Diagonals part one

The diagonals are muscle structures that hold and moves our body. In this article (part one) we explore the development of these diagonals from childhood and the enhancement of them in professional athletes Part two will then explore what happens when neurological diseases damage these muscle pattern. Neurological disease will affect how the diagonals work more than orthopedic diseases, due to its dependency on structures within the brain. Although these parts of the brain are not yet identified the innervation of the spine and the large joints give us a clear picture that one hemisphere controls both parts. The overall distribution is unequal (between 90%-10%) but this amount of variation in the distribution is what enables the diagonals to work in this way

How evident are the guidelines for stroke 2014?

In May of this year there was a “Round Table” conference, where specialists working in the area of rehabilitation for individuals following a stroke were brought together to discuss the current levels of investigations, published works and evidence based practice in care delivery. This resulting discussions identified concerns with the reporting accuracy and provision of replicatable data from the knowledge base on the subject, which also impacted on the validity and reliability of the current best practice guidelines available to practitioners. The outcome from these group identify the need to develop a greater level of clarity and transparency in the reporting of research to ensure programs designed to improve the therapy for individuals following a stroke are more robust and go further to inform practice into better guidelines for future care

Diagonals part seven. Stroke 5. Walking: what say the scientist and what is best practice

In this part we try to listen to the science, that has and still do over the whole world investigation by stroke patients over the walking aspect and the best way to get the best recovery or compensation. Recovery is only for a group possible, that had an “minor” stroke and there we see that the old system is not too much damaged and recovery is possible. But with greater damage of the brain individual after a stroke must go another way to get his independently and that is compensation. That compensation starts with the first movement in bed and will also affect the diagonal. The science has reported that the walking pattern on the EMG don’t change very much after a short period and they said that this pattern is fixed within in certain period. We have our doubt and have search to other forms of training and learning and see that changes is well possible but to be sure the science must have investigated that. Here is a problem because science gives another interpretation of the word intensity. For the scientist this is “more time” to do the exercises and in our view, it is the heaviness of the exercises and that can be done by an individual with a stroke a certain time before he is fatigue. In the treatment we start with the individual with a severe stroke that need all assistance to get him on his feet and will have need of a splint on his knee because the power in the knee muscle is to limited, to hold the knee. Regrettable an individual after a stroke that the scientist never investigates because this is too difficult. From this starting point we walk through all the steps, we must make to get independent walking individual when possible and what the problem were when that goal cannot fully be reached. And we discuss other forms, approach or new development to get walking possible with the use of the diagonals. Part 8 will discuss other cases with a severe stroke

The beginning of 'striker foot' (Pes equinus varus) with severe stroke patients

An exploratory investigation into identifying the answers to two specific questions related to this condition. 1. Why do many individuals develop 'striker foot' following severe stroke? 2. What is the best intervention to help control its development? The answer to the first question lies within the lack of stability in the paretic leg when the patient attempts to move in bed using the other leg. With the second question the answer is less obvious, although there are indications that greater stability helps to maintain the muscular tone of the calf leading to better overall control. Throughout this investigation the only changing factor with stability was the mattress which suggested that more would be required to prevent 'striker foot' developing. Therefore further investigations are needed to gain a better understanding and help to reduce the numbers of severe stroke patients who go on to develop this condition

Diagonals part two: assessment and trunk rules

Part two describes the assessment process of the diagonals, including the front, back and homolateral structures. We discuss various positions for assessment including patients laying down on their back and side, sitting and standing. We also look at the use of the balance reaction test Statiek to assess the capability of both the diagonals and homolateral structures. This provides a greater understanding of what the diagonals can do, and what would be considered normal or abnormal as assessing both gives the examiner a greater appreciation of what to expect. We can use this practice to increase our awareness of what to observe and feel for, identifying some tips of where to place your hands to enable you to both apply pressure and feel for the amount of resistance the patient can apply in response. Subtle differences can be observed in patients depending on various individual characteristics they may have such as different leg lengths when comparing the left and right sides, or if somebody has a recognized problems within the structure and function of their backs. We begin to describe “trunk rules” as everyone should has the same reaction response when performing movements but these can present differently depending on the individuals level of mobility and selectivity. This article starts to briefly consider body scheme which is the perception of the body and its influence on the reaction of muscle patterns This perception can alter the overall function of the diagonals. In part three Pathology we will go more into developing the understanding of the impact that perception plays in the control and movement of diagonals. In the final section we move on to describing the trunk rules, discussing how both diagonals and the homolateral structures work in collaboration to help control and enable a greater range of movements of the trunk, and how this supports the keypoints of the great joints, identifying which movements are enabled and which are restricted

