By Patricia E.Sullivan
Massachusetts normal medical institution, Boston. Reference for actual therapists at the choice and development of healing workout courses. Stresses that courses needs to be logical, clinically effective, and cost-efficient. Halftone illustrations. DNLM: workout remedy.
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Extra info for Clinical Decision Making in Therapeutic Exercise
Supine, the ipsilateral limbs flex and adduct across the midline (Fig. 2-20). If the patient has one-sided weakness, the involved limb may be assisted by the uninvolved side. For example, when rolling toward the right, the head and trunk flex with rotation to the right, the left upper and lower extremities flex and adduct to or across the midline. The left lower ex tremity can push off with extension and abduction prior to the flexion-adduction motion. Because the BoS is large and the CoG low, mini mal postural control responses are needed; however, the body reacts to the self-imposed change of the CoM within the BoS.
Trunk and bilateral extremity combinations are not performed in sidelying because of the restrictions of the supporting surface. Circula tory perfusion and aeration of one lung may be di minished in sidelying and must be taken into account with patients who have CVP involvement. 55 Rolling Rolling is the transitional activity between supine and sidelying. Trunk, bilateral, and unilateral upper-extremity movement combinations and unilateral lower-ex tremity patterns can augment the trunk movement.
When the trunk and hip are positioned in ex tension and the scapula adducted, control of these muscles can be promoted in shortened ranges; antag onistic flexor muscles can be initiated and empha sized from lengthened ranges assisted by the ATLR influence. Segmental lumbar motions and pelvic tilt can be combined with mass lower-extremity (LE) flexion and extension motions (Fig. 2-18). A sequence of trunk movements incorporated into treatment might be: upper or lower body motions to initiate muscle contractions, isometrics to promote stability, log rolling for controlled movement, segmental ro tation to strengthen trunk muscles and to promote body-on-body reactions, and trunk counterrotation to improve the control needed for ambulation.