Janet H. Carr

Physiotherapy in stroke rehabilitation: Bases for Australian physiotherapists' choice of treatment

In a survey of Swedish physiotherapists working in neurology, the treatment of individuals following stroke was found to be essentially praxis-oriented (Nilsson and Nordholm, 1992). The present study replicated the Swedish survey in order to compare the responses of Australian physiotherapists with those of their Swedish colleagues. The questionnaire, designed to establish choice of treatment, factors influencing and theoretical bases for the choice of treatment, and attitudes towards new methods, was sent to the 331 members of the Neurology Special Interest Group of the Australian Physiotherapy Association. The response rate was 72%. Respondents viewed experience working with patients as the most important factor influencing current choice of treatment. As in the Swedish study, although the respondents were able to describe their treatment choices, they had difficulty explaining the underlying theoretical basis for their choice. Difficulty providing a scientific and rational explanation for intervention ...

Task-specific training of reaching and manipulation

Summary Full upper limb function following brain damage is frequently not achieved despite therapeutic intervention. A new approach to treatment is described in which strategies based on research in the movement sciences are employed to aid the recovery or re learning of functional upper limb movements. The chapter begins by describing some aspects of the dyscontrol characteristics resulting from central nervous system lesions. This is followed by an account of commonly observed adaptive motor behaviors resulting from the effects of the lesion. Finally, examples of task-specific clinical intervention derived from research in relevant movement sciences are given.

Enhancing Physical Activity and Brain Reorganization after Stroke

It is becoming increasingly clear that, if reorganization of brain function is to be optimal after stroke, there needs to be a reorganisation of the methods used in physical rehabilitation and the time spent in specific task practice, strength and endurance training, and aerobic exercise. Frequency and intensity of rehabilitation need to be increased so that patients can gain the energy levels and vigour necessary for participation in physical activity both during rehabilitation and after discharge. It is evident that many patients are discharged from inpatient rehabilitation severely deconditioned, meaning that their energy levels are too low for active participation in daily life. Physicians, therapists, and nursing staff responsible for rehabilitation practice should address this issue not only during inpatient rehabilitation but also after discharge by promoting and supporting community-based exercise opportunities. During inpatient rehabilitation, group sessions should be frequent and need to include specific aerobic training. Physiotherapy must take advantage of the training aids available, including exercise equipment such as treadmills, and of new developments in computerised feedback systems, robotics, and electromechanical trainers. For illustrative purposes, this paper focuses on the role of physiotherapists, but the necessary changes in practice and in attitude will require cooperation from many others.

The Shoulder following Stroke: Preserving Musculoskeletal Integrity for Function

A major role of the upper limbs is in actions involving reaching for objects in order to interact with the environment. After stroke, the primary motor impairment is decreased motor unit activation, which results in muscle weakness or paralysis. As a result of lack of use of the limb and persistent positioning in its resting position, secondary adaptive changes occur that result in muscle stiffness and length-associated changes. Shoulder pain is common, negatively affecting outcome. This article discusses the mechanisms causing the painful stiff glenohumeral joint and subluxation and argues the need for preventing these sequelae by early active training of the limb, together with vigorous methods of preserving muscle length and mechanical flexibility. If pain develops, early diagnosis of pathological mechanisms and appropriate treatment should take place as in the nonstroke population.

Muscle length effect on the pendulum test

OBJECTIVEnAn investigation of the effect of the length of knee extensor muscles on the pendulum test.nnnDESIGNnDescriptive. Statistical analysis utilized analysis of variance with planned comparisons.nnnSETTINGnCommunity clubs and a stroke rehabilitation unit.nnnPARTICIPANTSnTwenty subjects aged 54 to 83 yrs, more than 6 weeks after stroke, and 31 healthy subjects aged 60 to 79 yrs.nnnOUTCOME MEASURESnTwo tests: pendulum test and knee extensor muscle length test.nnnRESULTSnFor both affected and intact legs, stroke subjects had significantly smaller angle of reversal (p < .001), peak angular velocity (p < .001), and maximum passive knee flexion (p < .001) than healthy subjects. When angle of reversal was normalized for passive knee flexion, there were no significant differences between healthy and stroke subjects. There were no significant differences in any variable between the intact and affected legs of the stroke subjects.nnnCONCLUSIONnSoft tissue changes, rather than hyperreflexia, may explain the decreased angle of reversal and peak angular velocity in the stroke subjects studied.

Balancing the Centre of Body Mass During Standing Up

When individuals stand up from the sitting position, the body mass must be controlled within the limits imposed by the need to balance the massive upper body segment while the total body rotates and pivots over a fixed foot. Since postural adjustments occur in any movement of the body over a fixed base of support, standing up provides an interesting model for studying balance. Standing up requires an initial impulse in the horizontal direction, changing to the vertical direction when the thighs are lifted off the supporting surface. The horizontal distance moved by the centre of body mass (CBM) and the timing of lower limb extensor force in relation to the position of the CBM appear to be critical to ensure both a change in direction and the preservation of equilibrium. The findings from a biomechanical study of standing up, in which the extent of arm movement was varied, indicated that restricting arm movement affected the momentum and position of the CBM in relation to the base of support at thighs-off.