BOOK
Neurologic Interventions for Physical Therapy- E-Book
Suzanne Tink Martin | Mary Kessler
(2015)
Additional Information
Book Details
Abstract
Master the role of the physical therapist or physical therapist assistant in neurologic rehabilitation! Neurologic Interventions for Physical Therapy, 3rd Edition helps you develop skills in the treatment interventions needed to improve the function of patients with neurologic deficits. It provides a solid foundation in neuroanatomy, motor control, and motor development, and offers clear, how-to guidelines to rehabilitation procedures. Case studies help you follow best practices for the treatment of children and adults with neuromuscular impairments caused by events such as spinal cord injuries, cerebral palsy, and traumatic brain injuries. Written by physical therapy experts Suzanne ‘Tink’ Martin and Mary Kessler, this market-leading text will help you prepare for the neurological portion of the PTA certification exam and begin a successful career in physical therapy practice.
- Comprehensive coverage of neurologic rehabilitation explores concepts in neuroanatomy, motor control and motor learning, motor development, and evidence-based treatment of adults and children with neuromuscular impairments.
- Over 700 photos and drawings clarify concepts, show anatomy, physiology, evaluation, and pathology, and depict the most current rehabilitation procedures and technology.
- Case studies demonstrate the patient examination and treatment process, and show how to achieve consistency in documentation.
- Proprioceptive Neuromuscular Facilitation chapter describes how PNF can be used to improve a patient’s performance of functional tasks by increasing strength, flexibility, and range of motion — key to the treatment of individuals post stroke.
- Review questions are included at the end of each chapter, with answers at the back of the book.
- Illustrated step-by-step intervention boxes, tables, and charts highlight important information, and make it easy to find instructions quickly.
- Use of language of the APTA Guide to Physical Therapist Practice ensures that you understand and comply with best practices recommended by the APTA.
- NEW photographs of interventions and equipment reflect the most current rehabilitation procedures and technology.
- UPDATED study resources on the Evolve companion website include an intervention collection, study tips, and additional review questions and interactive case studies.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Inside Front cover | ES2 | ||
| Neurologic Interventions for Physical Therapy | iii | ||
| Copyright | iv | ||
| Contributors | v | ||
| Dedication | vii | ||
| Preface | ix | ||
| Acknowledgments | xi | ||
| Contents | xiii | ||
| Section 1: Foundations | 1 | ||
| Chapter 1: The Roles of the Physical Therapist and Physical Therapist Assistant in Neurologic Rehabilitation | 1 | ||
| Introduction | 1 | ||
| The role of the physical therapist in patient management | 3 | ||
| The role of the physical therapist assistant in treating patients with neurologic deficits | 4 | ||
| The physical therapist assistant as a member of the healthcare team | 8 | ||
| References | 9 | ||
| Chapter 2: Neuroanatomy | 10 | ||
| Introduction | 10 | ||
| Major components of the nervous system | 10 | ||
| Types of Nerve Cells | 10 | ||
| Neuron Structures | 10 | ||
| Synapses | 11 | ||
| Neurotransmitters | 11 | ||
| Axons | 11 | ||
| White Matter | 11 | ||
| Gray Matter | 12 | ||
| Fibers and Pathways | 12 | ||
| Brain | 13 | ||
| Supportive and Protective Structures | 13 | ||
| Lobes of the Cerebrum | 14 | ||
| Frontal lobe | 14 | ||
| Parietal lobe | 15 | ||
| Temporal lobe | 15 | ||
| Occipital lobe | 15 | ||
| Association Cortex | 15 | ||
| Motor Areas of the Cerebral Cortex | 15 | ||
| Hemispheric Specialization | 15 | ||
| Left Hemisphere Functions | 15 | ||
| Right Hemisphere Functions | 16 | ||
| Hemispheric Connections | 16 | ||
| Deeper Brain Structures | 16 | ||
| Internal Capsule | 16 | ||
| Diencephalon | 16 | ||
| Hypothalamus | 16 | ||
| Basal Nuclei | 16 | ||
| Limbic System | 17 | ||
| Cerebellum | 17 | ||
| Brain Stem | 17 | ||
| Spinal Cord | 18 | ||
| Internal Anatomy | 19 | ||
| Major Afferent (Sensory) Tracts | 20 | ||
| Major Efferent (Motor) Tract | 20 | ||
| Other Descending Tracts | 20 | ||
| Anterior Horn Cell | 21 | ||
| Muscle Spindle | 21 | ||
| PNS | 21 | ||
| Somatic Nervous System | 21 | ||
