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

1 Problems That Cannot Be Seen Directly

Problems Related to Disturbed Perception
Some Common Problems Associated with Disturbed Perception
Reciprocity of Perception and Learning
Disturbed Perception and Learning
Implications for Therapy
Guided Movement Therapy (Guiding)
Therapeutic or Intensive Guiding
Guiding When Giving Assistance
Guiding the Patient in a Standing Position
Considerations
2 Normal Movement Sequences and Balance Reactions
Analysis of Certain Everyday Movements
Balance, Righting and Equilibrium Reactions
Task-orientated Arm and Hand Movements
Considerations
3 Abnormal Movement Patterns in Hemiplegia
Persistence of Primitive Mass Synergies
The Synergies as They Appear in Association with Hemiplegia
Abnormal Muscle Tone
Typical Patterns of Spasticity or Hypertonicity
Placing
Reappearance of Tonic Reflex Activity
Associated Reactions and Associated Movements
Abnormal Tension in the Nervous System
Disturbed Sensation
Considerations
4 Practical Assessment - a Continuing Process
The Aims of Assessment
Recommendations for Accurate Assessment
Specific Aspects of Assessment
Recording the Assessment
The Comprehensive Evaluation
Considerations
5 The Acute Phase - Positioning and Moving in Bed and in the Chair
The Arrangement of the Patient's Room
Positioning the Patient in Bed
Sitting in a Chair
Self-assisted Arm Activity with Clasped Hands
Moving in Bed
Transferring from Bed to Chair and Back Again
Incontinence
Constipation
Considerations
6 Normalising Postural Tone and Teaching the Patient to Move Selectively and Without Excessive Effort
Important Activities for the Trunk and Lower Limbs in Lying
Activities in Sitting
Placing the Hemiplegic Leg and Facilitating Crossing It Over the Other Leg
Coming From Sitting to Standing
Activities in Standing with Weight on the Hemiplegic Leg
Pelvic Tilting with Selective Flexion/Extension of the Lumbar Spine
Activities inStanding with Weight on the Sound Leg
Considerations
7 Retraining Balance Reactions in Sitting and Standing
Activities in Sitting
Activities in Standing with the Weight on Both Legs
Activities in Standing with the Weight on the Hemiplegic Leg
Activities During Which the Weight Is on Alternate Legs
Activities in Standing with the Weight on the Sound Leg
Considerations
8 Encouraging the Return of Activity in the Arm and Hand and Minimising Associated Reactions
Activities in Supine Lying
Activities in Sitting
Activities in Standing
Stimulation of Active and Functional Movements
Retraining Selective Flexion of the Arm and Hand
Considerations
9 Re-educating Functional Walking
Considerations for Treatment
When to Start Walking
The Facilitation of Walking
Practical Ways to Facilitate Walking
Self-inhibition of Associated Reactions
Protective Steps to Regain Balance
Supporting the Hemiplegic Foot
Going Up and Down Stairs
Using a Walking-stickor Cane
Considerations
10 Some Activities of Daily Living
Therapeutic Considerations
Personal Hygiene
Dressing
Undressing
Eating
Driving a Car
Considerations
11 Mat Activities
Going Down Onto the Mat
Moving to Side-Sitting
Activities in Long-Sitting
Rolling
Prone Lying
Moving to Prone Kneeling
Activities in Prone Kneeling
Activities in Kneel-Standing
Activities in Half-Kneel-Standing
Standing up from Half-Kneeling
Considerations
12 Shoulder Problems Associated with Hemiplegia
The Subluxed or Malaligned Shoulder
The Painful Shoulder
The "Shoulder-Hand" Syndrome
Considerations
13 The Neglected Face
Important Considerations for Facilitation of the Movements of the Face and Mouth
Dentures
Appropriate Treatment for the Common Difficulties
Oral Hygiene
Considerations
14 Out of Line (the Pusher Syndrome)
The Typical Signs
Predisposing Factors
Specific Treatment
Considerations
15 Including Nervous System Mobilisation in the Treatment
Adaptation of the Nervous System to Movement
Loss of Nervous System Mobility Following a Lesion
Problems Associated with Abnormal Tension and Loss of Mobility
The Tension Tests for Assessment and Treatment
Conclusion
16 Maintaining and Improving Mobility at Home
Maintaining Mobility Without the Help of a Therapist
Common Sites of Increased Hypertonicity and/or Loss of Range of Motion
Ensuring the Patient's Participation
Specific Exercises for Muscles and Joints
Automobilisation of the Nervous System
Some Additional Active Exercises
Leisure Activities and Hobbies
Conclusion
17 References
18 Subject Index.