Steps to Follow The Comprehensive Treatment of Patients with Hemiplegia

Incorporates significant advances in the early and later rehabilitation of neurologically impaired patients. This title describes activities for correcting abnormal movement patterns and facial difficulties. It explains and demonstrates ways to regain walking, balance and other normal movement sequences with photographs of patients being treated.

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 meansof 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.

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 areclose 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