Physical Management for Neurological Conditions E-Book : Physical Management for Neurological Conditions E-Book

The second edition of the Neurological Physiotherapy Pocketbook is the only book for physiotherapists that provides essential evidence-based information in a unique and easy-to-use format, applicable to clinical settings. Written by new international editors and contributors, this pocketbook provides quick and easy access to essential clinical information. Comprehensive and handy reference on physical management and movement limitations, suitable to any health care context and environment Use of eclectic approach which focuses on selecting the appropriate evidence-based tools to assess and treat neurological conditions without subscribing to any specific treatment approaches International case studies are presented to provide worldwide scientific evidence Fully revised by international contributors with the inclusion of 8 new chapters covering: Common impairments Inherited neurological disorders Complex case management Virtual reality and interactive gaming technologies Front Cover IFC Physical Management for Neurological Conditions Series Page Physical Management for Neurological Conditions Copyight CONTENTS PREFACE ACKNOWLEDGEMENTS CONTRIBUTORS 1 - Background Knowledge 1 - Guiding Principles in Neurological Rehabilitation WHY IS A CONCEPTUAL FRAMEWORK IMPORTANT? GUIDING PRINCIPLES FOR NEUROLOGICAL REHABILITATION Principle 1: The ICF The Value of Participation Principle 2: Team Work Principle 3: Person-Centred Care Principle 4: Prediction Principle 5: Neural Plasticity What Type of Training Drives Neural Plasticity and Recovery of Function? Principle 6: Motor Control: A Systems Model Principle 7: Functional Movement Reeducation Principle 8: Skill Acquisition Task Practice Issues Role of Feedback Amount of Practice The Optimal Theory of Motor Learning Principle 9: Self-Management (Self-Efficacy) Principle 10: Health Promotion CONCLUSION REFERENCES 2 - Common Impairments and the Impact on Activity INTRODUCTION WEAKNESS Upper Motor Neurone Weakness Lower Motor Neurone Weakness FATIGUE General Fatigue Motor Fatigue DISORDERS OF MUSCLE TONE Hypertonus Hypotonus Dystonia Involuntary Muscle Spasms Dyskinesias Rigidity DISORDERS OF COORDINATION Cerebellar Ataxia Sensory Ataxia Resting Tremor Intention Tremor Loss of Dexterity DISORDERS OF MOTOR PLANNING Apraxia Bradykinesia/Akinesia Freezing of Gait VESTIBULAR DISORDERS Peripheral Vestibular Disorders Central Vestibular Disorders Unilateral Spatial Neglect Contraversive Pushing Paraesthesia and Dysaesthesia Pain SECONDARY COMPLICATIONS Contracture Physical Inactivity and Deconditioning Learned Non-Use CONCLUSION REFERENCES 3 - Observation and Analysis of Movement WALKING The Gait Cycle Walking Kinematics and Muscle Activity Walking Kinetics Spatiotemporal Characteristics Clinical Focus: Walking for People with Parkinson’s SIT TO STAND Typical Phases of Sit to Stand Muscle Action During Sit to Stand Contextual Factors Influencing Sit to Stand Clinical Focus on Sit to Stand for People Following Stroke ROLLING AND GETTING OUT OF BED Clinical Focus on Getting Out of Bed for People with Parkinson’s REACH AND GRASP Essential Components of Reach and Grasp Kinematics Muscle Activity Clinical Focus on Reach and Grasp for People with Stroke POSTURE AND BALANCE Sensorimotor Control of Balance Movement Analysis Strategies to Quantify Posture Movement Analysis Strategies to Quantify Balance Clinical Foci of Posture and Balance (Ataxia, Parkinson’s and Hemiplegic Stroke) KEY MESSAGES REFERENCES 4 - Measurement Tools INTRODUCTION Impairments (Problems in Body Functions or