Table Of Content
NEUROLOGIC
INTERVENTIONS
FOR
PHYSICAL THERAPY
SUZANNE "TINK" MARTIN,
PT, MACT
Professor
Department of Physical Therapy
University of Evansville
Evansville, Indiana
MARY KESSLER,
PT, MHS
Associate Professor and Chair
Department of Physical Therapy
University of Evansville
Evansville, Indiana
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SAUNDERS
ELSEVIER
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NEUROLOGIC INTERVENTIONS FOR PHYSICAL THERAPY, ED 2 ISBN-13: 978-0-7216-0427-5
ISBN-lO: 0-7216-0427-7
Copyright ,g 2007, 2000 by Saunders, an imprint of Elsevier Inc.
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Neither the Publisher nor the Authors assume any responsibility for any loss or injury and/or damage to
persons or property arising out of or related to any use of the material contained in this book. It is the
responsibility of the treating practitioner, relying on independent expertise and knowledge of the patient,
to determine the best treatment and method of application for the patient.
The Publisher
Previous edition copyrighted 2000
ISBN-13: 978-0-7216-0427-5
ISBN-I0: 0-7216-0427-7
Publishing Director: Linda Duncan
Senior Editor: Kathv Falk
Senior Dt'vclopment~l Editor: Christie Hart
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Contributors !
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Terry Chambliss, PT, MHS
Chapter 9, PNF
Assistant Professor
Department of Physical Therapy
University of Evansville
Evansville, Indiana
Cathy Jeremiason Finch, PT
Chapter 9, PNF
Faculty Member
Department of Health Science
Physical Therapist Assistant Program
Kirkwood Community College
Cedar Rapids, Iowa
Pam Ritzline, PT, PhD
Evolve Site
Director
Postprofessional Doctorate Program
Graduate School of Physical Therapy
University of Indianapolis
Indianaoplis, Indiana
Mary Kay Solon, PT, PhD
Evolve Site
Chairman
Physical Therapist Assistant Program
University of St. Francis
Fort Wayne, Indiana
v
Preface
We are gratifi.ed by the very positive response given to the neurorehabilitation courses in physical therapy programs.
first edition of Neurologic Intervention for P1J)Jsical Therapist We see this as a good use of the textbook and the name
Assistants. In an effort to make a good reference even better, change embraces its broader appeal. However, the name
we have taken the advice of reviewers and our physical ther change does not mean that we have dropped the emphasis
apy and physical therapist assistant students to complete a on the role of the physical therapist assistant in treating
second edition. The sequence of chapters now reflects a patients with neurologic deficits. On the contrary, the use of
developmental trend with motor development, handling, the textbook by physical therapy students should increase
and positioning and interventions for children coming the understanding ofand appreciation for the psychomotor
before the content on adults. Chapters on proprioceptive and critical thinking skills needed by all members of the
neuromuscular facilitation (PNF) and other neurologic dis team to maximize the function of patients with neurologic
orders will, we hope, be welcome additions to this edition. deficits. We are thrilled to be able to add the Evolve site
PNF remains a valuable adjunct to the treatment of indi because we think it will be an excellent resource for faculty
viduals with neuromuscular impairments; therefore, we and students.
sought contributors with expertise and experience to The mark of sophistication of any society is how well it
develop this chapter. The chapter on other neurologic dis treats the young and old-the most vulnerable segments of
orders has been added after the expected chapters on stroke, the population. We hope in some small measure that our
traumatic brain injury, and spinal cord injury. The chronic continuing efforts will make it easier to unravel the mystery
and, in some cases, progressive nature of these other disor of directing movement, guiding growth and development,
ders makes them particularly challenging. All patient cases and relearning lost functional skills to improve the quality
have been reworked into Guide format for ease of learning of life of the people we serve.
and consistency in documentation.
Tink Martin
The change in the title of the book came about as we
discovered that the text was being used as a lab manual for Mary Kessler
ix
Preface to the First Edition
Physical therapist assistants are providing more and more of hours given to the writing. Although the task seemed daunt
the physical therapy care to individuals with neurologic dys ing, we thought the project could realistically be completed
function. There was no textbook that we thought specifi in three years. Five years later, we feel joy, relief, happiness,
cally covered neurologic interventions for the physical and a real sense of accomplishment that the project is
therapist assistant, so we took on the challenge. Because we finally completed.
