Stroke Rehabilitation - Guidelines for Exercise and Training by Janet H. Carr MEd EdD DipPhty Col. FACP, Roberta B. Shepherd

By Janet H. Carr MEd EdD DipPhty Col. FACP, Roberta B. Shepherd ME EdD DipPhty Col. FACP

Completely up to date and revised, this long-awaited re-creation maintains to supply protocols for the recovery of standard sensible flow following stroke.

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Balance involves the regulation of movement of linked body segments over supporting joints and base of support (MacKinnon and Winter 1993). It is the ability to balance the body mass relative to the base of support that enables us to perform everyday actions effectively and efficiently. Many of these actions involve the lower limbs supporting and moving the body mass over the feet in standing or in sitting during reaching and manipulative tasks, raising and lower­ ing the body mass to stand up, or transporting the body from place to place as in walking.

The adjustments we make to preserve balance are flexible and varied. It is there­ fore clear that the terms 'equilibrium reactions', 'balance reactions' and 'pos­ tural reflexes', introduced into physiotherapy from the scientific literature half a century ago and still in use for the testing of balance and as a goal of therapy (de Weerdt and Spaepen 1999), do not account for balance control during skilled, purposeful movements. These terms, which reflect an older view that balance is essentially reflexive or reactive, can divert attention in physiotherapy away from the specificity of postural (balance) adjustments and the fact that they occur in anticipation of and during voluntary motor actions as well as in response to a perturbation.

Self-efficacy Patient satisfaction (self-efficacy) has also received little attention in rehabilita­ tion. Input from patients can be sought about such issues as their expectations and experiences during rehabilitation. Questionnaires completed anonymously provide an indication of the individual's perception of the value of aspects of rehabilitation such as their exercise and training programme. Although lal or )n IS­ nt Il-g ;e­ ll. g. Brodal 1973, Hewson 1996, McCrum 1998, Smits and Smits-Boone 2000).

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