CiNii Books - Starting again : early rehabilitation after traumatic brain injury or other severe brain lesion

This describes the early rehabilitation of the patient who has sustained a traumatic brain injury or a lesion of equal severity due to some other cause. The broad spectrum of treatment, ranging from the intensive care unit to the reeducation of walking, is presented in detail with over 600 photographs of actual patients.

Volume: gw ISBN 9783540559344

Description

What does "Starting Again" mean to the many different people this book reaches out to? This positive title may draw the reader to enquire why an immensely experienced physiotherapist is considering starting again. Perhaps it challenges patients to rethink their own limitations, or therapists to reconsider their own management strategies. Does it refer to a change in life for head-injured patients and their carers, or does it hint at a fresh approach to old problems? Since "Steps to Follow" and "Right in the Middle", Pat Davies has not been idle. She has remained aware of what may be new and worthwile in therapy around the world, incorporated it into her own vast experience and taken ideas, concepts and techniques back to her patients to test their clinical validity. This is, therefore, not a pedestrian text but one brimming with new ideas for immediate use. That in itself should be a message of hope for all involved in the consequences of head injury. The future will always hold new and better management strategies, the understanding of the nature and consequences of head injury will improve, and thus there should never be limits placed on what patients can achieve. Reduced to its simplicity and presented in modem day thinking, the nervous system is a neural network. It requires input for output, yet it possesses a delicate, powerful, inherent feedback system so it can drive itself optimally, test itself out, learn and adapt.