Structures) Activity Limitations TYPES OF MEASUREMENT TOOLS PSYCHOMETRIC PROPERTIES Reliability Assessing Reliability for Nominal and Ordinal Data with Two Scoring Categories Assessing Reliability for Ordinal Data with Three or More Categories Assessing Reliability for Interval and Ratio Data Validity Content Validity Construct Validity Criterion-Related Validity Responsiveness APPLIED MEASUREMENT SCIENCE: TOWARDS CLINICAL IMPLEMENTATION CONCLUSIONS REFERENCES 5 - Goal Setting in Rehabilitation INTRODUCTION DEFINITIONS AND ASSUMPTIONS Rehabilitation Goals and Goal Setting Activities to Enhance Goal Pursuit PRAGMATIC PERSON-CENTRED GOAL SETTING Family Involvement in Goal Setting Should Goals Be Measurable? GOAL SETTING IN STROKE REHABILITATION – ADDRESSING THE CHANGING NEEDS FROM ACUTE CARE TO COMMUNITY LIFE Acute Rehabilitation Postacute Inpatient Rehabilitation Postacute Community-Based Rehabilitation Long-Term Recovery Following Stroke GOAL ACHIEVEMENT AS AN OUTCOME MEASURE – CHALLENGING CURRENT ASSUMPTIONS The Appeal of Goal Attainment as an Outcome An Overview of Goal Attainment Scaling Problems with Goal Attainment as an Outcome CONCLUSION REFERENCES 6 - Respiratory Management INTRODUCTION CENTRAL NERVOUS CONTROL OF BREATHING RESPIRATORY ASSESSMENT OF THE NEUROLOGICAL PATIENT Lung Function Peak Cough Flow Arterial Blood Gases Chest Radiographs Respiratory Pattern Respiratory Reserve (PaO2/FiO2 Ratio) EARLY MOBILISATION RESPIRATORY TREATMENT AND MANAGEMENT Maximal Insufflation Capacity Manual Cough Mechanical Insufflation and Exsufflation Other Considerations Respiratory Muscle Training Management of Acute Respiratory Failure Tracheostomy and Weaning RESPIRATORY FUNCTION IN NEUROLOGICAL CONDITIONS Central Conditions Subarachnoid Haemorrhage Spinal Cord Injury and Disease Anterior Horn Cell Conditions Neuropathy Neuromuscular Junction Muscle Conditions MANAGEMENT OF TRAUMATIC BRAIN INJURY CONCLUSION REFERENCES 2- Management of Specific Conditions 7 - Stroke INTRODUCTION EPIDEMIOLOGY PATHOPHYSIOLOGY DIAGNOSIS MEDICAL MANAGEMENT SETTING INTERDISCIPLINARY TEAM CLINICAL PRESENTATION ASSESSMENT Hyperacute Phase Rehabilitation Phase Chronic Phase Prognosis and Time Course of Recovery INTERVENTIONS General Therapy Principles Lower Limb and Locomotor Recovery Gait Training Overground Walking Speed-Dependent Treadmill Training Body Weight Supported Treadmill Training Robot-Assisted Gait Training Circuit Class Training Electrostimulation of the Paretic Lower Limb Upper Limb Recovery Constraint-Induced Movement Therapy Bilateral Arm Training (With Rhythmic Auditory Cueing) Virtual Reality, Including Interactive Video Gaming Electrostimulation of the Paretic Arm and Hand Robot-Assisted Therapy for the Upper Limb Therapy Delivery CONCLUSIONS CASE STUDY REFERENCES 8 - Traumatic Brain Injury INTRODUCTION EPIDEMIOLOGY PATHOPHYSIOLOGY Primary Brain Injury Secondary Brain Injury Associated Injuries DIAGNOSIS Coma Posttraumatic Amnesia MEDICAL MANAGEMENT Intracranial Pressure Multidisciplinary Care CLINICAL PRESENTATION ASSESSMENT Abnormal Tone Muscle Paresis Disorders of Movement Balance and Vestibular Function Muscle and Joint Range of Motion Concurrent Musculoskeletal Injuries Pain Function Summary PROGNOSIS/TIME COURSE INTERVENTIONS Hypertonicity and Spasticity Muscle Paresis Disorders of Movement Balance and Vestibular Function Muscle and Joint Range of Motion Concurrent Musculoskeletal Injuries Pain Function OTHER CONSIDERATIONS CONCLUSION CASE STUDY REFERENCES 9 - Spinal Cord Injury INTRODUCTION EPIDEMIOLOGY Incidence Data AETIOLOGY PATHOPHYSIOLOGY DIAGNOSIS PROGNOSIS INCOMPLETE SYNDROMES EARLY ACUTE MANAGEMENT Breaking the