| Cervical plexus | 22 | ||
| Brachial plexus | 23 | ||
| Lumbosacral Plexus | 23 | ||
| Peripheral Nerves | 25 | ||
| Autonomic Nervous System | 25 | ||
| Cerebral Circulation | 26 | ||
| Anterior Circulation | 26 | ||
| Posterior Circulation | 28 | ||
| Reaction to injury | 30 | ||
| References | 32 | ||
| Chapter 3: Motor Control and Motor Learning | 33 | ||
| Introduction | 33 | ||
| Motor control | 33 | ||
| Motor Control Time Frame | 34 | ||
| Role of Sensation in Motor Control | 34 | ||
| Role of Feedback | 34 | ||
| Theories of Motor Control | 35 | ||
| Reflex and Hierarchical Theories | 35 | ||
| Development of Motor Control | 36 | ||
| Stages of Motor Control | 36 | ||
| Stage One | 36 | ||
| Stage Two | 36 | ||
| Stage Three | 37 | ||
| Stage Four | 38 | ||
| Development of Postural Control | 38 | ||
| Righting Reactions | 38 | ||
| Protective Reactions | 39 | ||
| Equilibrium Reactions | 39 | ||
| Motor Program Model of Motor Control | 39 | ||
| Systems Models of Motor Control | 40 | ||
| Components of the Postural Control System | 40 | ||
| Limits of Stability | 40 | ||
| Sensory Organization | 41 | ||
| Eye-Head Stabilization | 42 | ||
| Musculoskeletal System | 42 | ||
| Motor Coordination | 43 | ||
| Predictive Central Set | 43 | ||
| Environmental Adaptation | 43 | ||
| Nashners Model of Postural Control in Standing | 43 | ||
| Issues related to motor control | 44 | ||
| Top Down or Distributed Control | 44 | ||
| Degrees of Freedom | 44 | ||
| Optimization Principles | 45 | ||
| Age-Related Changes in Postural and Motor Control | 45 | ||
| Balance Strategies in Sitting | 45 | ||
| Strategies in Standing | 45 | ||
| Motor learning | 46 | ||
| Definition and Time Frame | 46 | ||
| Theories of motor learning | 46 | ||
| Adams Closed-Loop Theory | 47 | ||
| Schmidts Schema Theory | 47 | ||
| Stages of motor learning | 47 | ||
| Fitts Stages | 48 | ||
| ``Neo-Bernsteinian´´ Model | 48 | ||
| Open and Closed Tasks | 49 | ||
| Effects of Practice | 49 | ||
| Massed versus Distributed Practice | 49 | ||
| Random versus Blocked Practice | 49 | ||
| Whole versus Part Task Training | 49 | ||
| Constraints to Motor Development, Motor Control, and Motor Learning | 50 | ||
| Age-Related Changes in Motor Learning | 50 | ||
| Neural Plasticity | 50 | ||
| Interventions Based on Motor Control, Motor Learning, and Neural Plasticity Principles | 51 | ||
| References | 53 | ||
| Chapter 4: Motor Development | 56 | ||
| Introduction | 56 | ||
| The Life Span Concept | 56 | ||
| A Life Span Approach | 56 | ||
| Life-Span View of Motor Development | 57 | ||
| Developmental time periods | 57 | ||
| Infancy | 57 | ||
| Childhood | 57 | ||
| Adolescence | 58 | ||
| Adulthood | 58 | ||
| Family Systems | 58 | ||
| Older Adulthood | 59 | ||
| Influence of cognition and motivation | 59 | ||
| Piaget | 60 | ||
| Maslow and Erikson | 60 | ||
| Theories of Motor Development | 61 | ||
| Developmental concepts | 62 | ||
| Epigenesis | 62 | ||
| Directional Concepts of Motor Development | 63 | ||
| Cephalic to Caudal | 63 | ||
| Proximal to Distal | 63 | ||
| General Concepts of Development | 63 | ||
| Dissociation | 63 | ||
| Reciprocal Interweaving | 63 | ||
| Variation and Variability | 64 | ||
| Biomechanical Considerations in Motor Development | 64 | ||
| Physiologic Flexion to Antigravity Extension to Antigravity Flexion | 64 | ||
| Developmental processes | 64 | ||
| Growth | 64 | ||
| Maturation | 64 | ||
| Adaptation | 66 | ||
| Motor milestones | 66 | ||
| Head Control | 66 | ||
| Segmental Rolling | 66 | ||
| Sitting | 67 | ||
| Creeping and Cruising | 67 | ||
| Walking | 67 | ||
| Reach, Grasp, and Release | 67 | ||
| Hand Regard | 67 | ||
| Reflexive and Palmar Grasp | 68 | ||
| Evolution of Voluntary Grasp | 69 | ||
| Release | 69 | ||
| Typical motor development | 69 | ||
| Infant | 70 | ||
| Birth to Three Months | 70 | ||
| Four Months | 71 | ||
| Five Months | 72 | ||
| Six Months | 73 | ||
| Seven Months | 76 | ||
| Eight Months | 77 | ||
| Nine Months | 77 | ||
| Toddler | 78 | ||
| Twelve Months | 78 | ||
| Sixteen to Eighteen Months | 80 | ||
| Two Years | 81 | ||
| Fundamental Movement Patterns (Three to Six Years) | 81 | ||
| Three Years | 81 | ||
| Four Years | 81 | ||
| Five Years | 84 | ||
| Six Years | 84 | ||
| Gait | 85 | ||
| Age-Related Differences in Movement Patterns beyond Childhood | 85 | ||
| Posture, balance, and gait changes with aging | 86 | ||
| Posture | 86 | ||
