[ARTICLE] Rehabilitation of the upper limb after an stroke. Part 1. The Flexion Attitude Synergy. An multi-eclectic approach – Full Text PDF

Abstract

The rehabilitation of an arm after an stroke is the greatest problem the past centuries. The prognostic of the recovery is very poor ,especially by the group that hasn’t an cortical-spinal bane left. No activity in 72 hour after the stroke in the shoulder abduction and extension of the fingers means that the possibilities to an full recovery are poor. That has given many therapist no motivation to try to get the best result of his treatment for every individual after an stroke. And looking what therapist do, is an poor image what can be done by all individuals after an stroke. That means not that in this article you find the solution for full recovery but this will give so far as possible the possibilities that there are to get an optimal result. Even the “a-functional “arm need treatment to get an level that the individual has no pain and can handle this arm on the right way. Walking and balance difficulties will have always an reaction in the upper trunk and therefore also in the shoulder blade and the arm and that asked for an proper treatment. But there are an lot of possibilities to create an “function” for that “a-functional” arm/hand that makes that this arm/hand has an goal in the ADL and there are many books about this subject. Further one there are doubt that compensation in the early rehabilitation after an stroke is the best way to handle this problem, there are sounds that the amount of treatment isn’t right and the amount of investigation on the CIMT-approach gives an picture that an lot of scientist are searching for an greater intensity and for an longer time. Together they expect an better result because only more time isn’t the answer. But the most important issue that all arm/hand are treatable after stroke and that the therapist must assess what the level is and what the possibilities from there are. This part start with an arm/hand that has an low tone with what activity returning but as an flexion attitude synergy and with great problems to hold the mobility on his highest level.

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[ARTICLE] Walking: What say the scientist and what is best practice – Full Text PDF

Abstract

In this part we try to listen to the science, that has and still do over the whole world investigation by stroke patients over the walking aspect and the best way to get the best recovery or compensation. Recovery is only for an group possible, that had an “minor” stroke and there we see that the old system is not too much damaged and recovery is possible. But with greater damage of the brain individual after an stroke must go another way to get his independently and that is compensation. That compensation start with the first movement in bed and will also affect the diagonal. The science has reported that the walking pattern on the EMG don’t change very much after an short period and they said that this pattern are fixed within in certain period. We have our doubt and have search to other forms of training and learning and see that changes is well possible but to be sure the science must investigated that. Here is an problem because science gives another interpretation of the word intensity. For the scientist this is “more time” to do the exercises and in our view, it is the heaviness of the exercises and that can be done by an individual with an stroke an certain time before he is fatigue.

In the treatment we start with the individual with an severe stroke that need all assistance to get him on his feet and will have need of an splint on his knee because the power in the knee muscle is to limited, to hold the knee. Regrettable an individual after an stroke that the scientist never investigate because this is too difficult. From this starting point we walk through all the steps, we must make to get independent walking individual when possible and what the problem were when that goal cannot fully reached.

And we discuss other forms, approach or new development to get walking possible with the use of the diagonals. Part 8 will discuss other casus with an severe stroke. (Jan van de Rakt, Steve McCarthy-Grunwald -Diagonals Part 7 Stroke 5 Walking: What say the scientist and what is best practice. Ita. J. Sports Reh. Po. 2018; 5; 2 ; 1013 – 1062 ; ISSN 2385-1988 [online] IBSN 007-111-19-55 ; CGI J OAJI :0,101 )

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