News Physical Management Facilitation of Range, Length and Movement Mobilisation RESPIRATORY ASSESSMENT RESPIRATORY TREATMENT Weaning From Ventilatory Support (RISCI 2017) Long-Term Respiratory Management CLINICAL PRESENTATION Spinal Shock Autonomic Dysfunction Cardiovascular Thermoregulation Autonomic Dysreflexia Bladder, Bowels and Sexual Dysfunction Weakness Sensory Changes Balance Pain Spasticity ASSESSMENT PHYSICAL MANAGEMENT Strength Training Aquatic Therapy Facilitation of Movement Splinting Seating Functional Mobility Standing Gait Training Cardiovascular Fitness Other Modalities Loss of Range of Movement and Postural Deformity Shoulder Pain Tissue Viability Heterotropic Ossification Syrinx and Syringomyelia PAEDIATRIC CONSIDERATIONS DISCHARGE PLANNING AND LIFELONG CARE CONCLUSION CASE STUDY Progress With Rehabilitation ACKNOWLEDGEMENT REFERENCES 10 - Multiple Sclerosis INTRODUCTION EPIDEMIOLOGY PATHOPHYSIOLOGY DIAGNOSIS CLASSIFICATION MEDICAL MANAGEMENT Disease-Modifying Therapies Lifestyle Modifications and Comorbidities PROGNOSIS CLINICAL PRESENTATION ASSESSMENT MANAGEMENT Health Promotion Restorative Rehabilitation Maintenance Rehabilitation INTERVENTIONS Impaired Mobility, Balance and Falls Sedentary Behaviour, Weakness and Deconditioning Upper Limb Impairment Ataxia Spasticity Fatigue Pain Respiratory Dysfunction Bladder and Bowel Cognitive Impairment Anxiety and Depression Pressure Ulcers CONCLUSION Key Assessment Findings Treatment Plan Initial Outpatient Physiotherapy Session Progress Review at 3 Months REFERENCES 11 - Parkinson’s INTRODUCTION EPIDEMIOLOGY AND AETIOLOGY NEUROANATOMY AND PATHOPHYSIOLOGY Pharmacological Management Surgical Management TEAM MANAGEMENT Time Course From Diagnosis of Parkinson’s and Communication PHYSIOTHERAPY MANAGEMENT Framework for Physiotherapy Intervention Referral to Physiotherapy Physiotherapy History Taking Physical Assessment Goal Setting and Choosing Treatments Exercise Practice Movement Strategies Training CONCLUSION CASE STUDY: MAIN ISSUE OF SIT-TO-STAND TASK Quick Reference Card 1: History Taking Quick Reference Card 2: Physical Examination Quick Reference Card 3: Treatment Goal and Quick Reference Card 4: GRADE-Based Recommendations REFERENCES 12 - Inherited Neurological Conditions INTRODUCTION HUNTINGTON’S DISEASE Epidemiology Genetics Anatomy and Pathophysiology Clinical Presentation Medical Management A Standard of Care for Huntington’s Disease Physiotherapy Assessment and Prognosis Time Course and Corresponding Physiotherapy Management Treatment Selection and Secondary Complications/Special Problems HEREDITARY ATAXIAS Epidemiology and Genetics Autosomal Dominant Cerebellar Ataxias Autosomal Recessive Ataxias Friedreich’s Ataxia Diagnosis and Genetic Testing Spasticity and Dystonia Scoliosis and Orthotic Management Cardiac Symptoms Pharmacological and Surgical Management of Ataxia Coenzyme Q and Idebenone in Friedreich’s Ataxia Physiotherapy Assessment Disease-Specific Scales Time Course and Corresponding Management Balance, Walking and Mobility Anatomy, Pathophysiology and Clinical Presentation Diagnosis Physiotherapy Assessment Disease-Specific Scales Time Course and Corresponding Management Treatment Selection, Secondary Complications and Special Problems SUMMARY Classification Examination History Body Structures and Function Activities Prognosis Intervention Outcomes (8 months) ACKNOWLEDGEMENTS REFERENCES 13 - Motor Neurone Disease INTRODUCTION EPIDEMIOLOGY ANATOMY AND PATHOPHYSIOLOGY GENETIC FACTORS GEOGRAPHICAL AND ENVIRONMENTAL FACTORS CLINICAL PHENOTYPES DIAGNOSIS (EARLY) MEDICAL MANAGEMENT SIGNS, SYMPTOMS AND CLINICAL PRESENTATION ASSESSMENT