| Balance | 86 | ||
| Gait in the Older Adult | 87 | ||
| Implications for Treatment | 88 | ||
| References | 88 | ||
| Section 2: Children | 91 | ||
| Chapter 5: Positioning and Handling to Foster Motor Function | 91 | ||
| Introduction | 91 | ||
| Children with neurologic deficits | 91 | ||
| General physical therapy goals | 92 | ||
| Function related to posture | 92 | ||
| Supine and Prone | 93 | ||
| Sitting | 93 | ||
| Quadruped | 93 | ||
| Standing | 93 | ||
| Physical therapy intervention | 93 | ||
| Daily Routines | 94 | ||
| Home Program | 94 | ||
| Positioning and handling interventions | 95 | ||
| Positioning for Function | 95 | ||
| Handling at Home | 97 | ||
| Holding and Carrying Positions | 98 | ||
| Handling Techniques for Movement | 99 | ||
| Use of Manual Contacts | 99 | ||
| Handling Tips | 101 | ||
| Use of Sensory Input to Promote Positioning and Handling | 102 | ||
| Touch | 102 | ||
| Vestibular System | 103 | ||
| Approximation | 103 | ||
| Vision | 104 | ||
| Hearing | 104 | ||
| Preparation for movement | 105 | ||
| Postural Readiness | 105 | ||
| Postural Alignment | 105 | ||
| Manual Contacts | 105 | ||
| Rotation | 105 | ||
| Interventions to foster head and trunk control | 108 | ||
| Head Control | 108 | ||
| Positioning to Encourage Head Control | 108 | ||
| Prone over a Bolster, Wedge, or Half-Roll | 108 | ||
| Supine on a Wedge or Half-Roll | 109 | ||
| Interventions to Encourage Head Control | 109 | ||
| Modified Pull-to-Sit Maneuver | 109 | ||
| Upright in Supported Sitting | 109 | ||
| Weight Shifting from Supported Upright Sitting | 110 | ||
| Carrying in Prone | 111 | ||
| Carrying in Upright | 111 | ||
| Prone in a Hammock or on a Suspended Platform Swing | 111 | ||
| Trunk Control | 111 | ||
| Positioning for Independent Sitting | 111 | ||
| Sitting Propped Forward on Both Arms | 111 | ||
| Sitting Propped Forward on One Arm | 112 | ||
| Sitting Propped Laterally on One Arm | 112 | ||
| Sitting without Hand Support | 112 | ||
| Side Sitting Propped on One Arm | 112 | ||
| Side Sitting with No Hand Support | 113 | ||
| Movement Transitions that Encourage Trunk Rotation and Trunk Control | 113 | ||
| Rolling from Supine to Prone Using the Lower Extremity | 113 | ||
| Coming to Sit from Supine | 114 | ||
| Coming to Sit from Prone | 114 | ||
| Coming to Sit from Side-Lying | 114 | ||
| Sitting to Prone | 114 | ||
| Prone to Four-Point | 115 | ||
| Four-Point to Side Sitting | 115 | ||
| Four-Point to Kneeling | 115 | ||
| Kneeling to Side Sitting | 115 | ||
| Kneeling to Half-Kneeling | 115 | ||
| Coming to Stand | 115 | ||
| Adaptive equipment for positioning and mobility | 117 | ||
| Goals for Adaptive Equipment | 119 | ||
| Supine and Prone Posture Positioning | 119 | ||
| Sitting Posture Positioning | 120 | ||
| Adaptive Seating | 122 | ||
| Side-Lying Position | 123 | ||
| Positioning in Standing | 124 | ||
| Functional movement in the context of the childs world | 126 | ||
| References | 130 | ||
| Chapter 6: Cerebral Palsy | 131 | ||
| Introduction | 131 | ||
| Incidence | 131 | ||
| Etiology | 131 | ||
| Prenatal Causes | 131 | ||
| Perinatal Causes | 132 | ||
| Postnatal Causes | 133 | ||
| Classification | 133 | ||
| Distribution of Involvement | 133 | ||
| Abnormal Muscle Tone and Movement | 134 | ||
| Spasticity | 135 | ||
| Transient Dystonia | 135 | ||
| Rigidity | 135 | ||
| Dyskinesia | 135 | ||
| Ataxia | 135 | ||
| Functional classification | 136 | ||
| Diagnosis | 137 | ||
| Pathophysiology | 137 | ||
| Associated deficits | 137 | ||
| Feeding and Speech Impairments | 137 | ||
| Breathing Inefficiency | 138 | ||
| Intellectual Disability | 139 | ||
| Seizures | 140 | ||
| Visual Impairments | 140 | ||
| Hearing, Speech, and Language Impairments | 141 | ||
| Physical therapy examination | 141 | ||
| Neuromuscular Impairments, Activity Limitations, and Participation Restrictions | 141 | ||
| The Child with Spastic Cerebral Palsy | 141 | ||
| Head Control | 141 | ||
| Trunk Control | 141 | ||
| Influence of Tonic Reflexes | 142 | ||
| Movement Transitions | 144 | ||
| Mobility and Ambulation | 144 | ||
| Extremity Usage | 144 | ||
| The Child with Athetosis or Ataxia | 144 | ||
| Physical therapy intervention | 145 | ||
| General Treatment Ideas | 145 | ||
| Child with Spasticity | 145 | ||
| Advantages and Disadvantages of Different Positions | 146 | ||
| Supine | 146 | ||
| Side Lying | 146 | ||
| Prone | 146 | ||
| Sitting | 146 | ||