Diagonals part four: Stroke 2. Transfers in bed and the chain rules

An individual's diagonals tend to be severely affected following a stroke. Therefore training needs to focus on restoring the diagonals and if possible the homo- lateral structure on the affected side. Maintaining overall movement in bed is extremely important promoting the individual's independence. In part 4 we must consider the whole process of rehabilitation especially considering their home environment. Exercises lying in a sideways position are the most effective form of task specific strengthening exercises that have a greater impact on the potential re-establishment of movement in bed for individuals, along with developing greater coordination in the homo-lateral structure, which could eventually lead to the possibility of balance control and walking. Exercises are structured to consider the need to relearn the movements themselves, then progress towards making them more practical activities of daily living (A.D.L.) movements, where the movements will be required throughout the day (with some assistance initially), removing this support over time as the skills develop towards independence for the individual. Training/learning requires repetition by variation of which there are a wide range of exercises to choose from, which require load bearing movements which help develop better coordination and muscle power. To provide a complete package of recovery, every movement will be discussed and analyzed, to identify the best movements with the least level of assistance as a starting place, to increase the overall potential of reducing this assistance towards independence in the future. The appendix provides information on the training of limbs (Especially the arms) using the chain rules. Too often we start with an ‘open chain’ which can sometimes be too strenuous for the individual and can sometimes be very challenging affecting the individuals performance and overall motivation to achieve their full potential. Training using the variety of method of the chains enable the tasks to be more achievable, so by using these learning/training rules can promote better recovery

Physical treatment (Hydrotherapy) by individuals with and without dementia. Aquatic exercising. Part 1.

It still today “not done”, aquatic exercising with people with an neurological disease and especially people with an form of dementia. Why not? Is it the amount of work to transport undress them and escort them in the water? Or is it the cost for all this work and the cost for the swimming pool? Or is there still an culture problem that elderly with or without an neurological disease cannot participate as others in an swimming pool? The interest of science in this kind of therapy is long standing on an low level. Mid years 50-60 of the foreign century all rehabilitation centre must have an swimming pool and often more than that. Even Nursing homes were built with an pool inside, but when the sciences has discovery other things as robotica with an higher amount of cost, the positive elements of exercising in water were lost and swimming pools were closed. The great performance of an J.MacMillan to train disable girls in an swimming pool according the rules of water was introduced in several countries but now this knowledge and especially the skills are decreasing, an pity. The content of people with an neurological disease and especially dementia that have learn to swim is increasing and the possibilities for an better live, better quality , by exercising is growing. From science there are more investigations that discover that exercising in water has great benefit and that this is better than exercising on land. Conclusion .The investment in training in water has an significant influence on the quality of people with neurological disease and also on people with dementia. The environment –water- makes movement normal, it push people to move and search for the best way to handle the up thrust. And it give an aerobe boost that is essential to decrease the speed of dementia, certainly when is combined with cognitive games. Furthermore is has all kinds of anaerobe elements that can use to increase the balance performance of this people. Therefore why we don’t do it !

Treatment possibilities of “contractures” by neurological diseases

This is an contracture !! We have heard this “Often and almost every time too fast”, That “An restriction in movement is called an contracture”. This give the physical therapist and others an tool to say: “That this isn’t treatable”. But is every contractures an irreversible situation and therefore not treatable? Working in an nursing home, there were so many situations in which there was an “contracture” and always was the reaction, that this wasn’t treatable. Of course, there were joint deformation, that makes an movement not possible and the only cure was and is an joint replacement. But in the nursing home, the most people suffer often from an neurological disease and one of the most remarkable symptoms is the increased tone, together with the loss of selectivity, gives attitudes that had an great “resemblance” with the joint destruction symptoms. That has lead, that this attitude with high tone was called an contracture and regrettable give that almost always the same reaction: “Irreversible and not treatable”. People with an neurological disease with great loss of control (selectivity) can suffer from loss of mobility, but often it was possible to find, what this loss of mobility caused. Par example an restriction in the extension of knee was caused by the high tone in the hamstrings muscle. Try of change this with stretch exercise, that will give no or almost no reaction, but the reason was and is high tone, that don’t react on stretch alone. That means only, that this therapy isn’t correct or incomplete. And there must be an good assessment, WHY the tone of the hamstrings is so high and not react ? Observe an Individual with an neurological disease and an high tone in his hamstrings and this person has an epileptic insult. He lost his conscious and the tone decrease fast and the restriction ( “the contracture”) is gone. After that, when he is coming back, the tone will come back

Diagonals part three: Pathology. The stroke patient: how we can train the diagonals to create a better result

Perception of the body is one way in which the brains makes direct contact with the outside world. This is essential information which following a stroke can present as a problem for individuals due to the differences in ability. It is important to identify what the brain “feels” and then interprets from the information which results in our external bodily responses. We are already aware that our vision and other senses can alter on two levels. These differences can be either in the sense itself or in the assimilation of the damage brain. This information assimilation provides the brain with the tools to react using the damage muscle system, especially damage in the selectivity process. Following a stroke there is always a degree of damage sustained in the diagonals, therefore it would be incorrect to differentiate by using of affect and unaffected side for identification purposes. However for the purpose of this article we do so to prevent the possible confusion this could pose to the reader. Damage to the diagonal makes lying and moving in bed more difficult. Within part 3 we will consider bed attitude which gives the individual a starting position to perform movements because now the brain can search for solutions. In severe cases it is often the lack of stability which results in the individual being unable to move sufficiently and therefore affects recovery. In this article we explain how to supporting the individual to start developing this stability and work towards building-up movement whilst in bed