AND PROGNOSIS Disease-Specific Measures Prognosis TIME COURSE AND CORRESPONDING MANAGEMENT TREATMENT SELECTION AND SECONDARY COMPLICATIONS AND SPECIAL PROBLEMS Assistive Devices and Orthoses Exercise in Motor Neurone Disease Overwork Damage Versus Disuse Atrophy Types of Exercise Evolving Wheelchair Needs Respiratory Issues CONCLUSION CASE STUDY REFERENCES 14 - Polyneuropathies INTRODUCTION ANATOMY AND PHYSIOLOGY CAUSES OF NEUROPATHY SPECIFIC TYPES OF NEUROPATHY Acquired Neuropathies Guillain–Barré Syndrome Chronic Demyelinating Polyradiculoneuropathy Diabetic Neuropathy ASSESSMENT OF PEOPLE WITH POLYNEUROPATHIES PHYSICAL MANAGEMENT AND REHABILITATION APPROACHES FOR PEOPLE WITH POLYNEUROPATHIES Acute Rehabilitation of Acquired Polyneuropathies Long-Term Physical Management and Rehabilitation Self-Management Exercise and Physical Activity Interventions in Polyneuropathy Balance Interventions Orthotic Management Pain and Fatigue Management CASE STUDY Presenting Impairments Muscle Strength and Sensation Gait Balance Pain Physiotherapy Options for Mr V Orthotic Prescription Range of Movement Muscle Strength and Aerobic Exercise Balance Outcome Management of Upper Limb Function Orthotics and Equipment Stretches Outcome Management of Fatigue Outcome Follow Up REFERENCES 15 - Muscle Disorders INTRODUCTION CLASSIFICATION, DIAGNOSIS AND MANAGEMENT OF MUSCLE CONDITIONS THE MUSCULAR DYSTROPHIES Classification Diagnosis Duchenne Muscular Dystrophy Clinical Presentation Disease Course and Prognosis Medical Management of Duchenne Muscular Dystrophy Physiotherapy Management of Duchenne Muscular Dystrophy ASSESSMENT OF MUSCLE DISORDERS Measurement of Muscle Strength Measurement of Joint Range Measurement of Functional Performance and Motor Ability Tests Timed Function Tests Lung Function Delaying Onset of Contracture and its Progression Promoting and Prolonging Ambulation Maintenance of Activities Management of Scoliosis Management of Respiratory Complications SOCIAL AND PSYCHOSOCIAL ISSUES IN MUSCLE DISORDERS Transition From Childhood to Adulthood Classification Diagnosis Reason for Review Medical History Medication Home and Social Situation Impairments (on Assessment) Activities and Participation (on Assessment) Recommendations and Plan REFERENCES 16 - Functional Motor Disorders INTRODUCTION HISTORICAL PERSPECTIVE EPIDEMIOLOGY PATHOPHYSIOLOGY A Biopsychosocial Formulation DIAGNOSIS PROGNOSIS CLINICAL PRESENTATIONS Functional Weakness Functional Gait Disorder Functional Tremor Functional Jerks (Myoclonus) Functional Dystonia Fixed Functional Dystonia Other Categories Other Common Symptoms and Comorbidities in Patients With Functional Motor Disorder ROLE OF THE MULTIDISCIPLINARY TEAM Neurology Psychiatry Psychological Therapy Physical Therapy Other Treatments EVIDENCE FOR PHYSICAL REHABILITATION OF FUNCTIONAL MOTOR DISORDER BEFORE COMMENCING REHABILITATION Physical Assessment Outcome Measures PHYSIOTHERAPY INTERVENTIONS Education Movement Retraining Addressing Persistent Pain and Fatigue Self-Management CONSIDERATIONS FOR TREATMENT Contractures Recognising Comorbidities Medications Nonepileptic (Functional) Seizures and Physiotherapy Adaptive Aids, Equipment and Environmental Modifications Functional Motor Disorder and Falls Treatment Intensity, Duration and Setting Concluding Treatment CONCLUSION CASE STUDY REFERENCES CASE STUDY 3 - Specific Aspects ofManagement 17 - Self-Management INTRODUCTION SELF-MANAGEMENT: WHAT IS IT AND WHY NOW? Defining Self-Management Self-Management Is Not New SELF-MANAGEMENT PROGRAMMES: THEORY AND RESEARCH Understanding Responses to Neurological Disability Social Cognitive Theory and Self-Efficacy – a