| Quadruped | 146 | ||
| Kneeling | 146 | ||
| Standing | 146 | ||
| Child with Athetosis or Ataxia | 146 | ||
| Valued Life Outcomes | 146 | ||
| First Stage of Physical Therapy Intervention: Early Intervention (Birth to 3 Years) | 147 | ||
| Role of the Family | 147 | ||
| Role of the Physical Therapist Assistant | 147 | ||
| Handling and Positioning | 148 | ||
| Feeding and Respiration | 148 | ||
| Therapeutic Exercise | 149 | ||
| Motor Skill Acquisition | 149 | ||
| Constraint-Induced Movement Therapy (CIMT) | 150 | ||
| Functional Postures | 150 | ||
| Independent Mobility | 150 | ||
| Ambulation Predictors | 152 | ||
| Body Weight-Supported Treadmill Training (BWSTT) | 153 | ||
| Power Mobility | 154 | ||
| Second Stage of Physical Therapy Intervention: Preschool Period | 154 | ||
| Independent Mobility | 154 | ||
| Gait | 155 | ||
| Orthoses | 156 | ||
| Assistive Devices | 157 | ||
| Power Mobility | 158 | ||
| Medical Management | 158 | ||
| Medications | 158 | ||
| Botulinum Toxin | 159 | ||
| Surgical Management | 159 | ||
| Neurosurgery | 160 | ||
| Functional Movement | 161 | ||
| Activities of Daily Living and Peer Interaction | 161 | ||
| Third Stage of Physical Therapy Intervention: School Age and Adolescence | 162 | ||
| Self-Responsibility and Motivation | 162 | ||
| Physiologic Changes | 163 | ||
| Independence | 163 | ||
| Strength | 163 | ||
| Fitness | 163 | ||
| Community Integration | 164 | ||
| Fourth Stage of Physical Therapy Intervention: Adulthood | 164 | ||
| Future Directions | 164 | ||
| References | 167 | ||
| Chapter 7: Myelomeningocele | 171 | ||
| Introduction | 171 | ||
| Incidence | 171 | ||
| Etiology | 171 | ||
| Prenatal diagnosis | 173 | ||
| Clinical features | 173 | ||
| Neurologic Defects and Impairments | 173 | ||
| Functional Movement Related to Level | 173 | ||
| Musculoskeletal Impairments | 173 | ||
| Osteoporosis | 174 | ||
| Neuropathic Fractures | 174 | ||
| Spinal Deformities | 175 | ||
| Arnold-Chiari Malformation | 176 | ||
| Hydrocephalus | 176 | ||
| Central Nervous System Deterioration | 176 | ||
| Hydromyelia | 177 | ||
| Tethered Spinal Cord | 177 | ||
| Sensory Impairment | 177 | ||
| Bowel and Bladder Dysfunction | 178 | ||
| Latex Allergy | 178 | ||
| Physical therapy intervention | 178 | ||
| First Stage of Physical Therapy Intervention | 178 | ||
| Prevention of Deformities: Postoperative Positioning | 179 | ||
| Prone Positioning | 179 | ||
| Effects of Gravity | 179 | ||
| Orthoses for Lower Extremity Positioning | 179 | ||
| Prevention of Skin Breakdown | 180 | ||
| Sensory Precautions | 180 | ||
| Prevention of Contractures: Range of Motion | 181 | ||
| Promotion of Age-Appropriate Sensorimotor Development | 181 | ||
| Therapeutic Handling: Development of Head Control | 181 | ||
| Therapeutic Handling: Developing Righting and Equilibrium Reactions | 182 | ||
| Handling: Developing Trunk Control in Sitting | 182 | ||
| Preparation for Ambulation: Acclimation to Upright and Weight Bearing | 182 | ||
| Upper Extremity Strengthening | 183 | ||
| Mat Mobility | 183 | ||
| Standing Frames | 184 | ||
| Family Education | 184 | ||
| Second Stage of Physical Therapy Intervention | 185 | ||
| Orthotic Management | 186 | ||
| Orthotic Selection | 186 | ||
| Level of Lesion | 186 | ||
| Age | 186 | ||
| Types of Orthoses | 187 | ||
| Parapodium | 188 | ||
| Reciprocating Gait Orthosis | 188 | ||
| Swivel Walker | 189 | ||
| Donning and Doffing of Orthoses | 189 | ||
| Wearing Time of Orthoses | 189 | ||
| Upper Limb Function | 189 | ||
| Cognition | 189 | ||
| Vision and Visual Perception | 190 | ||
| Cocktail Party Speech | 190 | ||
| Principles of Gait Training | 190 | ||
| Level of Ambulation | 191 | ||
| Strength, Flexibility, and Endurance | 192 | ||
| Independence in Pressure Relief | 192 | ||
| Independence in Self-Care and Activities of Daily Living | 192 | ||
| Promotion of Cognitive and Social-Emotional Growth | 193 | ||
| Identification of Perceptual Problems | 193 | ||
| Collaboration for Total Management | 193 | ||
| Third Stage of Physical Therapy Intervention | 193 | ||
| Reevaluation of Ambulation Potential | 193 | ||
| Wheelchair Mobility | 194 | ||
| Environmental Accessibility | 194 | ||
| Driver Education | 194 | ||
| Flexibility, Strength, and Endurance | 194 | ||
| Hygiene | 195 | ||
| Socialization | 195 | ||
| Independent Living | 195 | ||
| Quality of Life | 195 | ||
| References | 199 | ||
| Chapter 8: Genetic Disorders | 201 | ||