Table of Contents

1 Getting in Touch Again.- Disturbances of Tactile Input.- Assessing Sensation.- Other Perceptual Disturbances.- Problems Related to Disturbed Tactile/Kinaesthetic Input.- Incongruous Behaviour and Movement.- Spasticity.- Additional Factors Contributing to Increased Tone.- Ataxia or Tremor.- Activities Performed Slowly and with Undue Effort.- Dizziness and Nausea.- Persistent Incontinence.- Memory Disorders.- Behavioural Problems.- Inattention or Shortened Attention Span.- Lack of Motivation.- Enhancing Learning in the Treatment Programme.- Choice of Therapeutic Intervention.- Therapeutic Guiding.- Pressing Juice from an Orange.- Tidying up After Completion of a Task.- Important Considerations for Guiding.- The Position of the Therapist and the Patient.- Comprehension of the Ultimate Goal of the Task.- One Hand Always Provides Information About the Stability of the Support.- An Instrument Is Only Necessary After A Problem Has Been Identified.- Right to the Fingertips of Both Hands.- The Patient's Hand Should Feel Light and Be Easy to Move.- The Patient, Guided by the Therapist, Performs Every Step of the Task.- Verbal Input Is Avoided During A Guided Activity.- The Therapist or Helper Must Feel Relaxed and Confident.- Feeling Through an Intermediary Tool, Object or Sub-stance.- Choosing a Suitable Task.- Mechanical Factors.- Degree of Complexity.- Judging the Suitability of a Task.- Interpretation of Behaviour Signals.- Ways in Which Guiding Can Be Implemented.- Therapeutic Guiding.- Spontaneous Guiding as a Way of Assisting.- Teaching Relatives How to Guide.- Guiding Tasks in Different Clinical Situations.- Guiding in the Intensive Care Unit.- With the Patient Still in Bed.- When the Patient Is Sitting Out of Bed for a Short Period.- Guiding to Overcome Difficulties with Sitting Posture.- The Effect of a Guided Task on the Patient's Sitting Posture.- Guiding in Conjunction with Walking.- While Regaining Independence in the Activities of Daily Living.- Guiding While the Patient Is Getting Dressed.- Increased Tactile Information to Maintain Lying Positions.- The Problem of Incontinence.- Urinary Incontinence.- Considerations for Management.- Faecal Incontinence and/or Constipation.- Considerations for Management.- Avoiding the Negatives Associated with Post-traumatic Epilepsy.- Problems Related to PTE.- The Seizures Per Se.- Anticonvulsant Drug Therapy.- The Attitude of Others Towards the Patient with PTE.- Conclusion.- 2 Early Positioning in Bed and in the Wheelchair.- Turning and Positioning in Bed.- Supine Lying.- Side Lying.- Turning the Patient onto His Side.- Positioning the Patient on His Side.- Overcoming Difficulties in Maintaining the Position.- Prone Lying.- Turning Over to Prone.- Position in Prone.- Sitting Out of Bed.- Transferring the Patient from Bed to Wheelchair.- Moving from Lying to Sitting.- Moving to the Edge of the Bed.- Recommended Transfers.- Method 1. With the Patient's Arms Resting on the Therapist's Shoulders.- Method 2. With the Patient's Arms Down in Front of Him.- Method 3. With the Patient's Trunk Flexed.- Method 4. Using A Sliding Board.- Position in the Wheelchair.- Choosing a Suitable Wheelchair.- Points to Consider.- Suggestions for Using Additional Support.- Adjusting the Patient's Position in the Wheelchair.- Lengthening the Time Spent in Sitting.- Propelling the Wheelchair Independently.- A Standard Wheelchair.- An Electric Wheelchair.- A Wheelchair with a One-Hand Drive Mechanism.- The Importance of Turning and Positioning the Patient.- Preventing Contractures and Deformity.- Avoiding the Development of Pressure Sores.- Improving the Circulation.- Maintaining Mobility of the Spine.- Improving Respiratory function.- Preventing Pain of Cervical Origin.- Reducing Hypertonicity.- Preventing Any Peripheral Nerve Damage.- Accustoming the Patient to Being Moved.- A Case in Point.- 3 Moving and Being Moved in Lying and Sitting.- Requirements for Efficient Muscle Action.- Possible Lengthening Mechanisms.- The Importance of Mobilizing the Nervous System.- Maintaining or Restoring Adaptive Lengthening of the Nervous System.- The Tension Tests.- The Nervous System Is a Continuum.- Causing Pain Is Not The Aim.- Persistent Pain of Undiagnosed Origin.- Important Movement Sequences.- Moving the Head.- Moving the Ribcage.- Rotating the Upper Trunk.- Maintaining Full, Painfree Range of Motion in the Upper Limbs.- Elevation of the Shoulder Through Flexion.- Problem Solving.- Abduction of the Arm including ULTT1.- Problem Solving.- Incorporating ULTT1 Mobilization in Other Activities.- Turning the Upper Part of the Body.- Rolling to One Side and Back Again in a Normal Pattern.- Rotating the Trunk in Sitting with Arm Support Sideways.- Mobilizing Abduction of the Arm in Sitting.- Including ULTT 2 and ULTT 3 in the Treatment.- ULTT 2.- ULTT 3.- Regaining Active Control of the Arm.- Mobilizing the Trunk and Lower Limbs.- Moving the Lower Trunk.- Mobilizing Flexion of the Trunk and Lower Limbs.- Trunk Flexion in Sitting.- Flexing and Extending the Trunk in Sitting.- Mobilizing the Trunk and Hips in Cross-Sitting.- Mobilization in Long-Sitting.- Movement Sequence for Mobilization.- Problem Solving.- Using LLTT 1 as a Treatment Technique.- Using the Slump Test to Mobilize the Nervous System.- The Slump Test with the Legs Abducted.- Conclusion.- A Case in Point.- 4 Early Standing.- The Importance of Standing the Patient.- Considerations Before Standing the Patient.- Standing the Patient Upright.- Using Knee-Extension Splints.- Bandaging on the Splints.- Bringing the Patient from Lying to Standing.- Lifting the Patient Back onto the Bed.- Using a Standing Frame.- Using a Tilt Table.- Problem Solving.- Moving While Standing.- Flexion of the Trunk in Standing.