Critical Factor in Self-Management Stress Coping Model Transtheoretical Model of Behaviour Change and Motivational Interviewing Components of Self-Management Programmes SELF-MANAGEMENT PROGRAMMES: THE EVIDENCE BASE FOR NEUROLOGICAL CONDITIONS Adapting the Self-Management Approach to Neurological Conditions Issues in Self-Management Research Self-Management and Stroke Measurement of Self-Management SUPPORTING SELF-MANAGEMENT: PROVIDING INFORMATION ALONE IS NOT ENOUGH CONCLUSION REFERENCES 18 - Virtual Rehabilitation: Virtual Reality and Interactive Gaming Technologies in Neurorehabilitation INTRODUCTION ROLE OF VIRTUAL REALITY TECHNOLOGIES IN NEUROLOGICAL REHABILITATION VIRTUAL REALITY TECHNOLOGIES WITH POTENTIAL FOR USE IN THE REHABILITATION SETTING Nintendo Wii and Nintendo Wii Fit Microsoft Xbox with Kinect Sensor PlayStation2 EyeToy, PlayStation3 Eye and PlayStation MOVE Head-Mounted Displays Smartphones, Tablets and Apps Customised Software for Rehabilitation Current Evidence PRACTICAL TIPS FOR CHOOSING VIRTUAL REALITY TECHNOLOGIES Choosing Technology Choosing a Virtual Reality Task/Game Client Considerations Resources for Clinicians CONCLUSION CASE HISTORY REFERENCES 19 - Falls and Their Management INTRODUCTION FALLS AND FALLING Extent of the Problem Causes of Falling Consequences of Falling ASSESSING PEOPLE WHO HAVE FALLEN Interviewing Patients and Carers Falls Diaries Observing Fall-Related Activities Video Standard Tests and Outcome Measures PREVENTING FALLS AND MANAGING PEOPLE WHO HAVE FALLEN The Person at Risk for Falling Exercise and Other Training Programmes Continued Physical Activity Movement Strategies External Environment Engagement With Fall Prevention Not Every Fall is Preventable EFFECTIVE FALLS SERVICES AND TEAMS Service Models A Multifactorial Approach CONCLUSION REFERENCES 20 - Physical Activity and Exercise in Neurological Rehabilitation NEUROLOGICAL CONDITIONS PHYSICAL ACTIVITY Exercise Fitness Physical Activity, Exercise and Fitness in Long-Term Neurological Conditions Considerations for Prescribing Neurological Conditions Stage/Severity of Disease Condition Progression Neurological Symptoms Likelihood of Secondary Conditions Exercise Response/Recovery ASSESSMENT AND MONITORING OF EXERCISE Safety International Classification of Function Model and Exercise, Physical Activity and Fitness Assessment of Key Body Functioning Fitness Components Assessment and Monitoring of Health Monitoring Symptoms Monitoring Participation, Health and Well-being Monitoring Exercise and Physical Activity Levels Wider Assessment Exercise Prescription Exercise Prescription Setting Exercise Prescription Content Limit to Capacity Exercise Response and Recovery Frequency Intensity Timing Type Reducing Sedentary Time Barriers and Facilitators Changing Behaviour Conclusion Summary of Exercise Prescription Guidance REFERENCES 21 - Vestibular Rehabilitation INTRODUCTION EPIDEMIOLOGY ANATOMY AND PHYSIOLOGY OF THE VESTIBULAR SYSTEM VESTIBULAR OCULAR REFLEX AND VESTIBULOSPINAL REFLEX PATHOPHYSIOLOGY PERIPHERAL DISORDERS CENTRAL DISORDERS Vestibular Migraine PERSISTENT POSTURAL PERCEPTUAL DIZZINESS DIAGNOSIS MEDICAL AND SURGICAL MANAGEMENT Ménière’s Disease Persistent Benign Paroxysmal Positional Vertigo Acoustic Neuromas ASSESSMENT Physical Impairments Functional Ability Outcome Measures PROGNOSIS INTERVENTIONS Vestibular Paresis/Hypofunction Balance and Gait Reeducation Management of Benign Paroxysmal Positional Vertigo Secondary Problems OTHER CONSIDERATIONS Multidisciplinary Team Specialist Centres and Support Groups Support Groups CONCLUSION CASE STUDIES Case 1: Peripheral Vestibular Neuritis Case 2: Benign Paroxysmal