| Introduction | 201 | ||
| Genetic transmission | 201 | ||
| Categories | 202 | ||
| Down syndrome | 202 | ||
| Clinical Features | 202 | ||
| Intelligence | 203 | ||
| Development | 203 | ||
| Section 3: Adults | 249 | ||
| Chapter 9: Proprioceptive Neuromuscular Facilitation* | 249 | ||
| Introduction | 249 | ||
| History of proprioceptive neuromuscular facilitation | 249 | ||
| Basic principles of PNF | 250 | ||
| Manual Contacts | 250 | ||
| Body Position and Body Mechanics | 250 | ||
| Stretch | 250 | ||
| Manual Resistance | 250 | ||
| Irradiation | 251 | ||
| Joint Facilitation | 251 | ||
| Timing of Movement | 251 | ||
| Patterns of Movement | 251 | ||
| Visual Cues | 251 | ||
| Verbal Input | 251 | ||
| Application of Proprioceptive Neuromuscular Facilitation Principles | 252 | ||
| Biomechanical considerations | 252 | ||
| Patterns | 252 | ||
| Extremity Patterns | 252 | ||
| Upper Extremity Patterns | 252 | ||
| Scapular Patterns | 254 | ||
| Lower Extremity Patterns | 254 | ||
| Pelvic Patterns | 257 | ||
| Trunk Patterns | 257 | ||
| Upper Trunk Patterns | 257 | ||
| Proprioceptive neuromuscular facilitation techniques | 262 | ||
| Rhythmic Initiation | 264 | ||
| Rhythmic Rotation | 264 | ||
| Hold Relax Active Movement | 264 | ||
| Hold Relax | 267 | ||
| Contract Relax | 267 | ||
| Alternating Isometrics | 267 | ||
| Rhythmic Stabilization | 273 | ||
| Slow Reversal | 275 | ||
| Slow Reversal Hold | 275 | ||
| Agonistic Reversals | 275 | ||
| Resisted Progression | 278 | ||
| Application of PNF Techniques | 278 | ||
| Developmental sequence | 279 | ||
| Supine Progression | 279 | ||
| Rolling | 281 | ||
| Prone Progression | 283 | ||
| Quadruped | 283 | ||
| Kneeling | 283 | ||
| Sitting | 284 | ||
| Scooting | 287 | ||
| Sit to Stand | 288 | ||
| Standing | 291 | ||
| Pregait Activities | 292 | ||
| Proprioceptive neuromuscular facilitation and motor learning | 298 | ||
| References | 299 | ||
| Chapter 10: Cerebrovascular Accidents | 300 | ||
| Introduction | 300 | ||
| Definition | 300 | ||
| Etiology | 300 | ||
| Ischemic Cerebrovascular Accidents | 300 | ||
| Hemorrhagic Cerebrovascular Accidents | 301 | ||
| Transient Ischemic Attacks | 301 | ||
| Medical intervention | 301 | ||
| Diagnosis | 301 | ||
| Acute Medical Management | 301 | ||
| Recovery from stroke | 301 | ||
| Prevention of cerebrovascular accidents | 302 | ||
| Stroke syndromes | 302 | ||
| Anterior Cerebral Artery Occlusion | 302 | ||
| Middle Cerebral Artery Occlusion | 303 | ||
| Vertebrobasilar Artery Occlusion | 303 | ||
| Posterior Artery Occlusion | 303 | ||
| Lacunar Infarcts | 303 | ||
| Other Stroke Syndromes | 303 | ||
| Thalamic Pain Syndrome | 303 | ||
| Pusher Syndrome | 303 | ||
| Summary | 304 | ||
| Clinical findings: Patient impairments | 304 | ||
| Motor Impairments | 304 | ||
| Spasticity | 304 | ||
| Assessment of Tone | 304 | ||
| Brunnstrom Stages of Motor Recovery | 304 | ||
| Development of Spasticity in Proximal Muscle Groups | 305 | ||
| Other Motor Impairments | 306 | ||
| Motor Planning Deficits | 306 | ||
| Sensory Impairments | 306 | ||
| Communication Impairments | 306 | ||
| Other Communication Deficits | 306 | ||
| Orofacial Deficits | 307 | ||
| Respiratory Impairments | 307 | ||
| Reflex Activity | 307 | ||
| Spinal Reflexes | 307 | ||
| Deep Tendon Reflexes | 307 | ||
| Brain Stem Reflexes | 308 | ||
| Associated Reactions | 308 | ||
| Bowel and Bladder Dysfunction | 308 | ||
| Functional Limitations | 308 | ||
| Treatment planning | 308 | ||
| Functional Assessments | 309 | ||
| Goals and Expectations | 309 | ||
| Complications seen following stroke | 309 | ||
| Abnormal Posturing and Positioning | 309 | ||
| Complex Regional Pain Syndrome | 310 | ||
| Additional Complications | 310 | ||
| Acute care setting | 310 | ||
| Directing interventions to a physical therapist assistant | 310 | ||
| Early physical therapy intervention | 311 | ||
| Cardiopulmonary Retraining | 311 | ||
| Diaphragmatic Strengthening | 311 | ||
| Other Cardiopulmonary Activities | 311 | ||
| Positioning | 311 | ||
| Supine Positioning | 311 | ||
| Side-Lying Positioning | 312 | ||
| Minimizing the Development of Abnormal Tone and Patient Neglect | 312 | ||
| Leaving Items within Reach | 313 | ||
| Other Considerations | 313 | ||
| Early Functional Mobility Tasks | 313 | ||
| Bridging and Bridging with Approximation | 313 | ||
| Other Bedside Activities | 314 | ||
