Steps to Follow : The Comprehensive Treatment of Patients with Hemiplegia

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.

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 with 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 ways to retrain selective movements and prevent or 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 Butler's concept of the mobilization of neural structures throughout the body can be of inestimable value
-Examples of ways in which therapists, nurses and relatives can help to avoid the development of secondary complications such as pain and loss of range of motion or overcoming existing difficulties
-Ways in which 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

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 Front Matter....Pages I-XXXII Problems That Cannot Be Seen Directly....Pages 1-33 Normal Movement Sequences and Balance Reactions....Pages 34-56 Abnormal Movement Patterns in Hemiplegia....Pages 57-81 Practical Assessment — A Continuing Process....Pages 82-98 The Acute Phase — Positioning and Moving in Bed and in the Chair....Pages 99-129 Normalising Postural Tone and Teaching the Patient to Move Selectively and Without Excessive Effort....Pages 130-165 Retraining Balance Reactions in Sitting and Standing....Pages 166-197 Encouraging the Return of Activity in the Arm and Hand and Minimising Associated Reactions....Pages 198-234 Re-educating Functional Walking....Pages 235-276 Some Activities of Daily Living....Pages 277-299 Mat Activities....Pages 300-321 Shoulder Problems Associated with Hemiplegia....Pages 322-375 The Neglected Face....Pages 376-402 Out of Line (the Pusher Syndrome)....Pages 403-428 Including Nervous System Mobilisation in the Treatment....Pages 429-470 Maintaining and Improving Mobility at Home....Pages 471-499 References....Pages 500-507 Back Matter....Pages 508-514 This new edition of a best-selling guide incorporates significant advances in the early and later rehabilitation of neurologically impaired patients. Based on the Bobath concept, Davies' approach to stroke rehabilitation stresses the need to equip the patient for a full life, rather than setting arbitrary goals for functioning in a sheltered environment. Activities are described for encouraging the recovery of active movements in more normal patterns as well as treatment to overcome oro-facial and perceptual difficulties. Ways to retrain functional walking, balance reactions and independence in daily life are explained and illustrated with 750 photographs of patients being treated This new edition of a best-selling guide incorporates significant advances in the early and later rehabilitation of neurologically impaired patients. Based on the Bobath concept, Davies' approach to rehabilitation stresses the need to equip the patient for a full life, rather than setting arbitrary goals for functioning in a sheltered environment. Activities are described for correcting abnormal movement patterns and facial difficulties. Ways to regain walking, balance and other normal movement sequences are explained and demonstrated with 750 photographs of patients being treated. In the rehabilitation of patients who have suffered a stroke or some other unilateral brain lesion there is a widespread tendency to focus attention only on those problems which can actually be seen.