Positional Vertigo REFERENCES 22 - Pain Management INTRODUCTION Contemporary Views on Pain Patient Experience of Pain Types of Pain Epidemiology of Pain Associated with Neurological Conditions ANATOMY AND PATHOPHYSIOLOGY OF PAIN SIGNS AND SYMPTOMS AND CLINICAL PRESENTATION Musculoskeletal Pain Neuropathic Pain Peripheral Neuropathic Pain Central Neuropathic Pain Progressive Neurological Conditions Multiple Sclerosis Parkinson’s Huntington’s Disease Amyotrophic Lateral Sclerosis: Motor Neurone Disease Other Neurological Diseases Central Nervous System Damage Stroke Traumatic Brain Injuries Spinal Cord Injuries DIAGNOSIS, ASSESSMENT AND PROGNOSIS Subjective Assessment Red and Yellow Flags Factors that Influence the Reliability of Subjective Pain Report Objective Assessment PRINCIPLES OF PAIN MANAGEMENT Pharmacological Management of Pain Surgical Management of Pain Electrophysical Techniques Manual Therapy Physical Activity and Exercise Splinting, Casting and Bracing Invasive Electrical Stimulation Techniques Noninvasive Electrical Brain Stimulation Techniques Transcutaneous Electrical Nerve Stimulation Acupuncture Therapeutic Ultrasound Thermal Therapies Low-Level Laser Therapy Visual Feedback, Motor Imagery and Body Illusions Psychological Approaches Self-Management Setting Treatment Goals Evaluating Response to Treatment Strategies to Improve Treatment Effect CONCLUSIONS CASE STUDIES Case 1: Diabetic Neuropathic Pain Case 2: Phantom Limb Pain REFERENCES 23 - Clinical Neuropsychology in Rehabilitation INTRODUCTION NEUROPSYCHOLOGICAL ASSESSMENT Cognitive Functions Assessment of Emotional and Behavioural Adjustment Affective and Mediating Factors Assessment of Outcomes and Quality of Life NEUROPSYCHOLOGICAL INTERVENTIONS Cognitive Interventions Behavioural Interventions Psychotherapy: Staff, Team and Organisational Support and Research NEUROPSYCHOLOGICAL CONSEQUENCES OF NEUROLOGICAL DISORDERS Age of Acquisition and Neuroplasticity Focal Versus Diffuse Acute Versus Chronic Progressive Versus Static Site and Lateralisation Traumatic Brain Injury Stroke Hypoxic Brain Injury Degenerative Conditions Spinal Injuries Neuropsychological Disorders of Movement Apraxia Neglect Functional Disorders PROCESS OF REHABILITATION CONCLUSIONS Psychological Adjustment ACKNOWLEDGEMENTS REFERENCES 24 - Complex Case Management INTRODUCTION MUSCULOSKELETAL INTEGRATION IN NEUROLOGICAL UPPER LIMB APPROACH -MOVEMENT AND MUSCLE ACTIVATION OF THE SHOULDER COMPLEX AFTER STROKE: A MUSCULOSKELETAL VIEW ON POSTSTROKE SHOULDER ASSESSMENT AND REHABILITATION Evaluation of the Shoulder Complex from a Musculoskeletal Viewpoint Musculoskeletal Management of Shoulder Complex Dysfunctions After Stroke Illustration by Means of a Case Presentation Summary SPASTICITY: WHEN AND HOW TO TREAT THE CLINICAL PROBLEM IN NEUROLOGICAL REHABILITATION Upper Motor Neurone Syndrome Spasticity Principles of Management Physical and Pharmacological Treatment Evaluation of Outcome Summary ON THE ROAD WITH MULTIPLE SCLEROSIS - CHALLENGES IN SCREENING, ASSESSMENT AND TRAINING OF DRIVING Driving as an Important Instrumental Activity ofDaily Living Aspects of the Driving Evaluation Process Case Presentation REFERENCES Answers to Self-Assessment Questions CHAPTER 1 CHAPTER 2 Sit to Stand Rolling and Getting Out of Bed Reach and Grasp Posture and Balance CHAPTER 4 CHAPTER 5 CHAPTER 6 CHAPTER 7 CHAPTER 8 CHAPTER 9 CHAPTER 10 CHAPTER 11 Hereditary Ataxia HSP (Henoch-Schonlein Purpura) CHAPTER 13 CHAPTER 14 CHAPTER 15 CHAPTER 16 CHAPTER 17 CHAPTER 18 CHAPTER 19 CHAPTER 20 CHAPTER 21 CHAPTER 22 CHAPTER 23 CHAPTER 24 Abbreviations INDEX A B C D E F G H I J K L M N O P Q R S T U V W IBC