| Importance of Movement Assessment | 316 | ||
| Scapular Mobilization | 317 | ||
| Other Upper Extremity Activities | 317 | ||
| Facilitation and Inhibition Techniques | 317 | ||
| Facilitation Techniques | 317 | ||
| Primitive or Spinal Level Reflexes | 318 | ||
| Using Brain Stem or Tonic Reflexes | 318 | ||
| Other Facilitation Techniques | 319 | ||
| Inhibition Techniques | 319 | ||
| Treatment Adjunct | 319 | ||
| Long Arm Splint | 319 | ||
| Elbow and Hand Splint | 319 | ||
| Long Leg Splint | 321 | ||
| Foot Splint | 321 | ||
| Neurodevelopmental Treatment Approach | 322 | ||
| Neuroplasticity | 322 | ||
| Functional Activities | 323 | ||
| Rolling | 323 | ||
| Rolling to the Involved Side | 323 | ||
| Rolling to the Uninvolved Side | 323 | ||
| Scooting | 324 | ||
| Movement Transitions | 324 | ||
| Supine-to-Sit Transfer | 324 | ||
| Wheelchair-to-Bed/Mat Transfers | 325 | ||
| Summary | 325 | ||
| Other Functional Positions | 325 | ||
| Sitting | 325 | ||
| Motor Control | 327 | ||
| Sitting Posture: Positioning the Pelvis | 328 | ||
| Achieving Pelvic Tilts in Supine | 328 | ||
| Positioning the Trunk | 328 | ||
| Positioning the Head | 328 | ||
| Additional Sitting Balance Activities: Weight Bearing on the Involved Hand | 329 | ||
| Shoulder Subluxations | 330 | ||
| Weight-Shifting Activities | 330 | ||
| Sitting Balance Activities to Improve Trunk Control | 331 | ||
| Assessing Protective Reactions | 332 | ||
| Sitting Activities | 333 | ||
| Standing | 334 | ||
| Position of the Physical Therapist Assistant in Relation to the Patient | 334 | ||
| Sit-to-Stand Transition | 334 | ||
| Establishing Knee Control | 336 | ||
| Positioning the Standing Patient | 337 | ||
| Early Standing Activities: Weight Shifting | 337 | ||
| Assessing Balance Responses | 339 | ||
| Standing Progression (Walking): Position of the Physical Therapist Assistant in Relation to the Patient | 339 | ||
| Advancing the Uninvolved Lower Extremity | 340 | ||
| Advancing the Involved Lower Extremity | 341 | ||
| Achieving a Normal Gait Pattern: Positioning the Pelvis | 341 | ||
| Advancing the Involved Lower Extremity Forward | 341 | ||
| Backward Stepping | 341 | ||
| Putting It All Together | 341 | ||
| Normal Components of Gait | 341 | ||
| Turning Around | 342 | ||
| Upper Extremity Positioning During Ambulation | 342 | ||
| Common Gait Deviations | 344 | ||
| Ambulation | 344 | ||
| Quality of Movement versus Function | 344 | ||
| Selection of an Assistive Device | 344 | ||
| Ambulation Training with Assistive Devices | 345 | ||
| Ambulation Progression with a Cane | 345 | ||
| Cane Use and Asymmetry | 346 | ||
| Walking on Different Surfaces | 346 | ||
| Pusher Syndrome | 346 | ||
| Orthoses | 347 | ||
| Prefabricated Ankle-Foot Orthoses | 347 | ||
| Posterior Leaf Splints | 347 | ||
| Checking for Skin Irritation | 347 | ||
| Customized Ankle-Foot Orthoses | 348 | ||
| Articulated Ankle-Foot Orthoses | 348 | ||
| Following the Developmental Sequence | 349 | ||
| Prone Activities | 349 | ||
| Transition from Prone on Elbows to Four-Point | 349 | ||
| Four-Point Activities | 350 | ||
| Creeping | 350 | ||
| Transition from Four-Point to Tall-Kneeling | 350 | ||
| Physical Observations | 350 | ||
| Tall-Kneeling Activities | 351 | ||
| Transition from Tall-Kneeling to Half-Kneeling | 352 | ||
| Half-Kneeling Activities | 352 | ||
| Modified Plantigrade Position | 353 | ||
| Midrecovery to late recovery | 353 | ||
| Negotiation of Environmental Barriers | 354 | ||
| Stairs | 354 | ||
| Stair Climbing with a Cane | 355 | ||
| Curbs and Ramps | 356 | ||
| Family Participation | 356 | ||
| Working on Fine Motor Skills | 356 | ||
| Advanced Exercises for the Lower Extremity | 356 | ||
| Advanced Exercises for the Ankle | 356 | ||
| Coordination Exercises | 356 | ||
| Balance Exercises | 356 | ||
| Dynamic Balance Activities | 357 | ||
| Dual Task Training | 357 | ||
| Advanced Balance Exercises | 357 | ||
| Dynamic Sitting and Standing Balance Exercises Using Movable Surfaces | 357 | ||
| Swiss Ball | 357 | ||
| Tilt Boards | 358 | ||
| Observations | 358 | ||
| Anterior and Posterior Weight Shifts on the Tilt Board | 359 | ||
| Management of Abnormal Tone | 360 | ||
| Neuroplasticity | 360 | ||
| Preparation for Discharge | 361 | ||
| Assessing the Patients Home Environment | 361 | ||
| References | 366 | ||
| Chapter 11: Traumatic Brain Injuries | 368 | ||
| Introduction | 368 | ||
| Classifications of brain injuries | 368 | ||
