 Important Considerations Before Standing Activities Are Begun 166
8.2 Activities to Train Selective Trunk and Leg Movement 168
8.2.1 Tilting the Pelvis Forwards and Backwards 168
8.2.2 Weight Bearing on the Hemiplegic Leg with Abduction and Adduction of the Contra-lateral Hip 169
8.2.3 Bending the Trunk Forwards and Bringing It to the Vertical Again 171
8.2.4 Bending the Trunk Forwards and Returning to an Upright Position While Standing on a Sloping Surface 174
8.2.5 Weight Bearing on the Hemiplegic Leg While Placing the Sound Foot on a Step 177
8.2.6 Weight Bearing on the Hemiplegic Leg with the Sound Leg Abducting 182
8.2.7 Hip Extension with Abduction and Outward Rotation 185
8.2.8 Active Plantar Flexion of the Ankles with Flexed Knees 186
8.2.9 Controlling the Hemiplegic Leg Actively Against Gravity 189
8.2.10 Active Control of the Hemiplegic Leg when the Hip Is Extended 194
8.2.11 Moving the Arms Actively While Standing 194
8.2.11.1 Holding a Pole in Both Hands 194
8.2.11.2 Hitting a Ball with a Pole 194
8.2.11.3 Hitting a Balloon Away with the Hemiplegic Hand 196
8.3 Conclusion 196
9 Ball Activities 197
9.1 Ball Activities in Supine Lying 198
9.1.1 Lifting the Ball off the Bed with Both Legs 201
9.1.2 Abducting and Adducting One Leg with the Other Leg Supported on the Ball 205
9.2 Ball Activities in Prone Lying 209
9.2.1 Lying Prone on the Ball with Weight Supported Through Both Arms 209
9.2.2 Lower Trunk and Hip Flexion with Both Knees Supported on the Ball 209
9.2.3 Rotating the Trunk Until Only One Trochanter Is Supported on the Ball 212
9.3 Ball Activities in Sitting 213
9.3.1 Flexing and Extending the Lumbar Spine 214
9.3.2 Lateral Flexion of the Lumbar Spine 215
9.3.3 Bouncing on the Ball 218
9.3.4 Walking Both Feet Forwards Until Only the Shoulders Are Supported on the Ball 219
9.4 Ball Activities in Standing 221
9.4.1 Standing on One Leg with the Other Foot on a Moving Ball 221
9.5 Conclusion 223
10 Walking 224
10.1 Observing, Analysing, and Facilitating Walking Theoretical Considerations 225
10.1.1 Rhythm and Cadence 225
10.1.2 Step Length 225
10.1.3 Position of the Feet on the Floor 226
10.1.4 The Knee 226
10.1.5 The Pelvis 227
10.1.6 The Trunk 227
10.1.7 The Arms 227
10.1.8 The Head 227
10.1.9 Maintaining Balance 228
10.2 Facilitating Walking Practical Considerations 228
10.2.1 Footwear 228
10.2.2 Assisting Hip Extension 229
10.3 Facilitating Walking Backwards 230
10.3.1 Tipped Backwards Without Taking a Step 230
10.3.2 Taking Steps Backwards 231
10.4 Facilitating Walking Sideways 235
10.4.1 Towards the Sound Side 235
10.4.2 Towards the Hemiplegic Side 236
10.5 Facilitating Walking Forwards 239
10.5.1 Stabilising the Thorax and Moving the Trunk Forwards 239
10.5.2 Facilitation to Prevent Side Flexion of the Trunk and Associated Reactions in the Arm 242
10.5.2.1 Supporting the Hemiplegic Arm 242
10.5.2.2 Holding a Ball 243
10.5.2.3 Holding a Pole in Both Hands 244
10.5.2.4 Applying Pressure to the Patient's Chest 244
10.5.3 Facilitation Using Stimulating and Inhibitory Tapping 248
10.5.3.1 Stimulating Tapping over the Hip Extensors 248
10.5.3.2 Stimulating Tapping for the Lower Abdominal Muscles 250
10.5.3.3 Inhibitory Tapping 250
10.5.4 Facilitation to Narrow the Stride Width 252
10.5.4.1 Walking Along a Line 252
10.5.4.2 Walking Along a Plank 254
10.5.5 Facilitation to Re-establish Rhythm 255
10.5.5.1 Using a Tambourine 255
10.5.5.2 Bouncing a Ball with the Sound Hand 257
10.5.5.3 Bouncing a Large Ball with Both Hands 257
10.5.5.4 Imitating the Therapist's Steps 259
10.5.6 Facilitating Walking on the Toes 260
10.5.7 Walking with the Head Moving Freely 261
10.5.7.1 Throwing and Catching a Ball 263
10.5.7.2 Beating a Tambourine 265
10.6 Conclusion 265
References 269
Subject Index 273
END