have taught physical therapist assistants about neurologic One always embarks hoping for clear sailing with a quick
treatment interventions for adults and children for many passage to the destination. As with most things, life inter
years, it seemed a logical step to put the anatomy, pathol venes. We have persevered and hope that the end result will
ogy, and treatment together in a textbook. meet its intended purpose-to teach and provide a basis for
This textbook provides a link between the pathophysiol physical therapist assistants to learn how to implement
ogy of neurologic conditions and possible interventions to interventions within their knowledge base and abilities. In
improve movement outcomes. What started as a techniques addition, it is our hope that academicians involved in the
book has, we hope, transcended a cookbook approach, to education of physical therapist assistants will find this text
provide background information regarding interventions to be a useful reference.
that can be used in the rehabilitation ofadults and children. The mark of sophistication of any society is how well it
We are hopeful that this text will assist student physical treats the young and the old, the most vulnerable segments
therapist assistants in their acquisition of knowledge regard of the population. We hope in some small measure that our
ing the treatment of adults and children with neurologic efforts will make it easier to unravel the mystery of directing
dysfunction. movement, guiding growth and development, and relearn
Writing is not the easiest thing to do, as Tink had previ ing lost functional skills to improve the quality of life of the
ously experienced in authoring an entry-level text. However, people we serve.
we thought a second book would be manageable.
Tink Martin
Colleagues encouraged us, students critiqued it, reviewers
reviewed it, and our spouses tacitly supported all the extra Mary Kessler
xi
Acknowledgments
I again want to acknowledge the dedication and hard work of my colleague, friend, and coauthor,
Mary Kessler. Special thanks go to Pam Ritzline and Mary Kay Solon for their exemplary contribu
tion to the Evolve site. Also thanks to Terry Chambliss and Cathy Finch for their work on the PNF
chapter. Donna Cech was kind enough to provide feedback on the pediatric cases as they were
updated to Guide format. Thank you to the students at the University of Evansville. You are really
the reason this book happened in the first place and the reason it has evolved into its present form.
Last but not least, I want to acknowledge the work of Sue Bredensteiner, our development editor.
She kept us going in the correct direction and helped diffuse the frustration that inevitably occurs
in projects of this nature. Your feedback was super.
Tink
I must thank my good friend, mentor, colleague, and coauthor, Tink Martin. Without Tink, neither
of these editions would have been completed. She has continued to take care of many of the
details, always keeping us focused on the end result. Tink's ongoing encouragement and support
have been most appreciated.
A special thank you to all of the students at the University of Evansville. They are the reason that
we originally started this project. Additional thanks must be extended to Dr. Pam Ritzline, Mary
Kay Solon, Janet Szczepanski, and Terry Chambliss for all of the suggestions they offered to
improve the overall excellence of the manuscript. Other recognition is necessary for Suzy Sims, a
dear friend who is the patient model in the new chapters and our two graduates, Beth Jankauski
and Amanda Fisher, whose assignments appear in this text.
Mary
xii
Contents
4
SECTION CHAP T ER
FOUNDATIONS Motor Development, 47
Introduction, 47
1
CHAP T ER Developmental Time Periods, 48
The Role ofthe Physical Therapist
Influence of Cognition and Motivation, 49
and PTAssistant in Neurologic
Developmental Concepts, 51
Rehabilitation, 3
Developmental Processes, 54
Introduction, 3
Gross- and Fine-Motor Milestones, 54
The Role of the Physical Therapist
Typical Motor Development, 59
in Patient Management, 4
Posture, Balance, and Gait Changes with Aging, 77
The Role of the Physical Therapist Assistant in Treating
Chapter Summary 79
Patients with Neurologic Deficits, 5
Review Questions, 80
The Physical Therapist Assistant as a Member
of the Health Care Team, 6
Chapter Summary, 6
SECTION
Review Questions, 7
CHILDREN
5
2
CHAPTER
CHAPTER
Positioning and Handling
Neuroanatomy, 8
to Foster Motor Function, 85
Introduction, 8
Introduction, 85
Major Components of the Nervous System, 8
Children with Neurologic Deficits, 85
Reaction to Injury, 25
General Physical Therapy Goals, 85
Chapter Summary, 27
Function Related to Posture, 86
Review Questions, 27
Physical Therapy Intervention, 87
Positioning and Handling Interventions, 88
3
CHAPTER Preparation for Movement, 99
Motor Control and Motor Learning, 28
Interventions to Foster Head and Trunk Control, 101
Introduction, 28
Adaptive Equipment for Positioning and Mobility, 113
Motor Control, 28
Functional Movement in the Context of the
Relationship of Motor Control with
Child's World, 119
Motor Development, 39
Chapter Summary, 120
Motor Learning, 39
Review Questions, 121
Relationship of Motor Learning with
Case Studies: Reviewing Positioning and Handling
Motor Development, 42
Care: Josh, Angie, and Kelly, 122
Chapter Summary, 45
Review Questions, 45
xiii