| Open and Closed Injuries | 368 | ||
| Subtypes of Traumatic Brain Injuries | 368 | ||
| Concussion | 368 | ||
| Contusion | 369 | ||
| Hematomas | 370 | ||
| Locked-in Syndrome, Acquired Brain Injuries, and Sudden Impact Syndrome | 370 | ||
| Secondary problems | 370 | ||
| Increased Intracranial Pressure | 370 | ||
| Anoxic Injuries | 371 | ||
| Seizures | 371 | ||
| Patient examination and evaluation | 371 | ||
| Glasgow Coma Scale | 371 | ||
| Classifying the Severity of Traumatic Brain Injury | 371 | ||
| Patient problem areas | 372 | ||
| Decreased Level of Consciousness | 372 | ||
| Cognitive Deficits | 372 | ||
| Motor Deficits | 372 | ||
| Sensory Deficits | 373 | ||
| Communication Deficits | 373 | ||
| Behavioral Deficits | 373 | ||
| Associated Problems | 373 | ||
| Physical therapy intervention: acute care | 373 | ||
| Positioning | 373 | ||
| Heterotopic Ossification | 375 | ||
| Reflex-Inhibiting Postures | 375 | ||
| Activities Aimed at Increasing Patient Awareness | 375 | ||
| Sensory Stimulation | 375 | ||
| Cognitive Functioning | 376 | ||
| Patient and Family Education | 376 | ||
| Physical therapy interventions during inpatient rehabilitation | 376 | ||
| Positioning | 376 | ||
| Wheelchair Propulsion | 379 | ||
| Range of Motion | 379 | ||
| Improving Awareness | 379 | ||
| Family Education | 380 | ||
| Functional Mobility Training | 380 | ||
| Sitting Activities | 381 | ||
| Transfers | 383 | ||
| Standing Activities | 383 | ||
| Treatment Planning | 383 | ||
| The Physical Environment | 383 | ||
| Integrating physical and cognitive components of a task into treatment interventions | 387 | ||
| Cognitive and Behavioral Impairments | 387 | ||
| Disorientation | 387 | ||
| Attention Deficits | 387 | ||
| Memory Deficits | 387 | ||
| Problem-Solving Deficits | 387 | ||
| Behavioral Deficits | 388 | ||
| Aggressive Behaviors | 388 | ||
| Motor Deficits and Interventions | 389 | ||
| Incorporating Physical and Cognitive Components of a Task | 389 | ||
| Discharge planning | 390 | ||
| References | 393 | ||
| Chapter 12: Spinal Cord Injuries | 395 | ||
| Introduction | 395 | ||
| Etiology | 395 | ||
| Naming the level of injury | 395 | ||
| Mechanisms of injury | 397 | ||
| Cervical Flexion and Rotation Injuries | 397 | ||
| Cervical Hyperflexion Injuries | 398 | ||
| Cervical Hyperextension Injuries | 398 | ||
| Compression Injuries | 398 | ||
| Medical intervention | 398 | ||
| Pathologic changes that occur following injury | 399 | ||
| Types of lesions | 400 | ||
| Complete Injuries | 400 | ||
| Incomplete Injuries | 400 | ||
| Brown-Séquard Syndrome | 400 | ||
| Anterior Cord Syndrome | 401 | ||
| Central Cord Syndrome | 401 | ||
| Dorsal Column Syndrome | 401 | ||
| Conus Medullaris Syndrome | 401 | ||
| Cauda Equina Injuries | 401 | ||
| Root Escape | 402 | ||
| Clinical manifestations of spinal cord injuries | 402 | ||
| Resolution of spinal shock | 402 | ||
| Complications | 402 | ||
| Pressure Ulcers | 402 | ||
| Autonomic Dysreflexia | 402 | ||
| Postural Hypotension | 403 | ||
| Pain | 403 | ||
| Contractures | 403 | ||
| Heterotopic Ossification | 403 | ||
| Deep Vein Thrombosis | 403 | ||
| Osteoporosis | 404 | ||
| Respiratory Compromise | 404 | ||
| Bladder and Bowel Dysfunction | 404 | ||
| Sexual Dysfunction | 404 | ||
| Spasticity | 405 | ||
| Functional outcomes | 405 | ||
| Key Muscles by Segmental Innervation | 406 | ||
| Functional Potentials | 406 | ||
| C1 Through C3 | 406 | ||
| C4 | 408 | ||
| C5 | 408 | ||
| C6 | 408 | ||
| C7 | 408 | ||
| C8 | 408 | ||
| T1 Through T9 | 408 | ||
| T10 Through L2 | 409 | ||
| L3 Through L5 | 409 | ||
| Physical therapy intervention: acute care | 409 | ||
| Breathing Exercises | 409 | ||
| Glossopharyngeal Breathing | 410 | ||
| Lateral Expansion | 410 | ||
| Incentive Spirometry | 410 | ||
| Chest Wall Stretching | 410 | ||
| Postural Drainage | 410 | ||
| Coughs | 410 | ||
| Assisted Cough Techniques | 410 | ||
| Technique 1 | 410 | ||
| Technique 2 | 410 | ||
| Technique 3 | 410 | ||
| Technique 4 | 410 | ||
| Range of Motion | 411 | ||
| Passive Range of Motion | 412 | ||
| Strengthening Exercises | 413 | ||
| Acclimation to Upright | 414 | ||
| Physical therapy interventions during inpatient rehabilitation | 415 | ||
| Physical Therapy Goals | 415 | ||
| Development of the Plan of Care | 415 | ||
| Early Treatment Interventions | 416 | ||
| Mat Activities | 416 | ||
| Prone | 416 | ||
| Prone on Elbows | 416 | ||