- Therapeutic Value of Trunk Flexion in Standing.- Conclusion.- A Case In Point.- 5 Reanimating the Face and Mouth.- Common Problems and Their Treatment.- Problems.- Prevention and Treatment.- Handling Hints.- Useful Grips.- Illuminating the Inside of the Mouth.- Wearing Rubber Gloves.- Therapeutic Procedures.- Mobilizing the Neck.- Mobilizing Lateral Flexion.- Achieving Flexion of the Upper Cervical Area.- Moving the Face.- Treating the Inside of the Mouth.- The Notorious Bite Reflex.- Problem Solving.- Assessing and Treating the Mouth.- Treating The Tongue.- Passive Mobilization.- Facilitating Movement Within the Mouth.- Moving the Tongue Outside the Mouth.- Stimulating Activity with an Orange Segment.- Regaining Selective Movements of the Tongue.- Oral Hygiene.- Care of the Teeth and Gums.- Cleaning the Teeth and the Oral Cavity.- Brushing the Patient's Teeth.- Rinsing the Mouth.- Problem Solving.- Starting to Eat and Drink Again.- A Case in Point.- When to Start Oral Feeding.- Evaluating Dysphagia.- Swallowing Difficulties.- Guiding Factors and Safety Precautions.- Facilitating Eating.- Removal of Nasogastric Tube.- Correct Posture.- Manual Facilitation of Eating.- Assistance from Relatives.- Quality of Food.- Appropriate Type of Food.- Eating with Others.- Problem Solving.- Drinking.- Manual Facilitation of Drinking.- Problem Solving.- Prolonged Postacute Tube Feeding.- The Merits of PEG.- Specific Advantages.- Explaining PEG to Staff and Relatives.- Placement of the Gastrostomy Tube.- Removal of the Tube.- Learning to Speak Again.- Mobilizing the Larynx.- Assisting Deep Expiration.- Facilitating Phonation.- Facilitating Different Vowel Sounds.- Activating the Soft Palate.- Providing an Alternative Means of Communicating.- Movements to Signal "Yes" and "No 293" Using an Alphabet Board.- Complex Computer-Based Communication Augmentation Systems.- Using a Voice Output Communication Aid (VOCA).- Conclusion.- 6 Overcoming Limitation of Movement, Contracture and Deformity.- Reasons for the Development of Contractures.- Overcoming Contractures and Restoring Functional Movement.- Theoretical Principles.- Putting the Principles into Action.- Moving the Patient and Changing His Position Regularly.- Providing Additional Information from the Environment.- Mobilizing Adverse Mechanical Tension in the Nervous System.- Eliminating Painful Stretching of Contracted Structures While Increasing Range of Motion.- Serial Casting.- Advantages of Serial Plastering over Other Methods.- Requirements for Serial Plastering.- General.- Materials.- Instruments.- General Principles for Serial Casting.- Serial Plastering of the Knee.- Applying the Initial Cast.- Changing the Cast.- Preventing a Downward Sliding of the Cast.- Avoiding Pressure on the Patient's Heel.- Duration of Serial Casting.- Maintaining Full Range of Knee Extension with a Hinged Cast.- Serial Plastering for a Plantarflexed Foot.- Applying the Cast.- Preparing the Bottom of the Cast for Standing.- Changing the Cast.- Serial Plastering for the Flexed Elbow.- Applying the Cast.- Maintaining the Regained Elbow Extension.- The Hinged Cast.- Serial Plastering for the Flexed Wrist.- Applying the Initial Cast.- Changing the Cast.- Maintaining Wrist Extension After Serial Casting.- Making the Volar Splint.- Surgical Intervention.- Antispastic Drugs and Nerve Blocks.- Nerve and Motor Point Blocks.- Management of Fractures and Soft Tissue Injuries.- Fractures.- A Case in Point.- Cervical Spine Injuries.- Treatment.- Other Soft Tissue Injuries.- Heterotopic Ossification.- The Appearance and Development of HO.- Factors Which Could Cause or Precipitate the Development of HO.- Loss of Protective Pain Responses.- Repeated Minor Traumatic Injuries.- Repeated Forcible Distention of Previously Immobilized Soft Tissues.- Muscle Injury and Soreness Are Selectively Associated with Eccentric Contractions.- HO Occurs Almost Exclusively in the Vicinity of Proximal Joints.- Other Risk Factors Associated with HO.- Considerations for the Prevention of HO.- Preventative Measures.- Overcoming the Problems of Existing HO.- Treatment Measures.- A Case in Point.- HO Causing Loss of Elbow Flexion.- Conclusion.- 7 Towards Attaining Independent Walking: Preparation and Facilitation.- Considerations for Treatment.- When to Start Walking.- A Case in Point.- Preparatory Activities.- Retraining Selective Movements of the Lower Limb.- Selective Hip Extension (Bridging).- Selective Knee Extension.- Selective Hip and Knee Extension During Weight Bearing.- Regaining Balance Reactions and Selective Trunk Control.- Returning to an Upright Position After Leaning Down to Either Side.- Maintaining Balance with Weight Transferred Sideways in Sitting.- Selective Lateral Flexion of the Lumbar Spine.- Selective Flexion and Extension of the Lumbar Spine.- Mobilizing and Activating the Trunk.- Flexion and Extension.- Flexion/Rotation of the Trunk in Sitting.- Rotation of the Lumbar Spine with the Abdominal Muscles Activated.- The Facilitation of Walking.- Stabilizing the Thorax and Eliciting Reactive Steps.- Assisting Hip Extension and Avoiding a Hyperextended Knee.- A Walking Frame with Wheels.- Adapting the Walking Frame for Functional Tasks.- Using Other Walking Aids.- Facilitating Standing Up and Sitting Down.- Problem Solving.- Dealing with Additional Problems Which Prevent Walking.- A Case in Point.- Learning to Go Up and Down Stairs.- Going Up Stairs.- Going Down Stairs.- Recreational Activities Which Encourage Active Movement.- Swimming.- Cycling.- Conclusion.- References.

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Starting again : early rehabilitation after traumatic brain injury or other severe brain lesion

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