| Prone to Supine | 418 | ||
| Supine on Elbows | 418 | ||
| Long Sitting | 421 | ||
| Transfers | 424 | ||
| Preparation Phase | 424 | ||
| Two-Person Lift | 424 | ||
| Sit-Pivot Transfer | 424 | ||
| Modified Stand-Pivot Transfer | 425 | ||
| Airlift | 425 | ||
| Sliding Board Transfers | 425 | ||
| Prone-on-Elbows Transfer | 427 | ||
| Rolling Out of the Wheelchair | 427 | ||
| Lateral Push-Up Transfer | 427 | ||
| Intermediate Treatment Interventions | 428 | ||
| Mat Activities | 428 | ||
| Independent Self-Range of Motion | 428 | ||
| Advanced Treatment Interventions | 431 | ||
| Advanced Mat Activities | 431 | ||
| Transfers | 434 | ||
| Wheelchair-to-Floor Transfers | 434 | ||
| Righting the Wheelchair | 434 | ||
| Advanced Wheelchair Skills | 438 | ||
| Wheelies | 438 | ||
| Ascending Ramps | 438 | ||
| Descending Ramps | 438 | ||
| Ascending a Curb | 438 | ||
| Descending a Curb | 439 | ||
| Powered Mobility | 439 | ||
| Wheelchair Cushions | 439 | ||
| Cardiopulmonary Training | 439 | ||
| Circuit Training | 441 | ||
| Aquatic Therapy | 441 | ||
| Pool Program | 441 | ||
| Pool Exercises | 442 | ||
| Floating and Swimming | 442 | ||
| Other Advanced Rehabilitation Interventions | 442 | ||
| Ambulation Training | 442 | ||
| Benefits of Standing and Walking | 443 | ||
| Orthoses | 443 | ||
| Preparation for Ambulation | 445 | ||
| Standing in the Parallel Bars | 445 | ||
| Gait Progression | 446 | ||
| Quarter-Turns | 446 | ||
| Sitting | 446 | ||
| Swing-Through Gait Pattern | 446 | ||
| Other Gait Patterns | 446 | ||
| Backing Up | 446 | ||
| Progressing the Patient | 446 | ||
| Standing From the Wheelchair | 448 | ||
| Gait Training with Crutches | 448 | ||
| Falling | 448 | ||
| Getting up From the Floor | 448 | ||
| Negotiating Environmental Barriers | 450 | ||
| Ascending a Ramp | 450 | ||
| Descending a Ramp | 451 | ||
| Ascending a Curb | 451 | ||
| Descending a Curb | 452 | ||
| Ascending Stairs | 452 | ||
| Descending Stairs | 452 | ||
| Body-weight-supported treadmill | 452 | ||
| Discharge planning | 453 | ||
| Discharge Planning Conference | 453 | ||
| Procurement of Equipment | 454 | ||
| Home Exercise Program | 455 | ||
| Things to Consider When Developing a Home Exercise Program | 455 | ||
| Family Teaching | 455 | ||
| Community Reentry | 455 | ||
| Quality of Life | 455 | ||
| Long-Term Health-Care Needs | 456 | ||
| References | 459 | ||
| Chapter 13: Other Neurologic Disorders | 461 | ||
| Introduction | 461 | ||
| Parkinson disease | 461 | ||
| Pathophysiology | 462 | ||
| Clinical Features | 462 | ||
| Fatigue | 463 | ||
| Gait | 463 | ||
| Falls | 464 | ||
| Systemic Manifestations | 464 | ||
| Stages | 464 | ||
| Diagnosis | 464 | ||
| Medical Management | 464 | ||
| Surgical Management | 465 | ||
| Physical Therapy Management | 465 | ||
| Gait Interventions | 465 | ||
| Postural Interventions | 466 | ||
| Lee Silverman Voice Treatment (LSVT®) BIG | 468 | ||
| Exercise Strategy and Results | 469 | ||
| Multiple sclerosis | 469 | ||
| Pathophysiology | 470 | ||
| Clinical Features | 470 | ||
| Fatigue | 470 | ||
| Cognitive Impairment | 470 | ||
| Autonomic Dysfunction | 471 | ||
| Disease Course | 471 | ||
| Diagnosis | 471 | ||
| Medical Management | 471 | ||
| Physical Therapy Management | 471 | ||
| Weakness | 472 | ||
| Spasticity | 472 | ||
| Ataxia | 474 | ||
| Additional Concerns | 477 | ||
| Summary | 478 | ||
| Amyotrophic lateral sclerosis | 478 | ||
| Incidence and Etiology | 478 | ||
| Clinical Presentation | 478 | ||
| Medical Management | 479 | ||
| Physical Therapy Management | 479 | ||
| Guillain-barré syndrome | 479 | ||
| Incidence and Etiology | 479 | ||
| Pathophysiology | 480 | ||
| Clinical Features | 480 | ||
| Medical Management | 480 | ||
| Physical Therapy Management | 480 | ||
| Acute Phase | 480 | ||
| Plateau Phase | 481 | ||
| Recovery Phase | 482 | ||
| Summary | 483 | ||
| Postpolio syndrome | 483 | ||
| Etiology | 483 | ||
| Clinical Features | 484 | ||
| Fatigue | 484 | ||
| New Weakness | 484 | ||
| Pain | 484 | ||
| Other Symptoms | 484 | ||
| Cold Intolerance | 484 | ||
| Decreased Function | 484 | ||
| Medical Management | 485 | ||
| Physical Therapy Management | 485 | ||
| Physical Activity/Exercise | 485 | ||
| Stretching | 485 | ||
| Pain Management | 486 | ||
| Lifestyle Modification | 486 | ||
| Energy Conservation | 486 | ||
| Balance Between Activity and Rest | 487 | ||
| References | 489 | ||
| Index | 493 |